A POPULATION-BASED STUDY OF NEUROPATHY AMONG DIABETICS IN ROCHESTER, MN

明尼苏达州罗彻斯特糖尿病患者神经病变的人群研究

• 批准号: 3782668
• 负责人: PETER JAMES DYCK
• 金额: --
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/3782668
• 关键词: autonomic disorder; body weight; carpal tunnel syndrome; case history; death; diabetic neuropathy; disease /disorder classification; disease /disorder proneness /risk; gender difference; human population study; human subject; hyperlipidemia; hypertension; impotence; insulin dependent diabetes mellitus; longitudinal human study; medical complication; nervous system disorder diagnosis; noninsulin dependent diabetes mellitus; peripheral nervous system; peripheral nervous system disorders; prognosis; questionnaires; stroke; sudden cardiac death; tobacco abuse; ulcer

We have prospectively evaluated a cohort of 380 diabetics from Rochester, MN and have found:1) the cohort is representative of diabetics in Rochester, MN; 2) approximately one-half do not have neuropathy; one-third have asymptomatic neuropathy without weakness of foot dorsiflexion; and 15% of ID and 12% of NID diabetics had symptomatic neuropathy but only 6% and 1% of these, respectively, had weakness of foot dorsiflexion; 3) neuropathy test results were sufficiently, had weakness of foot dorsiflexion; 3) neuropathy test results were sufficiently sensitive to detect statistically significant worsening in 24 mo; and 4) various risk factors were found to be correlated with staged severity of neuropathy and also with change in neuropathy test results. Because we have recruited a unique diabetic cohort, representative of Rochester diabetics, have demonstrated that they can be maintained in study over long times, shown that the battery of nerve evaluations obtained at periodic intervals are sensitive, reproducible, and meaningful of neuropathic change, and that the cost is modest by comparison to other studies of this type, this study is now to be extended for a further 5 years with the following objectives in mind: 1) extending the prevalence estimates to carpal tunnel syndrome (CTS), cranial neuropathy (CN), proximal asymmetric neuropathy (PAN), truncal radiculopathy (TR), and autonomic neuropathy (AN) and assessing for the prevalence of these neuropathies in a control population; 2) determining the course of neuropathy (and of test results) over a period of 8 years to refine rates of progression and outcome; 3) validate which minimal criteria for polyneuropathy (and also of CTS, CN, PAN, TR, and AN) and criteria for staged severity are best; and especially 4) critically evaluate the influence of a variety of risk factors (serially evaluated oer many years to ensure that they are representative and valid measures) for alterations in staged severity of neuropathy and also for neuropathy test results (evaluated over at least 8 years to ensure that a measurable change has occurred in sufficient patients to allow a robust assessment of such risk factors as glycemic control, nephropathy (creatinine and microalbuminuria), hypertension and hyperlipidemia (cholesterol, triglycerides, lipoproteins, and apolipoproteins). Also to be assessed are whether certain risk factor alterations might predict cardiac death (through arhythmia or heart attack), stroke, CTS, AN, PAN, TR, sexual impotence in the male, Charcot joints, plantar ulcers, or related phenomena.

我们对来自罗切斯特的380名糖尿病患者进行了前瞻性评估， MN，并发现：1）队列是糖尿病患者的代表， 罗切斯特，明尼苏达州; 2）大约一半没有神经病变;三分之一 无症状神经病变，无足背屈无力; 15% 的ID和12%的NID糖尿病患者有症状性神经病变，但只有6%， 其中1%的人，分别有足背屈无力; 3）神经病变 测试结果充分，足背屈无力; 3） 神经病变试验结果足够敏感， 24个月内显著恶化;和4）发现各种风险因素， 与神经病变的分期严重程度以及 神经病变测试结果。 因为我们招募了一个独特的糖尿病队列， 罗切斯特糖尿病患者，已经证明他们可以维持研究 经过很长一段时间，显示在 定期间隔是敏感的，可重复的，有意义的， 神经性变化，并且与其他治疗相比， 这一类型的研究，这项研究现在将进一步延长5 年，并铭记以下目标：1）扩大普及率 估计腕管综合征（CTS），颅神经病变（CN）， 近端不对称神经病（PAN）、神经根干病（TR）和 自主神经病变（AN）和评估这些患病率 对照人群中的神经病变; 2）确定 神经病变（和测试结果）超过8年，以完善率 3）确定哪些最低标准， 多发性神经病（以及CTS、CN、PAN、TR和AN）和 阶段性的严重程度是最好的;特别是4）批判性地评估 多种危险因素的影响（多年连续评估 以确保它们是代表性和有效的措施） 神经病变的分级严重程度以及神经病变检测结果 （至少在8年内进行评估，以确保可衡量的变化 在足够的患者中发生，以允许对此类风险进行稳健评估 血糖控制，肾病（肌酐和微量白蛋白尿）， 高血压和高脂血症（胆固醇，甘油三酯，脂蛋白， 和载脂蛋白）。 还需要评估的是某些风险因素是否 这些变化可能预测心源性死亡（通过心律失常或心脏 发作）、中风、CTS、AN、PAN、TR、男性阳痿、Charcot 关节、足底溃疡或相关现象。