Response to Comment on Andersen et al. Risk-Factor Trajectories Preceding Diabetic Polyneuropathy: ADDITION-Denmark. Diabetes Care 2018;41:1955–1962

We thank Rigalleau et al. (1) for their interest in our study (2) on risk-factor trajectories preceding a clinical diagnosis of diabetic polyneuropathy (DPN) 13 years after a diagnosis of type 2 diabetes by screening. Rigalleau et al. showed that in patients with long-standing diabetes, retrospectively analyzed strong declines in HbA1c levels over 6 years were associated with higher indices of DPN (vibration perception thresholds and skin autofluorescence) (1). Strong decline was defined as the quintile of patients experiencing the greatest decline in HbA1c in the 6 years preceding DPN assessments. Associations were studied in linear regression models adjusted for sex, age, diabetes duration, BMI, blood lipids, and arterial hypertension. In our study (2), we hypothesized that the velocity of risk-factor changes during the course of diabetes might reflect distinct pathophysiological mechanisms and that the effect …