Risk Factors Of Peripheral Neuropathy In Patients With Type 2 Diabetes Mellitus

Objective: Diabetic peripheral neuropathy(DPN)is a major complication of type 2 diabetes,and it has recently been recognized as the common cause of foot ulcers,gangrene and infection.Inspection the common indexes of diabetic neuropathy in the screening and diagnosis of neuropathy is important.Early detection of DPN,strengthen the glycemic control and foot care can significantly reduce foot ulceration and amputation.To investigate the character and risk factor of DPN,we analyzed related clinical data with diabetic peripheral neuropathy.Methods:We selected diabetic type 2 diabetes patients with peripheral neuropathy,age >20 years from January 1,2016 to December 31,2016 hospitalized in The Third Hospital of Xingtai as case group.Type 2 diabetes patients without peripheral neuropathy were selected as control group.The inspection of content included basic information,laboratory indexes and nerve electrophysiological examination.The basic information included demographic characteristics and physical examination.Blood samples were collected after an overnight fast to evaluate fasting venous blood glucose(FPG),glycosylated hemoglobin A1c(Hb A1C),blood uric acid(UA),cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)and postprandial 2 hours blood glucose(2h PBG).Motor nerve conduction velocity(MCV)measurement and sensory nerve conduction velocity(SCV)were also inspected.Evaluate the normal value of nerve conduction velocity in clinical electromyography as reference standard,normal values of MCV and SCV in median nerve and ulnar nerve were greater than or equal to 45 m/s and 47 m/s.Normal values of MCV and SCV in peroneal of nerve and tibial nerve were greater than or equal to 42 m/s and 40 m/s,lower than the values of above were anomaly EMG.Statistical description of measurement data were used with mean ± standard deviation.Comparison of the mean between two groups was carried out using the t-test.Mean among multigroups were compared using analysis of variance.Skewness distribution measurement data were represented by the median,two or more groups were compared using the Wilcoxon rank sum test.We used rate(%)to describe the cases of the count data,count data were analyzed by using X2 test.Logistic regression analysis was performed to screen the risk factors associated with peripheral neuropathy in type 2 diabetic patients.Value of P<0.05 was considered statistically significant.Results:1 Comparison of age,course of disease,height,weight and blood pressure between DPN and NDPN groupsThe average age of DPN patients was(57.1±6.04)years old and the average age of NDPN patients was(53.6±5.59)years old,the age of the patients in DPN group was significantly older than those in NDPN group(t=2.937,P=0.004);the average duration of DPN patients was(10.5±3.8)years and the average duration of NDPN patients was(4.6±2.9)years,the duration of DPN patients was significantly longer than NDPN group(t=2.248,P=0.029).There was no difference in height,weight,body mass index,systolic blood pressure and diastolic blood pressure(P>0.05).2 Comparison of Gender,smoking history,past history and family history between DPN and NDPN groupsIn group DPN,35 cases were male patients(59.3%),24 cases were female patients(40.7%),in group NDPN,16 cases were male patients(39%),25 cases were female patients(61%),the proportion of male patients in DPN group was significantly higher than NDPN patients(X2=3.988,P=0.046).There was no statistically significant difference in disease history and smoking history(P>0.05).3 Comparison of blood glucose between DPN and NDPN groupsGlycosylated hemoglobin in DPN group was(9.31±2.07)%,in NDPN patients was(7.96±1.82)%,glycosylated hemoglobin in DPN group was significantly higher than NDPN group(t=3.367,P=0.001).Fasting blood glucose in DPN group was(9.77±2.65)mmol/L,in NDPN group of patients was(8.29±1.92)mmol/L,the fasting blood glucose in DPN group was significantly higher than that NDPN group(t=3.059,P=0.003).The postprandial blood glucose(2h)of the patients in DPN group was(15.2±3.99)mmol/L,in the NDPN group was(13.5±4.40)mmol/L,and the postprandial 2H blood glucose was significantly higher in the DPN group than in NDPN(t=2.009,P=0.047).4 Comparison of blood lipid between DPN and NDPN groupThe mean value of triglyceride in DPN group was(2.72±0.65)mmol/L,in NDPN group was(2.45±0.53)mmol/L,it is significantly higher in the DPN group than in the NDPN group(t=2.199,P=0.03).The mean value of low density lipoprotein cholesterol in DPN group was(3.28±1.05)mmol/L,in NDPN group was(2.79±0.89)mmol/L,low density lipoprotein cholesterol levels in DPN group was significantly higher than in NDPN group(t=2.44,P=0.016).There were no significant difference in the total cholesterol and the level of high density lipoprotein cholesterol between DPN group and NDPN group(P>0.005).5 Comparison of uric acid between DPN and NDPN groupThe mean value of uric acid of the patients in DPN group was(269.8±96.5)?mol/L,and the mean value of uric acid in the NDPN group was(231.3±89.8)? mol/L,the uric acid level in the DPN group was significantly higher than that in the NDPN group(t=2.018,P=0.046).6 The effects of stratification in age,duration of disease and glycosylated hemoglobin on DPNAge: The prevalence of DPN in the age group of less than 65 years was 50.8%,in the age group of equal to or greater than 65 years old was 70.7%,the prevalence of DPN increased with age,the age between two groups has significant differences(X2 =3.954,P=0.047).Duration: The prevalence of DPN in the duration group of less than 7 years was 51.5%,the prevalence rate of DPN in equal to or greater than 7 years group was 73.5%,the prevalence of DPN increased with duration,the duration between two groups has significant differences(X2=4.496,P=0.037).Glycosylated hemoglobin: The prevalence of DPN in the glycated hemoglobin group of less than 7% was 50.8%,the prevalence of DPN in equal to or greater than 7% groups of patients was 73%,the prevalence of DPN increased with the level of glycosylated hemoglobin,there was significant difference between two groups of glycosylated hemoglobin(X2=4.740,P=0.029).7 Multivariate Logistic regression analysis of DPNTaking the occurrence of peripheral neuropathy as the dependent variable,8 potential risk factors of single factor were screened into multiple Logistic regression model(Age,Course of disease,Hb A1C?FPG?2h PBG?TG?LDL-C and UA),The final entry into the model and meaningful factors include Age(OR=1.865),Course of disease(OR=2.180),Hb A1C(OR=1.607),FPG(OR=1.247),TG(OR=1.301),LDL-C(OR=2.268)and UA(OR=1.429)?8 Multivariate Logistic regression analysis of the relationship between blood glucose and DPNThe glycosylated hemoglobin,fasting blood glucose and 2 hours postprandial blood glucose were respectively substitution into the multivariate Logistic regression analysis,after correction of factors,we detected that glycosylated hemoglobin was risk factors of elevated DPN(OR=1.348,95%CI 1.128-1.612,P=0.001),blood glucose and 2h postprandial blood glucose was not risk factors of elevated DPN(P>0.05).9 Multivariate Logistic regression analysis of the relationship between serum lipids and DPNThe triglyceride,total cholesterol,high density lipoprotein cholesterol and low density lipoprotein cholesterol were respectively substitution into multivariate Logistic regression analysis,after correction of factors,we detected that low density lipoprotein cholesterol was risk factors of DPN(OR=1.257,95%CI 1.074-1.448,P=0.005),triglyceride,total cholesterol and high density lipoprotein cholesterol were not risk factors of DPN(P>0.05).10 Multivariate Logistic regression analysis of the relationship between uric acid and DPNUric acid was substitution into the multivariate Logistic regression analysis,after adjusting for the influencing factors,the increase of uric acid was still a risk factor for DPN(OR=1.429,95%CI = 1.254-1.638,P=0.001).Conclusions:1 Type 2 diabetes patients with diabetic peripheral neuropathy were older than those without diabetic peripheral and had a longer course of diabetes.2 There were more cases of diabetic peripheral neuropathy in male.3 Glycosylated hemoglobin,fasting blood glucose,postprandial 2h blood glucose,triglyceride,low density lipoprotein cholesterol and uric acid in the patients with diabetic peripheral neuropathy were significantly higher than the patients without diabetic peripheral neuropathy.4 Glycosylated hemoglobin,elevated low-density lipoprotein cholesterol and uric acid were independent risk factors of diabetic peripheral neuropathy.