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Subclinical Neuropathy among Diabetes Control and Complications Trial Participants without Diagnosable Neuropathy at Trial Completion. Possible Predictors of Incident Neuropathy?

*A completes list of investigators and members of the Research Group appears in Reference numbers 1 & 15

jwalbers{at}umich.edu

ABSTRACT

Objective:To evaluate the prevalence of subclinical neuropathy in intensive and conventional treatment groups at completion of the Diabetes Control and Complications Trial (DCCT).

Research Design and Methods:We assessed neuropathy using nerve conduction results obtained at DCCT completion after stratifying the DCCT cohort to exclude subjects with progressively less severe degrees of diagnosable neuropathy, beginning with those with confirmed clinical neuropathy (the primary DCCT endpoint) and eventually excluding all subjects with any clinical or electrodiagnostic evidence of neuropathy.

Results:After excluding subjects with confirmed clinical neuropathy at DCCT completion, 8 of 10 nerve conduction measures (including all lower extremity measures) were significantly better in the intensive treatment group (O'Brien rank-sum test across all nerve conduction measures; p < 0.0001). Conduction velocity group differences were substantial, and the peroneal conduction velocity averaged 3.1 M/sec faster in intensive compared to conventional treatment group (45.1 vs 42.0 M/sec, p < 0.0001). Numerous significant differences in median and peroneal motor conduction velocities favoring the intensive treatment group persisted regardless of the exclusion criteria applied.

Conclusion:Intensive and conventional treatment group subjects without diagnosable neuropathy at DCCT completion had significant differences in electrophysiologic measurements favoring the intensive treatment group. Differences in subsequent incident neuropathy between the original treatment groups may reflect, in part, their levels of subclinical neuropathy at DCCT completion, rather than persistent metabolic effects.

Key Words: Type 1 diabetes • distal symmetrical polyneuropathy • metabolic memory • DCCT • neuropathy • glycemic control • clinical trials

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