Endocrine Abstracts

Background and aims: The distribution of arterial occlusive disease is not fully explained in diabetes. The aim of this study was to examine the prevalence of CHD and PAD in diabetic patients complicated by abnormal test of distal autonomic function (Neuropad®) and large fibre neuropathy.

Materials and Methods: 237 patients were analysed, M/F 111/126, age (mean±SD) 61.3±9.5years (ys), diabetes duration 16.4±10.6ys., type 1 n=22 (9.3%), HbA1c 9±1.98%, 66.5% on insulin therapy, BMI 25.5±4.8 kg/m2, W 97±12.4 cm, high BMI 28.8±5.96. Sudomotor neuropathy was determined on the sole of the foot using the Neuropad® response. 32 patients (pts) with small fibre neuropathy (DN), (group 1; G1); 42pts with small and large fibre DN (group 2; G2); 60pts with large fibre neuropathy, VPT<6, AR>3 (group 3; G3); and 103pts without DN (G4).

Results: ANOVA: age (G1 58.3±11.3, G2 64.5±7.8yrs; p 0.01), DM duration (G1 13.5±8.6, G2 20.5±9.6, G3 19.3±11.9, G4 14±9.8yrs; p<0.01), proteinuria (G1 147.2±131.8, G2 350.9±485.2, G3 615.4±1174.2, G4 446±1197 mg/dU; P<0.05), W (G1 92.1±14.8, G2 99.7±10.8, G3 99.3±10.6, G4 96.1±12.7; P 0.02;). The contingency tables (X2) were used: maculopathy (G1 15.6%, G2 46.6%, G3 40%, G4 17.5%; p<0.01), prolipherative retinopathy (G1 0%, G2 14.3%, G3 16.6, G4 2.9%; p 0.01), CHD (G1 15.6%, G2 40.5%, G3 33.3%, G4 29.1%; P 0.02), PAD (G1 14.8%, 30.95%, 26.7%, 8.3%; P 0.05), major amputation (G1 0%, G2 11.9%, G3 0%, G4 0%; P 0.04).

Conclusion: Small fibre neuropathy on feet together with large fibre neuropathy is strongly associated with both micro- and macro- vascular diabetic complications. In patients without neuropathy (G4) there is still increase in prevalence of coronary artery disease but not peripheral artery disease. It is possible that endogenous insulin may exert an adverse effect on the incidence of coronary atherosclerosis and protective on microvascular in this group of patients.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.