Practice Update: Diabetes

DIABETES 16

High Prevalence of Diabetic Peripheral Neuropathy Found in Young People with Diabetes Diabetes Care Take-home message • The authors of this study aimed to characterize risk factors and measure the prevalence of diabetic peripheral neuropathy (DPN) in young people with type 1 diabetes (T1D) and type 2 diabetes (T2D). Researchers assessed 1734 individuals with T1D (age, 18 ± 4 years; diabetes duration, 7.2 ± 1.2 years; HbA1c, 9.1 ± 1.9%) and 258 individuals with T2D (age, 22.0 ± 3.5 years; diabetes duration, 7.9 ± 2 years; HbA1c, 9.4 ± 2.3%) using the Michigan Neuropathy Screening Instrument. High rates of DPN were identified in both groups: 7% in participants with T1D and 22% in participants with T2D. In both groups, older age, longer diabetes duration, smoking, and lower HDL cholesterol levels were associated with risk of DPN. Poor glycemic control, obesity, increased LDL levels, and higher triglyceride levels were also associated with DPN, but only in T1D. • DPN occurs frequently in youth with T1D and T2D. The authors suggest that better screening procedures and strategies to manage risk factors are needed to curb the rate of neuropathic complications in young people with diabetes.

COMMENT By Jencia Wong MD, PhD T he study from the SEARCH investigators is one of few cohort studies examining the prevalence of diabetic peripheral neuropathy in type 1 diabetes and specifically in youth- onset type 2 diabetes. This study, using a robust and validated neuropathy assessment tool (the MNSI) adds a further perspective to the recently published SEARCH study results on the development of microvascular complications in youth with diabetes. 1 These are important and practical results that should concern clinicians for several reasons. First, these data show the high prevalence of neuropathy already evident at a young age, a diabetic peripheral neuropathy (DPN) prevalence of 13%and 36%after 10 years duration for type 1 and young-onset type 2 diabetes, respectively. Given the early age of onset and the noted increase in prevalence over 5 years, extrapolated further this could predict a high lifetime risk of clinically significant sequelae including ulceration, Charcot’s arthropathy, and amputation for such youth. Second, the almost threefold higher prevalence of DPN in youth with type 2 diabetes compared with type 1 diabetes is concerning, and the results suggest that factors other than glycemia are at play. Third, it is also notable that there are several modifiable risk factors associated with prevalent DPN in youth; in particular, glycemic control and dyslipidemia. Taken together, these data add to the growing body of evidence that screening for DPN and attention to modifiable risk factors should take place early for youth with either type of diabetes. Youth-specific intervention trials are needed in this area. Reference 1. Dabelea D, Stafford JM, Mayer-Davis EJ, et al. Association of type 1 diabetes vs type 2 diabetes diagnosed during childhood and adolescence with complications during teenage years and young adulthood. JAMA 2017; 317 (8):825-835. Dr Wong is Senior Staff Specialist Endocrinologist at Royal Prince Alfred Hospital, Sydney; Clinical Associate Professor, Central Clinical School, Sydney Medical School, University of Sydney; and Director of Research at Royal Prince Alfred Hospital Diabetes Centre.

Abstract OBJECTIVE We assessed the prevalence of and risk factors for diabetic peripheral neuropathy (DPN) in youth with type 1 diabetes (T1D) and type 2 diabetes (T2D) enrolled in the SEARCH for Diabetes in Youth study. RESEARCH DESIGN AND METHODS The Michigan Neuropathy Screening Instrument (MNSI) was

used to assess DPN in 1,734 youth with T1D (age 18 ± 4 years, T1D duration 7.2 ± 1.2 years, and HbA1c 9.1 ± 1.9%) and 258 youth with T2D (age 22.0 ± 3.5 years, T2D duration 7.9 ± 2 years, and HbA1c 9.4 ± 2.3%) who were enrolled in the SEARCH study and had ≥5 years of diabe- tes duration. DPN was defined as an MNSI exam score of >2. Glycemic control over time was esti- mated as area under the curve for HbA1c. RESULTS The prevalence of DPN was 7% in youth with T1D and 22% in youth with T2D. Risk fac- tors for DPN in youth with T1D were older age, longer diabetes duration, smoking, increased diastolic blood pressure, obesity, increased LDL cholesterol and triglycerides, and lower HDL cholesterol (HDL-c). In youth with T2D, risk fac- tors were older age, male sex, longer diabetes duration, smoking, and lower HDL-c. Glycemic control over time was worse among those with DPN compared with those without for youth with T1D (odds ratio 1.53 [95% CI 1.24; 1.88]) but not for youth with T2D (1.05 [0.7; 1.56]). CONCLUSIONS The high rates of DPN among youth with diabetes are a cause of concern and suggest a need for early screening and better risk factor management. Interventions in youth that address poor glycemic control and dyslipidemia may prevent or delay debilitating neuropathic complications. Prevalence of and risk factors for diabetic peripheral neuropathy in youth with type 1 and type 2 diabetes: SEARCH for Diabetes in Youth Study. Diabetes Care 2017 Jul 03;[EPub Ahead of Print], M Jaiswal, J Divers, D Dabelea, et al.

www.practiceupdate.com/c/55511

PRACTICEUPDATE DIABETES