The frequency of undiagnosed diabetes and impaired glucose tolerance in patients with idiopathic sensory neuropathy

Novella, Steven; Inzucchi, Silvio E.; Goldstein, Jonathan

doi:10.1002/mus.1137

Cited by 232 publications

(160 citation statements)

References 6 publications

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“…The present findings provide a mechanistic basis for the clinical observations of improved nerve function in type 1 diabetic patients treated with C-peptide (40,41). Clinically, painful diabetic neuropathy occurs in patients with pre-diabetes (8,9) and early in the course of diabetic neuropathy in type 2 patients (42,43). This has been linked to deficits in neurotrophic factors such as NGF and impaired insulin action with impacts on neuroeffector peptides like substance P and CGRP (36,38,44).…”

Section: Discussionmentioning

confidence: 66%

C-Peptide Reverses Nociceptive Neuropathy in Type 1 Diabetes

et al. 2006

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We examined the therapeutic effects of C-peptide on established nociceptive neuropathy in type 1 diabetic BB/Wor rats. Nociceptive nerve function, unmyelinated sural nerve fiber and dorsal root ganglion (DRG) cell morphometry, nociceptive peptide content, and the expression of neurotrophic factors and their receptors were investigated. C-peptide was administered either as a continuous subcutaneous replacement dose via osmopumps or a replacement dose given once daily by subcutaneous injection. Diabetic rats were treated from 4 to 7 months of diabetes and were compared with control and untreated diabetic rats of 4-and 7-month duration. Osmopump delivery but not subcutaneous injection improved hyperalgesia and restored the diabetes-induced reduction of unmyelinated fiber number (P < 0.01) and mean axonal size (P < 0.05) in the sural nerve. High-affinity nerve growth factor (NGF) receptor (NGFR-TrkA) expression in DRGs was significantly reduced at 4 months (P < 0.01). Insulin receptor and IGF-I receptor (IGF-IR) expressions in DRGs and NGF content in sciatic nerve were significantly decreased in 7-month diabetic rats (P < 0.01, 0.05, and 0.005, respectively). Osmopump delivery prevented the decline of NGFR-TrkA, insulin receptor (P < 0.05), and IGF-IR (P < 0.005) expressions in DRGs and improved NGF content (P < 0.05) in sciatic nerve. However, subcutaneous injection had only marginal effects on morphometric and molecular changes in diabetic rats. We conclude that C-peptide exerts beneficial therapeutic effects on diabetic nociceptive neuropathy and that optimal effects require maintenance of physiological C-peptide concentrations for a major proportion of the day. Diabetes 55: [3581][3582][3583][3584][3585][3586][3587] 2006

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Section: Discussionmentioning

confidence: 66%

C-Peptide Reverses Nociceptive Neuropathy in Type 1 Diabetes

et al. 2006

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“…It is likely that some of these patients had undiagnosed diabetes, because people who are overweight are more likely to have diabetes, and there is some evidence that undetected diabetes is associated with at least some cases of neuropathy. 41 Another pos-sibility is that neuropathy is caused in part by nerve compression or by trauma associated with weightbearing. On the other hand, neuropathy may lead to inactivity with resultant weight gain.…”

Section: Clues To Etiologiesmentioning

confidence: 99%

The Prevalence, Predictors, and Consequences of Peripheral Sensory Neuropathy in Older Patients

Mold

Vesely²,

Keyl³

et al. 2004

The Journal of the American Board of Family Medicine

212

135

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Background:The prevalence, predictors, and consequences of peripheral neuropathy in the elderly have not been well defined.Methods: Seven hundred ninety-five noninstitutionalized patients 65 years of age and older, recruited from the practices of family physicians, completed questionnaires and underwent peripheral neurologic examinations and tests of gait and balance. Variables included sociodemographic information, medical conditions, symptoms (numbness, pain, trouble with balance or walking, and restless legs), quality of life measures, ankle reflexes, position sense, vibratory sense, fine touch sensation, Tinnetti balance examination, and a 50-foot timed walk.Results: The prevalence of at least one bilateral sensory deficit rose from 26% for 65-to 74-yearolds to 54% for those 85 and older. The most common deficit was loss of ankle reflex followed by loss of fine touch. Only 40% of those with bilateral deficits reported having a disease known to cause peripheral neuropathy. Predictors of bilateral deficits included increasing age, income less than $15,000, a history of military service, increasing body mass index, self-reported history of diabetes mellitus, Vitamin B 12 deficiency or rheumatoid arthritis, and absence of a history of hypertension. Deficits were associated with numbness, pain, restless legs, trouble walking, trouble with balance, and reduced quality of life.Conclusions

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“…However, studies that have investigated the contributions of the individual components have revealed mixed results 15, 16, 17, 18, 19, 20, 21. We have recently shown that diabetes, prediabetes, and obesity are the main metabolic components associated with peripheral neuropathy in a United States obese population 22.…”

Section: Introductionmentioning

confidence: 99%

Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

Callaghan

Gao

Li³

et al. 2018

Ann Clin Transl Neurol

149

110

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ObjectiveTo determine the associations between individual metabolic syndrome (MetS) components and peripheral neuropathy in a large population‐based cohort from Pinggu, China.MethodsA cross‐sectional, randomly selected, population‐based survey of participants from Pinggu, China was performed. Metabolic phenotyping and neuropathy outcomes were performed by trained personnel. Glycemic status was defined according to the American Diabetes Association criteria, and the MetS using modified consensus criteria (body mass index instead of waist circumference). The primary peripheral neuropathy outcome was the Michigan Neuropathy Screening Instrument (MNSI) examination. Secondary outcomes were the MNSI questionnaire and monofilament testing. Multivariable models were used to assess for associations between individual MetS components and peripheral neuropathy. Tree‐based methods were used to construct a classifier for peripheral neuropathy using demographics and MetS components.ResultsThe mean (SD) age of the 4002 participants was 51.6 (11.8) and 51.0% were male; 37.2% of the population had normoglycemia, 44.0% prediabetes, and 18.9% diabetes. The prevalence of peripheral neuropathy increased with worsening glycemic status (3.25% in normoglycemia, 6.29% in prediabetes, and 15.12% in diabetes, P < 0.0001). Diabetes (odds ratio [OR] 2.60, 95% CI 1.77–3.80) and weight (OR 1.09, 95% CI 1.02–1.18) were significantly associated with peripheral neuropathy. Age, diabetes, and weight were the primary splitters in the classification tree for peripheral neuropathy.InterpretationSimilar to previous studies, diabetes and obesity are the main metabolic drivers of peripheral neuropathy. The consistency of these results reinforces the urgent need for effective interventions that target these metabolic factors to prevent and/or treat peripheral neuropathy.

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The frequency of undiagnosed diabetes and impaired glucose tolerance in patients with idiopathic sensory neuropathy

Cited by 232 publications

References 6 publications

C-Peptide Reverses Nociceptive Neuropathy in Type 1 Diabetes

C-Peptide Reverses Nociceptive Neuropathy in Type 1 Diabetes

The Prevalence, Predictors, and Consequences of Peripheral Sensory Neuropathy in Older Patients

Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

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