TY - JOUR
T1 - Risk factors for diabetic peripheral neuropathy in adolescents and young adults with type 2 diabetes
T2 - Results from the today study
AU - Levitt Katz, Lorraine E.
AU - White, Neil H.
AU - Ghormli, Laure El
AU - Chan, Christine L.
AU - Copeland, Kenneth C.
AU - Lipman, Terri H.
AU - Marcus, Marsha D.
AU - Zeitler, Philip
N1 - Funding Information:
The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the respective Tribes and the Indian Health Service. Funding. This work was completed with funding from the National Institutes of Health Office of the Director and the National Institute of Diabetes and Digestive and Kidney Diseases through grants U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254.
Publisher Copyright:
© 2022 by the American Diabetes Association.
PY - 2022/5
Y1 - 2022/5
N2 - OBJECTIVE Data related to diabetic neuropathy in youth with type 2 diabetes are limited. We examined the relationship of glycemic control, sex, race/ethnicity, BMI, and other type 2 diabetes-associated factors with the development of diabetic peripheral neuropathy (DPN) in youth with type 2 diabetes enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. RESEARCH DESIGN AND METHODS The Michigan Neuropathy Screening Instrument (MNSI) and a 10-g monofilament exam were performed annually. DPN was defined as a score (2) on the MNSIexam or combined MNSI-exam and MNSI-survey scores (exam 2 and/or survey ≥4), or monofilament exam (8 of 10 correct responses) at two or more consecutive visits. Multivariable time-to-event models assessed the association of risk factors evaluated longitudinally with DPN events. RESULTS A total of 674 participants (35% male), with a mean age of 14 years and diabetes duration 2 years at study entry, were evaluated annually over an average of 10.2 years. Male subjects had a significantly higher cumulative incidence of DPN than female subjects (38.5% vs. 27.2% via MNSI-exam, P = 0.002; 14.0% vs. 5.1% via monofilament exam, P = 0.01). Rates did not differ by race/ethnicity. Higher HbA1c and BMI were associated with higher DPN, by both MNSI and the monofilament test. In multivariable models, male sex, older age, and higher BMI were associated with MNSI-exam DPN risk. CONCLUSIONS DPN was evident early in the course of youth-onset type 2 diabetes and increased over time. It was higher in male subjects and related to glycemic control. These findings raise concern for long-term development of neuropathy-related morbidity in youth with type 2 diabetes and the need to achieve improved glycemic control.
AB - OBJECTIVE Data related to diabetic neuropathy in youth with type 2 diabetes are limited. We examined the relationship of glycemic control, sex, race/ethnicity, BMI, and other type 2 diabetes-associated factors with the development of diabetic peripheral neuropathy (DPN) in youth with type 2 diabetes enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. RESEARCH DESIGN AND METHODS The Michigan Neuropathy Screening Instrument (MNSI) and a 10-g monofilament exam were performed annually. DPN was defined as a score (2) on the MNSIexam or combined MNSI-exam and MNSI-survey scores (exam 2 and/or survey ≥4), or monofilament exam (8 of 10 correct responses) at two or more consecutive visits. Multivariable time-to-event models assessed the association of risk factors evaluated longitudinally with DPN events. RESULTS A total of 674 participants (35% male), with a mean age of 14 years and diabetes duration 2 years at study entry, were evaluated annually over an average of 10.2 years. Male subjects had a significantly higher cumulative incidence of DPN than female subjects (38.5% vs. 27.2% via MNSI-exam, P = 0.002; 14.0% vs. 5.1% via monofilament exam, P = 0.01). Rates did not differ by race/ethnicity. Higher HbA1c and BMI were associated with higher DPN, by both MNSI and the monofilament test. In multivariable models, male sex, older age, and higher BMI were associated with MNSI-exam DPN risk. CONCLUSIONS DPN was evident early in the course of youth-onset type 2 diabetes and increased over time. It was higher in male subjects and related to glycemic control. These findings raise concern for long-term development of neuropathy-related morbidity in youth with type 2 diabetes and the need to achieve improved glycemic control.
UR - http://www.scopus.com/inward/record.url?scp=85138024595&partnerID=8YFLogxK
U2 - 10.2337/dc21-1074
DO - 10.2337/dc21-1074
M3 - Article
C2 - 34716210
AN - SCOPUS:85138024595
SN - 0149-5992
VL - 45
SP - 1065
EP - 1072
JO - Diabetes care
JF - Diabetes care
IS - 5
ER -