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Established diabetic neuropathy seems irreversible despite improvements in metabolic and vascular risk markers—a retrospective case–control study in a hospital patient cohort
Author(s) -
Coppini D. V.,
Spruce M. C.,
Thomas P.,
Masding M. G.
Publication year - 2006
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2006.01934.x
Subject(s) - medicine , peripheral neuropathy , diabetes mellitus , retrospective cohort study , diabetic neuropathy , cohort , metabolic control analysis , cohort study , risk factor , case control study , surgery , endocrinology
Aims To gain insight into the natural history of diabetic peripheral neuropathy (DPN) and its risk factors by means of sequential quantitative testing in a hospital patient cohort. Methods A retrospective case–control study involving 300 diabetic patients (100 subjects with neuropathy and 200 control subjects) attending Poole Hospital diabetes clinic between 1995 and 2002. All subjects had a detailed annual clinic assessment including vibration perception threshold (VPT) and physical and metabolic assessments and were categorized according to neuropathy status. Established neuropathy was defined as a VPT > 25 V. Cross‐sectional data were analysed by means of a t ‐test and longitudinal data by means of anova . Results VPTs increased over time in neuropathy patients, with no change in control patients ( P < 0.001). Glycaemic control was better over that period in control patients but the rate of improvement in HbA 1c over time was similar in both groups. Triglyceride and high‐density lipoprotein cholesterol levels improved in both groups, with significantly greater change in the control group. Conclusions Data on reversibility of neuropathy are scarce and our 8‐year series shows a continual deterioration in VPT in patients with a threshold > 25 V despite modest improvements in glycaemic control and lipid parameters. This work also supports a vascular association with neuropathy and identifies neuropathic patients as a high‐risk cardiovascular group in whom, despite little influence on neuropathy itself, the above metabolic factors should be actively addressed.