Risk Factors For Distal Symmetric Neuropathy in NIDDM: The San Luis Valley Diabetes Study

Gary M Franklin; Susan M Shetterly; Jeffrey A Cohen; Judith Baxter; Richard F Hamman

doi:10.2337/diacare.17.10.1172

Original Articles

Risk Factors For Distal Symmetric Neuropathy in NIDDM: The San Luis Valley Diabetes Study

Gary M Franklin, MD, MPH,
Susan M Shetterly, MS,
Jeffrey A Cohen, MD,
Judith Baxter, MA and
Richard F Hamman, MD, DRPH

Departments of Environmental Health and Medicine (Neurology) Kaiser Permanente, Denver, Colorado
University of Washington School of Public Health and Community Medicine, and School of Medicine Seattle, Washington; the San Luis Valley Diabetes Study Department of Preventive Medicine and Biometrics Kaiser Permanente, Denver, Colorado
University of Colorado School of Medicine; and the Department of Neurology Kaiser Permanente, Denver, Colorado

Address correspondence and reprint requests to Gary M. Franklin, MD, MPH, University of Washington, Occupational Epidemiology and Health Outcomes Program, 1914 North 34 Street, Suite 101, Seattle, WA 98103.

Diabetes Care 1994 Oct; 17(10): 1172-1177. https://doi.org/10.2337/diacare.17.10.1172

Abstract

OBJECTIVE To investigate risk factors for distal symmetric (sensory) neuropathy among prevalent cases of non-insulin-dependent diabetes mellitus (NIDDM) in apopulation-based study in southern Colorado.

RESEARCH DESIGN AND METHODS Prevalent neuropathy was identified in 77 of 277 people with NIDDM by a standardized history and neurologic examination. Fifteen known or suspected risk factors for neuropathy were determined without knowledge of neuropathy status.

RESULTS Older age at examination, longer duration of diabetes, higher glycohemoglobin percentage, lower fasting C-peptide, insulin use, and presence of retinopathy and nephropathy (microalbumin ≥ 200 µg/ml) were all significantly associated with neuropathy. Sex, ethnicity (Hispanic versus non-Hispanic white), height, systolic blood pressure, peripheral vascular disease, cigarette and alcohol use, and serum lipid levels were not significantly associated with neuropathy. In a multivariate logistic model, increasing age (odds ratio [OR] = 1.3, 95% confidence interval [CI] = 1.1–1.6), longer duration of diabetes (OR = 1.3, CI = 1.0–1.6), increased glycohemoglobin percentage (OR = 1.5, CI = 1.1–2.1), and insulin use (OR = 2.8, CI = 1.3–6.1) were associated with neuropathy. Retinopathy (OR = 3.0, CI = 1.2–7.7), but not nephropathy, was important when added to this model.

CONCLUSIONS Worse glycemic control and insulin use were independently associated with neuropathy in people with NIDDM. Whether insulin use represents another marker for severity of the metabolic disturbance or is an independent risk factor for neuropathy requires further study. We could not confirm associations of neuropathy with height, with nephropathy, or with retinopathy, independent of duration of diabetes.