Severe hypoglycemia, diabetic ketoacidosis twice as prevalent among adults with diabetic peripheral neuropathy
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Adults with type 1 diabetes who have diabetic peripheral neuropathy are more likely to experience severe hypoglycemia or diabetic ketoacidosis than their peers without peripheral neuropathy, according to findings published in Diabetes Care.
Nicole C. Foster, MS, senior biostatistician at the Jaeb Center for Health Research in Tampa, Florida, and colleagues used the Michigan Neuropathy Screening Instrument questionnaire to identify cases of diabetic peripheral neuropathy among 5,936 adults who had type 1 diabetes for at least 5 years in the T1D Exchange Clinic Network (mean age, 39 years; 55% women). There are 15 questions on the questionnaire, and diabetic peripheral neuropathy was confirmed when participants answered “yes” to four or more questions. The researchers used medical records to identify cases of severe hypoglycemia, diabetic ketoacidosis, cardiovascular disease and retinopathy as well as to determine race, sex and type of health insurance for each participant.
The researchers found that 11% of participants had diabetic peripheral neuropathy, including 427 participants who had painful diabetic peripheral neuropathy, which was confirmed if a patient “reported burning foot pain.”
“A diabetic peripheral neuropathy prevalence of 11% is markedly lower compared with prior published studies in earlier cohorts, suggesting potential beneficial effects of the improvement in the clinical care and risk factor control in the U.S. adult population with type 1 diabetes,” the researchers wrote.
The researchers also found that 14% of those with diabetic peripheral neuropathy and 7% of those without experienced severe hypoglycemia (P = .04). In addition, 7% of those with diabetic peripheral neuropathy and 3% of those without experienced diabetic ketoacidosis (P < .001).
“This finding highlights a potential relationship between diabetic peripheral neuropathy and glycemic variability,” the researchers wrote. “Larger observational studies with more stringent measures of glycemic variability are needed to confirm these observations.”
Black adults had a greater likelihood of developing diabetic peripheral neuropathy than white adults (OR = 1.95; 95% CI, 1.11-3.42), and women had a greater likelihood than men (OR = 2.44; 95% CI, 1.77-3.37). In addition, those who did not have private health insurance had a greater likelihood than those who did have private health insurance (OR = 1.89; 95% CI, 1.46-2.44).
“We have also found associations with novel nonglycemic diabetic peripheral neuropathy risk factors, such as CVD risk factors, both severe hypoglycemia and diabetic ketoacidosis, potentially reflecting effects of glycemic variability, and lower socioeconomic status, highlighting the importance of social determinants of health in patients with type 1 diabetes,” the researchers wrote. – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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