Pain in diabetes-related polyneuropathy predicts vascular events, mortality

Pain in patients with type 2 diabetes (T2D)-related polyneuropathy (DPN) is significantly associated with a higher risk of vascular events and mortality, suggests a recent study.

To determine the effect of neuropathic pain on vascular events and mortality in T2D patients, the investigators carried out a retrospective cohort study within a large health system of adult T2D patients from 1 January 2009 through 31 December 2016. An electronic algorithm was used to classify participants as no DPN, DPN with pain (DPN + P), or DPN without pain (DPN-P).

The number of vascular events and time to mortality were the primary endpoints. Multivariable negative binomial and Cox proportional hazard regression models, adjusting for demographics, socioeconomic characteristics, and comorbidities, were used to assess the independent associations with DPN + P.

A total of 43,945 patients with T2D (mean age, 64.6 years; 52.1 percent female) were included, of whom 13,910 (31.7 percent) had DPN (9,104 DPN + P; 65.4 percent vs 4,806 DPN-P; 34.6 percent). Vascular events occurred in 4,538 (15.1 percent) patients without DPN, 2,401 (26.4 percent) DPN + P, and 1,006 (20.9 percent) DPN-P.

DPN + P remained significantly associated with an increased risk of vascular events after adjustment (incidence rate ratio [IRR], 1.55, 95 percent CI, 1.29–1.85), while no DPN appeared to be protective (IRR, 0.70, 95 percent CI, 0.60–0.82), as compared to DPN-P. DPN + P was also a significant predictor of mortality (hazard ratio, 1.42, 95 percent CI, 1.25–1.61) compared to DPN-P.

“This observation warrants longitudinal study of the risk factors and natural history of pain in DPN,” the investigators said.