PMID- 37335990 OWN - NLM STAT- MEDLINE DCOM- 20230724 LR - 20230725 IS - 1935-5548 (Electronic) IS - 0149-5992 (Linking) VI - 46 IP - 8 DP - 2023 Aug 1 TI - The Prevalence of Polyneuropathy in Type 2 Diabetes Subgroups Based on HOMA2 Indices of beta-Cell Function and Insulin Sensitivity. PG - 1546-1555 LID - 10.2337/dc23-0079 [doi] AB - OBJECTIVE: Metabolic syndrome components may cumulatively increase the risk of diabetic polyneuropathy (DPN) in type 2 diabetes mellitus (T2DM) patients, driven by insulin resistance and hyperinsulinemia. We investigated the prevalence of DPN in three T2DM subgroups based on indices of beta-cell function and insulin sensitivity. RESEARCH DESIGN AND METHODS: We estimated beta-cell function (HOMA2-B) and insulin sensitivity (HOMA2-S) in 4,388 Danish patients with newly diagnosed T2DM. Patients were categorized into subgroups of hyperinsulinemic (high HOMA2-B, low HOMA2-S), classical (low HOMA2-B, low HOMA2-S), and insulinopenic (low HOMA2-B, high HOMA2-S) T2DM. After a median follow-up of 3 years, patients filled the Michigan Neuropathy Screening Instrument questionnaire (MNSIq) to identify DPN (score >/= 4). We used Poisson regression to calculate adjusted prevalence ratios (PRs) for DPN, and spline models to examine the association with HOMA2-B and HOMA2-S. RESULTS: A total of 3,397 (77%) patients filled in the MNSIq. The prevalence of DPN was 23% among hyperinsulinemic, 16% among classical, and 14% among insulinopenic patients. After adjusting for demographics, diabetes duration and therapy, lifestyle behaviors, and metabolic syndrome components (waist circumference, triglycerides, HDL cholesterol, hypertension, and HbA1c), the PR of DPN was 1.35 (95% CI 1.15-1.57) for the hyperinsulinemic compared with the classical patients. In spline analyses, we observed a linear relation of higher DPN prevalence with increasing HOMA2-B, independent of both metabolic syndrome components and HOMA2-S. CONCLUSIONS: Hyperinsulinemia marked by high HOMA2-B is likely an important risk factor for DPN beyond metabolic syndrome components and insulin resistance. This should be considered when developing interventions to prevent DPN. CI - (c) 2023 by the American Diabetes Association. FAU - Kristensen, Frederik Pagh Bredahl AU - Kristensen FPB AUID- ORCID: 0000-0001-5311-8924 AD - Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark. FAU - Christensen, Diana Hedevang AU - Christensen DH AUID- ORCID: 0000-0002-2693-5651 AD - Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark. AD - Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark. FAU - Callaghan, Brian Christopher AU - Callaghan BC AUID- ORCID: 0000-0002-8885-6748 AD - Department of Neurology, University of Michigan, Ann Arbor, MI. FAU - Stidsen, Jacob Volmer AU - Stidsen JV AUID- ORCID: 0000-0003-2711-5927 AD - Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark. FAU - Nielsen, Jens Steen AU - Nielsen JS AD - Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark. AD - Department of Clinical Research, University of Southern Denmark, Odense, Denmark. FAU - Hojlund, Kurt AU - Hojlund K AUID- ORCID: 0000-0002-0891-4224 AD - Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark. AD - Department of Clinical Research, University of Southern Denmark, Odense, Denmark. FAU - Beck-Nielsen, Henning AU - Beck-Nielsen H AD - Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark. FAU - Jensen, Troels Staehelin AU - Jensen TS AD - Department of Neurology, Aarhus University Hospital, Aarhus, Denmark. FAU - Andersen, Henning AU - Andersen H AD - Department of Neurology, Aarhus University Hospital, Aarhus, Denmark. FAU - Vestergaard, Peter AU - Vestergaard P AD - Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark. FAU - Jessen, Niels AU - Jessen N AUID- ORCID: 0000-0001-5613-7274 AD - Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark. FAU - Olsen, Michael Hecht AU - Olsen MH AD - Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. AD - Department of Internal Medicine and Steno Diabetes Center Zealand, Holbaek Hospital, Holbaek, Denmark. FAU - Hansen, Torben AU - Hansen T AUID- ORCID: 0000-0001-8748-3831 AD - Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark. FAU - Brons, Charlotte AU - Brons C AUID- ORCID: 0000-0002-6653-9020 AD - Charlotte Brons, Steno Diabetes Center Copenhagen, Region Hovedstaden, Herlev, Denmark. FAU - Vaag, Allan AU - Vaag A AD - Charlotte Brons, Steno Diabetes Center Copenhagen, Region Hovedstaden, Herlev, Denmark. AD - Allan Vaag, Steno Diabetes Center Copenhagen, Region Hovedstaden, Herlev, Denmark + Lund University Diabetes Center, Lund University, Malmo, Sweden. FAU - Sorensen, Henrik Toft AU - Sorensen HT AD - Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark. FAU - Thomsen, Reimar Wernich AU - Thomsen RW AUID- ORCID: 0000-0001-9135-3474 AD - Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark. LA - eng SI - figshare/10.2337/figshare.23264558 PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Diabetes Care JT - Diabetes care JID - 7805975 SB - IM MH - Humans MH - *Diabetes Mellitus, Type 2/complications/epidemiology/diagnosis MH - *Insulin Resistance MH - *Metabolic Syndrome/epidemiology/complications MH - Prevalence MH - *Polyneuropathies MH - *Diabetic Neuropathies/epidemiology/complications EDAT- 2023/06/19 19:12 MHDA- 2023/07/24 06:42 CRDT- 2023/06/19 17:02 PHST- 2023/01/13 00:00 [received] PHST- 2023/05/26 00:00 [accepted] PHST- 2023/07/24 06:42 [medline] PHST- 2023/06/19 19:12 [pubmed] PHST- 2023/06/19 17:02 [entrez] AID - 151596 [pii] AID - 10.2337/dc23-0079 [doi] PST - ppublish SO - Diabetes Care. 2023 Aug 1;46(8):1546-1555. doi: 10.2337/dc23-0079.