The Prevalence of Polyneuropathy in Type 2 Diabetes Subgroups Based on HOMA2 Indices of β-Cell Function and Insulin Sensitivity
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The Prevalence of Polyneuropathy in Type 2 Diabetes Subgroups Based on HOMA2 Indices of β-Cell Function and Insulin Sensitivity. / Kristensen, Frederik Pagh Bredahl; Christensen, Diana Hedevang; Callaghan, Brian Christopher; Stidsen, Jacob Volmer; Nielsen, Jens Steen; Højlund, Kurt; Beck-Nielsen, Henning; Jensen, Troels Staehelin; Andersen, Henning; Vestergaard, Peter; Jessen, Niels; Olsen, Michael Hecht; Hansen, Torben; Brøns, Charlotte; Vaag, Allan; Sørensen, Henrik Toft; Thomsen, Reimar Wernich.
In: Diabetes Care, Vol. 46, No. 8, 2023, p. 1546-1555.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - The Prevalence of Polyneuropathy in Type 2 Diabetes Subgroups Based on HOMA2 Indices of β-Cell Function and Insulin Sensitivity
AU - Kristensen, Frederik Pagh Bredahl
AU - Christensen, Diana Hedevang
AU - Callaghan, Brian Christopher
AU - Stidsen, Jacob Volmer
AU - Nielsen, Jens Steen
AU - Højlund, Kurt
AU - Beck-Nielsen, Henning
AU - Jensen, Troels Staehelin
AU - Andersen, Henning
AU - Vestergaard, Peter
AU - Jessen, Niels
AU - Olsen, Michael Hecht
AU - Hansen, Torben
AU - Brøns, Charlotte
AU - Vaag, Allan
AU - Sørensen, Henrik Toft
AU - Thomsen, Reimar Wernich
N1 - Publisher Copyright: © 2023 by the American Diabetes Association.
PY - 2023
Y1 - 2023
N2 - OBJECTIVE Metabolic syndrome components may cumulatively increase the risk of diabetic polyneuropathy (DPN) in type 2 diabetes mellitus (T2DM) patients, driven by insulin resistance and hyperinsulinemia. We investigated the prevalence of DPN in three T2DM subgroups based on indices of b-cell function and insulin sensitivity. RESEARCH DESIGN AND METHODS We estimated b-cell function (HOMA2-B) and insulin sensitivity (HOMA2-S) in 4,388 Danish patients with newly diagnosed T2DM. Patients were categorized into subgroups of hyperinsulinemic (high HOMA2-B, low HOMA2-S), classical (low HOMA2-B, low HOMA2-S), and insulinopenic (low HOMA2-B, high HOMA2-S) T2DM. After a median follow-up of 3 years, patients filled the Michigan Neuropathy Screening Instrument questionnaire (MNSIq) to identify DPN (score ‡ 4). We used Poisson regression to calculate adjusted prevalence ratios (PRs) for DPN, and spline models to examine the association with HOMA2-B and HOMA2-S. RESULTS A total of 3,397 (77%) patients filled in the MNSIq. The prevalence of DPN was 23% among hyperinsulinemic, 16% among classical, and 14% among insulinopenic pa-tients. After adjusting for demographics, diabetes duration and therapy, lifestyle behaviors, and metabolic syndrome components (waist circumference, triglycer-ides, HDL cholesterol, hypertension, and HbA1c), the PR of DPN was 1.35 (95% CI 1.15–1.57) for the hyperinsulinemic compared with the classical patients. In spline analyses, we observed a linear relation of higher DPN prevalence with increasing HOMA2-B, independent of both metabolic syndrome components and HOMA2-S. CONCLUSIONS Hyperinsulinemia marked by high HOMA2-B is likely an important risk factor for DPN beyond metabolic syndrome components and insulin resistance. This should be considered when developing interventions to prevent DPN.
AB - OBJECTIVE Metabolic syndrome components may cumulatively increase the risk of diabetic polyneuropathy (DPN) in type 2 diabetes mellitus (T2DM) patients, driven by insulin resistance and hyperinsulinemia. We investigated the prevalence of DPN in three T2DM subgroups based on indices of b-cell function and insulin sensitivity. RESEARCH DESIGN AND METHODS We estimated b-cell function (HOMA2-B) and insulin sensitivity (HOMA2-S) in 4,388 Danish patients with newly diagnosed T2DM. Patients were categorized into subgroups of hyperinsulinemic (high HOMA2-B, low HOMA2-S), classical (low HOMA2-B, low HOMA2-S), and insulinopenic (low HOMA2-B, high HOMA2-S) T2DM. After a median follow-up of 3 years, patients filled the Michigan Neuropathy Screening Instrument questionnaire (MNSIq) to identify DPN (score ‡ 4). We used Poisson regression to calculate adjusted prevalence ratios (PRs) for DPN, and spline models to examine the association with HOMA2-B and HOMA2-S. RESULTS A total of 3,397 (77%) patients filled in the MNSIq. The prevalence of DPN was 23% among hyperinsulinemic, 16% among classical, and 14% among insulinopenic pa-tients. After adjusting for demographics, diabetes duration and therapy, lifestyle behaviors, and metabolic syndrome components (waist circumference, triglycer-ides, HDL cholesterol, hypertension, and HbA1c), the PR of DPN was 1.35 (95% CI 1.15–1.57) for the hyperinsulinemic compared with the classical patients. In spline analyses, we observed a linear relation of higher DPN prevalence with increasing HOMA2-B, independent of both metabolic syndrome components and HOMA2-S. CONCLUSIONS Hyperinsulinemia marked by high HOMA2-B is likely an important risk factor for DPN beyond metabolic syndrome components and insulin resistance. This should be considered when developing interventions to prevent DPN.
U2 - 10.2337/dc23-0079
DO - 10.2337/dc23-0079
M3 - Journal article
C2 - 37335990
AN - SCOPUS:85165521717
VL - 46
SP - 1546
EP - 1555
JO - Diabetes Care
JF - Diabetes Care
SN - 1935-5548
IS - 8
ER -
ID: 361392719