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Among adults with type 2 diabetes, those reporting polyneuropathy pain have a significantly higher rate of major vascular events and are 42% more likely to die of any cause than those without pain.
“About half of people with type 2 diabetes eventually develop polyneuropathy, and patients with diabetic polyneuropathy may or may not report pain,” Brittany Lapin, PhD, MPH, assistant staff in biostatistics at the Center for Outcomes Research and Evaluation at Cleveland Clinic. “Investigation and clinical review of pain in diabetic polyneuropathy thus far has largely focused on pharmacological management and associations with poorer quality of life. Our observational study found heretofore unrecognized associations of vascular disease and mortality with pain in diabetic polyneuropathy.”
In a retrospective study, Lapin and colleagues analyzed data from 43,945 adults with type 2 diabetes assessed between 2009 and 2016 (mean age, 65 years; 52.1% women). Using an electronic algorithm, researchers classified patients as having no polyneuropathy, polyneuropathy plus pain or polyneuropathy with no pain. Primary outcomes were the number of vascular events and time to death. Researchers used negative binomial and Cox proportional models to evaluate independent associations between polyneuropathy plus pain with outcomes.
Within the cohort, 13,910 patients (31.7%) had polyneuropathy; among those with polyneuropathy, 9,104 patients (65.4%) had polyneuropathy plus pain and 4,806 patients (34.6%) had polyneuropathy with no pain.
Researchers observed vascular events among 15.1% of patients with no polyneuropathy, 26.4% of patients with polyneuropathy plus pain and 20.9% of patients with polyneuropathy with no pain.
Polyneuropathy plus pain was a predictor of number of vascular events, with an incidence rate ratio (IRR) of 1.55 (95% CI, 1.29-1.85) compared with no polyneuropathy. Additionally, those without polyneuropathy were 30% less likely to experience a vascular event (IRR = 0.7; 95% CI, 0.6-0.82) when compared with patients who had polyneuropathy plus pain.
Compared with patients who had polyneuropathy with no pain, those reporting pain were 42% more likely to die of any cause (HR = 1.42; 95% CI, 1.25-1.61).
“In clinical practice, providers need to be aware that pain in diabetic polyneuropathy is an indicator of increased vascular risk and mortality,” Lapin said. “A pain history should be proactively sought because it may not be reported, and those who report neuropathic pain should be targeted for aggressive vascular risk factor modification. Although this observation study does not demonstrate mediation of risk by pain, it is reasonable to aggressively control pain to improve quality of life and function.”