Explanations for less small fibre neuropathy in South Asian versus European subjects with type 2 diabetes in the UK

Hassan Fadavi, Mitra Tavakoli, Philip Foden, Maryam Ferdousi, Ioannis N. Petropoulos, Maria Jeziorska, Nishi Chaturvedi, Andrew J.M. Boulton, Rayaz Malik, Caroline A. Abbott

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Low foot ulcer risk in South Asian, compared with European, people with type 2 diabetes in the UK has been attributed to their lower levels of neuropathy. We have undertaken a detailed study of corneal nerve morphology and neuropathy risk factors, to establish the basis of preserved small nerve fibre function in South Asians versus Europeans. Methods: In a cross-sectional, population-based study, age- and sex-matched South Asians (n = 77) and Europeans (n = 78) with type 2 diabetes underwent neuropathy assessment using corneal confocal microscopy, symptoms, signs, quantitative sensory testing, electrophysiology and autonomic function testing. Multivariable linear regression analyses determined factors accounting for ethnic differences in small fibre damage. Results: Corneal nerve fibre length (22.0 ± 7.9 vs. 19.3 ± 6.3 mm/mm2; P = 0.037), corneal nerve branch density (geometric mean (range): 60.0 (4.7-246.2) vs. 46.0 (3.1-129.2) no./mm2; P = 0.021) and heart rate variability (geometric mean (range): 7.9 (1.4-27.7) vs. 6.5 (1.5-22.0); P = 0.044), were significantly higher in South Asians vs. Europeans. All other neuropathy measures did not differ, except for better sural nerve amplitude in South Asians (geometric mean (range): 10.0 (1.3-43.0) vs. 7.2 (1.0-30.0); P = 0.006). Variables with the greatest impact on attenuating the P value for age- and HbA1C-adjusted ethnic difference in corneal nerve fibre length (P = 0.032) were pack-years smoked (P = 0.13), BMI (P = 0.062) and triglyceride levels (P = 0.062). Conclusions: South Asians have better preserved small nerve fibre integrity than equivalent Europeans; furthermore, classic, modifiable risk factors for coronary heart disease are the main contributors to these ethnic differences. We suggest that improved autonomic neurogenic control of cutaneous blood flow in Asians may contribute to their protection against foot ulcers.

Original languageEnglish
JournalDiabetes/Metabolism Research and Reviews
DOIs
Publication statusAccepted/In press - 1 Jan 2018

Fingerprint

Type 2 Diabetes Mellitus
Nerve Fibers
Foot Ulcer
Sural Nerve
Electrophysiology
Confocal Microscopy
Signs and Symptoms
Coronary Disease
Small Fiber Neuropathy
Linear Models
Triglycerides
Heart Rate
Regression Analysis
Skin
Population

Keywords

  • corneal nerves
  • ethnicity
  • foot ulcer
  • neuropathy
  • South Asian

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Fadavi, H., Tavakoli, M., Foden, P., Ferdousi, M., Petropoulos, I. N., Jeziorska, M., ... Abbott, C. A. (Accepted/In press). Explanations for less small fibre neuropathy in South Asian versus European subjects with type 2 diabetes in the UK. Diabetes/Metabolism Research and Reviews. https://doi.org/10.1002/dmrr.3044

Explanations for less small fibre neuropathy in South Asian versus European subjects with type 2 diabetes in the UK. / Fadavi, Hassan; Tavakoli, Mitra; Foden, Philip; Ferdousi, Maryam; Petropoulos, Ioannis N.; Jeziorska, Maria; Chaturvedi, Nishi; Boulton, Andrew J.M.; Malik, Rayaz; Abbott, Caroline A.

In: Diabetes/Metabolism Research and Reviews, 01.01.2018.

Research output: Contribution to journalArticle

Fadavi, Hassan ; Tavakoli, Mitra ; Foden, Philip ; Ferdousi, Maryam ; Petropoulos, Ioannis N. ; Jeziorska, Maria ; Chaturvedi, Nishi ; Boulton, Andrew J.M. ; Malik, Rayaz ; Abbott, Caroline A. / Explanations for less small fibre neuropathy in South Asian versus European subjects with type 2 diabetes in the UK. In: Diabetes/Metabolism Research and Reviews. 2018.
@article{e1e2181e4e004a48aadcf29a777e77ce,
title = "Explanations for less small fibre neuropathy in South Asian versus European subjects with type 2 diabetes in the UK",
abstract = "Background: Low foot ulcer risk in South Asian, compared with European, people with type 2 diabetes in the UK has been attributed to their lower levels of neuropathy. We have undertaken a detailed study of corneal nerve morphology and neuropathy risk factors, to establish the basis of preserved small nerve fibre function in South Asians versus Europeans. Methods: In a cross-sectional, population-based study, age- and sex-matched South Asians (n = 77) and Europeans (n = 78) with type 2 diabetes underwent neuropathy assessment using corneal confocal microscopy, symptoms, signs, quantitative sensory testing, electrophysiology and autonomic function testing. Multivariable linear regression analyses determined factors accounting for ethnic differences in small fibre damage. Results: Corneal nerve fibre length (22.0 ± 7.9 vs. 19.3 ± 6.3 mm/mm2; P = 0.037), corneal nerve branch density (geometric mean (range): 60.0 (4.7-246.2) vs. 46.0 (3.1-129.2) no./mm2; P = 0.021) and heart rate variability (geometric mean (range): 7.9 (1.4-27.7) vs. 6.5 (1.5-22.0); P = 0.044), were significantly higher in South Asians vs. Europeans. All other neuropathy measures did not differ, except for better sural nerve amplitude in South Asians (geometric mean (range): 10.0 (1.3-43.0) vs. 7.2 (1.0-30.0); P = 0.006). Variables with the greatest impact on attenuating the P value for age- and HbA1C-adjusted ethnic difference in corneal nerve fibre length (P = 0.032) were pack-years smoked (P = 0.13), BMI (P = 0.062) and triglyceride levels (P = 0.062). Conclusions: South Asians have better preserved small nerve fibre integrity than equivalent Europeans; furthermore, classic, modifiable risk factors for coronary heart disease are the main contributors to these ethnic differences. We suggest that improved autonomic neurogenic control of cutaneous blood flow in Asians may contribute to their protection against foot ulcers.",
keywords = "corneal nerves, ethnicity, foot ulcer, neuropathy, South Asian",
author = "Hassan Fadavi and Mitra Tavakoli and Philip Foden and Maryam Ferdousi and Petropoulos, {Ioannis N.} and Maria Jeziorska and Nishi Chaturvedi and Boulton, {Andrew J.M.} and Rayaz Malik and Abbott, {Caroline A.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1002/dmrr.3044",
language = "English",
journal = "Diabetes/Metabolism Research and Reviews",
issn = "1520-7552",
publisher = "John Wiley and Sons Ltd",

}

TY - JOUR

T1 - Explanations for less small fibre neuropathy in South Asian versus European subjects with type 2 diabetes in the UK

AU - Fadavi, Hassan

AU - Tavakoli, Mitra

AU - Foden, Philip

AU - Ferdousi, Maryam

AU - Petropoulos, Ioannis N.

AU - Jeziorska, Maria

AU - Chaturvedi, Nishi

AU - Boulton, Andrew J.M.

AU - Malik, Rayaz

AU - Abbott, Caroline A.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Low foot ulcer risk in South Asian, compared with European, people with type 2 diabetes in the UK has been attributed to their lower levels of neuropathy. We have undertaken a detailed study of corneal nerve morphology and neuropathy risk factors, to establish the basis of preserved small nerve fibre function in South Asians versus Europeans. Methods: In a cross-sectional, population-based study, age- and sex-matched South Asians (n = 77) and Europeans (n = 78) with type 2 diabetes underwent neuropathy assessment using corneal confocal microscopy, symptoms, signs, quantitative sensory testing, electrophysiology and autonomic function testing. Multivariable linear regression analyses determined factors accounting for ethnic differences in small fibre damage. Results: Corneal nerve fibre length (22.0 ± 7.9 vs. 19.3 ± 6.3 mm/mm2; P = 0.037), corneal nerve branch density (geometric mean (range): 60.0 (4.7-246.2) vs. 46.0 (3.1-129.2) no./mm2; P = 0.021) and heart rate variability (geometric mean (range): 7.9 (1.4-27.7) vs. 6.5 (1.5-22.0); P = 0.044), were significantly higher in South Asians vs. Europeans. All other neuropathy measures did not differ, except for better sural nerve amplitude in South Asians (geometric mean (range): 10.0 (1.3-43.0) vs. 7.2 (1.0-30.0); P = 0.006). Variables with the greatest impact on attenuating the P value for age- and HbA1C-adjusted ethnic difference in corneal nerve fibre length (P = 0.032) were pack-years smoked (P = 0.13), BMI (P = 0.062) and triglyceride levels (P = 0.062). Conclusions: South Asians have better preserved small nerve fibre integrity than equivalent Europeans; furthermore, classic, modifiable risk factors for coronary heart disease are the main contributors to these ethnic differences. We suggest that improved autonomic neurogenic control of cutaneous blood flow in Asians may contribute to their protection against foot ulcers.

AB - Background: Low foot ulcer risk in South Asian, compared with European, people with type 2 diabetes in the UK has been attributed to their lower levels of neuropathy. We have undertaken a detailed study of corneal nerve morphology and neuropathy risk factors, to establish the basis of preserved small nerve fibre function in South Asians versus Europeans. Methods: In a cross-sectional, population-based study, age- and sex-matched South Asians (n = 77) and Europeans (n = 78) with type 2 diabetes underwent neuropathy assessment using corneal confocal microscopy, symptoms, signs, quantitative sensory testing, electrophysiology and autonomic function testing. Multivariable linear regression analyses determined factors accounting for ethnic differences in small fibre damage. Results: Corneal nerve fibre length (22.0 ± 7.9 vs. 19.3 ± 6.3 mm/mm2; P = 0.037), corneal nerve branch density (geometric mean (range): 60.0 (4.7-246.2) vs. 46.0 (3.1-129.2) no./mm2; P = 0.021) and heart rate variability (geometric mean (range): 7.9 (1.4-27.7) vs. 6.5 (1.5-22.0); P = 0.044), were significantly higher in South Asians vs. Europeans. All other neuropathy measures did not differ, except for better sural nerve amplitude in South Asians (geometric mean (range): 10.0 (1.3-43.0) vs. 7.2 (1.0-30.0); P = 0.006). Variables with the greatest impact on attenuating the P value for age- and HbA1C-adjusted ethnic difference in corneal nerve fibre length (P = 0.032) were pack-years smoked (P = 0.13), BMI (P = 0.062) and triglyceride levels (P = 0.062). Conclusions: South Asians have better preserved small nerve fibre integrity than equivalent Europeans; furthermore, classic, modifiable risk factors for coronary heart disease are the main contributors to these ethnic differences. We suggest that improved autonomic neurogenic control of cutaneous blood flow in Asians may contribute to their protection against foot ulcers.

KW - corneal nerves

KW - ethnicity

KW - foot ulcer

KW - neuropathy

KW - South Asian

UR - http://www.scopus.com/inward/record.url?scp=85052789709&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052789709&partnerID=8YFLogxK

U2 - 10.1002/dmrr.3044

DO - 10.1002/dmrr.3044

M3 - Article

JO - Diabetes/Metabolism Research and Reviews

JF - Diabetes/Metabolism Research and Reviews

SN - 1520-7552

ER -