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Aging and disease    2019, Vol. 10 Issue (3) : 592-600     DOI: 10.14336/AD.2018.0618
Orginal Article |
Age as an Independent Risk Factor for Diabetic Peripheral Neuropathy in Chinese Patients with Type 2 Diabetes
Fei Mao1, Xiaoming Zhu1, Siying Liu1, Xiaona Qiao1, Hangping Zheng1, Bin Lu1,*, Yiming Li1,2,*
1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
2Department of Endocrinology and Metabolism, Jing’an District Center Hospital of Shanghai, China
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Abstract  

Type 2 diabetes mellitus (T2DM) is more prevalent in aging populations. Older adults with diabetes have higher rates of macro and micro vascular complications. Our study assessed whether age is an independent factor for both large and small nerve dysfunctions in Chinese patients with T2DM. This cross-sectional study involved a total of 950 patients with type 2 diabetes (mean age: 60.01±12.30 years). Diabetic peripheral neuropathy (DPN) was assessed according to clinical symptoms and physical examinations by using neuropathy symptom score (NSS), the neuropathy disability score (NDS), Michigan Neuropathy Screening Instrument (MNSI score), vibration perception threshold (VPT) and SUDOSCAN test. By using independent logistic regression model, we showed that age was an independent risk factor of DPN (odds ratio [OR] = 1.036, 95% confidence interval [CI] 1.018-1.054, P< 0.01). T2DM patients over 71 years had a higher risk of DPN determined by using NSS/NDS (OR= 2.087; 95% CI 1.112-3.918; P <0.05), MNSI (OR=1.922; 95% CI 1.136-3.252; P<0.05), VPT (OR=3.452; 95%CI 1.052-11.332; P<0.05) and SUDOSCAN (OR=1.922; 95%CI 1.136-3.252; P<0.05) as diagnostic criteria respectively. The results of spline analysis showed a non-linearly positive association between age and OR of DPN. Individuals with 40, 50, 60, and 70 years old had LnOR of 1.22 (95%CI: 0.44- 2.00), 1.79(95%CI: 0.67- 2.91), 2.29 (95% CI: 0.98- 3.59), and 2.67(95% CI: 1.38-3.96) in DPN risk compared to T2DM patients with 19 years old, respectively. All of the above results in our study suggested age as an independent risk factor for the development of diabetic neuropathy in T2DM patients is significantly associated with the occurrence of both small and large nerve dysfunction, independent of other risk factors.

Keywords Age      T2DM      DPN      risk factor     
Corresponding Authors: Lu Bin,Li Yiming   
About author:

These authors contributed equally to this work.

Issue Date: 12 March 2018
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Fei Mao
Xiaoming Zhu
Siying Liu
Xiaona Qiao
Hangping Zheng
Bin Lu
Yiming Li
Cite this article:   
Fei Mao,Xiaoming Zhu,Siying Liu, et al. Age as an Independent Risk Factor for Diabetic Peripheral Neuropathy in Chinese Patients with Type 2 Diabetes[J]. Aging and disease, 2019, 10(3): 592-600.
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http://www.aginganddisease.org/EN/10.14336/AD.2018.0618     OR     http://www.aginganddisease.org/EN/Y2019/V10/I3/592
Clinical characteristicsMean ± SD
Age (years)60.01±12.30
Male/ Female555/395
Duration of T2DM (years)8.85±7.33
SBP (mmHg)128.69±13.63
DBP (mmHg)80.27±7.89
HbA1c (%)8.02±1.88
BMI (kg/m2)24.43±3.59
Waist circumference (cm)89.92±10.71
Hip circumference (cm)96.61±6.62
WHR0.93±0.07
Smokers (N, %)215 (22.5)
Alcoholic (N, %)126 (13.3%)
CHO (mmol/L)4.48±1.23
HDL-C (mmol/L)1.06±0.37
TG (mmol/L)1.91±1.93
LDL-C (mmol/L)2.54±0.88
NSS score2.86±2.71
NDS score2.85±2.62
VPT(V)12.07±8.03
Foot ESC (µS)62.25±19.28
Hand ESC (µS)62.45±17.58
Table 1  Baseline characteristics of 950 patients of T2DM enrolled in the study.
Clinical characteristicsWith DPN
(N=264)
Without DPN
(N=686)
P
Age (years)63.78±10.9157.73±12.470.000**

Male/Female157/107398/2880.069
Duration of T2DM (years)11.10±8.237.81±6.620.000**
SB P(mmHg)131.82±15.33127.81±13.100.000**
DBP (mmHg)80.52±7.6180.20±8.080.619
BMI (kg/m2)24.46±3.3924.36±3.630.741
Waist circumference (cm)90.74±9.9589.71±10.940.238
Hip circumference (cm)96.91±6.8996.50±7.850.517
HbA1c (%)8.19±1.818.05±1.970.400
Smokers (%)56(56/200)147(147/573)0.515
Alcoholic (%)23(23/200)93(93/573)0.134
MNSI score5.54±2.111.93±1.590.000**
NSS score4.05±2.762.50±2.580.000**
NDS score5.59±2.171.92±2.040.000**
VPT (V)17.11±10.6610.39±6.130.000**
Foot ESC (µS)53.49±22.6965.52±17.140.000**
Hand ESC (µS)55.86±19.2164.76±16.670.000**
Table 2  Characteristics of 950 T2DM patients enrolled in the study divided by DPN diagnosed by MNSI score.
≤50
(N=183)
51-60
(N=269)
61-70
(N=308)
≥71
(N=180)
P

Male (%)128 (69.95%)167 (62.08%)167 (54.22%)93 (51.67%)0.001**
Duration of T2DM (years)4.73±5.117.57±5.4210.28±7.8512.89±8.320.000**
SBP (mmHg)125.09±11.77126.46±14.09130.62±13.46132.42±13.470.000**
DBP (mmHg)81.03±7.9280.88±7.9780.26±7.8078.34±7.620.004**
BMI25.77±4.1123.84±3.3224.39±3.3624.05±3.480.000**
WHR0.93±0.080.93±0.060.92±0.070.93±0.090.952
NSS2.24±2.592.82±2.803.13±2.693.11±2.610.003**
NDS2.15±2.372.62±2.533.16±2.673.64±2.680.000**
MNSI1.14±1.301.39±1.271.86±1.452.16±1.480.000**
VPT (V)8.34±6.7811.11±7.5013.47±7.9717.18±7.910.000**
Foot ESC (µS)65.00±19.8565.32±17.7862.11±18.6755.35±20.120.000**
Hand ESC (µS)64.91±17.8963.47±16.0462.45±17.8258.29±18.190.002**
HbA1c (%)8.39±2.118.031±1.907.98±1.857.67±1.610.009**
Table 3  Characteristics of 950 T2DM patients enrolled in the study stratified by four age groups (≤50, 51-60, 61-70, ≥71).
Figure 1.  Adjusted dose-response association between age (years) and DPN diagnosed by different criteria including NSS/NDS score, MNSI score, VPT and SUDOSCAN

Adjusted dose-response association between age (years) and the presence of DPN with three knots located at the 5th, 50th, and 95th percentiles. Y-axis represents the Ln (Odds Ratio) to present DPN for any value of age compared to individuals with 19 years old. The red line is the adjusted curve and dashed lines are 95 percent confidence intervals. A) Adjusted dose-response association between age (years) and DPN diagnosed by MNSI score. B) Adjusted dose-response association between age (years) and DPN diagnosed by NSS/NDS score. C) Adjusted dose-response association between age (years) and DPN diagnosed by VPT value. D) Adjusted dose-response association between age (years) and DPN diagnosed by SUDOSCAN ESC value

Clinical factorsBSEORLCIUCIP
Age (years)0.0350.0091.0361.0181.0540.000**
Duration of T2DM (years)0.0340.0141.0341.0071.0620.015*
Gender-0.1490.1980.8620.5851.2700.452
SBP(mmHg)0.0170.0071.0171.0031.0320.015*
BMI (kg/m2)0.0140.0281.0140.9601.0710.618
HbA1c (%)0.1140.0511.1211.0141.2400.026*
Table 4  Multivariate logistic regression model of clinical factors and DPN diagnosed by MNSI score.
AgeNSS/NDSP valueMNSIP valueVPTP valueSUDOSCANP value
≤50RefRefRefRef
51-601.740
(1.011-2.996)
0.046*1.270
(0.810-1.992)
0.2981.371
(0.430-4.376)
0.5941.270
(0.810-1.992)
0.298
61-701.536
(0.880-2.681)
0.1311.270
(0.804-2.005)
0.3051.598
(0.505-5.060)
0.4261.270
(0.780-2.218)
0.305
≥712.087
(1.112-3.918)
0.022*1.922
(1.136-3.252)
0.015*3.452
(1.052-11.332)
0.041*1.922
(1.136-3.252)
0.015*
Table 5  Adjusted odds ratio of T2DM patients with DPN stratified by four age groups (≤50, 51-60, 61-70, ≥71) by using different diagnostic methods.
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