Exploration Of Screening Model And Risk Factors For Peripheral Neuropathy In Type 2 Diabetes

Chapter1:Cross-sectional analysis of risk factors associated with peripheral neuropathy in type 2 diabetesObjectiveThe triglyceride-glucose index(TyG index)and the triglyceride to high-density lipoprotein cholesterol(TG/HDL-C)ratio have been proposed as indicators to judge the degree of insulin resistance(IR).However,few studies have evaluated the role of IR assessed by the TyG index and TG/HDL-C ratio on diabetic Peripheral Neuropathy(DPN)in a type 2 diabetes population.Our study aims to evaluate the association of triglyceride glucose(TyG)index,triglyceride to high-density lipoprotein cholesterol(TG/HDL-C)ratio and other conventional risk factors with DPN in type 2 diabetes.MethodsA total of 1224 patients with type 2 diabetes were recruited into our study,all subjects underwent physical examination,biochemical examination,history collection,and nerve conduct tests(NCT).The TyG index was determined as In[fasting triglycerides(mg/dL)×fasting glucose(mg/dL)/2],The TG/HDL-C ratio was calculated as TG(mmol/L)divided by HDL-C(mmol/L),Confirmed clinical DPN is defined as an abnormal nerve-conduction test result and signs or symptoms of polyneuropathy.IBM SPSS statistical software(Version 25)and R software(Version 4.0.2)were used for calculation.ResultsThe mean age of the study participants was 54.2 ±11.42 years,and 732(59.80%)were men.Compared The DPN+ group and DPN-group,the differences between the two groups were statistically significant in age,sex,course of disease,hypertension,TyG index,TG/HDL,UACR,height,BMI,WC,WHR,HbAlc,fasting blood glucose,FPG,PBG,TG and LDL-C.The results of univariate logistic regression showed that the above indexes were correlated with DPN(P<0.05).HOMA-IR was well correlated with TyG index(r=0.46,P<0.001)and TG/HDL-C(r=0.34,P<0.001).The TyG index showed a strong positive association with TG/HDL-C(r=0.79,P<0.001)by Pearson’s correlation.Multivariate logistic regression demonstrated that age(OR 1.03,95%CI 1.01-1.05,P<0.001),duration(OR 1.05,95%CI 1.02-1.07,P<0.001),TyG index(OR 4.26,95%CI 2.16-8.34;P<0.001),UACR(OR 1.00,95%CI 1.00-1.00,p<0.001),HbAlc(OR 1.12,95%CI 1.06-1.13,P<0.001)are independent risk factors of DPN.ROC curve showed that the AUC of TyG index model was 0.761(95%CI 0.735-0.788),the optimal cut-off value was 7.535,the sensitivity was 66.80%,and the specificity was 76.10%.AUC of TG/LDL-c was 0.696(95%CI 0.666-0.725,P<0.001),the optimal cut-off value was,the sensitivity was 44.50%,and the specificity was 85.00%.ConclusionsThe TyG index is independently and strongly associated with DPN in patients with type 2 diabetes.Chapter 2:A New Screening Model for Peripheral Neuropathy in Patients with Type 2 DiabetesObjectiveIt’s vital to screen diabetic peripheral neuropathy early,the aim of our study was to develop a risk screening model for diabetic peripheral neuropathy(DPN)through readily accessible patients’ characteristics and serum biomarkers.MethodsA total of 1224 diagnosed type 2 diabetes were enrolled.Participants were randomly divided into the training group(n=928)and the validation group(n=296)at a ratio of 3:1.Multivariable logistic regression analyses were applied to establish the screening model.Then,the screening model was compared with other three conventional and simple screening tools(including Vibration Perception Threshold(VPT),Toronto Clinical Scoring System(TCSS)and Diabetic Neuropathy Symptom(DNS)score)through the receiver operating characteristic curve(ROC curve)analysis to estimate their predictive value for DPN.Confirmed clinical DPN is defined as an abnormal nerve-conduction test result and signs or symptoms of polyneuropathy.ResultsThere were 732(59.80%)men and 492(40.20%)women in this study.566(46.24%)of patients had DPN,averaging 54.2±11.42 years old.Based on routine characteristics and serum markers such as the urine albumin-to-creatinine ratio(UACR),the hemoglobinA1C(HbA1c),triglyceride-glucose index(TyG index),conicity index(CI)and duration of diabetes were used to establish a screening model to predict the risk of DPN in patients with type 2 diabetes and displayed as a nomogram in the training group.In the total group,the area under curves(AUCs)for the new screening model,Vibration Perception Threshold(VPT),Toronto Clinical Scoring System(TCSS)and Diabetic Neuropathy Symptom(DNS)score ranged from 0.599 to 0.782(p<0.001).Compared with VPT,TCSS and DNS,the AUC of screening model was the highest(0.782;95%CI,0.767-0.807)(sensitivity:0.721;specificity:0.730).In addition,there was a significant difference between the AUCs of the above four screening maneuvers(p<0.001).ConclusionsBased on anthropological characteristics and clinical routine serum markers,the risk screening model of DPN for type 2 diabetes patients includes TyG index,HbA1c,UACR,course of disease and CI.Compared with the existing VPT,TCSS and DNS,each tool has its own advantages.After further verification,it is expected to be one of the early screening tools for clinical DPN.