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Low peripheral nerve conduction velocities and amplitudes are strongly related to diabetic microvascular complications in type 1 diabetes: the EURODIAB Prospective Complications Study.

Charles M, Soedamah-Muthu SS, Tesfaye S, Fuller JH, Arezzo JC, Chaturvedi N, Witte DR, EURODIAB Prospective Complications Study Investigato - Diabetes Care (2010)

Bottom Line: In addition to an effect of duration of diabetes and A1C, which were both associated with low nerve conduction velocity and response amplitude, we found that the presence of nephropathy, retinopathy, or a clinical diagnosis of neuropathy was associated with low nerve conduction velocity and amplitude.A similar OR was found for each 2% difference in A1C (2.39 [1.68-3.41]).We show that the presence of other microvascular diabetes complications, together with diabetes duration and A1C, are associated with low nerve conduction velocity and amplitude response and that cardiovascular disease or risk factors do not seem to be associated with these measures.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, Aarhus University, Aarhus, Denmark. mc@alm.au.dk

ABSTRACT

Objective: Slow nerve conduction velocity and reduction in response amplitude are objective hallmarks of diabetic sensorimotor polyneuropathy. Because subjective or clinical indicators of neuropathy do not always match well with the presence of abnormal nerve physiology tests, we evaluated associations to nerve conduction in patients with type 1 diabetes.

Research design and methods: Nerve conduction studies were performed in the distal sural and ulnar sensory nerves and the peroneal motor nerve in 456 individuals with type 1 diabetes who participated in the follow-up visit of the EURODIAB Prospective Complications Study (EPCS). We used multivariate regression models to describe associations to decreased nerve conduction measures.

Results: In addition to an effect of duration of diabetes and A1C, which were both associated with low nerve conduction velocity and response amplitude, we found that the presence of nephropathy, retinopathy, or a clinical diagnosis of neuropathy was associated with low nerve conduction velocity and amplitude. In the case of nonproliferative retinopathy, the odds ratio (OR) for being in lowest tertile was 2.30 (95% CI 1.13-4.67) for nerve conduction velocity. A similar OR was found for each 2% difference in A1C (2.39 [1.68-3.41]).

Conclusions: We show that the presence of other microvascular diabetes complications, together with diabetes duration and A1C, are associated with low nerve conduction velocity and amplitude response and that cardiovascular disease or risk factors do not seem to be associated with these measures.

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OR of the lowest tertile of the velocity (left) and amplitude z score (right), adjusted for age, sex, height, center, diabetes duration, A1C, and determinants of nerve conduction measures (skin temperature and distance between electrodes). z scores are calculated from a summed score of standardized NCV/NCA from ulnar and distal sural sensory nerves and the peroneal motor nerve (knee to ankle) unilaterally on the nondominant side. *Microalbuminuria (microalb): 20–200 μg/min; macroalbuminuria (macroalb) >200 μg/min. **Prevalence of CVD. ″Composite score of symptoms, absent reflexes, abnormal vibration perception threshold, or autonomic dysfunction. non-prolifera, nonproliferative.
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Figure 1: OR of the lowest tertile of the velocity (left) and amplitude z score (right), adjusted for age, sex, height, center, diabetes duration, A1C, and determinants of nerve conduction measures (skin temperature and distance between electrodes). z scores are calculated from a summed score of standardized NCV/NCA from ulnar and distal sural sensory nerves and the peroneal motor nerve (knee to ankle) unilaterally on the nondominant side. *Microalbuminuria (microalb): 20–200 μg/min; macroalbuminuria (macroalb) >200 μg/min. **Prevalence of CVD. ″Composite score of symptoms, absent reflexes, abnormal vibration perception threshold, or autonomic dysfunction. non-prolifera, nonproliferative.

Mentions: We confirm that duration of diabetes and A1C were both negatively and statistically significantly associated with NCV and NCA in all three nerves. We also confirm that the presence of nephropathy or retinopathy or a clinical diagnosis of neuropathy was associated with low NCV and NCA z scores. Age, sex, and height have major effects on nerve conduction in health. These effects were also seen in our population. Sex was not consistently significantly associated with the NCV and NCA of individual nerves. Weight was associated with a higher NCV z score, but this effect was not observed for NCA. The association between height and lower NCV or NCA was only present in the nerves of the lower extremity. ORs for having a z score in the lowest tertile of NCV/NCA by diabetes complication status are shown in Fig. 1. All diabetic microvascular complications were associated with lower nerve conduction measures. Microalbuminuria was associated with increased odds of low NCV or NCA (OR 2.25 [95% CI 1.15–4.40] and 2.29 [1.12–4.66], respectively). In the case of nonproliferative retinopathy, values were 2.30 [1.13–4.67] and 2.29 [1.15–4.58] for NCV and NCA, respectively. A similar increase in the odds of low NCV or NCA was found for each 2% difference in A1C (2.39 [1.68–3.41] and 2.47 [1.72–3.54], respectively) or a difference of 10 years of duration of diabetes (3.09 [2.09–4.57] and 3.01 [2.03–4.47], respectively). We repeated our analyses on a subset of the patients without clinical signs of neuropathy. This restriction did not materially affect our findings (data not shown).


Low peripheral nerve conduction velocities and amplitudes are strongly related to diabetic microvascular complications in type 1 diabetes: the EURODIAB Prospective Complications Study.

Charles M, Soedamah-Muthu SS, Tesfaye S, Fuller JH, Arezzo JC, Chaturvedi N, Witte DR, EURODIAB Prospective Complications Study Investigato - Diabetes Care (2010)

OR of the lowest tertile of the velocity (left) and amplitude z score (right), adjusted for age, sex, height, center, diabetes duration, A1C, and determinants of nerve conduction measures (skin temperature and distance between electrodes). z scores are calculated from a summed score of standardized NCV/NCA from ulnar and distal sural sensory nerves and the peroneal motor nerve (knee to ankle) unilaterally on the nondominant side. *Microalbuminuria (microalb): 20–200 μg/min; macroalbuminuria (macroalb) >200 μg/min. **Prevalence of CVD. ″Composite score of symptoms, absent reflexes, abnormal vibration perception threshold, or autonomic dysfunction. non-prolifera, nonproliferative.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992206&req=5

Figure 1: OR of the lowest tertile of the velocity (left) and amplitude z score (right), adjusted for age, sex, height, center, diabetes duration, A1C, and determinants of nerve conduction measures (skin temperature and distance between electrodes). z scores are calculated from a summed score of standardized NCV/NCA from ulnar and distal sural sensory nerves and the peroneal motor nerve (knee to ankle) unilaterally on the nondominant side. *Microalbuminuria (microalb): 20–200 μg/min; macroalbuminuria (macroalb) >200 μg/min. **Prevalence of CVD. ″Composite score of symptoms, absent reflexes, abnormal vibration perception threshold, or autonomic dysfunction. non-prolifera, nonproliferative.
Mentions: We confirm that duration of diabetes and A1C were both negatively and statistically significantly associated with NCV and NCA in all three nerves. We also confirm that the presence of nephropathy or retinopathy or a clinical diagnosis of neuropathy was associated with low NCV and NCA z scores. Age, sex, and height have major effects on nerve conduction in health. These effects were also seen in our population. Sex was not consistently significantly associated with the NCV and NCA of individual nerves. Weight was associated with a higher NCV z score, but this effect was not observed for NCA. The association between height and lower NCV or NCA was only present in the nerves of the lower extremity. ORs for having a z score in the lowest tertile of NCV/NCA by diabetes complication status are shown in Fig. 1. All diabetic microvascular complications were associated with lower nerve conduction measures. Microalbuminuria was associated with increased odds of low NCV or NCA (OR 2.25 [95% CI 1.15–4.40] and 2.29 [1.12–4.66], respectively). In the case of nonproliferative retinopathy, values were 2.30 [1.13–4.67] and 2.29 [1.15–4.58] for NCV and NCA, respectively. A similar increase in the odds of low NCV or NCA was found for each 2% difference in A1C (2.39 [1.68–3.41] and 2.47 [1.72–3.54], respectively) or a difference of 10 years of duration of diabetes (3.09 [2.09–4.57] and 3.01 [2.03–4.47], respectively). We repeated our analyses on a subset of the patients without clinical signs of neuropathy. This restriction did not materially affect our findings (data not shown).

Bottom Line: In addition to an effect of duration of diabetes and A1C, which were both associated with low nerve conduction velocity and response amplitude, we found that the presence of nephropathy, retinopathy, or a clinical diagnosis of neuropathy was associated with low nerve conduction velocity and amplitude.A similar OR was found for each 2% difference in A1C (2.39 [1.68-3.41]).We show that the presence of other microvascular diabetes complications, together with diabetes duration and A1C, are associated with low nerve conduction velocity and amplitude response and that cardiovascular disease or risk factors do not seem to be associated with these measures.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, Aarhus University, Aarhus, Denmark. mc@alm.au.dk

ABSTRACT

Objective: Slow nerve conduction velocity and reduction in response amplitude are objective hallmarks of diabetic sensorimotor polyneuropathy. Because subjective or clinical indicators of neuropathy do not always match well with the presence of abnormal nerve physiology tests, we evaluated associations to nerve conduction in patients with type 1 diabetes.

Research design and methods: Nerve conduction studies were performed in the distal sural and ulnar sensory nerves and the peroneal motor nerve in 456 individuals with type 1 diabetes who participated in the follow-up visit of the EURODIAB Prospective Complications Study (EPCS). We used multivariate regression models to describe associations to decreased nerve conduction measures.

Results: In addition to an effect of duration of diabetes and A1C, which were both associated with low nerve conduction velocity and response amplitude, we found that the presence of nephropathy, retinopathy, or a clinical diagnosis of neuropathy was associated with low nerve conduction velocity and amplitude. In the case of nonproliferative retinopathy, the odds ratio (OR) for being in lowest tertile was 2.30 (95% CI 1.13-4.67) for nerve conduction velocity. A similar OR was found for each 2% difference in A1C (2.39 [1.68-3.41]).

Conclusions: We show that the presence of other microvascular diabetes complications, together with diabetes duration and A1C, are associated with low nerve conduction velocity and amplitude response and that cardiovascular disease or risk factors do not seem to be associated with these measures.

Show MeSH
Related in: MedlinePlus