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Prevalence and Determinants of Painful and Painless Neuropathy in Type 1 Diabetes Mellitus

Aims: To evaluate (1) the prevalence of diabetic distal symmetrical sensory–motor polyneuropathy (DSPN) and painful DSPN among patients with type 1 diabetes mellitus (DM1) aged over 18 years and (2) the determinant factors of neuropathy and pain in those patients. Materials and Methods: An epidemiol...

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Autores principales: Barbosa, Margarida, Saavedra, Ana, Oliveira, Sofia, Reis, Ligia, Rodrigues, Filipa, Severo, Milton, Sittl, Reinhard, Maier, Christoph, Carvalho, Davide M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610998/
https://www.ncbi.nlm.nih.gov/pubmed/31316463
http://dx.doi.org/10.3389/fendo.2019.00402
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author Barbosa, Margarida
Saavedra, Ana
Oliveira, Sofia
Reis, Ligia
Rodrigues, Filipa
Severo, Milton
Sittl, Reinhard
Maier, Christoph
Carvalho, Davide M.
author_facet Barbosa, Margarida
Saavedra, Ana
Oliveira, Sofia
Reis, Ligia
Rodrigues, Filipa
Severo, Milton
Sittl, Reinhard
Maier, Christoph
Carvalho, Davide M.
author_sort Barbosa, Margarida
collection PubMed
description Aims: To evaluate (1) the prevalence of diabetic distal symmetrical sensory–motor polyneuropathy (DSPN) and painful DSPN among patients with type 1 diabetes mellitus (DM1) aged over 18 years and (2) the determinant factors of neuropathy and pain in those patients. Materials and Methods: An epidemiological, cross-sectional, observational study was performed; 330,386 people were included, and a total of 444 people were diagnosed with DM1. After exclusion of possible confounders, 360 patients were assessed for painless and painful DSPNs using neurological examination and questionnaires for neuropathy and pain. Odds ratio (OR) and confidence intervals (95% CI) were estimated using multinomial logistic regression models. The analysis was based on a framework with four conceptual levels that consider feasible pathways between several risk factors: (1) socio-demographic factors and diabetes duration, (2) patient habits, (3) co-morbidities, and (4) metabolic factors and disease complications. Results: The prevalence of DSPN and painful DSPN were 42.8 and 18.9%, respectively. Diabetes duration was positively associated with painful (OR = 1.107, 95% CI: 1.107–1.139) and painless DSPN (OR = 1.069, 95% CI: 1.043–1.096). Education level was negatively associated with painful DSPN (OR = 0.889, 95% CI: 0.826–0.957). Sex (female) was positively associated only with painless DSPN (OR = 1.769, 95% CI: 1.007–3.107). Being a current or former smoker was positively associated only with painless DSPN (OR = 1.940, 95% CI: 1.069–3.518). Hypertension was positively associated with painful DSPN (OR = 2.474, 95% CI: 1.110–5.512) and painless DSPN (OR = 2.565, 95% CI: 1.252–5.256). Glycated hemoglobin (HbA1c) was positively associated only with painless DSPN (OR = 1.193, 95% CI: 1.018–1.399). Conclusions: Diabetes duration and hypertension have a direct impact on the development of painful and painless DSPN. However, female sex and HbA1c have a direct effect only on the development of painless DSPN, and education level has an indirect effect on the development of painful DSPN. Therefore, it can be concluded that different etiological factors have different contributions to the development of neuropathy and pain.
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spelling pubmed-66109982019-07-17 Prevalence and Determinants of Painful and Painless Neuropathy in Type 1 Diabetes Mellitus Barbosa, Margarida Saavedra, Ana Oliveira, Sofia Reis, Ligia Rodrigues, Filipa Severo, Milton Sittl, Reinhard Maier, Christoph Carvalho, Davide M. Front Endocrinol (Lausanne) Endocrinology Aims: To evaluate (1) the prevalence of diabetic distal symmetrical sensory–motor polyneuropathy (DSPN) and painful DSPN among patients with type 1 diabetes mellitus (DM1) aged over 18 years and (2) the determinant factors of neuropathy and pain in those patients. Materials and Methods: An epidemiological, cross-sectional, observational study was performed; 330,386 people were included, and a total of 444 people were diagnosed with DM1. After exclusion of possible confounders, 360 patients were assessed for painless and painful DSPNs using neurological examination and questionnaires for neuropathy and pain. Odds ratio (OR) and confidence intervals (95% CI) were estimated using multinomial logistic regression models. The analysis was based on a framework with four conceptual levels that consider feasible pathways between several risk factors: (1) socio-demographic factors and diabetes duration, (2) patient habits, (3) co-morbidities, and (4) metabolic factors and disease complications. Results: The prevalence of DSPN and painful DSPN were 42.8 and 18.9%, respectively. Diabetes duration was positively associated with painful (OR = 1.107, 95% CI: 1.107–1.139) and painless DSPN (OR = 1.069, 95% CI: 1.043–1.096). Education level was negatively associated with painful DSPN (OR = 0.889, 95% CI: 0.826–0.957). Sex (female) was positively associated only with painless DSPN (OR = 1.769, 95% CI: 1.007–3.107). Being a current or former smoker was positively associated only with painless DSPN (OR = 1.940, 95% CI: 1.069–3.518). Hypertension was positively associated with painful DSPN (OR = 2.474, 95% CI: 1.110–5.512) and painless DSPN (OR = 2.565, 95% CI: 1.252–5.256). Glycated hemoglobin (HbA1c) was positively associated only with painless DSPN (OR = 1.193, 95% CI: 1.018–1.399). Conclusions: Diabetes duration and hypertension have a direct impact on the development of painful and painless DSPN. However, female sex and HbA1c have a direct effect only on the development of painless DSPN, and education level has an indirect effect on the development of painful DSPN. Therefore, it can be concluded that different etiological factors have different contributions to the development of neuropathy and pain. Frontiers Media S.A. 2019-06-28 /pmc/articles/PMC6610998/ /pubmed/31316463 http://dx.doi.org/10.3389/fendo.2019.00402 Text en Copyright © 2019 Barbosa, Saavedra, Oliveira, Reis, Rodrigues, Severo, Sittl, Maier and Carvalho. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Barbosa, Margarida
Saavedra, Ana
Oliveira, Sofia
Reis, Ligia
Rodrigues, Filipa
Severo, Milton
Sittl, Reinhard
Maier, Christoph
Carvalho, Davide M.
Prevalence and Determinants of Painful and Painless Neuropathy in Type 1 Diabetes Mellitus
title Prevalence and Determinants of Painful and Painless Neuropathy in Type 1 Diabetes Mellitus
title_full Prevalence and Determinants of Painful and Painless Neuropathy in Type 1 Diabetes Mellitus
title_fullStr Prevalence and Determinants of Painful and Painless Neuropathy in Type 1 Diabetes Mellitus
title_full_unstemmed Prevalence and Determinants of Painful and Painless Neuropathy in Type 1 Diabetes Mellitus
title_short Prevalence and Determinants of Painful and Painless Neuropathy in Type 1 Diabetes Mellitus
title_sort prevalence and determinants of painful and painless neuropathy in type 1 diabetes mellitus
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610998/
https://www.ncbi.nlm.nih.gov/pubmed/31316463
http://dx.doi.org/10.3389/fendo.2019.00402
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