Investigation On The Status Of Peripheral Neuropathy In Outpatients With Diabetes In Beijing

Objective Diabetic peripheral neuropathy(DPN)is the most common complication of diabetes,the prevalence of DPN among individuals with diabetes is reported to be as high as 50%.Distal symmetric polyneuropathy(DSPN)is the strongest risk factor for foot ulceration and amputation.Cardiovascular autonomic neuropathy(CAN)is harmful and a predictor of death.This study investigated the prevalence of DPN and risk factors in outpatients with diabetes in Beijing,as well as compared the diagnostic methods for DPN.Methods This was a multicenter randomized cross-sectional study,a total of 2,048 diabetic patients from 13 centers in Beijing were assessed for DPN through questionnaires and examination,73 cases of type 1 diabetes mellitus(T1DM),1975 cases of type 2 diabetes mellitus(T2DM)were included in this study.Patients were divided into confirmed DSPN group,suspected DSPN group and non-DSPN group by the five physical examinations recommended by the Chinese Diabetes Society(CDS).According to the results of cardiovascular autonomic reflex tests(CARTs),patients were divided into CAN group and non-CAN group.Multivariate logistic regression was used to analyze the factors affecting DPN and CAN.The sensitivity,specificity,Yoden index and ROC curve area of each test and its combination for DSPN and CAN screening were analyzed to select the best combination.Results(1)In the diabetes patients,714 cases(34.86%)were identified with DPN,537 cases(26.22%)were suspected of having DSPN,and 797(38.92%)were not having DSPN.The prevalence of DSPN in patients with type 1 diabetes and type 2 diabetes was 21.92%and 35.34%,respectively.(2)Multivariate logistic regression analysis suggested that age,duration of diabetes and whether or not with diabetic retinopathy were risk factors for DSPN in T2DM.The odds ratio(OR)was 1.439[95%confidence interval(CI):1.282-1.616,P=0.000],1.297(95%Cl:1.151-1.462,P=0.000),and 1.363(95%CI 1.198-1.494,P=0.000),respectively.(3)For patients with both T1DM and T2DM,ankle reflex,temperature sensation plus vibration sensation yielded the highest sensitivity of 96.7%and 94.1%for screening DSPN,however,the specificity were 81.3%and 70.7%,the Youden index were 0.813and 0.649.(4)Among the patients with diabetes,1281 cases(62.55%)were clinically diagnosed with CAN,and 767 cases(37.45%)were not having CAN.The prevalence of CAN in patients with type 1 diabetes and type 2 diabetes was 61.64%and 62.58%,respectively.(5)Multivariate Logistic regression analysis showed that the course of disease and age were independent risk factors of CAN in patients with type 1 diabetes and type 2 diabetes,respectively(OR=1.122,95%CI 1.026-1.228,P=0.011;OR=1.040,95%CI 1.008～1.072,P=0.012).(6)The most common autonomic symptoms of CAN are fatigue(28.65%),dizziness(23.42%),frequent urination(19.59%),upper body sweating(18.35%)and erectile dysfunction(16.72%).(7)The best diagnostic method for CAN in T1DM group was Valsalva test(V test)+30/15 ratio in supine position(LS)(sensitivity was 97.62%,AUC-0.887).In T2DM group,the deep breathing heart rate difference test(DB)showd the highest sensitivity(83.62%),and the V test+DB test yielded the highest AUC(0.856).(8)There was an interaction between DSPN and CAN(X2=9.201,P=0.005).Conclusion The prevalence of DSPN in T1DM and T2DM patients in Beijing is 21.92%and 35.34%,respectively.Age,duration of diabetes,diabetic retinopathy are independent risk factors for DSPN.Ankle reflex,temperature sensation plus vibration sensation are the best combined diagnostic methods of DSPN.The prevalence of CAN in patients with type 1 diabetes and type 2 diabetes was 61.64%and 62.58%,respectively.The duration of diabetes and age are independent risk factors for CAN in T1DM and T2DM patients.V test+LS test and V test+DB test are the best diagnostic methods for CAN in T1DM and T2DM.There is an interaction between DSPN and CAN.