Prevalence of Distal Symmetrical Polyneuropathy by Diabetes Prevention Program Treatment Group, Diabetes Status, Duration of Diabetes, and Cumulative Glycemic Exposure

Authors

Christine G. Lee, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
Adam Ciarleglio, Biostatistics Center and Milken Institute School of Public Health, The George Washington University, Rockville, MD.
Sharon L. Edelstein, Biostatistics Center and Milken Institute School of Public Health, The George Washington University, Rockville, MD.
Jill P. Crandall, Division of Endocrinology and Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, NY.
Dana Dabelea, University of Colorado Anschutz Medical Campus, Aurora, CO.
Ronald B. Goldberg, University of Miami Leonard M. Miller School of Medicine, Miami, FL.
Steven E. Kahn, VA Puget Sound Health Care System and University of Washington, Seattle, WA.
William C. Knowler, Biostatistics Center and Milken Institute School of Public Health, The George Washington University, Rockville, MD.
Maxwell T. Ma, VA Puget Sound Health Care System and University of Washington, Seattle, WA.
Neil H. White, Department of Pediatrics, Washington University School of Medicine in St. Louis, St Louis, MO.
William H. Herman, University of Michigan, Ann Arbor, MI.

Document Type

Journal Article

Publication Date

3-19-2024

Journal

Diabetes care

DOI

10.2337/dc23-2009

Abstract

OBJECTIVE: To assess associations between distal symmetric polyneuropathy (DSPN) and Diabetes Prevention Program (DPP) treatment groups, diabetes status or duration, and cumulative glycemic exposure approximately 21 years after DPP randomization. RESEARCH DESIGN AND METHODS: In the DPP, 3,234 adults ≥25 years old at high risk for diabetes were randomized to an intensive lifestyle (ILS), metformin, or placebo intervention to prevent diabetes. After the DPP ended, 2,779 joined the Diabetes Prevention Program Outcomes Study (DPPOS). Open-label metformin was continued, placebo was discontinued, ILS was provided in the form of semiannual group-based classes, and all participants were offered quarterly lifestyle classes. Symptoms and signs of DSPN were assessed in 1,792 participants at DPPOS year 17. Multivariable logistic regression models were used to evaluate DSPN associations with treatment group, diabetes status/duration, and cumulative glycemic exposure. RESULTS: At 21 years after DPP randomization, 66% of subjects had diabetes. DSPN prevalence did not differ by initial DPP treatment assignment (ILS 21.5%, metformin 21.5%, and placebo 21.9%). There was a significant interaction between treatment assignment to ILS and age (P < 0.05) on DSPN. At DPPOS year 17, the odds ratio for DSPN in comparison with ILS with placebo was 17.4% (95% CI 3.0, 29.3) lower with increasing 5-year age intervals. DSPN prevalence was slightly lower for those at risk for diabetes (19.6%) versus those with diabetes (22.7%) and was associated with longer diabetes duration and time-weighted HbA1c (P values <0.001). CONCLUSIONS: The likelihood of DSPN was similar across DPP treatment groups, while higher for those with diabetes, longer diabetes duration, and higher cumulative glycemic exposure. ILS may have long-term benefits on DSPN for older adults.

APA Citation

Lee, Christine G.; Ciarleglio, Adam; Edelstein, Sharon L.; Crandall, Jill P.; Dabelea, Dana; Goldberg, Ronald B.; Kahn, Steven E.; Knowler, William C.; Ma, Maxwell T.; White, Neil H.; and Herman, William H., "Prevalence of Distal Symmetrical Polyneuropathy by Diabetes Prevention Program Treatment Group, Diabetes Status, Duration of Diabetes, and Cumulative Glycemic Exposure" (2024). GW Authored Works. Paper 4504.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4504

Department

Biostatistics and Bioinformatics