title: Aggregate cardiovascular risk is a stronger statistical correlate of clinically evident diabetic peripheral neuropathy than HbA1c alone.
abstract: BACKGROUND
  Apart from chronic hyperglycemia measured by hemoglobin A1c (HbA1c), other vascular risk factors contribute to the development of diabetic neuropathy. Even though these factors are synergistic, no study has measured the relative effect of aggregate cardiovascular risk load compared with chronic hyperglycemia alone on the risk of clinically evident diabetic peripheral neuropathy.
  
  
  OBJECTIVE
  To compare the effects of aggregate cardiovascular risk load and HbA1c on clinically evident diabetic peripheral neuropathy.
  
  
  METHODS
  We studied 277 consecutive and consenting type 2 diabetic outpatients attending the University College Hospital, Ibadan, Nigeria. Neuropathy was defined operationally as at least 7 positive responses on the Michigan Neuropathy Screening Instrument (MNSI) questionnaire or a score greater than 2.0 on the MNSI examination: thresholds defined by prior validation studies. Patients with nondiabetic causes of neuropathy were excluded. We determined the HbA1c using the ionic exchange chromatographic method and later computed the Diabetes Control Complications Trial referenced values. Aggregate cardiovascular risk load was determined using the UK Prospective Diabetes Study risk engines.
  
  
  RESULTS
  One hundred ninety-seven (71.1%) patients had clinically evident diabetic peripheral neuropathy. The mean HbA1c value was 6.9%. HbA1c correlated significantly with the average fasting plasma glucose (r = 0.36) but did not correlate significantly with the development of clinically evident diabetic peripheral neuropathy (p = .465, p = -0.045). Aggregate cardiovascular risk load had the strongest significant correlation with clinically evident diabetic peripheral neuropathy (p = .002, p = 0.186, odds ratio, 2.3 for score > 5). In the regression analysis, aggregate cardiovascular risk load was a stronger predictor of clinically evident diabetic peripheral neuropathy than HbA1c.
  
  
  CONCLUSIONS
  Aggregate cardiovascular risk load was a stronger statistical correlate and predictor of clinically evident diabetic peripheral neuropathy than HbA1c. This may have implications for prevention and monitoring of clinically evident diabetic peripheral neuropathy.
authors.affiliation: Department of Medicine, University College Hospital, Ibadan, Nigeria. mayowaowolabi@yahoo.com
authors.forename: Mayowa O
authors.initials: MO
authors.lastname: Owolabi
authors.forename: Arinola
authors.initials: A
authors.lastname: Ipadeola
authors.forename: Jokotade O
authors.initials: JO
authors.lastname: Adeleye
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood*; D016009:Chi-Square Distribution; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D003929:Diabetic Neuropathies / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D006442:Glycated Hemoglobin