Association Between HbA1c Levels and Diabetic Peripheral Neuropathy: A Case-Control Study of Patients with Type 2 Diabetes Using Claims Data

Prevalence and risk factors of painful diabetic neuropathy: A systematic review and meta-analysis

Painful diabetes-related peripheral neuropathy (PDPN) is a common and debilitating complication of diabetes, contributing significantly to morbidity and healthcare costs. This systematic review and meta-analysis aim to determine the global prevalence of PDPN among individuals with diabetic peripheral neuropathy (DPN) and to identify associated risk factors. A comprehensive search of four English and three Chinese databases was conducted for observational studies on PDPN prevalence up to June 22, 2024. Of the 41 studies included, the pooled global prevalence of PDPN was 46.7 % (95 % CI, 41.8-51.7). In subgroup analysis, significant statistical differences were observed in prevalence estimates between different diagnostic methods for neuropathic pain, with neuropathic-specific pain scales indicating higher rates (P = 0.03). Studies with mean diabetes duration of less than 10 years or more than 15 years reported higher prevalence (P < 0.01). Significant risk factors for PDPN included older age (OR = 1.02, 95 % CI, 1.01-1.04), female gender (OR = 1.58, 95 % CI, 1.19-2.11), BMI ≥ 30 kg/m2 (OR = 1.62, 95 % CI, 1.43-1.83), longer diabetes duration (OR = 1.05, 95 % CI, 1.01-1.08), and nephropathy (OR = 1.32, 95 % CI, 1.24-1.40). Targeted screening and standardized diagnostic tools are urgently needed to enhance PDPN management and mitigate its burden globally.

Nerve Conduction Study, Sympathetic Skin Response Test, and Demographic Correlates in Type 2 Diabetes Mellitus Patients

OBJECTIVE

To comprehensively assess the relationship between nerve conduction study (NCS), sympathetic skin response (SSR), and demographic factors in patients with diabetic neuropathy, exploring potential risk factors and mechanisms.

METHODS

A retrospective study (N=184) included patients diagnosed with type 2 diabetes mellitus undergoing NCS and SSR. Demographic, clinical, and laboratory data were analyzed. Patients were categorized by diabetic peripheral neuropathy (DPN) and SSR stages for comparative analysis.

RESULTS

HbA1c levels correlated with DPN progression. SSR stages exhibited age-related differences. Height correlated with DPN but not SSR stages. Body mass index showed no significant differences.

CONCLUSION

While DPN progression correlated with glycemic control and duration of diabetes, SSR was influenced by age. Unexpectedly, cholesterol levels remained within the normal range, challenging established concepts. Understanding these relationships is crucial for interpreting test results and developing targeted interventions for diabetic neuropathy.

Retrospective Cohort Study Comparing Pharmacist-Primary Care Provider Collaborative Practice to Usual Care for Diabetes Control in a Family Medicine Clinic

This retrospective cohort study examined whether patients (n = 122) with either type 1 or type 2 diabetes who participated in a pharmacist-primary care provider collaborative practice model (PPCPM) for diabetes management experienced greater decline in their A1C compared with patients who received usual care during the same period (June 2021 to June 2022). PPCPM patients experienced an A1C decline of ∼0.22% per month, whereas the mean A1C of patients in usual care did not change over the study period. Although participating in PPCPM was associated with a decline in A1C, number of visits with the pharmacist was not associated with either initial A1C or change in A1C for people in PPCPM.

Diabetic small fiber neuropathy: clinical and electrophysiological study

Background

Diabetic neuropathy is diagnosed late due to lack of easy and readily available biomarkers; early identification can prompt proper interventions before the irreversible large fiber damage. The aim of this study is to assess small fiber dysfunction using cutaneous silent period (CSP) and sympathetic skin response (SSR) tests in patients with diabetic small fiber neuropathy (SFN) and compare results with clinical, neuropathy severity and quality of life measures. A total of 45 subjects were classified into: Group I: diabetic patients with pure SFN, group II: diabetic patients with mixed fiber neuropathy, and group III: healthy subjects. All underwent evaluation by anthropometric, clinical and quality of life measures, electrophysiological evaluation by CSP and SSR and distal leg skin biopsy.

Results

Age and gender distribution did not significantly differ between the studied groups. Both patients’ groups showed comparable poor quality of life in relation to healthy subjects. CSP onset latencies and SSR amplitudes significantly correlated with studied clinical and severity measures, but neither correlate with each other in diabetic pure SFN patients. Both CSP and SSR measures were specific in diagnosing diabetic pure SFN, but mostly with poor sensitivity. Combining sensitivities of different CSP and SSR measures improved the overall sensitivity to early screen for SFN in diabetic patients.

Conclusions

Both CSP and SSR may have the potential to early detect diabetic pure SFN. Suspected diabetic patients with SFN should be separately screened for both somatosensory and sudomotor/autonomic affection.

Lower Free Triiodothyronine is a Risk Factor of Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes Mellitus

PURPOSE

Our objective is to investigate the potential involvement of free triiodothyronine (FT3), a key bioactive compound found in thyroid hormones (THs) in the pathogenesis of diabetic peripheral neuropathy (DPN) in patients diagnosed with type 2 diabetes mellitus (T2DM).

PATIENTS AND METHODS

A total of 121 T2DM patients were recruited. And then, they were divided into the control group and the DPN group. Clinical parameters were collected for each patient. Additionally, nerve conduction velocity was tested using neurophysiological methods. Correlation and regression analyses were employed to examine the relationship between the concentrations of FT3 and DPN.

RESULTS

Compared to 57 patients without DPN, 64 patients with DPN showed increased HbA1c and low-density lipoprotein cholesterol (LDL-C) levels (P=0.001 and 0.042), as well as decreased concentrations of FT3 (P=0.042). Additionally, FT3 levels are positively associated with the motor and sensory fibers conduction velocity of the Ulnar nerve, as well as the motor conduction velocity of the Tibial nerve, with (R=0.205, P=0.025; R=0.191, P=0.038; R=0.220, p=0.016) or without (R=0.257, P=0.004; R=0.227, P=0.012; R=0.227, p=0.012) adjustment for HbA1c and LDL-C. Furthermore, multiple linear regression analysis suggests that decreased FT3 levels may influence the motor and sensory fibers conduction velocity of the Ulnar nerve (β=0.795, P=0.025 and β=0.909, P=0.038), as well as the motor conduction velocity of the Tibial nerve (β=0.727, P=0.016). Moreover, our study demonstrated that decreased FT3 levels are one of the risk factors for DPN in T2DM patients, as determined by binary logistic regression analysis (OR=0.542, P=0.022).

CONCLUSION

Lower concentrations of FT3 are one of the risk factors for DPN in patients with T2DM. Additionally, decreased FT3 levels may influence peripheral neuropathy, particularly affecting the motor and sensory fibers conduction velocity of the ulnar nerve, as well as the motor fiber conduction velocity of the tibial nerve.

Assessment of Neuropathy by Temperature Threshold Testing in Type 2 Diabetes Mellitus

INTRODUCTION

Diagnosing diabetic neuropathy is a challenge at times as it is asymptomatic. Diagnosing diabetic neuropathy involves the use of quantitative sensory testing, nerve conduction study, and autonomic testing. Tempearture threshold testing (TTT) can aid in diagnosing small fiber neuropathy at early stages. This study aimed to assess the small fiber neuropathy using TTT in diabetes mellitus (DM) and correlate with age, duration of diabetes, and lipid profile.

MATERIALS AND METHODS

The study was commenced after obtaining ethics approval from the institute ethics committee. The study participants included 100 patients with type 2 DM of both genders between the ages of 40 and 65 years. The glycemic status and lipid profile were noted along with physical examination. Neuropathy assessment was done using Michigan Neuropathy Screening Instrument (MNSI) and TTT.

RESULTS

The prevalence of small fiber neuropathy based on TTT was 63%. The lipid profile was similar in both the groups. The MNSI B scale had significantly higher scores in the neuropathy group. In the neuropathy group, the thresholds for hot were significantly greater in all four limbs and cold were significantly lower. Age and years of DM were positively correlated with the neuropathy. Hot threshold in the lower limb had shown a strong positive correlation.

CONCLUSION

The age and duration of diabetes are independent risk factors for diabetic peripheral neuropathy. Small fiber neuropathy is a prequel to the motor neuropathy. Hot threshold testing in the lower limb is more sensitive than cold threshold testing for diagnosing small fiber neuropathy.

Clinical evaluation of painful diabetes peripheral neuropathy in type 2 diabetes patients: Lessons from expatriates in the United Arab Emirates

BACKGROUND

The high prevalence of Type 2 Diabetes (T2D) in the United Arab Emirates makes it imperative to screen and manage diabetes peripheral neuropathy (DPN) as a priority. Considering the high number of expats from different ethnicity a more thorough approach is necessary. Unfortunately, there are very few studies addressing this issue.

METHODS

The study uses the chi-square test to investigate the dependence of the progression of DNP on ethnic origin. The study uses Pearson Correlation to find the association between three prevalent scales used for the measurement of painful diabetes peripheral neuropathy. Student t-test was used further to investigate the significance of the association.

RESULTS

With a p-value (0.004) and p-value (0.015), the study concludes that DPN risk is dependent on the ethnic origin of the residents. The study further found that there is a significant association between three scales for measuring painful diabetes peripheral neuropathy (pDNP), Douleur Neuropathique en 4 questions (DN4), Neurological Symptoms Score (NSS), and Leeds Assessment of Neuropathic Symptoms and Signs (LANNS). The p-value for all pairwise comparisons for the strength of association between scales was found significant at the level of significance 0.05.

CONCLUSION

The study concludes that the risk of DNP is high in Arab-origin residents in UAE and the reasons behind the finding need to be empirically tested to customize its management. The study further finds a significant association between the score of the three scales used for measuring pDNP.

Old and Novel Predictors for Cardiovascular Risk in Diabetic Foot Syndrome—A Narrative Review

Diabetic foot syndrome (DFS) is a complication associated with diabetes that has a strong negative impact, both medically and socio-economically. Recent epidemiological data show that one in six patients with diabetes will develop an ulcer in their lifetime. Vascular complications associated with diabetic foot have multiple prognostic implications in addition to limiting functional status and leading to decreased quality of life for these patients. We searched the electronic databases of PubMed, MEDLINE and EMBASE for studies that evaluated the role of DFS as a cardiovascular risk factor through the pathophysiological mechanisms involved, in particular the inflammatory ones and the associated metabolic changes. In the era of evidence-based medicine, the management of these cases in multidisciplinary teams of “cardio-diabetologists” prevents the occurrence of long-term disabling complications and has prognostic value for cardiovascular morbidity and mortality among diabetic patients. Identifying artificial-intelligence-based cardiovascular risk prediction models or conducting extensive clinical trials on gene therapy or potential therapeutic targets promoted by in vitro studies represent future research directions with a modulating role on the risk of morbidity and mortality in patients with DFS.

Diabetic peripheral neuropathy is associated with diabetic kidney disease and cardiovascular disease – The Silesia Diabetes-Heart Project

Microvascular complications of diabetes seem to be clustered and put patients at higher risk of developing cardiovascular disease (CVD). This was a questionnaire-based study designed to screen for the presence of diabetic peripheral neuropathy (DPN), defined as the score in the Michigan Neuropathy Screening Instrument (MNSI) above 2, and to evaluate its association with other complication of diabetes, including CVD. There were 184 patients included into the study. The prevalence of DPN in the study group was 37.5%. The regression model analysis revealed that the presence of DPN was significantly associated with the presence of diabetic kidney disease (DKD) (P = 0.0034;) and patient's age (P < 0.0001). Thirty-four patients (49.3%) with MNSI score >2 were diagnosed with CVD in comparison to 24 (20.1%) subjects with MNSI score ≤ 2 (P = 0.00006). In case of having one diabetes complication diagnosed, it is important to screen for others, including macrovascular ones.