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The Risk Factors For Diabetic Complications
Author(s) -
Dyck Pj
Publication year - 2000
Publication title -
journal of the peripheral nervous system
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1
H-Index - 67
eISSN - 1529-8027
pISSN - 1085-9489
DOI - 10.1046/j.1529-8027.2000.abstracts-6.x
Subject(s) - medicine , diabetes mellitus , retinopathy , microalbuminuria , glycated hemoglobin , nephropathy , diabetic retinopathy , population , peripheral neuropathy , risk factor , proteinuria , disease , endocrinology , type 2 diabetes , environmental health , kidney
The major late complications of diabetes mellitus can be classified into those attributable to atherosclerosis (heart attacks, stroke, and peripheral vascular disease) and to microvascular disease (diabetic polyneuropathy [DPN], retinopathy, and nephropathy). The risk factors for diabetic polyneuropathy had not previously been adequately assessed by: 1) assessing representative population‐based cohorts; 2) assessing DPN comprehensively and quantitatively; 3) expressing nerve tests as a percentile and normal deviate value correcting for anthropometric characteristics as based on study of a randomly selected normal subject cohort from which neurologic disease had been excluded; 4) assessing risk factors serially over time; and 5) performing multivariate analysis of risk factors. For DPN we have found that the risk factors are: 1) markers of diabetic microvessel disease (diabetic retinopathy, 24‐hour proteinuria, or 24‐hour microalbuminuria); 2) chronic hyperglycemic exposure; and 3) type of DM. Excluding markers of microvessel disease and type of DM we found that the highest correlation coefficients were obtained by glycated hemoglobin (GH) × duration of DM 1/2 × 18/age of onset DM (lowest score = 1) × total plasma antioxidant activity. Similarly, major determinants for diabetic retinopathy and nephropathy also are GH × duration of DM. These results provide strong supportive evidence that the product of chronic hyperglycemic (especially GH) exposure × duration of DM are the main determinants of the diabetic complications of retinopathy, nephropathy, and neuropathy.