DIABETIC PERIPHERAL NEUROPATHY - EFFECTS OF AGE, DURATION OF DIABETES, GLYCEMIC CONTROL, AND VASCULAR FACTORS

The aim of this study was to determine the factors associated with dia betic peripheral neuropathy and more particularly its relation to prec isely assessed microangiopathy. Peripheral neuropathy was assessed in 135 diabetic patients: 28 insulin-dependent diabetes mellitus (IDDM), 85 non-insulin-dependent diabetes mellitus (NIDDM), and 22 insulin-tre ated NIDDM patients, on the basis of both clinical findings and extens ive electrophysiological testing (four motor nerves and four sensory n erves, and right and left Hoffmann's reflex), using a total of 20 para meters. The percentage of women with severe clinical neuropathy was si gnificantly higher than that of men, and the clinical neurological sta ge correlated significantly with age and duration of diabetes. Accordi ng to multivariate analysis the clinical stage correlated only with ge nder and duration of diabetes. Several electrophysiological parameters were significantly more abnormal in women and correlated with age, ty pe and duration of diabetes, and recent glycemic control. The multivar iate analysis showed that 17 electrophysiological parameters correlate d with duration of diabetes, nine correlated with age, seven with glyc emic control, and only one with gender. The presence of clinical neuro pathy also correlated with presence of retinopathy, arterial hypertens ion, macroangiopathy, and biological signs of nephropathy. All the ele ctrophysiological parameters were significantly more abnormal in patie nts with retinopathy or macroangiopathy than in patients without these complications. Separate parameter analysis showed that at least one a bnormal electrophysiological parameter was almost always found in pati ents with retinopathy, macroangiopathy, or incipient nephropathy, but abnormalities were also found to a slightly lesser extent in patients without these complications. Multivariate analysis showed that when du ration of diabetes, retinopathy, macroangiopathy, and biological signs of nephropathy were introduced into the model, 11 electrophysiologica l parameters correlated with duration of diabetes, 11 with retinopathy , seven with macroangiopathy, and five with a sign of nephropathy. Thi s study demonstrates that age and glycemic control have an effect, and diabetes duration a major effect on peripheral nerve function. It sug gests that vascular factors may participate in the development of nerv e lesions. (C) Elsevier Science Inc., 1997.