Lipid-lowering Therapy Protects Against Peripheral Sensory Neuropathy in Type 2 Diabetes
Abstract Number: 0004-OR
Authors: TIMOTHY M. DAVIS, BU YEAP, DAVID G. BRUCE, WENDY A. DAVIS, Fremantle, Australia
Results: Peripheral sensory neuropathy is a common complication of diabetes that can lead to significant morbidity and mortality. There is evidence from in vitro and animal studies that both statins and fibrates may protect against nerve damage but clinical studies show that their use can also be associated with a reversible peripheral neuropathy. In the light of these observations, we assessed the relationship between lipid-lowering therapy and the prevalence and incidence of peripheral neuropathy in a large representative cohort of patients with type 2 diabetes. We studied i) a cross-sectional sample comprising all 1294 type 2 patients recruited to the Fremantle Diabetes Study between 1993 and 1996, and ii) a longitudinal sub-group of 531 who had attended 6 comprehensive annual assessments by November 2001. Neuropathy was defined as a score >2/8 on the clinical portion of the Michigan Neuropathy Screening Instrument, which is amongst the validated clinical screening tools for neuropathy with the highest sensitivity and specificity. At study entry, the 1294 type 2 participants had a mean±SD age of 64.1±11.3 years, 48.8% were male, they had been diagnosed a median (inter-quartile range) 4.0 (1.0-9.0) years previously, and 30.9% had peripheral neuropathy. Fibrates and statins were used by 3.5% and 6.8%, respectively. In multiple logistic regression analysis involving a range of sociodemographic, anthropometric, clinical, biochemical and other variables, older age, longer diabetes duration, central adiposity, increasing height, higher fasting plasma glucose, systolic blood pressure and urinary albumin:creatinine, and indigenous racial background were independent associates of prevalent peripheral neuropathy at baseline (p<0.03), while use of fibrate therapy was a negative associate (odds ratio (95% confidence interval), 0.30 (0.10-0.86); p=0.025). In the longitudinal sub-group, fibrate and statin use increased to 10.4% and 36.5%, respectively, during the 5 years of follow-up. In Cox proportional hazards analysis of time to new peripheral neuropathy in the longitudinal sub-group, time-dependent fibrate (0.52 (0.27-0.98)) and statin (0.65 (0.46-0.93)) use were also significant determinants (p<0.042). These observational data provide evidence that therapy with either a statin or fibrate protects against the development of diabetic peripheral sensory neuropathy, independent of the effect of these drugs on serum lipids.