CONTEXT Macrovascular outcomes in type 2 diabetes have improved over recent decades. There are no equivalent distal symmetric polyneuropathy (DSPN) data. OBJECTIVE To characterize temporal changes in DSPN prevalence and incidence rates (IRs) in community-based Australians. DESIGN Observational study. SETTING Urban population. PARTICIPANTS Participants with type 2 diabetes from the Fremantle Diabetes Study Phases I (FDS1; n = 1296 recruited 1993-1996) and II (FDS2; n = 1509 recruited 2008-2011). MAIN OUTCOME MEASURES Michigan Neuropathy Screening Instrument (MNSI) clinical grading. RESULTS DSPN prevalence by eight-point MNSI was 30.8% (FDS1) and 58.9% (FDS2; P < 0.001), and by six-point (excluding foot appearance) and two-point (biothesiometry alone) MNSI was 37.5% and 35.7% (P = 0.336), and 33.8% and 38.7% (P = 0.011), respectively. Given between-phase changes in appearance assessment, eight-point MNSI data were not analyzed further. In multivariable analysis, FDS2 versus FDS1 participation was associated with six-point (odds ratio (95% CI) 0.68 (0.56, 0.83); P < 0.001) but not two-point (0.90 (0.74, 1.11); P = 0.326) MNSI DSPN prevalence. Four-year DSPN IRs (95% CI) for six-point MNSI were 13.6 (12.0, 15.4) and 17.6 (15.9, 19.4)/100 person-years in FDS1 and FDS2, respectively (IR ratio (IRR) 1.31 (1.12, 1.55); P < 0.001)), and for two-point MNSI were 13.9 (12.3, 15.8) and 7.4 (16.3, 8.6)/100 person-years; IRR 0.53 (0.43, 0.64); P < 0.001)). FDS2 versus FDS1 independently predicted incident DSPN for six-point (hazard ratio (95% CI) 1.25 (1.06, 1.48); P = 0.009) and two-point (0.42 (0.33, 0.55); P < 0.001) MNSI. CONCLUSIONS DSPN prevalence was lower or equivalent in FDS2 versus FDS1, and its incidence was greater or lower, in multivariable models depending on the MNSI features used.

中文翻译：

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2 型糖尿病远端对称性多发性神经病的时间趋势：弗里曼特尔糖尿病研究。

背景 近几十年来，2 型糖尿病的大血管结局有所改善。没有等效的远端对称性多发性神经病 (DSPN) 数据。目的 描述澳大利亚社区居民 DSPN 患病率和发病率 (IR) 随时间的变化。设计观察性研究。设置城市人口。参与者 来自弗里曼特尔糖尿病研究第一阶段（FDS1；n = 1296 于 1993-1996 年招募）和 II 期（FDS2；n = 1509 于 2008-2011 年招募）的 2 型糖尿病参与者。主要观察指标 密歇根神经病变筛查仪 (MNSI) 临床分级。结果 八点 MNSI 的 DSPN 患病率分别为 30.8%（FDS1）和 58.9%（FDS2；P < 0.001），六点（不包括足部外观）和两点（仅生物电测）MNSI 的 DSPN 患病率分别为 37.5% 和 35.7% (P = 0.336)、33.8% 和 38.7% (P = 0.011)。鉴于外观评估的阶段间变化，八点 MNSI 数据没有进一步分析。在多变量分析中，FDS2 与 FDS1 参与与六点相关（优势比 (95% CI) 0.68 (0.56, 0.83)；P < 0.001），但与两点无关（0.90 (0.74, 1.11)；P = 0.326） MNSI DSPN 患病率。FDS1 和 FDS2 中六点 MNSI 的四年 DSPN IR (95% CI) 分别为 13.6 (12.0, 15.4) 和 17.6 (15.9, 19.4)/100 人年（IR 比率 (IRR) 1.31 (1.12, 1.55)；P < 0.001))，两点 MNSI 分别为 13.9 (12.3, 15.8) 和 7.4 (16.3, 8.6)/100 人年；内部收益率0.53（0.43，0.64）；P < 0.001))。FDS2 与 FDS1 独立预测六点（风险比 (95% CI) 1.25 (1.06, 1.48)；P = 0.009）和两点（0.42 (0.33, 0.55)；P < 0.001）MNSI 的事件 DSPN。结论 与 FDS1 相比，FDS2 中的 DSPN 患病率较低或相当，并且在多变量模型中，其发生率较高或较低，具体取决于所使用的 MNSI 特征。