The Contemporary Prevalence of Diabetic Neuropathy in Type 1 Diabetes: Findings From the T1D Exchange
Authors: Kara R. Mizokami-Stout, Zoey Li, Nicole C. Foster, Viral Shah, Grazia Aleppo, Janet B. McGill, Richard Pratley, Elena Toschi, Lynn Ang, Rodica Pop-Busui, Ruth Weinstock, Roberto Izquierdo, Umair Sheikh, Patricia Conboy, Jane Bulger, Suzan Bzdick, Georgeanna Klingensmith, Carolyn Banion, Jennifer Barker, Cindy Cain, Kristen Nadeau, Marian Rewers, Arleta Rewers, Robert Slover, Andrea Steck, Paul Wadwa, Philip Zeitler, Guy Alonso, Greg Forlenza, Andrea Gerard-Gonzalez, Melanie Green, Susan Gross, Shideh Majidi, Laurel Messer, Tyler Reznick-Lipina, Emily Simmons, Katie Thivener, Isabel Weber, Steven Willi, Terri Lipman, Olena Kucheruk, Pantea Minnock, Cathy Carchidi, Brian Grant, Diana Olivos, Linda DiMeglio, Tamara Hannon, Carmella Evans-Molina, David Hansen, Tina Pottorff, Stephanie Woerner, Megan Hildinger, Robin Hufferd, America Newnum, Devyn Purtlebaugh, Lisa Smith, Kathleen Wendholt, Robin Goland, Rachelle Gandica, Kristen Williams, Sarah Pollack, Emily Casciano, Julia Hochberg, Cecilia Uche, Joyce Lee, Brigid Gregg, Meng Tan, Lynn Ang, Rodica Pop-Busui, Inas Thomas, Emily Dhadphale, Janet Dominowski, Ashley Garrity, Virginia Leone, Cynthia Plunkett, Brittany Plunkett, Roshanak Monzavi, Clement Cheung, Lynda Fisher, Mimi Kim, Brian Miyazaki, Pisit Pitukcheewanont, Anna Sandstrom, Juliana Austin, Nancy Change, Jennifer Raymond, Brian Ichihara, Megan Lipton, Jaquelin Flores Garcia, Satish Garg, Aaron Michels, Rachel Garcetti, Raymond Gutin, Sarit Polsky, Viral Shah, Mary Voelmle, Lisa Myers, Gregory Coe, Jamie Demmitt, Yesenia Garcia Reyes, Dominique Giordano, Prakriti Joshee, Emily Nease, Nhung Nguyen, Joseph Wolfsdorf, Maryanne Quinn, Constance Fontanet, Susmita Mukherjee, Kathleen Bethin, Teresa Quattrin, Indrajit Majumdar, Lucy Mastrandrea, Emily Gorman, Amanda House, Sharon Michalovic, Wanda Musial, Barbara Shine, Andrew Ahmann, Jessica Castle, Farahnaz Joarder, Diana Aby-Daniel, Ines Guttmann-Bauman, Bethany Klopfenstein, Victoria Morimoto, Nancy Cady, Rebecca Fitch, Donald DeFrang, Kristin Jahnke, Claire Patoine, Vandana Raman, Carol Foster, Mary Murray, Trina Brown, Cassandra Davis, Hillarie Slater, Jennifer Langvardt, Bruce Bode, Jennifer Boyd, Joseph Johnson, Christopher Newton, Jonathan Ownby, RaShonda Hosey, Nitin Rastogi, Blake Winslett, Irl Hirsch, Anthony DeSantis, R. Alan Failor, Carla Greenbaum, Dace Trence, Subbulaxmi Trikudanathan, Dori Khakpour, Pam Thomson, Lori Sameshima, Corinna Tordillos, Mark Clements, Angela Turpin, Ghufran Babar, Julia Broussard, Joe Cernich, Kavitha Dileepan, Max Feldt, Wayne Moore, Tiffany Musick, Susana Patton, Yun Yan, Sarah Tsai, Jennifer Bedard, Aliza Elrod, Lois Hester, Marissa Beidelschies, Julie de la Garza, Emily Haith, Jennifer James, Elizabeth Ramey, Jessica Slover, Armenthia Valentine, Darta Watkins, Misty Whisenhunt, Jami Wierson, Darrell Wilson, Bruce Buckingham, David Maahs, Priya Prahalad, Liana Hsu, Ryan Kingman, Ideen Tabatabai, David Liljenquist, Mark Sulik, Carl Vance, Jean Halford, Christine Funke, Yaw Appiagyei-Dankah, Emily Beltz, Karen Moran, Harold Starkman, Barbara Cerame, Daisy Chin, Laurie Ebner-Lyon, Kristen Sabanosh, Lawrence Silverman, Christine Wagner, Sunita Cheruvu, Marie Fox, Frances Melchionne, Richard Bergenstal, Marcia Madden, Thomas Martens, Amy Criego, Margaret Powers, Anders Carlson, Shannon Beasley, Beth Olson, LeeAnn Thomas, Kathleen McCann, Sean Dunnigan, Charlotte Ashanti, Jill Simmons, William Russell, Sarah Jaser, Jennifer Kelley, Faith Brendle, Lauren Williams, Kimberly Savin, Kimberly Flowers, George Williams, Emily Hamburger, Angelia Davis, Brenna Hammel, Eda Cengiz, William Tamborlane, Kate Weyman, Michelle Van Name, Neha Patel, Jennifer Sherr, Eileen Tichy, Amy Steffen, Melinda Zgorski, Lori Carria, Jennifer Finnegan, Elvira Duran, Sanjeev Mehta, Michelle Katz, Lori Laffel, Elisa Giani, Rebecca Snelgrove, Anat Hanono, Persis Commissariat, Julie Griffith, Ashley Atkins, Kara Harrington, Kenny Kim, Luisa Masclans, Nisha Naik, Louise Ambler-Osborn, Alan Schultz, Charlotte Cohen, Brittany Anderson, Janet McGill, Andrea Granados, Mary Jane Clifton, Stacy Hurst, Sarah Kissel, Carol Recklein, Davida Kruger, Arti Bhan, Terri Brown, Andreana Tassopoulos, Angela Hailey, Heather Remtema, Terra Cushman, Kupper Wintergerst, Sara Watson, Suzanne Kingery, Lauren Rayborn, Heather Rush, Michael Foster, Amy Deuser, Manuel Rodriguez-Luna, Stephanie Eubanks, Henry Rodriguez, Sureka Bollepalli, Laura Smith, Dorothy Shulman, E. Verena Jorgensen, Emily Eyth, Rachel Brownstein, Janet Rodriguez, Juanita O’Brian, Grazia Aleppo-Kacmarek, Allison Hahr, Mark Molitch, El Muayed, Daniel Toft, Candice Fulkerson, Daphne Adelman, Elaine Massaro, Kimberly Webb, Anne Peters, Valerie Ruelas, Mark Harmel, Mark Daniels, Nikta Forghani, Timothy Flannery, Christina Reh, Amrit Bhangoo, Himala Kashmiri, Keirsten Montgomery, Lien Trinh, Heather Speer, Kristen Lane, Cassie Miller, Christine Burt Solorzano, Jennifer Puskaric, Robert Benjamin, Deanna Adkins, Amber Spruill, Cathy Williams, Eva Tsalikian, Michael Tansey, Nidhi Bansl, Joanne Cabbage, Julie Coffey, Rachel Bisbee, Desmond Schatz, Michael Clare-Salzler, Kenneth Cusi, Becky Fudge, Mike Haller, Collette Meehan, Henry Rohrs, Janet Silverstein, Ashby Walker, Anastasia Albanese-O’Niell, Stephanie Foss, Janey Adams, Miriam Cintron, Nicole Thomas, Michael Gottschalk, Ron Newfield, Marla Hashiguchi, David Sparling, Jeanie Tryggested, Joni Beck, Joane Less, Linda Weber, Saleh Adi, Stephen Gitelman, Srinath Sanda, Jenise Wong, Mary McDonnell, Monica Mueller, Zara Izadi, Swaroop Mistry, Bryce Nelson, Lisa Looper, Carrie Frost, Maria Redondo, Sarah Lyons, Sara Klinepeter, Kelly Fegan-Bohm, Fida Bacha, Daniel DeSalvo, Ashley Butler, Marisa Hilliard, Farida Khetani, Ronald Yulatic, Robert Hudson, Laura Irvine, Sadia Zubair, Cory Pace, Abelin Pitrello, Wendy Levy, Charity Njoku, William Zipf, Jennifer Dyer, Rolando Lozano, Diane Seiple, Grant Corven, Megan Jaycox, Jamie Wood, Sarah Macleish, Rose Gubitosi-Klug, Ramon Adams, Paul McGuigan, Terri Casey, Wendy Campbell, Julie Kittelsrud, Ashutosh Gupta, Vikki Peterson, Ingrid Libman, Ana Diaz, David Jelley, Christina Crowder, Dana Greer, Julia Crawford, Sharnella Goudeau, Catherine Pihoker, Joyce Yi-Frazier, Susan Kearns, Michael Pascual, Beth Loots, Natalie Beauregard, Michael Rickels, Shannon O’Brien, Shivani Agarwal, Amy Peleckis, Cornelia Dalton-Bakes, Eileen Markmann, Guillermo Umpierrez, Andrew Muir, Clementina Ramos, Keywan Behbahani, Neil Dhruv, Nolan Gartzman, Brandon Nathan, Melena Bellin, Muna Sunni, Nancy Flaherty, Janice Leschyshyn, Kara Schmid, Darcy Weingartner, Marrissa Ludwig, Brittney Nelson, Anne Kogler, Avery Bartyzal, Anne Street, Beth Pappenfus, Jessica Sweet, John Buse, Laura Young, Katherine Bergamo, April Goley, Marian Kirkman, Jamie Diner, Alex Kass, Milana Dezube, Kathleen Arnold, Traci Evans, Sharon Sellers, Scott Blackman, Kimber-Lee Abel, Lisa Rasbach, Omar Ali, Peter Wolfgram, Rosanna Fiallo-Sharer, Joanna Kramer, Christina Beesley, Clare Bingham-Tyson, Rachel Unteutsh, David Harlan, Mary Lee, Leslie Soyka, Penny Feldman, Michael Thompson, Karen Gallagher-Dorval, Lisa Hubacz, Celia Hartigan, Carol Ciccarelli, Rachel Edelen, Michelle Edelen, Trista Borgwadt, Kirstin Stauffacher, Kelly DeGrote, Crystal Gruetzmacher, Michael Shepperd, Anuj Bhargava, Diana Wright, Kathleen Fitzgerald, Teck Khoo, Natalie Young, Lisa Borg, Kirstie Stifel, Cindy Rail, Luis Casas, Elizabeth Eidenshink, Christina Huber, Alex Rieder, Amy Tuchscherer, Megan Broadbent, Lawrence Dolan, Sarah Corathers, Jessica Kichler, Nicole Sheanon, Holly Baugh, Debbie Standiford, Tammy Weis, Catherine Fox, Carrie Schultz, Amy Ritter, Francesco Vendrame, Carlos Blashke, Della Matheson, Natalia Sanders-Branca, Justen Rudolph, Doris Biersdorf, Jane Fitch-Danielson, Dara Eckerle-Mize, Janet Fry, Dianne Davis, Cynthia Lovell, Robert Hoffman, Monika Chaudhari, Manmohan Kamboj, Lindsey Carr, Julie Blehm, Anthony Tello, Julie Ann Walter, Rhonda Ward, Gabriel Blomquist, Maria Stewart, Paige Cross, Sarah Racki, Lindsey Sterchi, Diane Gouine, Becky Kiesow, Stephanie Welch, Athena Philis-Tsimikas, George Daily, Amy Chang, James McCallum, Isabel Garcia, Teresa Vela, Ioanna Loupasi, Rosario Rosal, Elena Toschi, Roeland Middelbeek, Medha Munshi, Christine Slyne, Astrid Atakov-Castillo, Larry Fox, Nelly Mauras, Rachel Wasserman, Ligeia Damaso, Kim Englert, Kaitlin Sikes, Kim Ponthieux, Louis Phillipson, Ashley Cohen, Gail Gannon, Larry Deeb, April Shiver, Leroy Schroeder, Wendi Schworm, Kristina Graham, Carol Levy, David Lam, Elizabeth Burtman, Camilla Levister, Selassie Ogyaadu, Heidi Gassner, Julie Duke, Leslie Touger, Dorothee Newbern, Francine Hoekstra, Katerina Harwood, Vijaya Prasad, JoAnne Daguanno, Richard Pratley, Karen Corbin, Mia Wright, Susann Nagel, Natasha Water, Matthew Ghere, Keri Whitaker, Rubina Heptulla, Ranjitha Katikaneni, Doreen Johnson-Newell, Jill Crandall, Danielle Powell, Valentin Anghel, Steven Ghanny, Javier Aisenberg, Amy Chartoff, Jennifer Sivitz, Susan Mathus, Toni-Lyn Cospito, Kathryn Thailkill, John Fowlkes, Evangelia Kalaitzoglou, Alba Morales Pozzo, Kathy Edwards
Journal: Diabetes Care (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 &amp;lt; 0.001). DPN participants also were more likely to have cardiovascular disease (CVD) (P &amp;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 &amp;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.