Chronic treatment with D-chiro-inositol prevents autonomic and somatic neuropathy in STZ-induced diabetic mice

Aim: d ‐chiro‐inositol (DCI) has been shown to prevent and reverse endothelial dysfunction in diabetic rats and rabbits. The present study evaluates the preventive effect of DCI on experimental diabetic neuropathy (DN). Methods: Streptozotocin‐induced (STZ) diabetic mice were treated by oral gavage for 60 days with DCI (20 mg/kg/12 h) or saline (NaCl 0.9%; 0.1 ml/10 g/12 h; Diab) and compared with euglycaemic groups treated with saline (0.1 ml/10 g/12 h; Eugly). We compared the response of the isolated sciatic nerve, corpora cavernosa or vas deferens to electrical stimulation. Results: The electrically evoked compound action potential of the sciatic nerve was greatly blunted by diabetes. The peak‐to‐peak amplitude (PPA) was decreased from 3.24 ± 0.7 to 0.9 ± 0.2 mV (p < 0.05), the conduction velocity (CV) of the first component was reduced from 46.78 ± 4.5 to 26.69 ± 3.8 ms (p < 0.05) and chronaxy was increased from 60.43 ± 1.9 to 69.67 ± 1.4 ms (p < 0.05). These parameters were improved in nerves from DCI‐treated mice (p < 0.05). PPA in the DCI group was 5.79 ± 0.8 mV (vs. 0.9 ± 0.2 mV—Diab; p < 0.05) and CV was 45.91 ± 3.6 ms (vs. 26.69 ± 3.8 ms—Diab; p < 0.05). Maximal relaxation of the corpus cavernosum evoked by electrical stimulation (2–64 Hz) in the Diab group was 36.4 ± 3.8% compared to 65.4 ± 2.8% in Eugly and 59.3 ± 5.5% in the DCI group (p < 0.05). Maximal contraction obtained in the vas deferens was 38.0 ± 9.2% in Eugly and 11.5 ± 2.6% in Diab (decrease of 69.7%; p < 0.05), compared to 25.2 ± 2.3% in the DCI group (p < 0.05 vs. diabetic). Electron microscopy of the sciatic nerves showed prevention of neuronal damage. Conclusions: DCI has a neuroprotective action in both autonomic and somatic nerves in STZ‐induced DN.     

Prevalence and risk factors for diabetic peripheral neuropathy,neuropathic pain and foot ulceration in the Arabian Gulf region

Aims/IntroductionThis study determined the prevalence and risk factors for diabetic peripheral neuropathy (DPN), painful DPN and diabetic foot ulceration (DFU) in patients with type 2 diabetes in secondary healthcare in Qatar, Kuwait and the Kingdom of Saudi Arabia.Materials and MethodsAdults aged 18–85 years with type 2 diabetes were randomly enrolled from secondary healthcare, and underwent clinical and metabolic assessment. DPN was evaluated using vibration perception threshold and neuropathic symptoms and painful Diabetic Peripheral Neuropathy was evaluated using the Douleur Neuropathique 4 questionnaire.ResultsA total of 3,021 individuals were recruited between June 2017 and May 2019. The prevalence of DPN was 33.3%, of whom 52.2% were at risk of DFU and 53.6% were undiagnosed. The prevalence of painful DPN was 43.3%, of whom 54.3% were undiagnosed. DFU was present in 2.9%. The adjusted odds ratios for DPN and painful DPN were higher with increasing diabetes duration, obesity, poor glycemic control and hyperlipidemia, and lower with greater physical activity. The adjusted odds ratio for DFU was higher with the presence of DPN, severe loss of vibration perception, hypertension and vitamin D deficiency.ConclusionsThis is the largest study to date from the Middle East showing a high prevalence of undiagnosed DPN, painful DPN and those at risk of DFU in patients with type 2 diabetes, and identifies their respective risk factors.     

Effect of hyperbaric oxygen on cardiac neural regulation in diabetic individuals with foot complications

Aims There are relatively few effective methods to treat autonomic neuropathy in patients with diabetes mellitus. Our aim was to test the hypothesis that hyperbaric oxygen therapy may restore cardiac neural regulation dysfunction in diabetic individuals with foot complications. Methods We conducted a prospective randomized controlled study in patients with diabetic foot problems. Daily heart‐rate variability analysis from 5‐min electrocardiography was used to evaluate the temporal change of cardiac neural regulation. The experimental group consisted of 23 subjects exposed to hyperbaric oxygen therapy of 202.65 kPa for 90 min every Monday to Friday for 4 weeks (20 treatments). The control group consisted of 15 age‐, sex‐ and disease‐matched subjects who were not exposed to hyperbaric therapy. Patients with medical complications and failure of wound healing were excluded to eliminate possible confounding effects. Results There was no significant difference in baseline R–R interval (RR), variance, high‐frequency power (HF), low‐frequency power (LF), and LF/HF ratio between the two groups. In the hyperbaric oxygen group there were significant increases in changes of RR (82.7 ± 16.02 ms); variance 0.88 ± 0.12 ln(ms²); HF 1.06 ± 0.18 ln(ms²); and LF 0.87 ± 0.15 ln(ms²) after the treatment. Measurements of tissue oxygen demonstrated significant increases in local tissue oxygenation in the hyperbaric oxygen group (53.0 ± 2.6 mmHg) compared with the control group (27.5 ± 3.1 mmHg), P < 0.05. Conclusion Hyperbaric oxygen therapy has a significant vagotonic effect, which is beneficial in improving cardiac neural regulation in patients with diabetic autonomic dysfunction. Diabet. Med. (2006)     

Autonomic neuropathy and transcutaneous oxymetry in diabetic lower extremities

Summary Transcutaneous oxygen tension is a useful method with which to assess the functional status of skin blood flow. The reduced values observed in diabetic patients have been interpreted as a consequence of peripheral vascular disease. However, diabetic patients show lower transcutaneous oxygen tension values than control subjects with equivalent degrees of peripheral vascular disease, suggesting that additional factors are involved. Since the autonomic nervous system influences peripheral circulation, we studied the relationship between autonomic neuropathy and foot transcutaneous oxymetry in non-insulin-dependent diabetic (NIDDM) patients without peripheral vascular disease. The following age-matched patients were selected and evaluated: control subjects, C, (n=20), NIDDM patients without autonomic neuropathy, D, (n=16) and with autonomic neuropathy, DN, (n=20). All diabetic patients showed lower transcutaneous oxygen tension values than control subjects, while no differences were observed between the diabetic patients with and without autonomic neuropathy. In addition the saturation index that increases in the presence of autonomic neuropathy does not correlate with foot TcPO₂. In conclusion autonomic neuropathy does not influence foot TcPO₂ and therefore it is unlikely that it contributes to development of foot lesions during induction of foot skin ischaemia.Abbreviations NIDDM Non-insulin-dependent diabetes mellitus - TcPO₂ transcutaneous oxymetry - A-V arterio-venous shunts - PVD peripheral vascular disease - HbA_1c glycated haemoglobin - SI saturation index     

Pseudoclaudication as a manifestation of diabetic neuropathy.

We present the case of a 64-year-old male Type 1 diabetic patient with painful diabetic neuropathy masquerading as intermittent claudication. Examination of the peripheral circulation (both arterial and venous) was normal. An MRI scan excluded lumbar spinal stenosis and nerve root compression as the cause of claudication. The case suggests that, in the absence of other identifiable causes and in the presence of peripheral diabetic neuropathy, "intermittent claudication" may be due to the neuropathy itself.     

糖尿病周围神经病变生物学标志物的临床研究进展

糖尿病周围神经病变（DPN）是糖尿病最常见的慢性并发症之一,可导致足部溃疡、坏疽,甚至截肢,对患者的生活质量造成极大影响。DPN的发病机制复杂。近年来,针对DPN发病各个环节的生物学标志物的研究取得了一定进展。本文以DPN的病理生理改变及发病机制为出发点,主要从神经组织损伤、内皮功能紊乱、氧化应激和炎症4个方面综述DPN的潜在生物学标志物。     

The role of Sudoscan feet asymmetry in the diabetic foot

The aim of this study was to investigate the role of Sudoscan asymmetry parameters in the diabetic foot.Patients and methodsIn this study we included 165 participants: 84 type 2 diabetes patients divided into three HbA1c matched groups – group 1: newly diagnosed diabetics (n = 31), group 2: people with longer diabetes duration and established neuropathy (n = 33), group 3: patients with diabetic foot ulcer (n = 20), and a control group of 81 people with prediabetes. All subjects underwent peripheral sudomotor evaluation using Sudoscan device (Impeto Medical, Paris).ResultsPatients with diabetic foot had significantly higher Sudoscan feet asymmetry (19.6%) compared to those with only diabetic neuropathy (7.9%), compared to the group with newly diagnosed diabetes (7.44%), and compared to controls (2.5%). This test has shown a good discriminative value (with a threshold of 9.5%) for diabetic foot with area under the ROC curve of 0.955 (p = 0.001). Additionally, in a regression model feet asymmetry proved its predictive value for participants with diabetic foot.ConclusionIn this study Sudoscan feet asymmetry proved to be a novel discriminator and predictor for diabetic foot patients. It might be considered as a marker for early damage in the neuropathy evaluation protocol.     

Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis,assessment and management

Painful diabetic peripheral neuropathy (DPN) is common, is associated with significant reduction in quality of life and poses major treatment challenges to the practising physician. Although poor glucose control and cardiovascular risk factors have been proven to contribute to the aetiology of DPN, risk factors specific for painful DPN remain unknown. A number of instruments have been tested to assess the character, intensity and impact of painful DPN on quality of life, activities of daily living and mood. Management of the patient with DPN must be tailored to individual requirements, taking into consideration the co‐morbidities and other factors. Pharmacological agents with proven efficacy for painful DPN include tricyclic anti‐depressants, the selective serotonin and noradrenaline re‐uptake inhibitors, anti‐convulsants, opiates, membrane stabilizers, the anti‐oxidant alpha‐lipoic acid and topical agents including capsaicin. Current first‐line therapies for painful DPN include tricyclic anti‐depressants, the serotonin and noradrenaline re‐uptake inhibitor duloxetine and the anti‐convulsants pregabalin and gabapentin. When prescribing any of these agents, other co‐morbidities and costs must be taken into account. Second‐line approaches include the use of opiates such as synthetic opioid tramadol, morphine and oxycodone‐controlled release. There is a limited literature with regard to combination treatment. In extreme cases of painful DPN unresponsive to pharmacotherapy, occasional use of electrical spinal cord stimulation might be indicated. There are a number of unmet needs in the therapeutic management of painful DPN. These include the need for randomized controlled trials with active comparators and data on the long‐term efficacy of agents used, as most trials have lasted for less than 6 months. Finally, there is a need for appropriately designed studies to investigate non‐pharmacological approaches. Copyright © 2011 John Wiley & Sons, Ltd.     

Neuropad as a diagnostic tool for diabetic autonomic and sensorimotor neuropathy

Aims The aim of the present study was to determine the diagnostic accuracy of the Neuropad sudomotor test for diabetic cardiovascular autonomic neuropathy (CAN) and diabetic polyneuropathy (DPN), the latter assessed using a multi‐level diagnostic approach. Methods In 51 diabetic patients, CAN, symptoms and signs of DPN, vibration perception threshold (VPT), cold (CTT) and warm thermal perception thresholds (WTT) were measured. Neuropad response was determined as normal (complete colour change) or abnormal (absent or incomplete colour change). The time until the complete colour change (CCC time) was recorded. Results CCC time showed significant correlations with all the neurological parameters, the strongest of which were with Valsalva ratio (ρ = ?0.64, P < 0.0001), symptoms of DPN (ρ = 0.66, P < 0.0001), postural hypotension (ρ = 0.54, P = 0.0001) and CTT (ρ = ?0.54, P = 0.0001). CCC time showed moderate diagnostic accuracy for both CAN and DPN: the areas under the receiver operating characteristic (ROC) curves were 0.71 and 0.76, respectively. The diagnostic characteristics of three cut‐off values of CCC time, identified by ROC analysis (i.e. 10, 15 and 18 min), were analysed. Compared with 10 min, the 15‐min cut‐off value provided better specificity (from 27% to 52% and from 31% to 62% for CAN and DPN, respectively) and a better likelihood ratio for negative result (from 0.67 to 0.34 and from 0.58 to 0.33) without lowering sensitivity (from 82% to 82% and from 85% to 80%). Conclusions Neuropad is a reliable diagnostic tool for both CAN and DPN, albeit of only moderate accuracy. Extending the observation period to 15 min provides greater diagnostic usefulness.     

Plantar pressure distribution in Type 2 diabetic patients without peripheral neuropathy and peripheral vascular disease.

AIMS: To evaluate the distribution of plantar pressure during walking on a level gradient in patients with Type 2 diabetes mellitus without any microvascular and macrovascular complications and to compare them with non-diabetic control subjects. METHODS: A group of 15 patients with Type 2 diabetes mellitus without either peripheral neuropathy or peripheral vascular disease (PVD), as well as without both diabetic retinopathy and nephropathy, was compared with a group of 15 non-diabetic subjects matched for age, sex, body weight and height. The plantar pressure and duration of plantar pressure were measured on big toe, 1st, 3rd and 5th metatarsal heads, and on the heel of both feet by Force Sensing Resistors sensors. The static contact plantar surface was measured by method of Harris footprints. RESULTS: The diabetic group showed a significant increase in peak plantar pressure at the level of the big toe [right foot 205 +/- 94 vs. 101 +/- 39 kPa (mean +/- SD), P = 0.01; left foot 165 +/- 61 vs. 104 +/- 43 kPa, P = 0.05] and 5th metatarsal head (right foot 160 +/- 68 vs. 97 +/- 32 kPa, P = 0.05; left foot 174 +/- 65 vs. 91 +/- 42 kPa, P = 0.02) with a significantly prolonged duration of plantar pressure at each step. Under the heel, the peak plantar pressure was significantly lower in the diabetic group (right foot 187 +/- 54 vs. 321 +/- 91 kPa, P = 0.05; left foot 184 +/- 63 vs. 298 +/- 110 kPa, P = 0.05). No significant differences were noted under 1st and 3rd metatarsal heads. The contact plantar surface was significantly reduced in the diabetic group compared with control subjects (right foot 118.2 +/- 10.8 vs. 141.5 +/- 12.7 cm2, P = 0.05; left foot 127.5 +/- 8.7 vs. 140.0 +/- 11.1 cm2, P = 0.05). CONCLUSIONS: We observed an anterior displacement of weight-bearing during walking on a level gradient as well as a reduced static contact plantar surface in diabetic patients without evidence of any complications compared with the non-diabetic control group. This could be a premature sign of peripheral neuropathy, which is not evaluated on clinical examination or quantitative sensory testing used in clinics.     

Non-invasive and quantitative assessment of sudomotor function for peripheral diabetic neuropathy evaluation

Aims

Perturbation of pain sensation is considered one of the major initiating risk factors for diabetic foot ulcer. Sweat dysfunction leading to abnormal skin conditions, including dryness and fissures, can increase foot ulcer risk. The aim of this study was to evaluate Sudoscan™, a new, quick, non-invasive and quantitative method of measuring sudomotor dysfunction as a co-indicator of the severity of diabetic polyneuropathy (DPN).

Methods

A total of 142 diabetic patients (age 62 ± 18 years, diabetes duration 13 ± 14 years, HbA_1c 8.9 ± 2.5%) were measured for vibration perception threshold (VPT), using a biothesiometer, and for sudomotor dysfunction, using electrochemical sweat conductance (ESC) based on the electrochemical reaction between sweat chloride and electrodes in contact with the hands and feet. Retinopathy status was also assessed, as well as reproducibility between two ESC measurements and the effect of glycaemia levels.

Results

ESC measurements in the feet of patients showed a descending trend from 66 ± 17 μS to 43 ± 39 μS, corresponding to an ascending trend in VPT threshold from < 15 V to > 25 V (P = 0.001). Correlation between VPT and ESC was −0.45 (P < 0.0001). Foot ESC was lower in patients with fissures, while VPT was comparable. Both VPT and foot ESC correlated with retinopathy status. Bland–Altman plots indicated good reproducibility between two measurements, and between low and high glycaemia levels.

Conclusion

Sudoscan™ is a reproducible technique with results that are not influenced by blood glucose levels. Sweating status may be a quantitative indicator of the severity of polyneuropathy that may be useful for the early prevention of foot skin lesions.     

Symptomatic treatment of peripheral diabetic neuropathy with carbamazepine (Tegretol®): Double blind crossover trial

Summary A double blind crossover study with placebo and carbamazepine was done in 30 diabetic patients who presented diverse clinical types of peripheral diabetic neuropathy. The active drug offered symptomatic relief of all sensory manifestations in 28 cases. No effort was made to assess the action of carbamazepine upon motor or visceral manifestations of neuropathy. There were two complete failures. Untoward effects were frequent but usually mild and transient; two patients presented a rash that required discontinuation of the drug.

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Symptomatische Behandlung der peripheren diabetischen Neuropathie mit Carbamazepin (Tegretol): Doppel-Blind-Austausch-Untersuchung

Zusammenfassung An 30 Diabetikern, die unterschiedliche Formen einer peripheren diabetischen Neuropathie aufwiesen, wurde eine Doppel-Blind-Austausch-Untersuchung mit Carbamazepin und einem Plazebo-Präparat durchgeführt. Bei 28 der Patienten führt die aktive Droge zu einer symptomatischen Besserung sämtlicher Symptome von Seiten des sensiblen Nevensystems. Die Wirkung von Carbamazepin auf die motorischen und visceralen Erscheinungsformen der Neuropathie wurde nicht geprüft. Es traten zwei komplette Therapie-Versager auf. Nebenwirkungen waren häufig festzustellen; sie waren jedoch gewöhnlich leicht und klangen schnell ab. Bei zwei Patienten zwang das Auftreten eines Exanthems zum Absetzen des Präparates.

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Traitement symptomatique de la neuropathie diabétique périphérique avec la carbamazépine (Tégrétol^®): Essaidouble aveugle en cross over

Résumé Une étude de cross over double aveugle avec placebo et carbamazépine a été effectuée chez 30 patients diabétiques présentant divers types cliniques de neuropathie diabétique périphérique. La drogue active apportait un soulagement symptomatique de toutes les manifestations sensorielles dans 28 cas. Aucun effort n'a été fait pour évaluer l'action de la carbamazépine sur les manifestations motrices ou viscérales de la neuropathie. Il y eut deux échecs complets. Les effets secondaires étaient fréquents, mais en général légers et temporaires. Deux patients présentèrent une éruption qui nécessita l'arrêt du traitement.

     

Pathophysiology and treatment of diabetic neuropathy

The scope of the present review is to describe epidemiology, classification, symptomatology and treatment of diabetic peripheral somatic neuropathy and autonomic neuropathy. Special attention is paid to the use of local anaesthetic agents in painful diabetic neuropathy. Denervation hypersensitivity is a characteristic of autonomic neuropathy in diabetic patients. The pathophysiology behind this phenomenon is elucidated in this review and most recent studies related to diabetic encephalopathy are reviewed. References for this review were acquired via a MedLine and MedLars literature search. © 1998 John Wiley & Sons, Ltd.     

Ethnic differences in plantar pressures in diabetic patients with peripheral neuropathy

Aims To compare plantar foot pressures between Caucasian and Hispanic diabetic patients with peripheral neuropathy (PN) without a history of foot ulceration and between Caucasian and Hispanic non-diabetic individuals. Methods Forty-four Hispanic diabetic patients with PN (HDPN), 35 Caucasian diabetic patients with PN (CDPN), 41 non-diabetic Hispanic subjects and 33 non-diabetic Caucasian subjects participated. Total and regional peak plantar pressures (PPs) and pressure time integrals (PTIs) were assessed using the EMED-SF-4 plantar pressure system. Results Hispanic diabetic patients with PN had significantly lower peak PP than Caucasian diabetic patients with PN in the entire foot (552.4 ± 227.9 vs. 810.1 ± 274.6 kPa; P < 0.001), forefoot (464.1 ± 222.6 vs. 699.6 ± 323.1 kPa; P < 0.001), hindfoot (296.3.4 + 101.8 vs. 398.1 + 178.3 kPa; P < 0.01) and at the fifth metatarsal head (MTH5; 204.3 ± 143.2 vs. 388.2 ± 273.9 kPa; P < 0.001). The PTI in the entire foot, forefoot and MTH5 were also lower in HDPN than in CDPN. The ethnic differences between the diabetic groups with PN for the entire foot, forefoot and MTH5 remained significant after adjusting for the effect of age, gender, weight and duration of diabetes. There were no significant differences in peak PP and PTI among non-diabetic individuals, except for a lower peak PP at the MTH5 in Hispanic compared with Caucasian subjects. Conclusions Despite a well-known higher incidence of foot complications in diabetic Hispanic subjects, dynamic plantar pressures are lower in Hispanic diabetic patients with PN when compared with their Caucasian counterparts, suggesting that differences in other risk factors exist between these two ethnic groups.     

Influence of autonomic neuropathy upon left ventricular dysfunction in insulin-dependent diabetic patients

BACKGROUND: Diabetic cardiomyopathy is a well-defined complication of diabetes that occurs in the absence of ischemic, vascular, and hypertensive disease. HYPOTHESIS: The study was undertaken to test the relationship among autonomic neuropathy (AN), 24-h blood pressure (BP) profile, and left ventricular function. METHODS: Nineteen type-1 diabetic patients underwent autonomic tests and echocardiographic examination. Patients were divided according to the presence (AN+) or absence (AN-) of AN. RESULTS: In the AN+ group (n = 8), the E/A ratio at echo was lower than in the AN- group (n = 11) (1.1 +/- 0.3 vs. 1.6 +/- 0.3; p < 0.005). Systolic and diastolic BP reductions during sleep were smaller in the AN+ than in the AN- group (6.6 +/- 6.6 vs. 13.0 +/- 4.3%; p < 0.03 for systolic and 12.8 +/- 6.8 vs. 20.0 +/- 4.0% for diastolic BP reduction; p < 0.03, respectively). Considering all patients, the E/A ratio correlated inversely with awake diastolic BP (r - 0.63; p = 0.005); sleep systolic BP (r - 0.48; p = 0.04), and sleep diastolic BP (r - 0.67; p = 0.002). The AN correlated with diastolic interventricular septum thickness (r 0.57; p = 0.01), sleep systolic BP (r 0.45; p = 0.05), sleep diastolic BP (r 0.54; p = 0.02), and correlated inversely with systolic and diastolic sleep BP reduction (r - 0.49; p = 0.03 and r - 0.67; p = 0.002, respectively). Finally, E/A ratio and AN score correlated between themselves (r - 0.6; p = 0.005). CONCLUSION: Our results suggest that left ventricular diastolic dysfunction may be detected very early in type-1 diabetic patients with AN. Parasympathetic lesion and nocturnal elevations in BP could be the link between AN and diastolic ventricular dysfunction.     

老年糖尿病周围神经病变的相关危险因素研究

目的探讨老年糖尿病周围神经病变(diabetic peripheral neuropathy,DNP)的相关危险因素。方法将89例老年糖尿病患者按是否合并周围神经病变分为病变组与对照组,观察2组体质量指数(BMI)、腰臀比(WHR)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC),高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及末梢神经功能、下肢血管超声等指标并进行比较分析。结果病变组WHR、LDL-C、下肢血管损伤程度均较对照组升高(P<0.05),神经传导速度、HDL-C较对照组降低(P<0.05),多元回归分析提示DNP与HbA1c、LDL-C、TG、血管病变负相关,与HDL-C正相关。结论DNP的发生与血糖、血脂及血管病变有关。     

临床氧化应激指标与糖尿病周围神经病变的相关研究

目的调查2型糖尿病患者的临床氧化应激指标情况,分析其与2型糖尿病患者伴发周围神经病变的相关性。方法收集2016年10月至2017年5月解放军第306医院内分泌科同期住院的212例2型糖尿病患者一般资料及临床资料。根据2型糖尿病患者伴发周围神经病变诊断标准,将入选患者分为伴发周围神经病变(n=97)和未伴发周围神经病变(n=115)2组。应用SPSS 23.0对2组患者的一般情况及临床资料进行比较,采用logistic回归分析2型糖尿病患者伴发周围神经病变的危险因素。探讨2型糖尿病患者伴发周围神经病变的特点及其与临床氧化应激指标的相关性。结果 2型糖尿病患者伴发周围神经病变组患者年龄、病程、糖化血红蛋白、总胆固醇显著高于未伴发周围神经病变组患者,空腹C肽、血红蛋白和总胆红素显著低于2型糖尿病非周围神经病变组患者(P0.05)。单因素logistic回归分析显示年龄、病程、糖化血红蛋白、总胆红素、血红蛋白可能与2型糖尿病患者伴发周围神经病变相关,进一步多因素logistic回归分析显示病程(OR=1.006,95%CI 1.003~1.010)、糖化血红蛋白(OR=1.403,95%CI 1.118~1.657)、血红蛋白(OR=0.976,95%CI0.958~0.994)是2型糖尿病患者伴发周围神经病变的独立危险因素。结论 2型糖尿病患者伴发周围神经病变患者临床氧化应激指标(总胆红素、血红蛋白)低于2型糖尿病非周围神经病变患者,且具有高龄、糖尿病病程长、血糖控制不佳及胰岛功能差的特点。