Immune-inflammatory Markers in Diabetic Peripheral Neuropathy and their Association with Quality of Life
-
Javad Poursamimi
,
Shima Mohammadkhani
,
Yahya Ehsanollahi
,
Marzieh Poursamimi
,
Elahe Haghighat-Manesh
Abstract
Diabetic peripheral neuropathy (DPN) is a disabling complication of type 2 diabetes, associated with neuropathic pain and reduced quality of life (QoL). Inflammation is implicated in DPN pathogenesis. We investigated associations between inflammatory markers, including C-reactive protein (CRP) and interleukin-6 (IL-6), and QoL in DPN patients in Eastern Iran.
One hundred seventeen type 2 diabetic patients from two from two Zabol hospitals/clinics were enrolled. QoL was assessed using WHOQOL-BREF questionnaire, and neuropathy was evaluated using Michigan neuropathy screening instrument (MNSI). Serum CRP and IL-6 levels were measured. Analyses included t-tests, analysis of variance, and linear regression in SPSS.
The prevalence of DPN among patients was 56.4%. Patients with DPN exhibited higher levels of CRP (mean: 4.2±1.8 mg/L) and IL-6 (mean: 5.6±2.1 pg/mL) compared with the non-neuropathic group. Additionally, QoL, particularly in the physical domain, was significantly lower in patients with higher levels of these inflammatory markers. However, multiple linear regression analysis after adjusting for confounding variables (including age, sex, BMI, diabetes duration, and HbA1c) revealed that neither CRP, IL-6, nor BMI were independently associated with QoL in the final model.
The overall regression model was not statistically significant, indicating that the measured variables collectively explained only a small fraction of QoL variance. In univariate analysis, elevated CRP and IL-6 correlated with poorer QoL in neuropathic patients, but these associations did not remain significant after adjusting for confounders. Our findings highlight the need for further research incorporating unmeasured factors, such as pain severity, depression, and medication use, to better understand determinants of QoL in this population.
2. Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-54.
3. Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33(10):2285-93.
4. Van Acker K, Bouhassira D, De Bacquer D, Weiss S, Matthys K, Raemen H, et al. Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics. Diabetes Metab. 2009;35(3):206-13.
5. Cevik AB, Olgun N. The predictors of painful diabetic neuropathy and its effect on quality of life. Pain Manag Nurs. 2022;23(3):345-52.
6. Herder C, Kannenberg JM, Huth C, Carstensen-Kirberg M, Rathmann W, Koenig W, et al. Proinflammatory cytokines predict the incidence and progression of distal sensorimotor polyneuropathy: KORA F4/FF4 study. Diabetes Care. 2017;40(4):569-76.
7. González-Clemente JM, Mauricio D, Richart C, Broch M, Caixàs A, Megia A, et al. Diabetic neuropathy is associated with activation of the TNF-alpha system in subjects with type 1 diabetes mellitus. Clin Endocrinol (Oxf). 2005;63(5):525-9.
8. Pfützner A, Forst T. High-sensitivity C-reactive protein as cardiovascular risk marker in patients with diabetes mellitus. Diabetes Technol Ther. 2006;8(1):28-36.
9. Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA. 2001;286(3):327-34.
10. Cameron NE, Eaton SE, Cotter MA, Tesfaye S. Vascular factors and metabolic interactions in the pathogenesis of diabetic neuropathy. Diabetologia. 2001;44(11):1973-88.
11. WHOQOL Group. The World Health Organization quality of life assessment (WHOQOL): development and general psychometric properties. Soc Sci Med. 1998;46(12):1569-85.
12. Kiani J, Moghimbeigi A, Azizkhani H, Kosarifard S. The prevalence and associated risk factors of peripheral diabetic neuropathy in Hamedan, Iran. Arch Iran Med. 2013;16(1):17-9.
13. Firouzabadi MD, Poopak A, Sheikhy A, Samimi S, Nakhaei P, Firouzabadi FD, et al. Glycemic profile variability: An independent risk factor for diabetic neuropathy in patients with type 2 diabetes. Prim Care Diabetes. 2023;17(1):38-42.
14. Sobhani S, Asayesh H, Sharifi F, Djalalinia S, Baradaran HR, Arzaghi SM, et al. Prevalence of diabetic peripheral neuropathy in Iran: a systematic review and meta-analysis. J Diabetes Metab Disord. 2014;13:97.
15. Davoudi M, Rezaei P, Rajaeiramsheh F, Ahmadi SM, Taheri AA. Predicting the quality of life based on pain dimensions and psychiatric symptoms in patients with painful diabetic neuropathy: a cross-sectional prevalence study in Iranian patients. Health Qual Life Outcomes. 2021;19(1):49.
16. Pop-Busui R, Ang L, Holmes C, Gallagher K, Feldman EL. Inflammation as a therapeutic target for diabetic neuropathies. Curr Diab Rep. 2016;16(3):29.
17. Sloan G, Selvarajah D, Tesfaye S. Pathogenesis, diagnosis and clinical management of diabetic sensorimotor peripheral neuropathy. Nat Rev Endocrinol. 2021;17(7):400-20.
18. Ellis A, Bennett DL. Neuroinflammation and the generation of neuropathic pain. Br J Anaesth. 2013;111(1):26-37.
19. Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444(7121):860-7.
20. Kolotkin RL, Meter K, Williams GR. Quality of life and obesity. Obes Rev. 2001;2(4):219-29.
| Files | ||
| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| C-reactive protein Diabetic Neuropathies Immunology Inflammation Interleukin-6 Quality of life Diabetes mellitus, Type 2 | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
