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    1 Comment for this article
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    Dyslipidemia and diabetic neuropathy
    Tomoyuki Kawada, MD, PhD | Nippon Medical School
    The authors conducted a cross-sectional study to evaluate the association between dyslipidemia and diabetic neuropathy (1). I understand that a limited number of patients were prepared for their analysis and multivariate analysis is difficult for making stable risk estimation. But caution should be paid to square values of each correlation coefficient. I suppose that dyslipidemia is not a main factor for diabetic neuropathy and some significant factors would contribute to neurodegeneration.

    The authors quoted some references, which were in consistent with their study outcomes. Among them, Andersen et al. conducted a prospective study to evaluate the effect of lipid
    profiles on diabetic polyneuropathy (DPN), presenting adjusted hazard ratios (95% confidence intervals) of HDL and LDL cholesterols at baseline for the incidence of DPN being 0.82 (0.69-0.99) and 0.92 (0.86; 0.98), respectively (2). This means that HDL and LDL cholesterols are both protective factors for DPN.

    Andersen et al. mentioned that clear explanation for the reason of the negative association between LDL cholesterol and DPN was unknown. Taken together, further prospective and interventional studies are needed to verify the causal association.


    References

    1. Jende JME, Groener JB, Rother C, et al. Association of serum cholesterol levels with peripheral nerve damage in patients with type 2 diabetes. JAMA Netw Open. 2019;2(5):e194798. doi:10.1001/jamanetworkopen.2019.4798

    2. Andersen ST, Witte DR, Dalsgaard EM, et al. Risk factors for incident diabetic polyneuropathy in a cohort with screen-detected type 2 diabetes followed for 13 years: ADDITION-Denmark. Diabetes Care. 2018;41(5):1068-1075. doi:10.2337/dc17-2062
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Original Investigation
    Neurology
    May 31, 2019

    Association of Serum Cholesterol Levels With Peripheral Nerve Damage in Patients With Type 2 Diabetes

    Author Affiliations
    • 1Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
    • 2Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
    • 3German Center of Diabetes Research (DZD), München-Neuherberg, Germany
    • 4Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
    • 5Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
    • 6Institute for Diabetes and Cancer, Helmholtz Diabetes Center, Helmholtz Center Munich, Munich, Germany
    JAMA Netw Open. 2019;2(5):e194798. doi:10.1001/jamanetworkopen.2019.4798
    Key Points español 中文 (chinese)

    Question  Is there an association between a low serum cholesterol level and the extent of peripheral nerve damage as assessed with magnetic resonance neurography in patients with type 2 diabetes?

    Findings  In this cross-sectional cohort study of 100 adults with type 2 diabetes, the amount of nerve lesions was negatively associated with total serum cholesterol levels.

    Meaning  The findings suggest that lowering serum cholesterol levels in patients with type 2 diabetes is associated with diabetic polyneuropathy.

    Abstract

    Importance  Lowering serum cholesterol levels is a well-established treatment for dyslipidemia in patients with type 2 diabetes (T2D). However, nerve lesions in patients with T2D increase with lower serum cholesterol levels, suggesting that lowering serum cholesterol levels is associated with diabetic polyneuropathy (DPN) in patients with T2D.

    Objective  To investigate whether there is an association between serum cholesterol levels and peripheral nerve lesions in patients with T2D with and without DPN.

    Design, Setting, and Participants  This single-center, cross-sectional, prospective cohort study was performed from June 1, 2015, to March 31, 2018. Observers were blinded to clinical data. A total of 256 participants were approached, of whom 156 were excluded. A total of 100 participants consented to undergo magnetic resonance neurography of the right leg at the Department of Neuroradiology and clinical, serologic, and electrophysiologic assessment at the Department of Endocrinology, Heidelberg University Hospital, Heidelberg, Germany.

    Exposures  Quantification of the nerve’s diameter and lipid equivalent lesion (LEL) load with a subsequent analysis of all acquired clinical and serologic data with use of 3.0-T magnetic resonance neurography of the right leg with 3-dimensional reconstruction of the sciatic nerve.

    Main Outcomes and Measures  The primary outcome was lesion load and extension. Secondary outcomes were clinical, serologic, and electrophysiologic findings.

    Results  A total of 100 participants with T2D (mean [SD] age, 64.6 [0.9] years; 68 [68.0%] male) participated in the study. The LEL load correlated positively with the nerve’s mean cross-sectional area (r = 0.44; P < .001) and the maximum length of a lesion (r = 0.71; P < .001). The LEL load was negatively associated with total serum cholesterol level (r = −0.41; P < .001), high-density lipoprotein cholesterol level (r = −0.30; P = .006), low-density lipoprotein cholesterol level (r = −0.33; P = .003), nerve conduction velocities of the tibial (r = −0.33; P = .01) and peroneal (r = −0.51; P < .001) nerves, and nerve conduction amplitudes of the tibial (r = −0.31; P = .02) and peroneal (r = −0.28; P = .03) nerves.

    Conclusions and Relevance  The findings suggest that lowering serum cholesterol levels in patients with T2D and DPN is associated with a higher amount of nerve lesions and declining nerve conduction velocities and amplitudes. These findings may be relevant to emerging therapies that promote an aggressive lowering of serum cholesterol levels in patients with T2D.

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