Risk-Factor Trajectories Preceding Diabetic Polyneuropathy: ADDITION-Denmark.

Area of Science:

• Endocrinology
• Neurology
• Metabolic Syndrome

Background:

• Diabetic polyneuropathy (DPN) is a common complication of type 2 diabetes.
• Understanding the trajectories of cardiometabolic risk factors preceding DPN is crucial for early intervention.
• Previous studies have focused on static risk factor levels rather than their changes over time.

Purpose of the Study:

• To investigate the association between cardiometabolic risk-factor trajectories and the development of DPN.
• To analyze how levels and changes in risk factors over 13 years predict DPN after a screen-detected type 2 diabetes diagnosis.

Main Methods:

• A nested case-control study within the ADDITION trial (Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care).
• Clinical diagnosis of DPN in 452 participants.
• Linear regression models to estimate risk-factor trajectories (levels and slopes) over 13 years.
• Multivariate logistic regression to assess DPN risk associated with trajectory intercepts and slopes, adjusting for covariates.

Main Results:

• Higher baseline HbA1c levels and steeper increases in HbA1c over time were significantly associated with an increased risk of DPN.
• Increased baseline levels of weight, waist circumference, and BMI were also independently associated with DPN.
• Specific odds ratios (ORs) were provided for HbA1c, weight, waist circumference, and BMI, indicating dose-dependent relationships.

Conclusions:

• Both elevated HbA1c levels and the rate of HbA1c increase are significant predictors of DPN development.
• The trajectory of HbA1c, not just its level, impacts DPN development.
• Obesity (indicated by weight, waist circumference, and BMI) is confirmed as a risk factor for DPN, reinforcing the need for comprehensive diabetes management.