Objectives: To investigate influence of metabolic syndrome on vibration perception threshold in first-degree relatives of type 2 diabetes who were not diagnosed with diabets before. Material and Methods: First-degree relatives of type 2 diabetes at the age of 40 - 60 s who had not been diagnosed with diabetes before were enrolled. Height, weight, waist circumference, hip circumference, blood pressure (systolic and diastolic blood pressure), body fat percentage, fasting plasma lipid, fasting plasma glucose, 2-hour blood glucose after 75 g oral glucose and vibration perception threshold were measured. Results: 58 subjects were diagnosed with the level of vibration perception threshold ≥ 16 V. Vibration perception threshold in the metabolic syndrome group was significantly higher than that in the non-metabolic syndrome group ( P < 0.05). Vibration perception threshold increased with the increase of metabolic syndrome component. The group with ≥3 components of metabolic syndrome had a significantly higher level of vibration perception, as compared with that of group with 0 component, group with 1 component of metabolic syndrome ( p < 0.01). Group with 2 components of metabolic syndrome had a significantly higher level of vibration perception threshold when comparing with group with 0 component ( P < 0.05). Vibration perception threshold was positively correlated with weight, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, fasting plasma glucose and 2-hour blood glucose. Stepwise multiple regression analysis showed that there was a positive correlation between waist circumference, systolic blood pressure and vibration perception threshold. Conclusion: Some first-degree relatives of type 2 diabetes who have not been diagnosed with diabetes have high risk of peripheral neuropathy, especially those with metabolic syndrome. Waist circumference and blood pressure are the main factors affecting Vibration perception threshold levels. Early detection of vibration perception threshold should be performed in first-degree relatives of type 2 diabetes with metabolic syndrome. Waist circumference and blood pressure may be important risk factors of peripheral neuropathy for them.
Peripheral neuropathy (PN) is a common complication of diabetes whose onset is always insidious. When clinical symptoms appear, peripheral nerves have undergone irreversible segmental demyelination and other pathological changes, such as foot ulcers, ulceration and necrosis necessitating limb amputations, which seriously affect the therapeutic effect and life quality. The vibration perception threshold (VPT) in lower extremity is a sensitive predictor of distal symmetric peripheral neuropathy, whose sensitivity and specificity are high, and its sensitivity increases with age [
We performed an observational study in the first-degree relatives of T2DM treated in our department from September 2013 to September 2014, and 405 FDR at the age of 40 - 60 s who had not been diagnosed with diabetes before were enrolled. The exclusion criteria were: with peripheral neuropathy caused by genetics, drugs, surgery, trauma and other diseases, recent trauma, infection, surgery and other stress condition, accompanied by liver and kidney disease, with cancer.
1) Questionnaires were used to collect all participants, age, medical history, and smoking and drinking habits. Physical examination included measurements of height, weight, waist circumference (WC), hip circumference (HC) and blood pressure. Height was measured after taking off the shoes. Weight was measured after taking off the coat, shoes and taking out the weight in the pocket. A single examiner used a standard measuring tape to measure WC twice at 1.0 cm horizontally above the navel of the participant who was standing and wearing light-weight clothing and after inhalation and exhalation. HC was horizontally measured in the maximum hip circumference. Blood pressure (systolic pressure (SBP), diastolic pressure (diastolic pressure (DBP)) was measured three times for all participants who were seated, after a 5-min rest, by use of an electronic sphygmomanometer (Omron, HEM-770AFuzzy, Kyoto, Japan). The percentage of body fat (Fat %) was measured by bioelectrical impedance method.
2) Overnight fasting blood samples were collected and stored at −20˚C for measuring fasting glucose (FPG), triglycerides (TG), serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood uric acid (UA), creatinine (Cr), urea nitrogen (BUN)) by use of an automatic biochemical analyzer (Beckmann DXC800, USA), HbA1c (high pressure liquid phase method) and 2 hours after oral administration of 75 g of glucose were also measured.
3) Vibration perception thresholds were measured at multiple frequencies using a Digital Vibration Sensing Threshold Checker (Sensiometer A, China) in accordance with previously described technique [
Modified criteria of the “International Diabetes Federation (IDF) to diagnose MetS in adults” [
All subjects were equally divided into three groups by the vibrations thresholds [i.e. VPT6.05 V - 10.20 V (group 1), VPT 10.25 V - 12.45 V (group 2), VPT 12.50 V - 26.85 V (group 3)]. All subjects were also divided by metabolic syndrome components (i.e. MS group and non-MS group; group with 0 MS component, group with 1MS component, group with 2 MS components, group with ≥3 MS components).Results were presented as mean ± SD. Independent t-tests and x2were performed for comparisons of general characteristics of participants between the two groups. Multiple groups were compared using analysis of variance of completely random design data. Comparison between each group was performed using the least significant difference method (LSD). Pearson correlation analysis was performed for correlation analysis and multiple linear stepwise regression analysis were performed for multivariate analysis. Statistical significance was defined as P value < 0.05.
Of all subjects, 186 (45.9%) with hypercholesterolemia, 118 (29.1%) with hypertriglyceridemia, 106 (26.2%) with high LDL-Cemia, and 54 with low HDL-Cemia (13.3%),118 with hypertension (29.1%), 58 with diabetes (14.3%), 48 with impaired fasting glucose (11.9%), 91 with impaired glucose tolerance (22.5%), 57 with VPT 16 - 25 V (14.07%),and 1with VPT > 25 V (0.25%).
The correlation between VPT on the left and right sides was good (r = 0.911,P < 0.05), so the average VPT on both sides was used for analysis. After being divided into three equal divisions according to VPT levels, the age, proportion of patients with dyslipidemia, proportion of patients with hypertension (respectively 23.7%, 28.2%, 30.4%), proportion of patients with diabetes (9.6%, 13.3%, 20.0%), proportion of smokers, proportion of drinking, BMI, Fat%, waist circumference, hip circumference, UA, Cr, CHO, LDL-C, FPG, 2h-PG, HbA1c, SBP, and DBP increased with the increase of VPT levels. There were significant differences in age, proportion of patients with hypertension, proportion of patients with diabetes, waist circumference, HbA1c, CHO, SBP and DBP (P < 0.05) (
Compared with non-MS group, the MS patients had significantly higher age and VPT (P < 0.05). There was a significant metabolic disturbance in the MS group (
Comparison of VPT levels in patients with different metabolic components with the increase of metabolic components, VPT levels gradually increased, and there was a significant difference between MS0 group and MS1 group, as well as MS1 group and MS ≥ 3 group (P < 0.01). There was also significant difference between MS0 group and MS2 group (P < 0.05) (
Group | Ia | IIb | IIIc | F or x2 | P-value |
---|---|---|---|---|---|
Cases (Male/Female) | 135 (47/88) | 135 (52/83) | 135 (51/84) | 0.444 | >0.05 |
Age (years) | 47.43 ± 5.82 | 49.12 ± 5.79 | 52.54 ± 5.64 | 9.56 | <0.05 |
BMI (Kg/m2) | 24.3 ± 3.0 | 24.6 ± 2.6 | 24.9 ± 2.6 | 1.28 | >0.05 |
WC (cm) | 81.58 ± 9.23 | 83.19 ± 8.32 | 84.41 ± 8.98 | 3.388 | <0.05 |
HC (cm) | 91.30 ± 6.22 | 91.56 ± 5.77 | 92.63 ± 5.92 | 1.859 | >0.05 |
Fat (%) | 31.78 ± 6.77 | 32.00 ± 6.51 | 32.26 ± 6.62 | 0.489 | >0.05 |
Smoking (Y/N) | 22/113 | 30/105 | 36/99 | 4.287 | >0.05 |
Drinking (Y/N) | 23/112 | 19/116 | 22/113 | 0.481 | >0.05 |
ALT (U/L) | 27.99 ± 1.61 | 24.94 ± 1.56 | 25.38 ± 1.64 | 1.056 | >0.05 |
AST (U/L) | 23.99 ± 3.78 | 22.05 ± 3.71 | 23.58 ± 3.53 | 2.522 | >0.05 |
UA (umol/l) | 264.18 ± 42.13 | 272.27 ± 35.95 | 275.25 ± 41.29 | 0.347 | >0.05 |
Cr (umol/l) | 59.22 ± 12.58 | 60.01 ± 14.10 | 60.46 ± 12.90 | 0.688 | >0.05 |
BUN (mmol/l) | 4.58 ± 1.13 | 4.54 ± 1.26 | 4.77 ± 1.08 | 0.330 | >0.05 |
SBP (mmHg) | 122.39 ± 15.98 | 124.51 ± 18.28 | 128.15 ± 17.13 | 3.813 | <0.05 |
DBP (mmHg) | 79.50 ± 9.49 | 80.76 ± 11.63 | 82.17 ± 10.88 | 2.06 | >0.05 |
CHO (mmol/l) | 5.09 ± 1.06 | 5.15 ± 1.04 | 5.23 ± 1.02 | 9.56 | <0.05 |
TG (mmol/l) | 1.65 ± 0.14 | 1.55 ± 0.19 | 1.56 ± 0.18 | 1.453 | >0.05 |
HDL (mmol/l) | 1.28 ± 0.23 | 1.29 ± 0.24 | 1.28 ± 0.24 | 1.003 | >0.05 |
LDL (mmol/l) | 2.94 ± 0.72 | 2.95 ± 0.77 | 3.06 ± 0.71 | 1.114 | >0.05 |
FPG (mmol/l) | 5.53 ± 1.37 | 5.62 ± 1.29 | 5.88 ± 1.25 | 6.062 | <0.05 |
2h-PG (mmol/l) | 7.64 ± 1.66 | 7.65 ± 1.60 | 8.71 ± 2.18 | 3.399 | <0.05 |
HbA 1c (%) | 5.60 ± 0.89 | 5.72 ± 0.96 | 5.88 ± 0.99 | 3.215 | <0.05 |
a: Group I: VPT 6.05 V - 10.20 V; b: Group II: VPT 10.25 V - 12.45 V; c: Group III VPT 12.50 V - 26.85 V.
Group | MS group | Non-MS group | x2 or t | P-value |
---|---|---|---|---|
Cases (Male/Female) | 120 (36/84) | 285 (114/171) | 3.205 | >0.05 |
Age (years) | 51.10 ± 5.27 | 49.13 ± 6.27 | 2.93 | <0.01 |
Weight (Kg) | 68.54 ± 10.98 | 61.70 ± 10.44 | 5.92 | <0.01 |
BMI (Kg/m2) | 26.3 ± 3.0 | 23.9 ± 1.7 | 6.99 | <0.01 |
wc (cm) | 89.63 ± 7.30 | 80.23 ± 7.90 | 11.00 | <0.01 |
hc (cm) | 94.85 ± 6.59 | 90.53 ± 5.21 | 6.36 | <0.01 |
HDL (mmol/l) | 1.24 ± 0.26 | 1.30 ± 0.22 | -2.17 | <0.05 |
CHO (mmol/l) | 5.24 ± 1.26 | 5.12 ± 0.94 | 0.90 | >0.05 |
FPG (mmol/l) | 5.94 ± 1.29 | 5.53 ± 1.36 | 3.40 | <0.01 |
2h-PG (mmol/l) | 9.24 ± 2.49 | 7.48 ± 1.75 | 3.83 | <0.01 |
HbA 1C (%) | 5.95 ± 0.97 | 5.64 ± 0.94 | 3.042 | <0.01 |
ALT (U/L) | 27.94 ± 5.38 | 28.31 ± 4.32 | 0.154 | >0.05 |
AST (U/L) | 23.21 ± 5.21 | 22.91 ± 4.45 | 0.301 | >0.05 |
Cr (umol/l) | 57.61 ± 11.57 | 60.68 ± 14.03 | 1.568 | >0.05 |
UA (umol/l) | 287.82 ± 45.98 | 271.51 ± 41.89 | 1.803 | >0.05 |
Fat (%) | 35.49 ± 5.58 | 30.62 ± 6.50 | 6.614 | <0.01 |
VPT (V) | 12.19 ± 3.56 | 11.38 ± 2.93 | 2.416 | <0.05 |
Taking VPT as the dependent variable, BMI, waist circumference, hip circumference, SBP, DBP, TG, LDL, HDL, CHO, FPG, 2h-PG, HbA1c, and Fat% as independent variables, Pearson correlation analysis was performed. It was showed that there was a positive correlation between VPT and weight, BMI, waist circumference, SBP, DBP, FPG and 2h-PG. The difference was statistically significant (
Multiple stepwise regression analysis showed that waist circumference and systolic pressure were positively correlated with VPT (r = 0.182, P < 0.01; r = 0.211, P < 0.01), and the regression equation was:
Y = 5.191 + 0.049 X 1 + 0.019 X 2
Symptomatic pain and paresthesia are clinically present in PN, and approximately 50% of patients with PN are asymptomatic, wihch may leading to non-sensory damage to foot and is a major risk factor for foot ulceration, infections, and gangrene [
r | P-value | |
---|---|---|
BMI | 0.106 | 0.029 |
WC | 0.131 | 0.010 |
HC | 0.091 | 0.070 |
SBP | 0.136 | 0.007 |
DBP | 0.191 | 0.043 |
TG | 0.043 | 0.370 |
LDL | 0.090 | 0.062 |
HDL | 0.022 | 0.644 |
CHO | 0.075 | 0.120 |
FPG | 0.206 | 0.000 |
2h-PG | 0.117 | 0.018 |
HbA 1c | 0.132 | 0.008 |
Fat% | 0.094 | 0.078 |
operation is simple, fast, painless, and well tolerated which is not affected by the temperature of the ankles and limbs. There is a standardized test algorithm, which is not only better than using a tuning fork. The sensory threshold of vibration is simple and accurate, and it can detect the trend of sensory changes in the nervous system. It is a popular method in PN assessment and research [
There have been many studies in the past to investigate the peripheral neuropathy in diabetic patients. However, studies have suggested that blood glucose control does not delay the development of PN in type 2 diabetic patients with peripheral neuropathy that has already occurred. [
Type 2 diabetes is a multifactorial disease associated with both genetic and environmental factors. FDR has a similar genetic background and similar living environment with patients with type 2 diabetes, thus the incidence of diabetes is significantly increased. Even without diabetes, FDR has significantly higher blood glucose and BMI than non-FDR [
The exact mechanism of the relationship between various metabolic factors and PN is not yet clear. It may be related to the effects on blood vessels and nerves. Hypertension can cause hyaline degeneration of small arteries and necrosis of small blood vessels, accelerating the hardening of small arteries and damage of the vascular endothelium [
Our study shows that some of the FDRs that have not diagnosed with diabetes have a high risk of DN, especially in patients with MS. Waist circumference and blood pressure are main factors affecting VPT. It suggests that in FDR, MS patients are more likely to have peripheral neuropathy. Early detection of VPT should be performed in these people. Meanwhile, waist circumference and blood pressure may be important risk factors for peripheral neuropathy (PN) in FDRs.
The data used to support the findings of this study are available from the corresponding author upon request.
This study was approved and agreed by the Ethics Committee.
The authors declare that there is no conflict of interest regarding the publication of this paper.
Yang, L.L., Yun, P., Liu, D., Zhang, Z., Yu, X.M. and Li, F.P. (2021) Influence of Metabolic Syndrome on Vibration Perception Threshold in First-Degree Relatives of Type 2 Diabetes Mellitus. Yangtze Medicine, 5, 43-53. https://doi.org/10.4236/ym.2021.51005