Endocrine Abstracts

Background and aims: After two decades of silence in classification system od type 2 diabetes there are some indices that the dibebtic retinopathy might be the sign for introduction of insulin therapy. The aim of this study was to examine associations between measures of diabetic foot in people with diabetes complicated by nonproliferative retinopathy (NPDR), maculopathy and proliferative retinopathy (PDR).

Materials and methods: People were included had following clinical examinations: fundoscopy, VPT(vibration perpection threshold), ankle reflexes (AR), sudomotor function using Neuropad, Continous wave Doppler and biochemical investigations. Presence of hypertension, cardiovascular disease, neuropathy symptom score (NSS) were documented. All tests were undertaken as part of routine clinical care.

Results: Of 469 people, 46.1% were male and 68.4% had T2DM. 252 had no evidence of retinopathy, 89 had NPDR 98 had maculopathy, 30 had PDR. Compared with people without retinopathy, those with retinopathy were older (58±12.5 vs 52.3±15.1 years), with lower VPT (5.1±2.8 vs 6.6±2), more often with missing AR (2.9±1.3 vs 2.0±1.6), higher prevalence of LEAD (18.4% vs 7.9%) and arterial hypertension (52.9% vs 36.5%), higher waist circumference (96.3±12.6 vs 91±13.6 cm) and longer diabetes duration (18.2±8.7 vs 12.2±8.6years); all P<0.01. After multivariable logistic regression analysis (MVLR), the differences in VPT, AR and diabetes duration all persisted (P<0.01). People with PDR compared with controls had worse VPT (3.8±3.3 vs 6.6±2; P<0.001). In a univariate model PDR was related to creatinine (OR 1.014 (95% CI: 1.005–1.023)), triglycerides (1.022 (1.02–1.46)), duration of insulin therapy (1.057 (1.015–1.101)); all P<0.01. After MVLR the differences remained significant (P<0.01) for creatinine and duration on insulin therapy. People with maculopathy had worse sudomotor neuropathy (10±7.3 vs 7±5.7min; P<0.001). In a univariate model maculopathy was related to NSS (OR 2.19 (1.35–3.04)), Neuropad time (1.07 (1.033–1.109)); T2DM (77.6 vs 62.3%), HbA1c 1.083 (1.058–1.108)); all P<0.01, and to fasting cholesterol (1.035 (1.05–1.71); P=0.02). After MVLG the significance remained: for NSS, Neuropad time, HbA1c (all P<0.05). Both PDR and maculopathy in univariate analyses was related to proteinuria (OR 1.000 (1.0–1.001)) and after MVLR with creatinine clearance (0.976 (0.98–0.99)) and highest life BMI (1.067 (1.029–1.106)); all P=0.000.

Conclusion: Our data showed associations between the presence of different clinical measures and peripheral neuropathy with both retinopathy and kidney disease. Diabetic neuropathy reinforce the need to strive to optimise metabolic control, including introduction of insulin therapy, on time.