title: Peripheral neuropathy is associated with insulin resistance independent of metabolic syndrome.
abstract: BACKGROUND
  To determine the association of insulin resistance, metabolic syndrome (MetS) with peripheral neuropathy (PN).
  
  
  METHODS
  This cross-sectional study consisted of 2035 subjects in Shanghai who were classified as with MetS and without MetS. The new International Diabetes Federation (IDF) criterion was used to define MetS. HOMA-IR was applied to evaluate insulin resistance. All subjects underwent complete foot examination. PN was assessed according to the neuropathy symptom and neuropathy disability scores. Binary logistic regression was performed to analyze the contributions of insulin resistance, features of MetS to PN.
  
  
  RESULTS
  (1) The percentage of PN was 4.0% in our study. Patients with MetS (47.7%) had a higher percentage of PN (5.5% vs. 2.6%, respectively, P = 0.001). With the components of MetS increased (non-MetS, three, four, five), a linear increase in the proportion of peripheral neuropathy was observed (2.6%, 4.8%, 5.6% and 7.2%; respectively, P for trend = 0.001). (2) In patients with PN, the average age of patients was significantly older than the corresponding non-PN patients. Waist circumference, fasting blood glucose, HbA1c, proportion of treatment for diabetes and hypertension were significantly higher in PN group compared with non-PN group in MetS patients. (3) The frequency of dysglycemia was the highest in PN patients both with and without MetS (96.2% and 82.1%, P = 0.084). (4) After adjusting for gender and smoking history, the PN was associated with MetS [odds ratio (OR) 2.0; 95% confidence interval (CI) 1.2, 3.2; P = 0.006], and age (OR 1.1; 95% CI 1.1, 1.1; P < 0.001). When HOMA-IR was added to this binary logistic regression, the association of PN with MetS disappeared (P = 0.110), but the PN was still associated with HOMA-IR (OR 1.2; 95% CI 1.1, 1.4, P < 0.001).
  
  
  CONCLUSIONS
  In metabolic syndrome, insulin resistance might play an important role in the development of peripheral neuropathy.
authors.affiliation: Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, No, 12 Wulumuqi Middle Road, Jing'an District, Shanghai 200040 China.|Department of Endocrinology, the Second Affiliated Hospital of Soochow University, Jiangsu, 215004 China.
authors.forename: Ling
authors.initials: L
authors.lastname: Han
authors.affiliation: Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, No, 12 Wulumuqi Middle Road, Jing'an District, Shanghai 200040 China.
authors.forename: Lijin
authors.initials: L
authors.lastname: Ji
authors.affiliation: Department of the Third Internal Medicine, Affiliated hospital of Shandong Academy of Medical Sciences, No. 38 Wuyingshan Road, Shandong, 250031 China.
authors.forename: Jing
authors.initials: J
authors.lastname: Chang
authors.affiliation: Department of Endocrinology, the Second Affiliated Hospital of Soochow University, Jiangsu, 215004 China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wen
authors.affiliation: Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, No, 12 Wulumuqi Middle Road, Jing'an District, Shanghai 200040 China.
authors.forename: Wenting
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, No, 12 Wulumuqi Middle Road, Jing'an District, Shanghai 200040 China.
authors.forename: Hongli
authors.initials: H
authors.lastname: Shi
authors.affiliation: Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, No, 12 Wulumuqi Middle Road, Jing'an District, Shanghai 200040 China.
authors.forename: Linuo
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, No, 12 Wulumuqi Middle Road, Jing'an District, Shanghai 200040 China.
authors.forename: Yiming
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, No, 12 Wulumuqi Middle Road, Jing'an District, Shanghai 200040 China.
authors.forename: Renming
authors.initials: R
authors.lastname: Hu
authors.affiliation: Department of Endocrinology, the Second Affiliated Hospital of Soochow University, Jiangsu, 215004 China.
authors.forename: Ji
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, No, 12 Wulumuqi Middle Road, Jing'an District, Shanghai 200040 China.
authors.forename: Bin
authors.initials: B
authors.lastname: Lu
keywords: Dysglycemia; Insulin resistance; Metabolic syndrome; Peripheral neuropathy