Neuropathies occur in much earlier stages of abnormal glucose metabolism than previously thought. Undiagnosed abnormal glucose metabolism is common among patients with chronic idiopathic axonal polyneuropathy, according to a report by physicians at the Mayo Clinic in Scottsdale, Arizona.
Lead investigator Charlene Hoffman-Snyder stated that, "The popular belief is that patients need to have an established diagnosis of diabetes for many years before they develop symptoms associated with chronic idiopathic axonal polyneuropathy,". "When no known cause is found to explain chronic idiopathic axonal polyneuropathy, further investigation for impaired glucose tolerance" is needed. "We suggest using the 2-hour oral glucose tolerance test."
Hoffman-Snyder and colleagues investigated the prevalence of undiagnosed abnormal fasting glucose metabolism in patients with chronic idiopathic axonal polyneuropathy and compared fasting plasma glucose levels with the oral glucose tolerance test for predicting abnormal fasting glucose metabolism in 100 patients with no known cause for their neuropathy.
Thirty-nine patients (39%) had abnormal fasting plasma glucose metabolism under the 2003 revised ADA criteria, the authors report, whereas 62 patients (62%) had abnormal fasting glucose metabolism using the 2-hour glucose tolerance test, the researchers report in the August issue of the Archives of Neuropathy.
Abnormal glucose metabolism occurred with similar frequency in patients with all subtypes of chronic idiopathic axonal polyneuropathy, the researchers note.
More patients with abnormal glucose metabolism (88%) than with normal glucose metabolism (76%) had neuropathic pain, the results indicate.
"Like previous studies, this investigation supports the hypothesis that distal axonal polyneuropathies may occur in much earlier stages of abnormal glucose metabolism than previously thought," the authors write.
"Our study showed value in adding the 2-hour oral glucose tolerance test to a neuropathy evaluation when impaired glucose was not found by fasting plasma glucose testing," Hoffman-Snyder said.
"We hope the study helps clinicians identify patients at high risk for impaired glucose metabolism and diabetes at an early point in these disorders to allow for reduction of their risk for long term complications," Hoffman-Snyder concluded.
Arch Neurol 2006;63:1075-1079.
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