Impact of impaired glucose regulation on the functions of large and small fibers of peripheral nerves
Background/aim:
This article analyzes the incidence and characteristics of peripheral neuropathy in patients with impaired glucose
regulation (IGR).
Materials and methods:
A total of 120 IGR patients and 60 healthy controls were enrolled. All subjects underwent nerve conduction
study (NCS) of large fibers and skin sympathetic response (SSR) and contact heat pain evoked potential (CHEP) testing of small fibers
with a Medtronic Keypoint machine (Medoc Ltd., Israel). IGR patients were evaluated using the Michigan Neuropathy Screening
Instrument (MNSI).
Results:
The abnormal rates (MNSI >2) in IGR patients and NCS and SSR evaluations were 18.3%, 22.5%, and 39.2%, respectively. All
abnormal NCS findings were accompanied with abnormal SSR findings. Compared with the control group, the sensory nerve action
potential wave of the posterior tibial and sural nerve was decreased in the IGR group (P = 0.01, P = 0.00), the SSR wave was reduced in
the upper and lower limbs (P = 0.002, P = 0.00), and the CHEP wave was decreased in opisthenar and shank (P = 0.00). Compared with
the control group, the CHEP wave was decreased in the shank in the normal SSR group (P < 0.05) and in the opisthenar and shank in
the normal NCS group (P < 0.05).
Conclusion:
: IGR patients have peripheral neuropathy characterized by impaired functions of large and small fibers focused on small
fiber and lower limb sensory nerves. CHEP can detect small fiber damage earlier than SSR and NCS.
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- Bansal N. Prediabetes diagnosis and treatment: A review.
World J Diabetes 2015; 6: 296-303.
- Yang WY, Lu JM, Weng JP, Jia WP, Ji LN, Xiao JZ, Shan ZY,
Liu J, Tian HM, Ji QH. Prevalence of diabetes among men and
women in China. N Engl J Med 2010; 362: 2425.
- Singleton JR, Smith AG, Bromberg MB. Increased prevalence
of impaired glucose tolerance in patients with painful sensory
neuropathy. Diabetes Care 2001; 24: 1448-1453.
- Smith AG, Ramachandran P, Tripp S, Singleton JR. Epidermal
nerve innervation in impaired glucose tolerance and diabetes-
associated neuropathy. Neurology 2001; 57: 1701-1704.
- World Health Organization. Definition and Diagnosis of
Diabetes Mellitus and Intermediate Hyperglycemia. Geneva,
Switzerland: World Health Organization; 2006.
- Chinese Medical Association, Neurology Branch.
Electromyogram standardized detection and clinical
application consensus. I. Chin J Neurol 2008; 41: 279-283 (in
Chinese).
- Chinese Medical Association, Neurology Branch.
Electromyogram standardized detection and clinical
application consensus. II. Chin J Neurol 2008; 41: 353-357 (in
Chinese).
- Zhang Z, Liu N, Xing G. Evaluation of the effect of contact
heat-induced evoked potential on diabetic small fibrosis. Chin
J Neurol 2008; 41: 653-656 (in Chinese).
- Novella S, Inzucchi S, Goldstein J. The frequency of
undiagnosed diabetes and impaired glucose tolerance in
patients with idiopathic sensory neuropathy. Muscle Nerve
2001; 24: 1229-1231.
- Kannan MA, Sarva S, Kandadai RM, Paturi VR, Jabeen SA,
Borgohain R. Prevalence of neuropathy in patients with
impaired glucose tolerance using various electrophysiological
tests. Neurol India 2014; 62: 656.
- Callaghan BC, Cheng HT, Stables CL, Smith AL, Feldman
EL. Diabetic neuropathy: clinical manifestations and current
treatments. Lancet Neurol 2012; 11: 521-534.
- Ziegler D, Rathmann W, Dickhaus T, Meisinger C, Mielck A.
Prevalence of polyneuropathy in pre-diabetes and diabetes is
associated with abdominal obesity and macroangiopathy: the
MONICA/KORA Augsburg Surveys S2 and S3. Diabetes Care
2008; 31: 464-469.
- Shen Q, Jia W, Bao Y, Lu J. A cross-sectional study of peripheral
neuropathy in diabetic and sugar-regulated people in Shanghai
community. Shanghai Med J 2009; 32: 374-378 (in Chinese).
- Green AQ, Krishnan S, Finucane FM, Rayman G. Altered
c-fiber function as an indicator of early peripheral neuropathy
in individuals with impaired glucose tolerance. Diabetes Care
2010; 33: 174-176.
- Isak B, Oflazo B, Tanridag T, Yitmen I, Us O. Evaluation of
peripheral and autonomic neuropathy among patients with
newly diagnosed impaired glucose tolerance. Diabetes-Metab
Res 2008; 24: 563-569.
- Liu N, Zhang ZC, Li Q, Zhang J, Zhu J. The roles of the contact
heat evoked potential in evaluating the small nerve fibers of
cranial and spinal in elderly diabetic patients. Chin J Geriatr
2013; 32: 507-509 (in Chinese with abstract in English).
- Wong MC, Chung JWY. Feasibility of contact heat evoked
potentials for detection of diabetic neuropathy. Muscle Nerve
2011; 44: 902.
- Mohseni S, Badii M, Kylhammar A, Thomsen NOB, Eriksson
KF, Malik RA, Rosén I, Dahlin LB. Longitudinal study of
neuropathy, microangiopathy, and autophagy in sural nerve:
implications for diabetic neuropathy. Brain Behav 2017; 7.
- Papanas N, Ziegler D. Prediabetic neuropathy: does it exist?
Current Diabetes Reports 2012; 12: 376-383.
- Li YF, Huang XS. Mechanism of prediabetes peripheral
neuropathy and progress in treatment. Chin J Neurol 2013; 46:
421-423 (in Chinese).