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Peripheral Neuropathy May Precede Diabetes Diagnosis

Components of metabolic syndrome associated with peripheral neuropathy in prediabetic patients…

Peripheral neuropathy is a common complication related to diabetes, and a major reason for a decreased quality of life in diabetes patients. There are contradicting studies estimating the prevalence of peripheral neuropathy in new-onset diabetes. Peripheral neuropathy in prediabetic patients is not well studied, but emerging evidence suggests that components of metabolic syndrome, specifically abdominal obesity and dyslipidemia, are associated with peripheral neuropathy in prediabetic patients. The objective of this study was to describe the prevalence of peripheral neuropathy and nerve dysfunction according to glucose tolerance and metabolic syndrome status and examine how these conditions was associated with neurological changes in individuals at risk for type 2 diabetes.

Researchers studied data on 467 individuals in the longitudinal Prospective Metabolism and Islet Cell Evaluation (PROMISE) cohort. The participants were chosen based on the presence of one or more risk factors for type 2 diabetes, including, obesity, hypertension, familial history, and history of gestational diabetes. Patients who developed diabetes after the baseline and before the three year follow up were excluded. Peripheral neuropathy was measured using the Michigan Neuropathy Screening Instrument (MNSI) (>2) and the measure of nerve dysfunction was quantified using a neurothesiometer to test the vibration perception threshold (VPT). The measure of metabolic syndrome was defined using the International Diabetes Federation and American Heart Association harmonized criteria.

Of the 467 patients who made it to the three year follow-up examination, 344 had normal glycemic control, 101 had prediabetes, and 22 had new onset diabetes. The prevalence of peripheral neuropathy was 29% for those with normal glycemic control, 49% for those with prediabetes, and 50% with new onset diabetes. These numbers showed a significant difference between the prevalence of neuropathy across categories of glucose tolerance. The average VPT was 6.5 for those with normal glycemic control, 7.9 for those with prediabetes, and 7.6 for those with new onset diabetes.

Individuals with prediabetes had similar risks of peripheral neuropathy and severity of nerve dysfunction as those with new onset diabetes. Prediabetes was associated with both the presence of peripheral neuropathy and the severity of nerve dysfunction, not metabolic syndrome.

The researchers concluded that peripheral neuropathy and nerve dysfunction could already be present without a diagnosis of diabetes. Medical professionals must be vigilant in testing for nerve dysfunction in patients with prediabetes, metabolic syndrome, and diabetes.

Practice Pearls:

  • Patients, both young and old, should be educated of the signs and symptoms of peripheral neuropathy, as well as made clear of their risks of developing it.
  • Early detections and intervention is important in patients with prediabetes or metabolic syndrome.
  • Physicians should perform more frequent foot examinations on all patients with several risk factors for diabetes.

Lee CC. Peripheral Neuropathy and Nerve Dysfunction in Individuals at High Risk for Type 2 Diabetes: The PROMISE Cohort. Diabetes Care. May 2015; 38(5) 793-800.