Relationship between Hyponatremia and Peripheral Neuropathy in Patients with Diabetes

Abstract

Objectives. Hyponatremia is a common complication of diabetes. However, the relationship between serum sodium level and diabetic peripheral neuropathy (DPN) is unknown. This study was aimed at investigating the relationship between low serum sodium level and DPN in Chinese patients with type 2 diabetes mellitus. Methods. A retrospective study was performed on 1928 patients with type 2 diabetes between 2010 and 2018. The multivariate test was used to analyze the relationship between the serum sodium level and the nerve conduction function. A restricted cubic spline was used to flexibly model and visualize the relationship between the serum sodium level and DPN, followed by logistic regression with adjustment. Results. As the serum sodium level increased, the prevalence of DPN had a reverse J-curve distribution with the serum sodium levels (69.6%, 53.7%, 49.6%, 43.9%, and 49.7%; P = 0.001 ). Significant differences existed between the serum sodium level and the motor nerve conduction velocity, sensory nerve conduction velocity, part of compound muscle action potential, and sensory nerve action potential of the participants. Compared with hyponatremia, the higher serum sodium level was a relative lower risk factor for DPN after adjusting for several potential confounders ( OR = 0.430 , 95 % CI = 0.220 – 0.841 ; OR = 0.386 , 95 % CI = 0.198 – 0.755 ; OR = 0.297 , 95 % CI = 0.152 – 0.580 ; OR = 0.376 , 95 % CI = 0.190 – 0.743 ; all P < 0.05 ). Compared with low-normal serum sodium groups, the high-normal serum sodium level was also a risk factor for DPN ( OR = 0.690 , 95 % CI = 0.526 – 0.905 , P = 0.007 ). This relationship was particularly apparent in male participants, those aged <65 years, those with a duration of diabetes of <10 years, and those with a urinary albumin − to − creatinine ratio UACR < 30 mg / g . Conclusions. Low serum sodium levels were independently associated with DPN, even within the normal range of the serum sodium. We should pay more attention to avoid the low serum sodium level in patients with type 2 diabetes mellitus.

The association between normal serum sodium levels and bone turnover in patients with type 2 diabetes

“…A 2019 review found that elevated fracture risk observed in patients with T2D may be in part a consequence of diabetic peripheral neuropathy (DPN) ( 48 ). Another cross-sectional study of Chinese patients with T2D detected an independent association between low-normal serum sodium levels and DPN incidence ( 49 ). Accordingly, low-normal serum sodium levels may contribute to muscle loss, neuropathy, and decreased bone turnover in patients with T2D.…”

A Nomogram for Predicting the Possibility of Peripheral Neuropathy in Patients with Type 2 Diabetes Mellitus

“…The diagnostic criteria of DPN varied in different studies [ 9 , 19 , 20 , 21 ]. Our study confirmed the diagnosis of DPN with nerve conduction.…”

Hyponatremia-induced worsening of trigeminal neuralgia- When the sodium plays the game

“…[ 5 ] It is also supported by studies showing changes in nerve conduction studies and F-wave latencies in hyponatremia. [ 6 7 ] To the best of our knowledge and after an exhaustive review of the literature, it is noted that worsening of trigeminal neuralgic pain due to hyponatremia has not been reported before. Our patient improved significantly within 72 h of correction in sodium levels.…”