The Analysis Of Risk Factors Among Type 2 Diabetic Patients With Peripheral Neuropathy

Objective:Diabetes is one of the chronic non-communicable diseases,which threatens human health.Type 2 diabetes mellitus(T2DM)accounts for more than 90%,its pathophysiological mechanism are insulin resistance(IR)and(or)insulin secretion defects.Along with the rapid development of economy and the improvement of living standards,the prevalence of T2 DM increased sharply.In 2017,Guidelines for the prevention and treatment of type 2 diabetes in China showed a 10.4% prevalence of adult diabetes in China.T2 DM,especially its chronic complications,brings a heavy financial burden to patients,their families and society.Type 2 diabetic neuropathy especially diabetic peripheral neuropathy(DPN)is one of the most common complication of T2 DM.The effect clinical treatment is poor.Once it happens,it's irreversible.It is a risk factor for diabetic foot disease,severe cases can lead to amputation,which can seriously affect the quality of life[1].The paper aims to explore the related risk factors of DPN and provide theoretical basis for the prevention and treatment of DPN.Methods:1.According to the T2 DM diagnosis and classification standard proposed from the WHO in 1999,a total of 183 T2 DM patients were selected from the endocrinology department in the third hospital of hebei medical university from August to December in 2017.The T2 DM patients were further divided into two groups according to with/without DPN.DPN group consisted of 54 men and 29 women.NDPN group consisted of 54 men and 29 women.2.The collection of medical history and clinical indicators: gender,age,the duration of diabetes and past history.The right brachial artery systolic blood pressure(SBP)and diastolic blood pressure(DBP)were measured.Record height and body weight,and count body mass index(BMI)= body weight / height squared.3.The blood biochemistry data: fasting plasma glucose(FPG),total cholesterol(TC),triglycerides(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),serum Uric Acid(SUA),hypersensitive C-reactive protein(hs-CRP),serum ferritin(SF),thyroid strmulating hormone(TSH)were measured.4.Fasting insulin(FINS)and Fasting C-peptide(FCP)were measuered by chemiluminescence;HOMA insulin resistance index(HOMA-IR)= FINS(m IU/L)×FPG(mmol/L)/22.5,HOMA insulin sensitivity index(HOMA-ISI)=1/(FINS×FPG).5.Hb A1 c and urinary A/Cr were measuered by immunonephelometry.6.All T2 DM patients were examined under the direct ophthalmoscope and the fundus color photography to determine the presence of diabetic retinopathy(DR)7.Statistical analysis: All data was analyzed by software SPSS21.0 version.The normality of data was tested at first,data with normal distribution were expressed as mean±standard deviation((?)±s),non-normal data was showed by the median interquartile range.T-test was performed to compare measurement data between two groups.ANOVA was performed to compare measurement data among groups.Rank sum test was performed for non-normal data.Logistic regession analysis was used to analyzed the risk factors of DPN.P<0.05 was defined as inclusion criteria.P>0.10 as the exclusion criteria.Results:1.The age(62.19±10.95 years),course of disease [13(11)years],LDL-C [3.17(1.30)mmol/L],hs-CRP [3.20(3.40)mg/L],SF [203.90(151.40)ng/m],SUA(360.42±78.159?mol/L)and UACR [7.51(9.00)mg/mmol] in group DPN were higher than that in group NDPN(P<0.05 or P<0.01),The HDL-C [1.110(0.35)mmol/L] in group DPN was lower than that in group NDPN(P<0.05).The incidence of DR in group DPN was 30.1%,which is higher than 8% in group NDPN(P<0.01).Difference between the two groups has statistical significance.There was no significant difference of gender,BMI,SBP,DBP,FPG,Hb A1 c,TC,TG,FCP,FINS,TSH and smoking history between the two groups.2.Logistic regression analysis showed that course(?=0.127,OR=1.135,P<0.01),DR(?=1.324,OR=3.760,P<0.05),hypertension(?=1.119,OR=3.062,P<0.01),hs-CRP(?=0.237,OR=1.267,P<0.01),UACR(?=0.091,OR=1.095,P<0.05),LDL-C(?=2.307,OR=10.047,P<0.01),SUA(?=0.006,OR=1.006,P<0.05)and SF(?=0.004,OR=1.004,P<0.01)were independent risk factors of DNP.Conclusions:1.The increase of LDL-C,hyperuricemia,hypertension were closely related to development of DPN.2.Serum ferritin was an independent risk factor of DPN.3.As an inflammatory response index,hs-CRP was elevated in DPN.4.Diabetic retinopathy,diabetic nephropathy and DPN were often present at the same time.