Peripheral Neuropathy and Nerve Dysfunction in Individuals at High Risk for Type 2 Diabetes: The PROMISE Cohort
Peripheral Neuropathy and Nerve Dysfunction in Individuals at High Risk for Type 2 Diabetes: The PROMISE Cohort
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DOI：
10.2337/dc14-2585
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发表时间：
2015-05-01
期刊：
影响因子：
16.2
通讯作者：
Hanley, Anthony J.
中科院分区：
文献类型：
--
作者：
Lee, C. Christine;Perkins, Bruce A.;Hanley, Anthony J.
新出现的证据表明周围神经病变开始于糖尿病发病的早期阶段。我们的目的是描述周围神经病变和神经功能障碍的患病率，根据葡萄糖耐量和代谢综合征的状态，并研究这些条件是如何与神经系统的变化在个人的风险为2型diabetes.RESEARCH设计和METHODS我们研究了467个人在纵向PROMISE（前瞻性代谢和胰岛细胞评价）队列。周围神经病变由密歇根神经病筛查仪器（MNSI）评分（>2）定义，并且神经功能障碍的严重程度由使用神经感觉计的振动感知阈值（VPT）客观地测量。代谢综合征的定义采用国际糖尿病联合会/美国心脏协会的协调标准。正常糖尿病、前驱糖尿病和新发糖尿病的周围神经病变患病率分别为29%、49%和50%（趋势P < 0.001）。平均VPT为6.5 V，正常的糖尿病，7.9 V的糖尿病前期，7.6 V的新发糖尿病（P = 0.024的趋势）。糖尿病前期与较高的MNSI评分（P = 0.01）和VPT（P = 0.004）相关联，与正常BMI无关，与已知的风险因素无关。此外，葡萄糖耐受不良的进展超过3年预测周围神经病变（P = 0.007）和神经功能障碍（P = 0.002）的风险较高。代谢综合征与MNSI评分或VPTs.CONCLUSIONSIn个人与糖尿病的多个危险因素，糖尿病前期与周围神经病变和神经功能障碍的严重程度，新发糖尿病的风险相似。糖尿病前期，而不是代谢综合征，与周围神经病变和神经功能障碍的严重程度独立相关。
OBJECTIVEEmerging evidence suggests that peripheral neuropathy begins in the early stages of diabetes pathogenesis. Our objective was to describe the prevalence of peripheral neuropathy and nerve dysfunction according to glucose tolerance and metabolic syndrome status and examine how these conditions are associated with neurological changes in individuals at risk for type 2 diabetes.RESEARCH DESIGN AND METHODSWe studied 467 individuals in the longitudinal PROMISE (Prospective Metabolism and Islet Cell Evaluation) cohort. Peripheral neuropathy was defined by Michigan Neuropathy Screening Instrument (MNSI) scores (>2), and the severity of nerve dysfunction was measured objectively by vibration perception thresholds (VPTs) using a neurothesiometer. Metabolic syndrome was defined using the International Diabetes Federation/American Heart Association harmonized criteria.RESULTSThe prevalence of peripheral neuropathy was 29%, 49%, and 50% for normal glycemia, prediabetes, and new-onset diabetes, respectively (P < 0.001 for trend). The mean VPT was 6.5 V for normal glycemia, 7.9 V for prediabetes, and 7.6 V for new-onset diabetes (P = 0.024 for trend). Prediabetes was associated with higher MNSI scores (P = 0.01) and VPTs (P = 0.004) versus normal glycemia, independent of known risk factors. Additionally, progression of glucose intolerance over 3 years predicted a higher risk of peripheral neuropathy (P = 0.007) and nerve dysfunction (P = 0.002). Metabolic syndrome was not independently associated with MNSI scores or VPTs.CONCLUSIONSIn individuals with multiple risk factors for diabetes, prediabetes was associated with similar risks of peripheral neuropathy and severity of nerve dysfunction as new-onset diabetes. Prediabetes, but not metabolic syndrome, was independently associated with both the presence of peripheral neuropathy and the severity of nerve dysfunction.