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Alon Abraham Carolina Barnett Hans D. Katzberg Leif E. Lovblom Bruce A. Perkins Vera Bril 《Journal of diabetes and its complications》2018,32(4):424-428
Aims
To determine the cross-sectional threshold at which hemoglobin A1c (HbA1c) is associated with polyneuropathy in healthy controls, and the values associated with the most pronounced decline in nerve function in patients with diabetes.Methods
We used data from a cross-sectional cohort study of healthy controls and type 2 diabetes patients assessed between November 2010 and May 2013. Healthy controls and patients with diabetes were compared at different HbA1c ranges: <5.5%, 5.5–5.9%, and 6–6.4% for controls, and 6.5–7.4% and >7.5% for patients with diabetes.Results
The total cohort included 53 controls and 164 patients with diabetes. Subclinical small nerve fiber impairments were observed in controls at HbA1c levels of 5.5–6%, compared with HbA1c <5.5%, for example: lower Laser Doppler flare imaging area of 2.8?±?1.4 versus 3.9?±?2?mm2. The most prominent decline in both small and large nerve fiber function was seen with less impaired glycemic control and shorter duration of diabetes, i.e. at HbA1c levels of 6.5–7.4%, compared with >7.5%.Conclusions
These findings underscore the importance of early treatment at the prediabetes and early diabetes stages to prevent nerve fiber decline that is likely irreversible. 相似文献53.
Nancy Cardinez Leif E. Lovblom Johnny-Wei Bai Evan Lewis Alon Abraham Daniel Scarr Julie A. Lovshin Yuliya Lytvyn Genevieve Boulet Mohammed A. Farooqi Andrej Orszag Alanna Weisman Hillary A. Keenan Michael H. Brent Narinder Paul Vera Bril David Z. Cherney Bruce A. Perkins 《Journal of diabetes and its complications》2018,32(7):660-664
Aim
Neuropathy and neuropathic pain are common complications of type 1 diabetes (T1D). We aimed to determine if sex-specific differences in neuropathic pain are present in adults with longstanding T1D.Methods
Canadians with ≥50?years of T1D (n?=?361) completed health history questionnaires that included assessment of neuropathy (defined by Michigan Neuropathy Screening Instrument questionnaire components ≥3; NEUROPATHYMNSI-Q) and neuropathic pain. Multivariable logistic regression was used to determine sex-differences in neuropathic pain controlling for neuropathy.Results
Participants had mean age 66?±?9?years, median diabetes duration 53[51,58] years, mean HbA1c 7.5?±?1.0%, and 207(57%) were female. Neuropathic pain was present in 128(36%) of all participants, more prevalent among those with NEUROPATHYMNSI-Q compared to those without [96(63%) vs. 31(15%), p?<?0.001], and more prevalent in females compared to males [87(42%) vs. 41(27%), p?=?0.003]. Independent of the presence of NEUROPATHYMNSI-Q and other factors, female sex was associated with the presence of neuropathic pain [OR 2.68 (95% CI 1.4–5.0), p?=?0.002].Conclusions
We demonstrated a novel sex-specific difference in neuropathic pain in females compared to males with longstanding T1D, independent of the presence of neuropathy. Further research using more objective measures of neuropathy than the MNSI is justified to further understand this sex-specific difference. 相似文献54.
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