title: Subclinical neuropathy among Diabetes Control and Complications Trial participants without diagnosable neuropathy at trial completion: possible predictors of incident neuropathy?
abstract: OBJECTIVE
  We sought to evaluate the prevalence of subclinical neuropathy in intensive and conventional treatment groups at completion of the Diabetes Control and Complications Trial (DCCT).
  
  
  METHODS
  We assessed neuropathy using nerve conduction results obtained at DCCT completion after stratifying the DCCT cohort to exclude subjects with progressively less severe degrees of diagnosable neuropathy. We began with those who had confirmed clinical neuropathy (the primary DCCT end point) and eventually excluded all subjects with any clinical or electrodiagnostic evidence of neuropathy.
  
  
  RESULTS
  After excluding subjects with confirmed clinical neuropathy at DCCT completion, 8 of 10 nerve conduction measures (including all lower-extremity measures) were significantly improved in the intensive treatment group (O'Brien rank-sum test across all nerve conduction measures, P < 0.0001). Conduction velocity group differences were substantial, and the peroneal conduction velocity averaged 3.1 m/s faster in the intensive compared with the conventional treatment group (45.1 vs. 42.0 m/s, P < 0.0001). Numerous significant differences in median and peroneal motor conduction velocities favoring the intensive treatment group persisted, regardless of the exclusion criteria applied.
  
  
  CONCLUSIONS
  Intensive and conventional treatment group subjects without diagnosable neuropathy at DCCT completion had significant differences in electrophysiologic measurements favoring the intensive treatment group. Differences in subsequent incident neuropathy between the original treatment groups may reflect, in part, their levels of subclinical neuropathy at DCCT completion, rather than persistent metabolic effects.
authors.affiliation: DCCT/EDIC Research Group, Box DCCT/EDIC, Bethesda, MD 20892, USA. jwalbers@umich.edu
authors.forename: James W
authors.initials: JW
authors.lastname: Albers
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.forename: Rodica
authors.initials: R
authors.lastname: Pop-Busui
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Martin
authors.forename: Patricia
authors.initials: P
authors.lastname: Cleary
authors.forename: Barbara
authors.initials: B
authors.lastname: Waberski
mesh_terms: D003920:Diabetes Mellitus / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000145:classification / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D004594:Electrophysiology; D005500:Follow-Up Studies; D006801:Humans; D009431:Neural Conduction / Q000502:physiology; D015995:Prevalence