Insulin resistance is independently associated with peripheral and autonomic neuropathy in Korean type 2 diabetic patients

Abstract

In addition to chronic hyperglycemia, insulin resistance itself has been proposed to cause a diabetic neuropathy. We evaluated the role of insulin resistance in the pathogenesis of peripheral and autonomic neuropathy in patients with type 2 diabetes. Eighty-six patients with type 2 diabetes were evaluated for the anthropometric and biochemical profiles, and Kitt value was calculated from insulin tolerance test to assess the insulin resistance. Various autonomic function tests, nerve conduction velocity, and quantitative sensory tests were performed to assess autonomic and peripheral neuropathy. In univariate analysis, both autonomic and peripheral neuropathy were significantly associated with glycemic exposure index (GE index), HDL-cholesterol, duration of DM, and Kitt value. In stepwise linear regression analysis, GE index was an independent predictor of autonomic and peripheral neuropathy (β = 0.643, P < 0.001; β = 0.207, P = 0.013, respectively), and Kitt value was also an independent factor for the autonomic and peripheral neuropathy (β = - 0.306, P < 0.001; β = - 0.329, P < 0.001, respectively). Low HDL-cholesterol increased the odds ratio for peripheral neuropathy. Insulin resistance is independently associated with peripheral and autonomic neuropathy in Korean Type 2 diabetic patients along with hyperglycemia and HDL-cholesterol.

Risk Factors and Comorbidities in Diabetic Neuropathy: An Update 2015

“…Additional risk factors include height, smoking, insulin resistance, hypoinsulinemia, prediabetes, and several others [1,15,21,64]. Of these, hyperglycemia, hypertension, dyslipidemia, obesity, prediabetes, and metabolic syndrome are modifiable, providing some opportunity to prevent and/or reduce the progression of DSPN.…”

“…A study in 86 T2D patients has identified insulin resistance as a major independent risk factor of DSPN (p < 0.001) [64]. Of these patients, 48 were followed for 6 years [58].…”

“…Patients with DSPN frequently suffer from diabetic autonomic neuropathy (DAN) as well; approximately 50% have concomitant CAN [1,64,[129][130][131][132]. The co-existence of DSPN and DAN increases with progressive diabetes duration and poor metabolic control, although this varies with the cohort studied and method of assessment [132].…”

Non-invasive Screening of Diabetes Risk by Assessing Abnormalities of Sudomotor Function

“…Müller G et al Sweat Dysfunction and Screening of Diabetes Risk … Exp Clin Endocrinol Diabetes 2015; 123: [34][35][36][37][38] effi cacy, are unfortunately limited in the practical sense. An added value to clinical practice would be to have a fast, non-invasive, and reproducible diagnostic method to effi ciently identify those with increased diabetes risk.…”

“…Recent studies have shown a link in patients with pre-diabetes between more severe stages of insulin resistance and peripheral autonomic nerve fi ber impairment [ 15 , 34 ] and also and association in childhood obesity were increased BMI and elevated HOMA-IR is associated with impaired autonomic function [ 35 ] . In addition a recent study evidenced that insulin resistance itself was independently associated with peripheral and autonomic neuropathy [ 36 ] . Impairment of these autonomic sympathetic C nerve fi bers innervating sweat glands leads to sudomotor dysfunction.…”