Does prediabetes cause small fiber sensory polyneuropathy? Does it matter?

Kassardjian, Charles D.; Davies, Julian; Carter, Rickey E.; Dyck, Peter J.

doi:10.1016/j.jns.2015.05.026

Cited by 11 publications

(15 citation statements)

References 29 publications

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“…Measures of glycemic control including fasting glucose, 2‐h glucose on an oGTT, and HbA1C were all significantly higher in PD vs NG; thus, the lack of significant differences in rates of SFN, skin biopsy abnormality, or IENFD between those with PD and NG are not explainable on the basis of only minimal differences in glycemic measures. The results of our study are in line with four previous studies that did not support an association between PD and SFN.…”

Section: Discussionsupporting

confidence: 93%

“…However, some mild degree of distal leg IENF loss may be tolerated, before functional impairments (eg, altered sensory thresholds) emerge. These findings with respect to MetS components, are in accordance with some prior studies using abnormal skin biopsy as a singular diagnostic marker for SFN, which found correlations between SFN and either PD or attributes of the metabolic syndrome such as TRIG, whereas studies using functional measures of small fiber nerves such as autonomic function or QST did not find such associations.…”

Section: Discussionsupporting

confidence: 91%

“…Prediabetes (PD) or glucose intolerance has been considered a potential cause of SFN. However, multiple studies have come to different conclusions regarding an association between PD and otherwise idiopathic peripheral neuropathy . The seemingly contradictory conclusions of these studies regarding an association between PD and SFN may stem in part from use of variable case definitions for SFN, and a fragmentary assessment of PD.…”

Section: Introductionmentioning

confidence: 99%

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Prediabetes, diabetes, metabolic syndrome, and small fiber neuropathy

et al. 2020

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Introduction This study was conducted to evaluate the association between prediabetes (PD), elements of the metabolic syndrome (MetS), and small fiber neuropathy (SFN). Methods A total of 268 patients with SFN symptoms and normal electrophysiology underwent tests to assess small fibers. SFN was diagnosed based on abnormality of at least two among intraepidermal nerve fiber density (IEFND), quantitative sensory testing, and quantitative sudomotor axon reflex testing. Results There was no difference in IENFD or abnormal skin biopsy frequency between PD and normoglycemia (NG). However, IENFD was lower in people with diabetes mellitus (DM) than in those with NG. An association between HbA1C and IENFD was observed only if DM patients were included. Attributes of the MetS were more common in those with an abnormal skin biopsy but not among those with autonomic dysfunction or meeting SFN criteria. Discussion DM, but not PD alone, is associated with SFN. Other MetS elements appear to preferentially impact small fiber structure over function.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Prediabetes, diabetes, metabolic syndrome, and small fiber neuropathy

et al. 2020

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“…showed that 56% of patients with idiopathic neuropathy had abnormal OGTT results, and the neuropathy associated with impaired glucose tolerance (IGT) is milder than the neuropathy associated with diabetes mellitus (DM) . However, Kassardjian et al . and Pourhamidi et al .…”

Section: Resultsmentioning

confidence: 99%

Small fiber neuropathy: Getting bigger!

2016

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Etiological and clinical heterogeneity of small fiber neuropathy (SFN) precludes a unifying approach and necessitates reliance on recognizable clinical syndromes. Symptoms of SFN arise from dysfunction in nociception, temperature, and autonomic modalities. This review focuses on SFN involving nociception and temperature, examining epidemiology, etiology, clinical presentation, diagnosis, pathophysiology, and management. Prevalence of SFN is 52.95 per 100,000 population, and diabetes and idiopathic are the most common etiologies. Dysesthesia, allodynia, pain, burning, and coldness sensations frequently present in a length-dependent pattern. Additional autonomic features in gastrointestinal, urinary, or cardiovascular systems are frequent but poorly objectified. SFN is diagnosed by intraepidermal nerve fiber density and quantitative sensory and autonomic tests in combination with normal nerve conduction. Pathophysiological understanding centers on sodium channel dysfunction, and genetic forms are beginning to be understood. Treatment is directed at the underlying etiology supported by symptomatic treatment using antidepressants and anticonvulsants. Little is known about long-term outcomes, and systematic cohort studies are needed.

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“…It is thought that IGT associated neuropathy mainly affects the small nerve fibers, perhaps explaining why some researchers have found no correlation between IGT and large fiber polyneuropathy60666768 and others have questioned the association between IGT and SFN 6469. Such incongruent findings across studies are probably the result of differences in definitions of polyneuropathy (including the use of symptoms or intraepidermal nerve fiber density (IENFD)), degrees of surveillance, and polyneuropathy endpoints 69. Nonetheless, the identification of prediabetes is of utmost importance because 50% of patients with prediabetes ultimately develop type 2 diabetes,70 and reducing the risk of conversion to diabetes decreases the risk of developing polyneuropathy.…”

Section: Differential Diagnosis Of Small Fiber Neuropathiesmentioning

confidence: 99%

Diagnosis and management of sensory polyneuropathy

Gwathmey

Pearson

2019

BMJ

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Sensory polyneuropathies, which are caused by dysfunction of peripheral sensory nerve fibers, are a heterogeneous group of disorders that range from the common diabetic neuropathy to the rare sensory neuronopathies. The presenting symptoms, acuity, time course, severity, and subsequent morbidity vary and depend on the type of fiber that is affected and the underlying cause. Damage to small thinly myelinated and unmyelinated nerve fibers results in neuropathic pain, whereas damage to large myelinated sensory afferents results in proprioceptive deficits and ataxia. The causes of these disorders are diverse and include metabolic, toxic, infectious, inflammatory, autoimmune, and genetic conditions. Idiopathic sensory polyneuropathies are common although they should be considered a diagnosis of exclusion. The diagnostic evaluation involves electrophysiologic testing including nerve conduction studies, histopathologic analysis of nerve tissue, serum studies, and sometimes autonomic testing and cerebrospinal fluid analysis. The treatment of these diseases depends on the underlying cause and may include immunotherapy, mitigation of risk factors, symptomatic treatment, and gene therapy, such as the recently developed RNA interference and antisense oligonucleotide therapies for transthyretin familial amyloid polyneuropathy. Many of these disorders have no directed treatment, in which case management remains symptomatic and supportive. More research is needed into the underlying pathophysiology of nerve damage in these polyneuropathies to guide advances in treatment.

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Does prediabetes cause small fiber sensory polyneuropathy? Does it matter?

Cited by 11 publications

References 29 publications

Prediabetes, diabetes, metabolic syndrome, and small fiber neuropathy

Prediabetes, diabetes, metabolic syndrome, and small fiber neuropathy

Small fiber neuropathy: Getting bigger!

Diagnosis and management of sensory polyneuropathy

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