Abstract
Background Diabetes is associated with systemic complications. Prevalence
of diabetic nephropathy, and retinopathy, in type 1 diabetes mellitus (T1DM) is
declining, but it is not known if this is true also for diabetic neuropathy.
Aim: To investigate the relationship between large fibre diabetic neuropathy and
other diabetic complications.
Materials and methods Neuropathy, defined here as large fibre neuropathy,
was assessed by measuring vibration perception thresholds at four different
frequencies on the sole of the foot, using a standard VibroSense Meter
and/or neuropathic symptoms, in 599 individuals with T1DM. Retinopathy
status was graded using the International Clinical Disease Severity Scale. Grade
of albuminuria and previous history of any macrovascular complications were
registered.
Results Diabetic individuals without retinopathy had similar vibration
thresholds as age- and gender-matched control participants without diabetes,
whereas those without microalbuminuria had higher thresholds than controls. Two
individuals out of 599 (0.3%) had microalbuminuria, but not retinopathy
or neuropathy, and 12/134 (9%) without retinopathy had signs of
neuropathy. Totally 119/536 (22%) of the patients without
microalbuminuria had neuropathy. Vibration thresholds increased with the rising
severity of retinopathy and grade of albuminuria. In a multinomial logistic
regression analysis, neuropathy was associated with retinopathy (OR 2.96
[1.35–6.49], p=0.007), nephropathy (OR 6.25
[3.21–12.15]; p=6.7×10–8) and macrovascular
disease (OR 2.72 [1.50–4.93], p=0.001).
Conclusions Despite recent changes in the incidence of diabetic
complications, the onset of large fibre neuropathy follows that of retinopathy
but precedes the onset of nephropathy in T1DM.
Key Words
Type 1 diabetes - diabetic complications - multifrequency vibrometry - diabetic neuropathy - diabetic retinopathy - diabetic nephropathy
