HYPERTENSION AS A RISK FACTOR FOR DIABETIC NEUROPATHY - A PROSPECTIVE-STUDY

The pathogeneses of diabetic neuropathy is still unclear. This study p rospectively investigated the risk factors for distal symmetrical poly neuropathy (DSP) in a cohort of childhood-onset IDDM patients. Subject s from the Epidemiology of Diabetes Complications (EDC) Study were cli nically examined at baseline and then biennially. DSP was diagnosed by a combination of clinical criteria, symptoms and signs (Diabetes Cont rol and Complications Trial [DCCT] exam), and quantitative sensory thr eshold (QST). Among the 463 (70.4%) subjects who were free of DSP at b aseline, 453 (97.8%) participated in at least one biennial reexaminati on during the first 6 years of follow-up and were included in the curr ent analysis. A total of 68 (15.0%) subjects developed DSP in 6 years, giving a cumulative probability of 0.29. The Cox proportional hazards model shows that longer IDDM duration, hypertension, poor glycemic co ntrol, height, and smoking were all independent predictors of the inci dence of DSP (all P < 0.0001, except for smoking for which P = 0.03). Hypertension showed the greatest impact on the development of DSP for individuals with either short or long IDDM duration. This study confir ms some risk factors for DSP found in cross-sectional studies and sugg ests a strong relationship between hypertension and DSP. The results i ndicate that in addition to good glycemic control, avoidance of smokin g and good blood pressure control may be helpful in preventing or dela ying the onset of DSP in IDDM patients.