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Diabetic Peripheral Neuropathy In Young Adults

Long-term uncontrolled glycemic levels primary cause of complication.

There is a gradual increase in incidence of type 1 diabetes (T1D) and type 2 diabetes (T2D) among the U.S. youth population. Studies show that if this continues, diabetes prevalence among the youth population will triple within three decades. One of the most distressing complications of chronic diabetes is DPN and contributes to significant disability and diminished quality of life. It has been well-researched and documented among the adult population but not so with the adolescents and young adults in the U.S.

Prevalence and predictors of DPN in children and adolescents with diabetes have been well studied in Australia and Denmark. The Australian cohort study reported a DPN prevalence of 21% and 27% for adolescents with T1D and T2D respectively while the Denmark study reported a DPN of 62% among adolescents with T1D.

In the search for diabetes youth study, participants who were younger than 20 years and newly diagnosed with T1D and T2D between 2002 and 2006 and 2008 were recruited. These patients also had to complete a SEARCH baseline exam for risk factors and were living with diabetes for at least 5 years from 2011 to 2015. Participants who were less than 10 years, those who did not have antibodies for diabetes and participants who failed to perform a neuropathy assessment were excluded from the study.

Risk factors were measured at baseline and during cohort visits while DPN was assessed during cohort visits only. Baseline characteristics included height, weight, waist circumference, blood pressure, race ethnicity, smoking, resting systolic blood pressure, resting diastolic blood pressure, hypertension (BP at ≥140/≥90 or use of hypertension medications), HDL, LDL, triglycerides, HbA1c, and renal function. Diabetic peripheral neuropathy was measured using Michigan neuropathy screening instrument; a validated screening tool with a DPN threshold of >2 out of a total score of 8. MNSI exam include feet appearance, ulcerations, reflexes of the ankles, and perception for vibrations.

Chi square test was employed for categorical variables for T1D and T2D participants respectively and Fisher test was applied for cell counts that were less than 5. Overall estimates of DPN were performed or they were categorized by age of diagnoses or by length of time the patient has had diabetes. This was done separately for patients with T1D and T2D.

The search study had 1,734 youth with T1D who completed the study of which 7% had DPN while T2D had 258 of which 22% had DPN. T1D who had DPN were older (21 vs 18 years, P < 0.0001) had lived with diabetes for a longer time (8.7 vs 7.8 years, P < 0.0001), had a higher diastolic blood pressure (71 vs 69 mmHg, P < 0.002), a higher BMI (26 vs 24 kg/M2, P <0.001), higher LDL-c (101 vs 96 mg/dL, P < 0.01), higher triglycerides (85 vs 74 mg/dL, P < 0.005) and a lower HDL-c (51 vs 55, P < 0.01) This was in comparison to those participants who did not have DPN. Current smokers and those who had quit smoking had a 10% prevalence for DPN compared to 5% for nonsmokers (P < 0.001).

T2D participants who had DPN were also older (23vs 22 years, P < 0.01), had lived with diabetes for a longer time (8.6 vs 7.6 years, P < 0.002) and their HDL-c was lower (40 vs 43 mg /dL, P < 0.04). This was also in comparison to participants who did not have DPN. Male patients had a higher prevalence for DPN compared to their female counterparts while current smokers had a higher prevalence compared to nonsmokers and those who had quit smoking. (33% vs 17% vs 15%, P < 0.01).

In conclusion, DPN risk factors for adolescents and younger adults with T1D were older age, longer duration of diabetes, poor blood sugar control over a long time, smoking, and cardiovascular risk factors. Risk factors for the youth with T2D were older age smoking, and longer duration of diabetes. Risk factors that can be treated in both T1D and T2D were poor glycemic control and poor cholesterol.

Practice Pearls:

  • Diabetic peripheral neuropathy is a complication of long-term uncontrolled glycemic levels.
  • Risk factors for DPN include age, duration of diabetes, poor glycemic control, smoking and CVD risk factors.
  • Monitoring and controlling blood sugar levels and treating dyslipidemia can prevent DPN in both T1D and T2D

References:

Jaiswal M. Divers j. Dabelea D Et al. Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy in Youth with Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study. care.diabetesjournals.org. doi.org/10.2337/dc17-0179 date accessed July 26, 2017

Charles M. Eiskjear N. Witte NR, Borch-JK. Et al. Prevalence of Neuropathy and Peripheral Arterial Disease and the Impact of Treatment in People with Screen-Detected Type 2 Diabetes. Diabetes Care 34:2244–2249, 2011

 

Josephat Macharia, PharmD candidate, Lecom School of Pharmacy class of 2018