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New risk tool aims to prevent neuropathy

By Emma Wilkinson

UK researchers are developing a risk score to identify patients with diabetes who are most vulnerable to developing 'clinically evident' neuropathy.

The researchers ­ the team behind the landmark UKPDS trial ­ combined risk estimates on seven key signs of neuropathy to create an algorithm accurately predicting those most in need of preventive treatment.

The research was presented at the Diabetes UK annual conference in Birmingham this week alongside a second study finding patients with neuropathy had often missed out on intensive treatment to lower their cardiovascular risk.

Researchers quantified the role of risk factors such as macroalbuminuria, blood sugar and BMI, while excluding several others, surprisingly finding that neither ethnicity nor waist circumference predicted risk. (see box).

The findings will form a stand-alone risk score and be added to previously developed tools on retinopathy and nephropathy to create a microvascular risk calculator.

Study leader Professor Rury Holman, professor of diabetic medicine at the University of Oxford and director of the Diabetes Trial Unit, said there had never before been an attempt to identify people at risk of microvascular disease.

'Treatments are being developed for early use to prevent or slow progression. This is about identifying people most at risk so treatments can be used appropriately,' he said.

The score would be applicable to white, south Asian and Afro-Caribbean patients, he said.

'We are talking to the NHS to see about this being added to GP computer databases as some GPs have done with our heart disease risk engine,' he added.

Dr Brian Karet, a GP in Bradford and diabetes lead for North Bradford PCT, said: 'One of the problems with the QOF is the parameters are not particularly high so there's always a temptation to get the target and then don't do anything else. But with microvascular disease that's not good enough. This would give us a further tool to help us focus our attention on people who have an extra need.'

Researchers analysed data from more than 1,800 patients aged between 25 and 65 who took part in the UKPDS study between 1977 and 1991.

The microvascular risk cal-culator will be available online later this year at:

Significant factors in neuropathy risk

· Age at diagnosis

(per year) 1.06

· Female 0.63

· HbA1C (per 1 per cent) 1.14

· BMI (per kg/m2) 1.06

· Height (per cm) 1.03

· Macroalbuminuria 2.48

· Duration of diabetes

(per year) 1.08

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