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Impact of Glycemic Control Strategies on Diabetic Peripheral Neuropathy Progression in BARI 2D

This study examines the effects of insulin-sensitizing (IS) versus insulin-providing (IP) glycemic control strategies on the prevalence and incidence of diabetic peripheral neuropathy (DPN) in the BARI 2D cohort. Over four years, DPN was assessed in 2,159 participants. Results indicated no difference in prevalence; however, the incidence of DPN was significantly lower in the IS group among those without DPN at baseline, particularly in men. This suggests that IS strategies may offer better outcomes in reducing DPN incidence in type 2 diabetes patients.

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Impact of Glycemic Control Strategies on Diabetic Peripheral Neuropathy Progression in BARI 2D

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  1. Featured Article: Impact of Glycemic Control Strategies on the Progression of Diabetic Peripheral Neuropathy in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Cohort Rodica Pop-Busui, M.D., P.H.D., Jiang Lu, M.S., Maria Mori Brooks, P.H.D., Stewart Albert, M.D., Andrew D. Althouse, M.A., Jorge Escobedo, M.D., F.A.C.P., Jenifer Green, M.D., Pasquale Palumbo, M.D., Bruce A. Perkins, M.D., Fred Whitehouse, M.D., Teresa L.Z. Jones, M.D., For the Bari 2D Study Group Diabetes Care Volume 36: 3208-3215 October, 2013

  2. STUDY OBJECTIVE • The BARI 2D trial demonstrated similar long-term clinical effectiveness of insulin-sensitizing (IS) versus insulin-providing (IP) treatments for type 2 diabetes on cardiovascular outcomes • Effects of randomized glycemic control strategy (IS vs. IP) on the prevalence and incidence of diabetic peripheral neuropathy (DPN) were evaluated Pop-Busui R. et al. Diabetes Care 2013;36:3208-3215

  3. STUDY DESIGN AND METHODS • DPN was assessed at baseline and yearly for 4 years • DPN was defined as a Michigan Neuropathy Screening Instrument (MNSI) clinical examination score >2 • DPN prevalence and incidence were compared by intention-to-treat modeling by logistic generalized estimating equation models for prevalence and Kaplan-Meier estimates and Cox regression models for incidence rates Pop-Busui R. et al. Diabetes Care 2013;36:3208-3215

  4. Pop-Busui R. et al. Diabetes Care 2013;36:3208-3215

  5. Pop-Busui R. et al. Diabetes Care 2013;36:3208-3215

  6. Pop-Busui R. et al. Diabetes Care 2013;36:3208-3215

  7. RESULTS • Results are included for 2,159 BARI 2D participants (70% males) with valid baseline and at least one follow-up MNSI score • No differences existed in the prevalence of DPN between the IS and IP groups throughout 4 years of follow-up • In 1,075 BARI 2D participants with no DPN at baseline, the 4-year cumulative incidence rate of DPN was significantly lower in the IS than in the IP strategy group • In subgroup analyses, IS strategy had a greater benefit in men Pop-Busui R. et al. Diabetes Care 2013;36:3208-3215

  8. CONCLUSIONS • Among type 2 diabetes patients, a glycemic control therapy with IS significantly reduced the incidence of DPN compared with IP therapy Pop-Busui R. et al. Diabetes Care 2013;36:3208-3215

  9. Pop-Busui R. et al. Diabetes Care 2013;36:3208-3215

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