The Contemporary Prevalence of Diabetic Neuropathy in Type 1 Diabetes: Findings From the T1D Exchange
Authors: Mizokami-Stout Kara R. , Li Zoey , Foster Nicole C. , Shah Viral , Aleppo Grazia , McGill Janet B. , Pratley Richard , Toschi Elena , Ang Lynn , Pop-Busui Rodica ,   T1D Exchange Clinic Network, Weinstock Ruth , Izquierdo Roberto , Sheikh Umair , Conboy Patricia , Bulger Jane , Bzdick Suzan , Klingensmith Georgeanna , Banion Carolyn , Barker Jennifer , Cain Cindy , Nadeau Kristen , Rewers Marian , Rewers Arleta , Slover Robert , Steck Andrea , Wadwa Paul , Zeitler Philip , Alonso Guy , Forlenza Greg , Gerard-Gonzalez Andrea , Green Melanie , Gross Susan , Majidi Shideh , Messer Laurel , Reznick-Lipina Tyler , Simmons Emily , Thivener Katie , Weber Isabel , Willi Steven , Lipman Terri , Kucheruk Olena , Minnock Pantea , Carchidi Cathy , Grant Brian , Olivos Diana , DiMeglio Linda , Hannon Tamara , Evans-Molina Carmella , Hansen David , Pottorff Tina , Woerner Stephanie , Hildinger Megan , Hufferd Robin , Newnum America , Purtlebaugh Devyn , Smith Lisa , Wendholt Kathleen , Goland Robin , Gandica Rachelle , Williams Kristen , Pollack Sarah , Casciano Emily , Hochberg Julia , Uche Cecilia , Lee Joyce , Gregg Brigid , Tan Meng , Ang Lynn , Pop-Busui Rodica , Thomas Inas , Dhadphale Emily , Dominowski Janet , Garrity Ashley , Leone Virginia , Plunkett Cynthia , Plunkett Brittany , Monzavi Roshanak , Cheung Clement , Fisher Lynda , Kim Mimi , Miyazaki Brian , Pitukcheewanont Pisit , Sandstrom Anna , Austin Juliana , Change Nancy , Raymond Jennifer , Ichihara Brian , Lipton Megan , Flores Garcia Jaquelin , Garg Satish , Michels Aaron , Garcetti Rachel , Gutin Raymond , Polsky Sarit , Shah Viral , Voelmle Mary , Myers Lisa , Coe Gregory , Demmitt Jamie , Garcia Reyes Yesenia , Giordano Dominique , Joshee Prakriti , Nease Emily , Nguyen Nhung , Wolfsdorf Joseph , Quinn Maryanne , Fontanet Constance , Mukherjee Susmita , Bethin Kathleen , Quattrin Teresa , Majumdar Indrajit , Mastrandrea Lucy , Gorman Emily , House Amanda , Michalovic Sharon , Musial Wanda , Shine Barbara , Ahmann Andrew , Castle Jessica , Joarder Farahnaz , Aby-Daniel Diana , Guttmann-Bauman Ines , Klopfenstein Bethany , Morimoto Victoria , Cady Nancy , Fitch Rebecca , DeFrang Donald , Jahnke Kristin , Patoine Claire , Raman Vandana , Foster Carol , Murray Mary , Brown Trina , Davis Cassandra , Slater Hillarie , Langvardt Jennifer , Bode Bruce , Boyd Jennifer , Johnson Joseph , Newton Christopher , Ownby Jonathan , Hosey RaShonda , Rastogi Nitin , Winslett Blake , Hirsch Irl , DeSantis Anthony , Failor R. Alan , Greenbaum Carla , Trence Dace , Trikudanathan Subbulaxmi , Khakpour Dori , Thomson Pam , Sameshima Lori , Tordillos Corinna , Clements Mark , Turpin Angela , Babar Ghufran , Broussard Julia , Cernich Joe , Dileepan Kavitha , Feldt Max , Moore Wayne , Musick Tiffany , Patton Susana , Yan Yun , Tsai Sarah , Bedard Jennifer , Elrod Aliza , Hester Lois , Beidelschies Marissa , de la Garza Julie , Haith Emily , James Jennifer , Ramey Elizabeth , Slover Jessica , Valentine Armenthia , Watkins Darta , Whisenhunt Misty , Wierson Jami , Wilson Darrell , Buckingham Bruce , Maahs David , Prahalad Priya , Hsu Liana , Kingman Ryan , Tabatabai Ideen , Liljenquist David , Sulik Mark , Vance Carl , Halford Jean , Funke Christine , Appiagyei-Dankah Yaw , Beltz Emily , Moran Karen , Starkman Harold , Cerame Barbara , Chin Daisy , Ebner-Lyon Laurie , Sabanosh Kristen , Silverman Lawrence , Wagner Christine , Cheruvu Sunita , Fox Marie , Melchionne Frances , Bergenstal Richard , Madden Marcia , Martens Thomas , Criego Amy , Powers Margaret , Carlson Anders , Beasley Shannon , Olson Beth , Thomas LeeAnn , McCann Kathleen , Dunnigan Sean , Ashanti Charlotte , Simmons Jill , Russell William , Jaser Sarah , Kelley Jennifer , Brendle Faith , Williams Lauren , Savin Kimberly , Flowers Kimberly , Williams George , Hamburger Emily , Davis Angelia , Hammel Brenna , Cengiz Eda , Tamborlane William , Weyman Kate , Van Name Michelle , Patel Neha , Sherr Jennifer , Tichy Eileen , Steffen Amy , Zgorski Melinda , Carria Lori , Finnegan Jennifer , Duran Elvira , Mehta Sanjeev , Katz Michelle , Laffel Lori , Giani Elisa , Snelgrove Rebecca , Hanono Anat , Commissariat Persis , Griffith Julie , Atkins Ashley , Harrington Kara , Kim Kenny , Masclans Luisa , Naik Nisha , Ambler-Osborn Louise , Schultz Alan , Cohen Charlotte , Anderson Brittany , McGill Janet , Granados Andrea , Clifton Mary Jane , Hurst Stacy , Kissel Sarah , Recklein Carol , Kruger Davida , Bhan Arti , Brown Terri , Tassopoulos Andreana , Hailey Angela , Remtema Heather , Cushman Terra , Wintergerst Kupper , Watson Sara , Kingery Suzanne , Rayborn Lauren , Rush Heather , Foster Michael , Deuser Amy , Rodriguez-Luna Manuel , Eubanks Stephanie , Rodriguez Henry , Bollepalli Sureka , Smith Laura , Shulman Dorothy , Jorgensen E. Verena , Eyth Emily , Brownstein Rachel , Rodriguez Janet , O’Brian Juanita , Aleppo-Kacmarek Grazia , Hahr Allison , Molitch Mark , Muayed El , Toft Daniel , Fulkerson Candice , Adelman Daphne , Massaro Elaine , Webb Kimberly , Peters Anne , Ruelas Valerie , Harmel Mark , Daniels Mark , Forghani Nikta , Flannery Timothy , Reh Christina , Bhangoo Amrit , Kashmiri Himala , Montgomery Keirsten , Trinh Lien , Speer Heather , Lane Kristen , Miller Cassie , Burt Solorzano Christine , Puskaric Jennifer , Benjamin Robert , Adkins Deanna , Spruill Amber , Williams Cathy , Tsalikian Eva , Tansey Michael , Bansl Nidhi , Cabbage Joanne , Coffey Julie , Bisbee Rachel , Schatz Desmond , Clare-Salzler Michael , Cusi Kenneth , Fudge Becky , Haller Mike , Meehan Collette , Rohrs Henry , Silverstein Janet , Walker Ashby , Albanese-O’Niell Anastasia , Foss Stephanie , Adams Janey , Cintron Miriam , Thomas Nicole , Gottschalk Michael , Newfield Ron , Hashiguchi Marla , Sparling David , Tryggested Jeanie , Beck Joni , Less Joane , Weber Linda , Adi Saleh , Gitelman Stephen , Sanda Srinath , Wong Jenise , McDonnell Mary , Mueller Monica , Izadi Zara , Mistry Swaroop , Nelson Bryce , Looper Lisa , Frost Carrie , Redondo Maria , Lyons Sarah , Klinepeter Sara , Fegan-Bohm Kelly , Bacha Fida , DeSalvo Daniel , Butler Ashley , Hilliard Marisa , Khetani Farida , Yulatic Ronald , Hudson Robert , Irvine Laura , Zubair Sadia , Pace Cory , Pitrello Abelin , Levy Wendy , Njoku Charity , Zipf William , Dyer Jennifer , Lozano Rolando , Seiple Diane , Corven Grant , Jaycox Megan , Wood Jamie , Macleish Sarah , Gubitosi-Klug Rose , Adams Ramon , McGuigan Paul , Casey Terri , Campbell Wendy , Kittelsrud Julie , Gupta Ashutosh , Peterson Vikki , Libman Ingrid , Diaz Ana , Jelley David , Crowder Christina , Greer Dana , Crawford Julia , Goudeau Sharnella , Pihoker Catherine , Yi-Frazier Joyce , Kearns Susan , Pascual Michael , Loots Beth , Beauregard Natalie , Rickels Michael , O’Brien Shannon , Agarwal Shivani , Peleckis Amy , Dalton-Bakes Cornelia , Markmann Eileen , Umpierrez Guillermo , Muir Andrew , Ramos Clementina , Behbahani Keywan , Dhruv Neil , Gartzman Nolan , Nathan Brandon , Bellin Melena , Sunni Muna , Flaherty Nancy , Leschyshyn Janice , Schmid Kara , Weingartner Darcy , Ludwig Marrissa , Nelson Brittney , Kogler Anne , Bartyzal Avery , Street Anne , Pappenfus Beth , Sweet Jessica , Buse John , Young Laura , Bergamo Katherine , Goley April , Kirkman Marian , Diner Jamie , Kass Alex , Dezube Milana , Arnold Kathleen , Evans Traci , Sellers Sharon , Blackman Scott , Abel Kimber-Lee , Rasbach Lisa , Ali Omar , Wolfgram Peter , Fiallo-Sharer Rosanna , Kramer Joanna , Beesley Christina , Bingham-Tyson Clare , Unteutsh Rachel , Harlan David , Lee Mary , Soyka Leslie , Feldman Penny , Thompson Michael , Gallagher-Dorval Karen , Hubacz Lisa , Hartigan Celia , Ciccarelli Carol , Edelen Rachel , Edelen Michelle , Borgwadt Trista , Stauffacher Kirstin , DeGrote Kelly , Gruetzmacher Crystal , Shepperd Michael , Bhargava Anuj , Wright Diana , Fitzgerald Kathleen , Khoo Teck , Young Natalie , Borg Lisa , Stifel Kirstie , Rail Cindy , Casas Luis , Eidenshink Elizabeth , Huber Christina , Rieder Alex , Tuchscherer Amy , Broadbent Megan , Dolan Lawrence , Corathers Sarah , Kichler Jessica , Sheanon Nicole , Baugh Holly , Standiford Debbie , Weis Tammy , Fox Catherine , Schultz Carrie , Ritter Amy , Vendrame Francesco , Blashke Carlos , Matheson Della , Sanders-Branca Natalia , Rudolph Justen , Biersdorf Doris , Fitch-Danielson Jane , Eckerle-Mize Dara , Fry Janet , Davis Dianne , Lovell Cynthia , Hoffman Robert , Chaudhari Monika , Kamboj Manmohan , Carr Lindsey , Blehm Julie , Tello Anthony , Walter Julie Ann , Ward Rhonda , Blomquist Gabriel , Stewart Maria , Cross Paige , Racki Sarah , Sterchi Lindsey , Gouine Diane , Kiesow Becky , Welch Stephanie , Philis-Tsimikas Athena , Daily George , Chang Amy , McCallum James , Garcia Isabel , Vela Teresa , Loupasi Ioanna , Rosal Rosario , Toschi Elena , Middelbeek Roeland , Munshi Medha , Slyne Christine , Atakov-Castillo Astrid , Fox Larry , Mauras Nelly , Wasserman Rachel , Damaso Ligeia , Englert Kim , Sikes Kaitlin , Ponthieux Kim , Phillipson Louis , Cohen Ashley , Gannon Gail , Deeb Larry , Shiver April , Schroeder Leroy , Schworm Wendi , Graham Kristina , Levy Carol , Lam David , Burtman Elizabeth , Levister Camilla , Ogyaadu Selassie , Gassner Heidi , Duke Julie , Touger Leslie , Newbern Dorothee , Hoekstra Francine , Harwood Katerina , Prasad Vijaya , Daguanno JoAnne , Pratley Richard , Corbin Karen , Wright Mia , Nagel Susann , Water Natasha , Ghere Matthew , Whitaker Keri , Heptulla Rubina , Katikaneni Ranjitha , Johnson-Newell Doreen , Crandall Jill , Powell Danielle , Anghel Valentin , Ghanny Steven , Aisenberg Javier , Chartoff Amy , Sivitz Jennifer , Mathus Susan , Cospito Toni-Lyn , Thailkill Kathryn , Fowlkes John , Kalaitzoglou Evangelia , Morales Pozzo Alba , Edwards Kathy 
Published: February 2020

OBJECTIVE
To evaluate the contemporary prevalence of diabetic peripheral neuropathy (DPN) in participants with type 1 diabetes in the T1D Exchange Clinic Registry throughout the U.S.

RESEARCH DESIGN AND METHODS
DPN was assessed with the Michigan Neuropathy Screening Instrument Questionnaire (MNSIQ) in adults with ≥5 years of type 1 diabetes duration. A score of ≥4 defined DPN. Associations of demographic, clinical, and laboratory factors with DPN were assessed.

RESULTS
Among 5,936 T1D Exchange participants (mean ± SD age 39 ± 18 years, median type 1 diabetes duration 18 years [interquartile range 11, 31], 55% female, 88% non-Hispanic white, mean glycated hemoglobin [HbA1c] 8.1 ± 1.6% [65.3 ± 17.5 mmol/mol]), DPN prevalence was 11%. Compared with those without DPN, DPN participants were older, had higher HbA1c, had longer duration of diabetes, were more likely to be female, and were less likely to have a college education and private insurance (all P &lt; 0.001). DPN participants also were more likely to have cardiovascular disease (CVD) (P &lt; 0.001), worse CVD risk factors of smoking (P = 0.008), hypertriglyceridemia (P = 0.002), higher BMI (P = 0.009), retinopathy (P = 0.004), reduced estimated glomerular filtration rate (P = 0.02), and Charcot neuroarthropathy (P = 0.002). There were no differences in insulin pump or continuous glucose monitor use, although DPN participants were more likely to have had severe hypoglycemia (P = 0.04) and/or diabetic ketoacidosis (P &lt; 0.001) in the past 3 months.

CONCLUSIONS
The prevalence of DPN in this national cohort with type 1 diabetes is lower than in prior published reports but is reflective of current clinical care practices. These data also highlight that nonglycemic risk factors, such as CVD risk factors, severe hypoglycemia, diabetic ketoacidosis, and lower socioeconomic status, may also play a role in DPN development.