Background: Diabetic Peripheral Neuropathy (DPN) is a debilitating complication of diabetes. Current diabetes management guidelines recommend targeting modifiable risk factors like glycemia, blood pressure (BP), lipids, obesity, and smoking to prevent DPN, but their individual effectiveness is unclear.
Aim: To quantify the effectiveness of interventions targeting modifiable risk factors to prevent DPN in adults with Type 2 diabetes (T2D).
Methods: The PubMed database was searched for randomized clinical trials (RCTs) from 1980 to 2023 focused on DPN prevention in adults with T2D. Eligible studies evaluated glycemic control, BP control, lipid control, obesity, or smoking cessation interventions against placebo or usual care, and reported DPN incidence for intervention and control groups. Meta-analysis for each therapy was conducted using a random-effects model in R. Heterogeneity was assessed using the I2 statistic.
Results: Seven RCTs for glycemic control and three RCTs for BP control were identified for adults with T2D. There was no significant difference in the incidence of DPN between intervention and control groups for glycemic control (Odds Ratio [OR]=0.96, 95% Confidence Interval [CI] [0.88, 1.05], p=0.38, I2=0%) and BP control (OR=0.86, 95% CI [0.39, 1.88], p=0.70, I2=78%). We were unable to identify enough high-quality RCTs to conduct meta-analysis evaluating the effect of lipid control, smoking cessation, or obesity reduction on preventing DPN.
Conclusions: While glycemic and BP control are recommended in clinical guidelines to prevent DPN, they have not been definitively shown to prevent incident DPN in adults with T2D. Identifying high-risk DPN groups using genomics or other markers and conducting high-quality RCTs in these high-risk groups using the aforementioned therapies calibrated to reach clearly specified risk factor levels may be needed to develop personalized treatments that are effective in preventing DPN in T2D.
S. Gunawan: None. T. Antony: None. A. Nicholson: None. S. Natarajan: None.
