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American Journal of Epidemiology Vol. 150, No. 11: 1142-1151
Copyright © 1999 by The Johns Hopkins University School of Hygiene and Public Health
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Risk Factors for Progression of Distal Symmetric Polyneuropathy in Type 1 Diabetes Mellitus
1Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School Boston, MA
2Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School Boston, MA
3Department of Epidemiology, Harvard School of Public Health Boston, MA
4Department of Biostatistics, Harvard School of Public Health Boston, MA
5A complete listing of the Sorbinil Retinopathy Trial Research Group is available in Arch Ophthalmol 1990; 108:1234–44.
Reprint requests to Dr. William G. Christen, 900 Commonwealth Ave East, Boston, MA 02215–1204.
In a prospective cohort study, the authors examined risk factors for progression of distal symmetric polyneuropathy (DSP) in type 1 (insulin-dependent) diabetes mellitus. The study population consisted of participants in the Sorbinil Retinopathy Trial, a randomized trial of aldose reductase inhibition among patients aged 18-56 years with type 1 diabetes mellitus of 1-15 years' duration. Diagnosis of DSP was based on standardized clinical neurologic evaluation. A total of 407 participants who did not have definite DSP at randomization and had at least one follow-up visit were included in the analysis. Stepwise Cox proportional hazards models were used to examine the independent contribution of baseline variables to progression of DSP. During follow-up (median, 40 months), 68 participants (17%) showed progression to definite DSP. After adjustment for age and treatment assignment, independent predictors of progression to definite DSP were total glycosylated hemoglobin (relative risk (RR) for increase of one percentage point= 1.25; 95% confidence interval (Cl) 1.12,1.39), height (RR associated with being one inch (2.54 cm) taller= 1.15; 95% Cl 1.05,1.26), cigarette smoking (ever vs. never) (RR= 1.87; 95% Cl 1.09, 3.21), and female gender (RR= 2.26; 95% Cl 1.09, 4.67). These data indicate that, in addition to the previously established role for total glycosylated hemoglobin, other factors including height, cigarette smoking, and female gender may also be independent risk factors for progression of DSP in type 1 diabetes mellitus. Am JEp/ctem/o/1999;150:1142-51.
diabetes mellitus; insulin-dependent; distal symmetric polyneuropathy; prospective studies; risk factors
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