Background: The mechanisms responsible for the onset of sensorimotor peripheral diabetic neuropathy (SMPN) remain largely unknown. To address this issue, we studied the relationship between traditional cardiovascular risk factors, parameters of metabolic control, and the presence of SMPN in patients with type 2 diabetes of relatively short duration. Methods: Blood pressure, glycated hemoglobin, lipid profile, and the presence of micro- and macrovascular complications were assessed and monitored in 31 consecutive ambulatory patients with type 2 diabetes (age 60.7 ± 7.5 years, mean ± SD) within 10 years of diagnosis (mean diabetes duration 6.0 ± 2.3 years). Results: Clinical and neurophysiological features of SMPN were present in 10 patients (SMPN+, 32%). There were no significant differences in age, gender distribution, diabetes duration, body mass index, metabolic control, and serum cholesterol between SMPN– and SMPN+ patients. However, the prevalence of hypertension (i.e. blood pressure ≧140/90 mm Hg) was higher in SMPN+ patients (10/10 vs. 13/21, χ2 = 5.13, p = 0.025). Regression analysis showed that, after correcting for age, gender, duration of diabetes, glycated hemoglobin, and cholesterol, the presence of hypertension was independently associated with SMPN (R2 = 0.17, p = 0.023). Conclusions: There is a strong association between hypertension and SMPN in type 2 diabetic patients with relatively short duration of disease. This relationship is independent of other risk factors.

1.
Vinik AI, Park TS, Stansberry KB, Pittenger GL: Diabetic neuropathies. Diabetologia 2000;43:957–973.
2.
Harris M, Eastman R, Cowie C: Symptoms of sensory neuropathy in adults with NIDDM in the US population. Diabetes Care 1993;16:1446–1452.
3.
Cohen JA, Jeffers BW, Faldut D, Marcoux M, Schrier RW: Risks for sensorimotor peripheral neuropathy and autonomic neuropathy in non-insulin-dependent diabetes mellitus. Muscle Nerve 1998;21:72–80.
4.
Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM, Wilson DM, O’Brien PC, Melton LJ III, Service FJ: The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology 1993;43:817–824.
5.
Martyn CN, Hughes RA: Epidemiology of peripheral neuropathy. J Neurol Neurosurg Psychiatry 1997;62:310–318.
6.
Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA: A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care 1994;17:1281–1289.
7.
European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003;21:1011–1053.
8.
Proceedings of a Consensus Development Conference on Standardized Measures in Diabetic Neuropathy: Electrodiagnostic measures. Muscle Nerve 1992;15:1150–1154.
9.
Dyck PJ: Detection, characterization, and staging of polyneuropathy: assessed in diabetics. Muscle Nerve 1988;11:21–32.
10.
Trojaborg W: The electrophysiologic profile of diabetic neuropathy. Semin Neurol 1996;16:123–128.
11.
Ewing DJ, Clarke BF: Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed) 1982;285:916–918.
12.
Valensi P, Giroux C, Seeboth-Ghalayini B, Attali JR: Diabetic peripheral neuropathy: effects of age, duration of diabetes, glycemic control, and vascular factors. J Diabetes Complications 1997;11:27–34.
13.
Sands ML, Shetterly SM, Franklin GM, Hamman RF: Incidence of distal symmetric (sensory) neuropathy in NIDDM. The San Luis Valley Diabetes Study. Diabetes Care 1997;20:322–329.
14.
Ibrahim S, Harris ND, Radatz M, Selmi F, Rajbhandari S, Brady L, Jakubowski J, Ward JD: A new minimally invasive technique to show nerve ischaemia in diabetic neuropathy. Diabetologia 1999;42:737–742.
15.
Tesfaye S, Harris N, Jakubowski JJ, Mody C, Wilson RM, Rennie IG, Ward JD: Impaired blood flow and arteriovenous shunting in human diabetic neuropathy: a novel technique of nerve photography and fluorescein angiography. Diabetologia 1993;36:1266–1274.
16.
Giannini C, Dyck PJ: Basement membrane reduplication and pericyte degeneration precede development of diabetic polyneuropathy and are associated with its severity. Ann Neurol 1995;37:498–504.
17.
Malik RA, Newrick PG, Sharma AK, Jennings A, Ah-See AK, Mayhew TM, Jakubowski J, Boulton AJ, Ward JD: Microangiopathy in human diabetic neuropathy: relationship between capillary abnormalities and the severity of neuropathy. Diabetologia 1989;32:92–102.
18.
Yasuda H, Dyck PJ: Abnormalities of endoneurial microvessels and sural nerve pathology in diabetic neuropathy. Neurology 1987;37:20–28.
19.
UKPDS 38.UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. BMJ 1998;317:703–713.
20.
Reja A, Tesfaye S, Harris ND, Ward JD: Is ACE inhibition with lisinopril helpful in diabetic neuropathy? Diabet Med 1995;12:307–309.
21.
Malik RA, Williamson S, Abbott C, Carrington AL, Iqbal J, Schady W, Boulton AJ: Effect of angiotensin-converting-enzyme inhibitor trandolapril on human diabetic neuropathy: randomised double-blind controlled trial. Lancet 1998;352:1978–1981.
22.
Hotta N, Nakamura J, Sumita Y: Effects of the 5-HT2A receptor antagonist sarpogrelate in diabetic neuropathy. A pilot study. Clin Drug Invest 1999;18:199–207.
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