Metabolic factors, lifestyle habits, and possible polyneuropathy in early type 2 diabetes: A nationwide study of 5,249 patients in the Danish DD2 cohort

OBJECTIVE:To investigate the association of metabolic and lifestyle factors with possible diabetic polyneuropathy (DPN) and neuropathic pain in patients with early type 2 diabetes. RESEARCH DESIGN AND METHODS: We thoroughly characterized 6,726 patients with recently diagnosed diabetes. After a median of 2.8 years, we sent a detailed questionnaire on neuropathy, including the Michigan Neuropathy Screening Instrument questionnaire (MNSIq) to identify possible DPN (score ≥4) and the Douleur Neuropathique en 4 Questions (DN4) questionnaire for possible associated neuropathic pain (MNSIq ≥4 + pain in both feet + DN4-score ≥3). RESULTS: Among 5,249 patients with data on both DPN and pain, 17.9% (n=938) had possible DPN, including 7.4% (n=386) with possible neuropathic pain. In regression analyses, central obesity (waist circumference, waist-hip ratio, and waist-height ratio) was markedly associated with DPN. Other important metabolic factors associated with DPN included hypertriglyceridemia ≥1.7 mmol/L: adjusted prevalence ratio (aPR) 1.36 (1.17; 1.59), decreased HDL cholesterol <1.0/1.2 mmol/L (male/female): aPR 1.35 (1.12; 1.62), high-sensitive CRP ≥3.0 mg/L: aPR 1.66 (1.42; 1.94), C-peptide ≥1,550 pmol/L: aPR 1.72 (1.43; 2.07), HbA1c ≥78 mmol/mol: aPR 1.42 (1.06; 1.88), and antihypertensive drug use: aPR 1.34 (1.16; 1.55). Smoking: aPR 1.50 (1.24; 1.81) and lack of physical activity (0 vs ≥3 days/week): aPR 1.61 (1.39; 1.85) were also associated with DPN. Smoking, high alcohol intake, and failure to increase activity after diabetes diagnosis associated with neuropathic pain. CONCLUSIONS:Possible DPN was associated with metabolic syndrome factors, insulin resistance, inflammation, and modifiable lifestyle habits in early type 2 diabetes.

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Metabolic Factors, Lifestyle Habits, and Possible Polyneuropathy in Early Type 2 Diabetes: A Nationwide Study of 5,249 Patients in the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) Cohort

Diabetes Care ◽

10.2337/dc19-2277 ◽

2020 ◽

Vol 43 (6) ◽

pp. 1266-1275 ◽

Cited By ~ 4

Author(s):

Diana H. Christensen ◽

Søren T. Knudsen ◽

Sandra S. Gylfadottir ◽

Lotte B. Christensen ◽

Jens S. Nielsen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Early Type ◽

Metabolic Factors ◽

Lifestyle Habits ◽

Strategic Research ◽

Nationwide Study

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Diabetic Polyneuropathy Early in Type 2 Diabetes Is Associated With Higher Incidence Rate of Cardiovascular Disease: Results From Two Danish Cohort Studies

10.2337/figshare.14453349.v1 ◽

2021 ◽

Author(s):

Lasse Bjerg ◽

Sia K Nicolaisen ◽

Diana H Christensen ◽

Jens S Nielsen ◽

Signe T Andersen ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Incidence Rate ◽

Diabetic Polyneuropathy ◽

Diabetes Diagnosis ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Rate Ratios

Objective Symptoms indicative of diabetic polyneuropathy (DPN) early in type 2 diabetes may act as a marker for cardiovascular disease (CVD) and death. Research Design and Methods We linked data from two Danish type 2 diabetes cohorts, ADDITION-Denmark and DD2, to national healthcare registers. The Michigan Neuropathy Screening Instrument questionnaire (MNSIq) was completed at diabetes diagnosis in ADDITION-Denmark and at a median of 4.6 years after diagnosis of diabetes in DD2. An MNSIq score ≥ 4 was considered as indicative of DPN. Using Poisson regressions, we computed incidence rate ratios of CVD and all-cause mortality comparing MNSIq scores ≥ 4 with scores < 4. Analyses were adjusted for a range of established CVD risk factors. Results In total, 1,445 (ADDITION-Denmark) and 5,028 (DD2) individuals were included in the study. Compared with MNSIq scores < 4, MNSIq scores ≥ 4 were associated with higher incidence rate of CVD, with incidence rate ratios (IRRs) of 1.79 [95% confidence interval (CI) 1.38-2.31] in ADDITION-Denmark, 1.57 (CI: 1.27-1.94) in the DD2, and a combined IRR of 1.65 (CI: 1.41-1.95) in a fixed-effect meta-analysis. MNSIq scores ≥ 4 did not associate with mortality; combined mortality rate ratio 1.11 (CI: 0.83-1.48). Conclusions The MNSIq may be a tool to identify a subgroup within individuals with newly diagnosed type 2 diabetes who has a high incidence rate of subsequent CVD. MNSIq scores ≥ 4, indicating DPN, were associated with a markedly higher incidence rate of CVD, beyond that conferred by established CVD risk factors.

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DN4 QUESTIONNAIRE IN FAMILY PRACTICE FOR EVALUATION OF CLINICAL MANIFESTATIONS OF NEUROPATHIC PAIN IN TYPE 2 DIABETES PATIENTS TREATED BY LIGHT THERAPY

International Journal of Medicine and Medical Research ◽

10.11603/ijmmr.2413-6077.2018.1.8717 ◽

2018 ◽

Author(s):

N. R. Makarchuk

Keyword(s):

Type 2 Diabetes ◽

Neuropathic Pain ◽

Pain Treatment ◽

Clinical Manifestations ◽

Diabetic Polyneuropathy ◽

Light Therapy ◽

Neurological Complications ◽

Pharmacological Agents ◽

Complex Therapy

Background. Peripheral diabetic polyneuropathy (DPN) is one of the most frequent neurological complications of diabetes mellitus (DM). Despite the large number of pharmacological agents, its treatment is not sufficiently effective, which necessitates the search for new therapies.Objective. The aim of the study was to increase the effectiveness of treatment of neuropathic pain in the patients with diabetic polyneuropathy by incorporating procedures using polarizing polychromatic non-coherent light (Bioptron light therapy) into the complex therapy of this disease.Methods. We examined 67 patients with type 2 diabetes complicated with diabetic polyneuropathy. Patients were divided into two groups: group 1 consisted of 32 patients, who received standard treatment; group 2 comprised 35 patients, who additionally underwent 12 light therapy treatments by means of the Bioptron Physiotherapy Unit. The evaluation of neuropathic pain intensity was performed using a modified questionnaire DN4. Results. A positive clinical effect of treatment was evidenced in both groups in 12 days of treatment. In 3 months, the intensity of complaints was significantly lower (p<0.05) only in the group with additional use of polarizing light. In 6 months, the positive effect of the therapy was leveled in the patients of both groups.Conclusions. The use of the DN4 questionnaire with a modified scale for assessing the parameters of neuropathic pain can optimize its diagnosis. The light therapy procedures together with the standard complex therapy of diabetic polyneuropathy increase the clinical efficacy of neuropathic pain treatment and help to preserve the therapeutic effect within 3 months.

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Improvement in Glycemic and Lipid Profiles in Type 2 Diabetics with a 90-Day Ketogenic Diet

Journal of Diabetes Research ◽

10.1155/2019/8681959 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Chase M. Walton ◽

Katelyn Perry ◽

Richard H. Hart ◽

Steven L. Berry ◽

Benjamin T. Bikman

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Body Weight ◽

Blood Lipids ◽

Dietary Intervention ◽

Hdl Cholesterol ◽

Diabetes Diagnosis ◽

Type 2 Diabetics ◽

Low Carbohydrate

Because low-carbohydrate diets are effective strategies to improve insulin resistance, the hallmark of type 2 diabetes, the purpose of reporting these clinical cases was to reveal the meaningful changes observed in 90 days of low-carbohydrate (LC) ketogenic dietary intervention in female type 2 diabetics aged 18-45. Eleven women (BMI 36.3 kg/m2) who were recently diagnosed with type 2 diabetes based on HbA1c over 6.5% (8.9%) volunteered to participate in an intensive dietary intervention to limit dietary carbohydrates to under 30 grams daily for 90 days. The main outcome was to determine the degree of change in HbA1c, while secondary outcomes included body weight, blood pressure, and blood lipids. The volunteers lost significant weight (85.7±3.2 kg to 76.7±2.8 kg) and lowered systolic (134.0±1.6 to 123.3±1.1 mmHg) and diastolic (89.9±1.3 to 82.6±1.0 mmHg) blood pressure. HbA1c dropped to 5.6%. Most blood lipids were significantly altered, including HDL cholesterol (43.1±4.4 to 52.3±3.3 mg/dl), triglycerides (177.0±19.8 to 92.1±8.7 mg/dl), and the TG : HDL ratio (4.7±0.8 to 1.9±0.2). LDL cholesterol was not significantly different. AST and ALT, plasma markers of liver health, were reported for eight patients and revealed no significant changes. These findings indicate that a short-term intervention emphasizing protein and fat at the expense of dietary carbohydrate functionally reversed the diabetes diagnosis, as defined by HbA1c. Furthermore, the intervention lowered body weight and blood pressure, while eliciting favorable changes in blood lipids.

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Diabetic Polyneuropathy Early in Type 2 Diabetes Is Associated With Higher Incidence Rate of Cardiovascular Disease: Results From Two Danish Cohort Studies

10.2337/figshare.14453349 ◽

2021 ◽

Author(s):

Lasse Bjerg ◽

Sia K Nicolaisen ◽

Diana H Christensen ◽

Jens S Nielsen ◽

Signe T Andersen ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Incidence Rate ◽

Diabetic Polyneuropathy ◽

Diabetes Diagnosis ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Rate Ratios

Objective Symptoms indicative of diabetic polyneuropathy (DPN) early in type 2 diabetes may act as a marker for cardiovascular disease (CVD) and death. Research Design and Methods We linked data from two Danish type 2 diabetes cohorts, ADDITION-Denmark and DD2, to national healthcare registers. The Michigan Neuropathy Screening Instrument questionnaire (MNSIq) was completed at diabetes diagnosis in ADDITION-Denmark and at a median of 4.6 years after diagnosis of diabetes in DD2. An MNSIq score ≥ 4 was considered as indicative of DPN. Using Poisson regressions, we computed incidence rate ratios of CVD and all-cause mortality comparing MNSIq scores ≥ 4 with scores < 4. Analyses were adjusted for a range of established CVD risk factors. Results In total, 1,445 (ADDITION-Denmark) and 5,028 (DD2) individuals were included in the study. Compared with MNSIq scores < 4, MNSIq scores ≥ 4 were associated with higher incidence rate of CVD, with incidence rate ratios (IRRs) of 1.79 [95% confidence interval (CI) 1.38-2.31] in ADDITION-Denmark, 1.57 (CI: 1.27-1.94) in the DD2, and a combined IRR of 1.65 (CI: 1.41-1.95) in a fixed-effect meta-analysis. MNSIq scores ≥ 4 did not associate with mortality; combined mortality rate ratio 1.11 (CI: 0.83-1.48). Conclusions The MNSIq may be a tool to identify a subgroup within individuals with newly diagnosed type 2 diabetes who has a high incidence rate of subsequent CVD. MNSIq scores ≥ 4, indicating DPN, were associated with a markedly higher incidence rate of CVD, beyond that conferred by established CVD risk factors.

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Higher HDL cholesterol to apolipoprotein A-I ratio is protective against the development of type 2 diabetes

Endocrine Abstracts ◽

10.1530/endoabs.35.p342 ◽

2014 ◽

Author(s):

You-Cheol Hwang ◽

In-Kyung Jeong ◽

Kyu Jeung Ahn ◽

Ho Yeon Chung ◽

Cheol-Young Park

Keyword(s):

Type 2 Diabetes ◽

Hdl Cholesterol ◽

Apolipoprotein A

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1561-P: Associations between ß-Cell Function and Cognitive Measures Differ in Youth vs. Adults with Impaired Glucose Tolerance (IGT) or Early Type 2 Diabetes (T2D)

Diabetes ◽

10.2337/db19-1561-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1561-P

Author(s):

SUZANNE CRAFT ◽

AMY CLAXTON ◽

MARK TRIPPUTI ◽

SHARON EDELSTEIN ◽

SILVA A. ARSLANIAN ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Cell Function ◽

Early Type ◽

Cognitive Measures

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Diabetes Remission Clinical Trial (DiRECT)—Plasma Liver Function Tests Reflect Change in Liver Fat Content in Early Type 2 Diabetes

Diabetes ◽

10.2337/db18-1834-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1834-P

Author(s):

SVIATLANA V. ZHYZHNEUSKAYA ◽

AHMAD AL-MRABEH ◽

CARL PETERS ◽

ALISON C. BARNES ◽

KIEREN G. HOLLINGSWORTH ◽

...

Keyword(s):

Type 2 Diabetes ◽

Clinical Trial ◽

Liver Function ◽

Liver Function Tests ◽

Fat Content ◽

Diabetes Remission ◽

Liver Fat ◽

Early Type ◽

Liver Fat Content

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Relative risk of cardiovascular disease is higher in women with type 2 diabetes, but not in those with prediabetes, as compared with men

10.2337/figshare.12915272 ◽

2020 ◽

Author(s):

Elena Succurro ◽

Teresa Vanessa Fiorentino ◽

Sofia Miceli ◽

Maria Perticone ◽

Angela Sciacqua ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Longitudinal Study ◽

Relative Risk ◽

Hdl Cholesterol ◽

Cross Sectional Study ◽

Adverse Outcomes ◽

Cross Sectional ◽

Normal Glucose

Objective: Most, but not all studies suggested that women with type 2 diabetes have higher relative risk (RR) for cardiovascular disease (CVD) than men. More uncertainty exists on whether the RR for CVD is higher in prediabetic women compared to men. Research Design and Methods: In a cross-sectional study, in 3540 normal glucose tolerant (NGT), prediabetic, and diabetic adults, we compared the RR for prevalent non-fatal CVD between men and women. In a longitudinal study including 1658 NGT, prediabetic, and diabetic adults, we compared the RR for incident major adverse outcomes, including all-cause death, coronary heart disease, and cerebrovascular disease events after 5.6 years follow-up. Results: Women with prediabetes and diabetes exhibited greater relative differences in BMI, waist circumference, blood pressure, total, LDL and HDL cholesterol, triglycerides, fasting glucose, hsCRP, and white blood cell count than men with prediabetes and diabetes when compared with their NGT counterparts. We found a higher RR for prevalent CVD in diabetic women (RR 9.29; 95% CI 4.73-18.25; P<0.0001) than in men (RR 4.56; 95% CI 3.07-6.77; P<0.0001), but no difference in RR for CVD was observed comparing prediabetic women and men. In the longitudinal study, we found that diabetic, but not prediabetic women have higher RR (RR 5.25; 95% CI 3.22-8.56; P<0.0001) of incident major adverse outcomes than their male counterparts (RR 2.72; 95% CI 1.81-4.08; P<0.0001). Conclusions: This study suggests that diabetic, but not prediabetic, women have higher RR for prevalent and incident major adverse outcomes than men.

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