 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
PKC-beta inhibition is a potential treatment for diabetic peripheral neuropathy, retinopathy and macular edema.
Reviewed by Irene M. Stratton, MSC
Including those who had evidence of neuropathy at diagnosis, 71% of men and 51% of women have clinically significant neuropathy at 12 years.
Irene M. Stratton, MSc, presented data at the European Association for the Study of Diabetes in Munich on 5,102 patients in the UKPDS. Patients had newly diagnosed diabetes and had been followed for up to 25 years. Researchers defined clinical indices of neuropathy as mean great toe vibration sensory threshold >25, one or both ankle jerks absent and erectile dysfunction in men. Mrs. Stratton is a statistician in the Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism at the University of Oxford.
THREE NEUROPATHIC INDICES ASSESSED
At entry into the study, investigators assessed three neuropathic indices and then again at 3-year intervals. Incident cases were defined as patients without neuropathy initially who had evidence of neuropathy at two consecutive visits up to 12 years after diagnosis.
The investigators used logistic regression to determine prevalence of neuropathic indices and Cox proportional hazard models to examine incidence. The hazard ratios for age per 5 years, female gender, HbA1c per 1%, height per 5 cm, waist circumference per 5 cm, regular or heavy alcohol consumption, current smoking and weight per 5 kg are shown in the accompanying table where statistically significant (P<.05) (Table 1)(Refer to PDF for all Tables).
RISK INCREASED WITH AGE AT DIAGNOSIS
Thirty-six percent of men and 21% of women already have evidence of neuropathy when they are first diagnosed with type 2 diabetes. The risk of neuropathic abnormality increased with age at diagnosis and height. For men, regular alcohol consumption increased the risk of incident and prevalent erectile dysfunction.
The UKPDS2 trial, published in 1998, found that intensive blood glucose control decreased the risk of microvascular complications in patients with type 2 diabetes. Patients randomized to intensive control had an 11% reduction in HbA1c compared with the conventional group and a 12% lower risk of any diabetes related outcome.
Irene M. Stratton, MSc, is a statistician in the Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism at the University of Oxford. She can be reached at irene.stratton@dtu.ox.ac.uk.
1. Stratton, Holman RR, Boulton AJM. Risk factors for neuropathy in UKPDS. Presented at the 40th Annual Meeting of the European Association for the Study of Diabetes. Sept. 5 to 9, 2004. Munich.
2. UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet. 1998;352:837-853.
3. Nathan D. Some answers, more controversy, from UKPDS. Lancet. 1998;352:854-858.
4. Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabet Res Clin Pract 1995; 28: 103-117.
