Change Of Normal Baseline Albuminuria And Risk Of Diabetic Peripheral Neuropathy In Type 2 Diabetes

Aim: It’s reported that albuminuria is associated with diabetic peripheral neuropathy(DPN).It’s the aim to assess the association between changes of urine albumin-to-creatinine ratio(UACR)and the risk of DPN in type 2 diabetes.Method: Between May 2010 and September 2015,a retrospective study was performed,which including 185 individuals with type 2 diabetes(69 DPN patients and116 non-DPN patients)from the First Affiliated Hospital of Fujian Medical University.At baseline and follow-up after 2 years,we collected data such as gender,age,duration of diabetes and medication,recorded symptoms and signs of DPN and measured some biochemical indicators such as urinary albumin-to-creatinine ratio,estimated glomerular filtration rate,serum creatinine,glycosylated hemoglobin.Electromyography was performed to assess ulnar,median motor nerve conduction velocity(MCV)and sensory nerve conduction velocity(SCV),tibial,common peroneal nerve MCV,and superficial peroneal,sural SCV.Result:1.In patients without DPN,a decrease in UACR more than 30% was associated with a significantly reduction of SCV and MCV(P=0.004 and 0.003,respectively).Among patients with UACR≥20mg/g at baseline,SCV decreased by a median of 0.528m/s(P=0.021).Toronto clinical scoring system(TCSS)increased significantly(P<0.05)in those with UACR levels decreased >30% and baseline UACR levels 10-20 mg/g.2.In DPN patients,44.9%(n=31)experienced a decrease in UACR more than30%,which was related to TCSS increased by a median of 0.667(SD 4.368).In patients with baseline UACR≤10mg/g,MCV increased by a median of 0.276 m/s(P=0.005).3.It’s risk factors of DPN onset that UACR increased ≥30%(OR 3.059,95%CI1.012-9.249)and high-normal baseline UACR(OR 3.323,95%CI 1.040-10.620)in patient without DPN.4.Based on receiver operating characteristic curve analysis,areas under the curve(AUC)were 0.627±0.057 and 0.654±0.066 for baseline UACR and change of UACR in patients without DPN,respectively.5.Among patients without DPN,compared with patients who experienced a lower baseline UACR levels(baseline UACR ≤10mg/g)and a minor change of UACR(UACR decrease > 30 %),the risk of DPN onset was significantly higher in those with high-normal baseline UACR or an increase of UACR≥30 %(OR 12.527,95%CI1.272-123.329).Conclusions : Among non-DPN patients with normal UACR,a decrease of UACR could not improve nerve conduction velocity(NCV)and reduce the risk of DPN,but high-normal UACR and an increase of UACR have a negative correlation with NCV and a positive correlation with risk of DPN.In DPN patients with normal UACR,there was an insignificantly decrease of NCV as levels of baseline UACR rise and follow-up UACR increase.