Correlation Between Visceral Fat Area And Diabetic Peripheral Neuropathy In Patients With Type 2 Diabetes Mellitus

Objective:By analyzing the influential factors of diabetic peripheral neuropathy(DPN)to explore the correlation between visceral fat area(VFA)and DPN in patients with type 2 diabetic patients,and to provide strategies for the prevention of DPN.Methods:From August 2020 to May 2022,Type 2 diabetes mellitus(T2DM)patients with complete clinical data who were treated in Department of Endocrinology and Metabolic Diseases of Linyi People’s Hospital were collected for a cross-sectional study.According to the diagnosis and exclusion criteria,the enrolled patients were divided into T2 DM without DPN group(non-DPN group)and T2 DM with DPN group(DPN group).Baseline data including age,gender,course of T2 DM,history of hypertension,previous smoking and drinking status,height and weight were collected.BMI = weight(kg)/height ~2(m~2)was calculated.Collected fasting blood glucose(FPG),fasting C-peptide,fasting insulin,glycosylated hemoglobin(Hb A1c),serum free triiodothyronine,serum free thyroxin,thyrotropin,serum creatinine,serum uric acid,aspartic aminotransferase,alanine aminotransferase,urinary microalbumin to creatinine ratio(ACR),triglyceride,total cholesterol,high-density lipoprotein,low-density lipoprotein,VFA and subcutaneous fat area,calculated insulin resistance index =FPG× fasting insulin /22.5.Statistical analysis was used to compare differences between groups in general information and laboratory indicators.Spearman correlation analysis of DPN correlation factors.Logistic regression analysis of the risk factors affecting DPN.Visceral fat area level was divided into four groups by quartile method to compare the incidence and risk of DPN among different groups.Receiver operator characteristic curve(ROC)was plotted to evaluate the predictive value.Results:1.A total of 863 T2 DM patients were collected in this study,including 497T2 DM patients without DPN(non-DPN group)and 366 T2 DM patients with DPN(DPN group).Statistical analysis of clinical data between the two groups showed that there were no significant differences in gender,history of hypertension,systolic blood pressure,diastolic blood pressure,previous smoking and drinking status,fasting insulin,insulin resistance index,serum free thyroxine and thyrotropin between the two groups(P > 0.05).The levels of age,disease course,FPG,Hb A1 c and ACR in DPN group were higher than those in T2 DM group,and fasting C-peptide,body mass index,VFA,subcutaneous fat area,serum free triiodothyronine,serum uric acid,aspartic aminotransferase,alanine aminotransferase,total cholesterol and low-density lipoprotein in DPN group were lower than those in non-DPN group,with statistical significance(P < 0.05).2.Statistical results of spearman correlation: DPN was negatively correlated with VFA(r=-0.186,P < 0.05)3.Logistic regression analysis showed that disease course,FPG,Hb Alc,ACR and VFA were independent influencing factors of DPN.With the prolongation of disease course,the increase of Hb A1 c,FPG and ACR,and the decrease of VFA,the risk of DPN increased.4.The results of VFA four groups(Q1,Q2,Q3,Q4)showed that the prevalence of DPN was 51.4%,49.8%,37.5%,30.4%(P< 0.01).When group Q4 was taken as the reference,the risk of morbidity increased in groups Q1,Q2 and Q3,and the difference between groups Q1 and Q2 was statistically significant(P < 0.05).After adjusting for confounding factors with inter-group differences such as age,course of disease,FPG,fasting C-peptide,Hb A1 c,body mass index and ACR,the risk of morbidity in group Q1 increased by 88.6%(OR=1.886,95%CI: 1.116-3.189,P=0.018),the risk of disease in group Q2 increased by 88.1%(OR=1.881,95%CI:1.167-3.031,P=0.010),and the differences were statistically significant.The Q3 group had a 22.6% increased risk,but the difference was not statistically significant(OR=1.226,95%CI: 0.772-1.948,P=0.388).5.ROC curve analysis showed that T2 DM patients with VFA≤99.5 cm~2,disease course≥7.5 years,FPG≥9.325 mmol/l,Hb A1c≥7.85 %,ACR≥10.45 mg/g had a higher risk of DPN.The area under the curve predicted by VFA for DPN was0.609.The area under the curve of VFA combined with disease course,FPG,Hb A1 c and ACR predicted DPN occurrence was 0.717.The predictive value of single index was slightly lower,while the predictive value of combined index was higher.After adjusting for confounding factors that differed between groups,patients with a VFA≤99.5 cm~2 had a 98.7% increased risk(OR=1.987,95CI%:1.394-2.833,P=0.000)compared with patients with a VFA > 99.5 cm~2.Conclusions:1.The VFA of DPN patients is lower than that of non-DPN patients,and DPN is negatively correlated with VFA.With the decrease of VFA,the incidence of DPN increases gradually.2.Prolonged disease course,increased FPG、Hb A1 c and ACR,and decreased VFA in T2 DM patients are independent risk factors for DPN.With the increase of disease course,FPG,Hb A1 c and ACR,and the decrease of VFA,the risk of DPN in type 2 diabetes patients increases.3.When VFA≤99.5 cm~2,T2 DM patients have an increased risk of DPN.