Risk Factors For Diabetic Polyneuropathy

Yıl 2020, Cilt: 12 Sayı: 3, 486 - 491, 20.10.2020

Esra Aciman Demirel , Burcu Karpuz , Ulufer Çelebi , Mustafa Açıkgöz , Hüsyin Tuğrul Atasoy

https://doi.org/10.18521/ktd.744679

Öz

Objective: Diabetes Mellitus is one of the most common metabolic diseases. The most frequent complication of DM is diabetic polyneuropathy.Diabetic polyneuropathy is related to high mortality, morbidity, hospitalization rate and serious level of economic burden. We aimed in this study to determine the risk factors that affect DPN pathology.

Method: Patients with abnormalities in the nerve conduction study constituted the polyneuropathy group, and patients without abnormalities formed the control group When the laboratuary values of the patients were analyzed, blood tests of 168 of 202 patients were reached. 117 of these patients had PNP and 51 did not have PNP.

Results:
In patients with PNP, glycolyzed hba1c ratio and fasting blood sugar were significantly higher than patients without PNP. (p <.001)
While HDL rate was lower in patients with PNP than those without PNP (p <0.01), TG / HDL ratio was higher (p <0.05). In patients with PNP, glycolyzed urea (p <0.001) and creatinine (p <0.01) were significantly higher than those without PNP. The serum level of 25 (OH) vitamin D was significantly lower in patients with PNP than in patients without PNP (p <0.05). Ferritin was significantly higher in patients with PNP than patients without (P <0 .01).

Conclusion: Knowing and preventing risk factors for diabetic polyneuropathy, we can take a new direction to our treatment approaches and take early measures. Fasting blood sugar and hba1c control, regulation of lipid profile, monitoring of vitamin d and ferritin levels are particularly necessary for protection of polyneuropathy.

Anahtar Kelimeler

diabetic polyneuropathy, hba1c, ferritin

Diyabetik Polinöropati Risk Faktörleri

Öz

Amaç: Diyabet Mellitus(DM) en yaygın metabolik hastalıklardan biridir. DM' nin en sık görülen komplikasyonu diyabetik polinöropatidir. Diyabetik polinöropati (DPN) yüksek mortalite, morbidite, hastaneye yatış oranı ve ciddi ekonomik yük ile ilişkilidir. Biz çalışmada DPN patolojisini etkileyen risk faktörlerini belirlemeyi amaçladık.

Yöntem: Sinir iletim çalışmasında anormalliği olan hastalar polinöropati grubunu, anormalliği olmayan hastalar kontrol grubunu oluşturdu. Hastaların laboratuvar değerleri incelendiğinde 202 hastanın 168'inin kan testlerine ulaşıldı. Bu hastaların 117'sinde DPNvarken, 51'inde DPN yoktu.

Bulgular: DPN olan hastalarda glikolize hemoglobin A1c (HbA1c)oranı, açlık kan şekeri DPN olmayan hastalara göre anlamlı olarak yüksek bulundu (p <0,001). DPN’si olan hastalarda HDL oranı DPN’si olamayan hastalara göre düşük saptanırken (p < 0,01), TG/HDL-K oranı daha yüksek saptandı (p < 0,05). DPN olan hastalarda glikolize üre (p < 0,001) ve kreatinin (p < 0,01), DPN olmayan hastalara göre anlamlı olarak yüksek saptandı. DPN olan hastalarda 25(OH) vitamin D düzeyi DPN olmayan hastalara göre anlamlı olarak düşüktü (p < 0,05). DPN olan hastalarda ferritin, olmayan hastalara göre anlamlı olarak daha yüksek saptandı (p <0 ,01).

Sonuç: Diyabetik polinöropati açısından risk faktörlerinin bilinmesi ve önlenmesi ile tedavi yaklaşımlarımıza yeni bir yön vererek erken önlemler alabiriz. Açlık kan şekeri, HbA1ckontrolü, lipid profilinin düzenlenmesi, 25(OH) vitamin D düzeyive ferritin düzeylerinin takibi özellikle korunma açısından önemlidir.

Anahtar Kelimeler

Diyabetik polinöropati, HbA1C, Ferritin

Kaynakça

• References 1-Fitri A, Sjahrir H, Bachtiar A, Ichwan M, Fitri FI, Rambe AS. Predictive Model of Diabetic Polyneuropathy Severity Based on Vitamin D Level. Open access Macedonian journal of medical sciences 2019 ;7(16): 2626. 2- Vinik AI, Nevoret ML, Casellini C, Parson H. Diabetic neuropathy. Endocrinology and Metabolism Clinics 2013; 42(4):747-87. 3- Stino AM, Smith AG. Peripheral neuropathy in prediabetes and the metabolic syndrome. Journal of diabetes investigation 2017; 8(5):646-55. 4- Soheilykhah S, Rashidi M, Dehghan F, Shojaoddiny-Ardekani A, Rahimi-saghand S. Prevalence of peripheral neuropathy in diabetic patients. Iranian Journal of Diabetes and Obesity 2013; 5(3):107-13. 5- Kakrani AL, Gokhale VS, Vohra KV, Chaudhary N. Clinical and nerve conduction study correlation in patients of diabetic neuropathy. J Assoc Physicians India 2014 ;62(1):24-7. 6- Miric DJ, Kisic BM, Filipovic-Danic S, Grbic R, Dragojevic I, Miric MB,Puhalo-Sladoje D. Xanthine oxidase activity in type 2 diabetes mellitus patients with and without diabetic peripheral neuropathy. Journal of diabetes research 2016. Article ID 4370490, 7 pages. 7-Vukojević Z, Pekmezović T, Nikolić A, Perić S, Basta I, Marjanović I, Lavrnić D. Correlation of clinical and neurophysiological findings with healthrelated quality of life in patients with diabetic polyneuropathy. Vojnosanitetski pregled 2014; 71(9), 833-838. 8- Pençe HH, Aktaş HŞ. Diyabetik Nöropatisi Olan Kişilerde Monosit/HDL Kolesterol Oranı ile Kardiyovasküler Risk Arasındaki İlişki. Online Türk Sağlık Bilimleri Dergisi 2019; 4(4): 526-538. 9-Yıldırım A, Avcı HK, Güngen BD, Yağız O, Saçak Ş, Polat H. Tip 2 Diyabetes Mellitus Tanılı Hastalarda HbA1c Seviyesi ile Distal Simetrik Polinöropati Şiddeti Arasındaki İlişki. Istanbul Medical Journal 2014; 15(3): 175-177. 10-Kaplan Y, Kurt S, Ünaldı HK, Erkorkmaz Ü. Risk factors for diabetic polyneuropathy. NöroPsikiyatri Arşivi 2014; 51(1) :11-14. 11- Abougalambou SS, Abougalambou AS. Explorative study on diabetes neuropathy among type II diabetic patients in Universiti Sains Malaysia Hospital. Diabetes Metab Syndr 2012; 6: 167-72. 12-Ivan T, Vera B. Glycemic control is related to the electrophysiolgy severity of diabetic peripheral sensorimotor polyneuropathy. Diabetes care 1998; 21: 1749-52. 13-Joy KNI, Hasan AH, Islam MR, Kalam F, Kabir ML, Habib M, Mohammad QD. Glycemic Control and Clinico-Electrophysiological Severity of Diabetic Polyneuropathy. Journal of National Institute of Neurosciences Bangladesh 2019; 5(2): 177-184. 14- Abdelsadek SE, El Saghier EO, Raheem SIA. Serum 25 (OH) vitamin D level and its relation to diabetic peripheral neuropathy in Egyptian patients with type 2 diabetes mellitus. The Egyptian journal of neurology, psychiatry and neurosurgery 2018; 54(1): 36. 15- Atmaca M, Dilek İ, Atmaca B, Dülger AC, Taşdemir E. Yeni Tanı Tip 2 Diabetes Mellituslu Hastalarda Mikrovasküler Komplikasyonların Görülme Sıklığı. Van Tıp Dergisi 2010; 17(4):124-130. 16- Katulanda P, Ranasinghe R, Jayawardena R, Constantine GR, Sheriff MHR and Matthews DR. The prevalence, patterns and predictors of diabetic peripheral neuropathy in a developing country. Diabetology Metabolic Syndrome 2012;4(21):78-86. 17- . Ziegler D, Rathmann W, Dickhaus T, Meisinger C, Mielck A; KORA Study Group. Prevalence of polyneuropathy in pre-diabetes and diabetes is associated with abdominal obesity and macroangiopathy: the MONICA/KORA Augsburg Surveys S2 and S3. Diabetes Care 2008; 31: 464-469. 18- Mao F, Zhu X, Liu S, Qiao X, Zheng H, Lu B, Li, Y. Age as an Independent Risk Factor for Diabetic Peripheral Neuropathy in Chinese Patients with Type 2 Diabetes. Aging and disease 2019; 10(3): 592-600. 19- Tamer A, Yıldız S, Yıldız N, Kanat M, Gunduz H, Tahtacı M, Celebi H. The prevalence of neuropathy and relationship with risk factors in diabetic patients: a single-center experience. Med Princ Pract. 2006; 15:190-194. 20- Booya F, Bandarian, Larijani B, Pajouhi M, Nooraei M, Lotfi J. Potential risk factors for diabetic neuropathy: a case control study. BMC Neurology 2005; 5:24:1-5. 21- Barbosa AP, Medina JL, Ramos EP, Barros HP, The DPN in Porto Study Group. Prevalence and risk factors of clinical diabetic polyneuropathy in a Portuguese primary health care population. Diabetes Metab 2001; 27:496-502. 22- Perkins BA, Greene DA, Bril V. Glycemic control is related to the morphological severity of diabetic sensorimotor polyneuropathy. Diabetes Care 2001; 24:748-752. 23- Hicks CW, Selvin E. Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Current diabetes reports 2019; 19(10), 86. 24- Sajic, M. Mitochondrial dynamics in peripheral neuropathies. Antioxidants & redox signaling 2014;21(4): 601-620. 25- Babic N, Valjevac A, Zaciragic A, Avdagic N, Zukic S, Hasic S. The Triglyceride/HDL Ratio and Triglyceride Glucose Index as Predictors of Glycemic Control in Patients with Diabetes Mellitus Type 2. Medical Archives 2019; 73(3): 163-168. 26- Söğüt E, Avcı E, Üstüner F, Arıkan E. Serum aterojenite indeksi olarak (TG/HDL-K) oranının değerlendirilmesi. Türk Klinik Biyokimya Derg. 2006; 4: 1-8. 27- Li Z, Huang Q, Sun L, Bao T, Dai Z. Atherogenic index in type 2 diabetes and its relationship with chronic microvascular complications. International journal of endocrinology 2018; Article ID 1765835, 9 pages. 28- Bajaj S, Singh RP, Dwivedi NC, Singh K, Gupta A, Mathur M. Vitamin D levels and microvascular complications in type 2 diabetes. Indian J EndocrinolMetab. 2014;18(4):537–41. 29-Alam U. Vitamin D and diabetic neuropathy. University of Manchester, Doctor of Philosophy in Medicine 2013 ; 65-67. 30- Riaz S, Malcangio M, Miller M, Tomlinson DR. A vitamin D (3) derivative (CB1093) induces nerve growth factor and prevents neurotrophic deficits in streptozotocin-diabetic rats. Diabetologia. 1999;42(11):1308–13. 31- Suárez-Ortegón MF, Ensaldo-Carrasco E, Shi T, McLachlan S, Fernández-Real JM, Wild SH. Ferritin, metabolic syndrome and its components: a systematic review and metaanalysis. Atherosclerosis 2018;275: 97-106. 32- Hershenfeld S, Ye C, Hanley AJ, Connelly PW, Zinman B, Retnakaran R. Serum Ferritin and Glucose Homeostasis in Women With Recent Gestational Diabetes. Canadian journal of diabetes 2019; 43(8), 567-572. 33- El-Tagui MH, Salama KM, El-Sabbagh MH, Youness ER, Ragaey M, Abdel-Salam A. Polyneuropathy Associated with Severe Iron Overload and Oxidative Stress in β-Thalassemia Patients. Indian Journal of Hematology and Blood Transfusion 2019 ; 35(3): 518-522. 34- Bayhan T, Ünal Ş, Konuşkan B, Erdem O, Karabulut E, Gümrük F. Assessment of Peripheral Neuropathy in Patients with β-Thalassemia via Electrophysiological Study: Reevaluation in the Era of Iron Chelators. Hemoglobin 2018 ; 42(2) : 113-116.