July 17, 2018
2 min read
Save

Rate of HbA1c increase influences risk for diabetic polyneuropathy

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Among adults with type 2 diabetes, each 1% increase in HbA1c during 10 years increases the risk for diabetic polyneuropathy by nearly 66%, according to data from the ADDITION-Denmark study published in Diabetes Care.

“Hyperglycemia is considered the most important risk factor for the development of diabetic polyneuropathy in type 1 diabetes,” Signe T. Andersen, a doctoral fellow with the department of public health, Aarhus University, Denmark, and colleagues wrote in the study background. “A more complex risk factor profile exists for [diabetic polyneuropathy] in type 2 diabetes, as intervention trials have failed to show a clear effect of enhancing glucose control on the risk of [diabetic polyneuropathy].”

In the nested case-control analysis, Andersen and colleagues evaluated data from 452 participants who attended the 13-year follow-up visit for ADDITION-Denmark, a study of adults aged 40 to 69 years with screen-detected, previously undiagnosed diabetes via stepwise screening in primary care between 2001 and 2006 (median age, 71 years; 62.2% men; 94.5% white). In ADDITION-Denmark, researchers randomly assigned participating general practices to deliver either routine care for diabetes or intensive, multifactorial, target-driven care until 2009. Researchers followed participants observationally via questionnaires, registers and a clinical follow-up assessment in 2015-2016.

Researchers assessed diabetes risk factors at diagnosis and 6 and 13 years, including HbA1c, total cholesterol, HDL cholesterol, triglycerides, creatinine and albumin-to-creatinine ratio, and performed a nested case-control analysis comparing risk-factor levels and changes (trajectories) between those who developed diabetic polyneuropathy at follow-up (cases) and those without diabetic polyneuropathy (controls). Within the cohort, 27% had diabetic polyneuropathy and 4.9% had subclinical diabetic polyneuropathy at follow-up. Of the control group participants, 193 (59%) had potential or probable diabetic polyneuropathy.

In assessing risk for diabetic polyneuropathy, there were no between-group differences when stratified by sex (OR = 0.46; 95% CI, 0.46-1.13) or trial randomization group (OR = 1.15; 95% CI, 0.76-1.73). Greater risk for diabetic polyneuropathy was associated with advanced age (OR = 1.08; 95% CI, 1.04-1.13 per year of age), longer duration of diabetes (OR = 1.14; 95% CI, 1-1.3 per year) and being taller (OR = 1.06; 95% CI, 1.03-1.1 per cm), according to researchers.

Researchers found that diabetic polyneuropathy was associated with both a higher modeled baseline HbA1c (OR = 1.76; 95% CI, 1.37-2.27 per 1% increase during 10 years), as well as a sharper HbA1c increase over time (OR = 1.66; 95% CI, 1.21-2.28 per 1% increase during 10 years).

Diabetic polyneuropathy was also correlated with higher baseline weight (OR = 1.2; 95% CI, 1.1-1.31 per 5 kg), waist circumference (OR = 1.27; 95% CI, 1.13-1.43 per 5 cm) and BMI (OR = 1.24; 95% CI, 1.12-1.38 per 2 kg/m2). Conversely, sharper increases in total cholesterol over time were linked to lower risk of diabetic polyneuropathy (OR = 0.83; 95% CI, 0.70-0.99 per 0.5 mmol/mol during 10 years).

“This study indicates that the rate of increase in HbA1c affects the development of [diabetic polyneuropathy] over and above the effects of the baseline level of HbA1c, even within ranges considered well-controlled,” the researchers wrote. “Higher baseline levels of HbA1c and higher obesity levels were associated with higher risk of [diabetic polyneuropathy].” – by Jennifer Byrne

Disclosures: The authors report no relevant financial disclosures.