Cited by 708Peripheral Neuropathies and DisordersPain Mechanisms and TreatmentsHereditary Neurological Disorders

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The spectrum of neuropathy in diabetes and impaired glucose tolerance

Sumner, C.J., Sheth, S., Griffin, J.W., Cornblath, D.R., Polydefkis, M.·2003·Neurology

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Abstract

OBJECTIVE: To compare the neuropathy associated with impaired glucose tolerance (IGT) and diabetes mellitus (DM) determined by oral glucose tolerance testing (OGTT). METHODS: Patients with peripheral neuropathy of unknown cause were prescribed OGTT. Duration of neuropathic symptoms, neuropathic pain, neuropathy classification, nerve conduction test results, and intraepidermal nerve fiber densities (IENFD) were compared between IGT and DM groups. RESULTS: Seventy-three patients completed OGTT; 41 (56%) had abnormal results. Of these 41 patients, 26 had IGT and 15 had DM. Patients with IGT had less severe neuropathy than patients with diabetes, as measured by sural nerve amplitudes (p = 0.056), sural nerve conduction velocities (p = 0.03), and distal leg IENFD (p = 0.01). Patients with IGT had predominantly small fiber neuropathy, compared to patients with DM (p = 0.05), who had more involvement of large nerve fibers. CONCLUSIONS: The neuropathy associated with IGT is milder than the neuropathy associated with DM. Small nerve fibers are prominently affected and may be the earliest detectable sign of neuropathy in glucose dysmetabolism. OGTT is appropriate in patients with idiopathic neuropathy.

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Yum, Y., Park, S., Nam, Y. H., Yoon, J., Song, H., Kim, H. J., Lim, J., & Jung, S. (2024) · Tissue Engineering and Regenerative Medicine · doi:10.1007/s13770-024-00638-0 · Cited by 8
“The loss of small nerve ﬁbers in the skin is a hallmark of DN [50].”
High-resolution axon reflex sweat testing for diagnosis of neuropathy
Loavenbruck, A. J., Sit, N., Provitera, V., & Kennedy, W. R. (2018) · Clinical Autonomic Research · doi:10.1007/s10286-018-0546-7 · Cited by 8
Association of Small Fiber Function with Microvascular Perfusion of Peripheral Nerves in Patients with Type 2 Diabetes
Mooshage, C. M., Schimpfle, L., Κender, Ζ., Tsilingiris, D., Aziz-Safaie, T., Hohmann, A., Szendroedi, J., Nawroth, P. P., Sturm, V. J. F., Heiland, S., et al. (2023) · Clinical Neuroradiology · doi:10.1007/s00062-023-01328-5 · Cited by 9
“As SFN is regarded to be an early ﬁnding in patients with distorted glucose metabolism [4, 35], similar to the disruption and subsequent increased permeability of the blood nerve barrier [36], we hypothesize that an increase in capillary nerve permeability in type 2 diabetes patients may result in…”
Background
Impaired glucose tolerance in nondiabetic lumbosacral radiculoplexus neuropathy
Kelkar, P., & Hammer-White, S. (2004) · Muscle & Nerve · doi:10.1002/mus.20178 · Cited by 8
Small Fiber Functionality in Patients with Diabetic Neuropathic Pain
Ünal-Çevik, I., Orhan, D., Acar, N. P., & Ekinci, E. B. M. (2021) · Pain Medicine · doi:10.1093/pm/pnab150 · Cited by 8
Ginsenoside Rb1 relieves glucose fluctuation-induced oxidative stress and apoptosis in Schwann cells.
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“It is now recognized that “hyperglycemic spikes” may play a direct and significant role in the pathogenesis of diabetic complications, and intermittent high glucose is also associated with the development of Schwann cell injury and diabetic peripheral neuropathy [13, 16] .”
Background
Pathophysiology and treatment for diabetic neuropathy
Yasuda, H. (2009) · Rinsho Shinkeigaku · doi:10.5692/clinicalneurol.49.149 · Cited by 8
The Perfect Clinical Trial
Bril, V. (2016) · International review of neurobiology · doi:10.1016/bs.irn.2016.02.011 · Cited by 8
Loss of Small Fibers in Entrapment Neuropathy and Their Regeneration after Surgical Decompression in a Rat Model
Hsieh, C., Jeng, S., Lu, T., Chen, Y., Hsieh, M., & Chen, S.-S. (2007) · Journal of Neurotrauma · doi:10.1089/neu.2007.0279 · Cited by 8
Painful diabetic polyneuropathy: evidence-based diagnosis and treatment
Khramilin, V. N., & Давыдов, О. С. (2021) · Russian Journal of Pain · doi:10.17116/pain20211904144 · Cited by 9
Diabetes Complications at Presentation and One Year by Glycated Haemoglobin at Diagnosis in a Multiethnic and Diverse Socioeconomic Population: Results from the South London Diabetes Study
Azam, M. E., Marwood, L., Ismail, K., Evans, T., Sivaprasad, S., Winkley, K., & Amiel, S. A. (2015) · Journal of Diabetes Research · doi:10.1155/2015/587673 · Cited by 7
“One year follow-up assessment was made within a 3- month window of 12 months after recruitment.”
Method
Point process models for sweat gland activation observed with noise
Kuronen, M., Myllymäki, M., Loavenbruck, A. J., & Särkkä, A. (2021) · Statistics in Medicine · doi:10.1002/sim.8891 · Cited by 7
Pharmacotherapeutic options for prediabetes
Rendell, M. (2020) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2020.1817381 · Cited by 7
Impaired glucose tolerance and metabolic syndrome in idiopathic polyneuropathy: The role of pain and depression
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Association between the Levels of IL-6, sE-Selectin and Distal Sensory Nerve Conduction Studies in Patients with Prediabetes
Tiftikçioğlu, B. İ., Duksal, T., Bilgin, Ş., Köse, Ş., & Zorlu, Y. (2016) · European Neurology · doi:10.1159/000444661 · Cited by 9
Early diagnosis of diabetic polyneuropathy based on the results of corneal nerve fibers examination
Sé, A., Chernenkova, N. A., Сурнина, З. В., Ахмеджанова, Л. Т., Фокина, А. С., & Strokov, I. A. (2020) · Russian Annals of Ophthalmology · doi:10.17116/oftalma2020136052155 · Cited by 9
“Так, отмечено снижение плотности интраэпидермальных нервов у больных с нарушенной толерантностью к глюкозе при отсутствии изменений в проводимости миелинизированных нервов [5, 6].”
Myelinated and unmyelinated endoneurial axon quantitation and clinical correlation
Dori, A., Lopate, G., Choksi, R. M., & Pestronk, A. (2015) · Muscle & Nerve · doi:10.1002/mus.24740 · Cited by 7
EZSCAN for undiagnosed type 2 diabetes mellitus: A systematic review and meta-analysis
Bernabé‐Ortiz, A., Ruíz-Alejos, A., Miranda, J. J., Mathur, R., Perel, P., & Smeeth, L. L. (2017) · PLoS ONE · doi:10.1371/journal.pone.0187297 · Cited by 7
Controversies in Treating Diabetes
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Carpal Tunnel Syndrome and Diabetes Surgical outcome and nerve pathology
Thomsen, N. (2009) · Lund University Publications (Lund University) · Cited by 7
Neurology
Tarulli, A. W. (2016) · Springer eBooks · doi:10.1007/978-3-319-29632-6 · Cited by 8
Ophthalmic Surgeries and Systemic Medical Conditions Associated With the Development of Involutional Ptosis
Cohen, L. M., Campbell, B. C., Esfandiari, M., Goldberg, R. A., & Rootman, D. B. (2020) · Ophthalmic Plastic and Reconstructive Surgery · doi:10.1097/iop.0000000000001707 · Cited by 6
Pathogenesis of Human Diabetic Neuropathy
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“neuropathy in patients with IGT appears milder than the neuropathy associated with newly diagnosed diabetes and it may particularly affect the small nerve fibers ( 3 ).”
Background
Peripheral neuropathy: pattern recognition for the pragmatist
Overell, J. R. (2012) · Postgraduate Medical Journal · doi:10.1136/pgmj.2011.241612rep · Cited by 6
Phosphorylation of extracellular signal-regulated kinase 1/2 in subepidermal nerve fibers mediates hyperalgesia following diabetic peripheral neuropathy
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“5-IR IENFs has become an established pathological approach for the clinical diagnosis of human type 1 and type 2 DM (Polydefkis et al., 2001; Sumner et al., 2003; Shun et al., 2004).”
Small Fiber Neuropathy in the Elderly
Zhou, L. (2021) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2021.01.002 · Cited by 6
Peripheral neuropathy in the pre-diabetic state of the type 2 diabetes mouse model (TSOD mice) involves TRPV1 expression in dorsal root ganglions
Shida, K., Ohsawa, M., Takahashi, S., Ota, H., Tamura, T., Kusama, N., Nakasone, M., Yamazaki, H., & Sobue, K. (2022) · IBRO Neuroscience Reports · doi:10.1016/j.ibneur.2022.02.001 · Cited by 6
Diabetes-specific complications in prediabetes
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Assessment of Sudomotor Function to Predict Future Abnormalities of Glucose Tolerance in at Risk Population
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Diagnostic des neuropathies sensitives acquises
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Peripheral polyneuropathy in type 2 diabetes mellitus and impaired glucose tolerance. Correlations between morphology, neurophysiology, and clinical findings
Thrainsdottir, S. (2009) · Lund University Publications (Lund University) · Cited by 6
Cardiac Autonomic Neuropathy in Patients with Newly Diagnosed Carbohydrate Disturbances
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Chewing the fat: Genetic approaches to model dyslipidemia-induced diabetic neuropathy in mice
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Review: Microvascular complications: evaluation and monitoring relevance to clinical practice, clinical trials, and drug development
Greenstein, A. S., Tavakoli, M., Mojaddidi, M. A., Alsunni, A. A., Matfin, G., & Malik, R. A. (2007) · The British Journal of Diabetes · doi:10.1177/14746514070070040501 · Cited by 5
Let Hunger Be Your Guide? Being Hungry before a Meal Is Associated with Healthier Levels of Postmeal Blood Glucose
Gal, D. (2016) · Journal of the Association for Consumer Research · doi:10.1086/684395 · Cited by 6
3. Diabetic Neuropathies
Baba, M. (2009) · Nihon Naika Gakkai Zasshi · doi:10.2169/naika.98.779 · Cited by 5
Small-Fiber-Neuropathien
Sommer, C., & Üçeyler, N. (2017) · Klinische Neurophysiologie · doi:10.1055/s-0043-103477 · Cited by 5
“Insbesondere scheint die Stärke der CCM in der sehr frühen Detektion einer Innervationsänderung zu liegen, während sich in den anderen Kleinfasertests wie etwa QST oder Hautstanzbiopsie noch keine Auffälligkeiten finden – dies wurde zumindest für die diabetische Neuropathie bzw. ihre Vorstufe, die Glukosetoleranzstöru…”
BackgroundInfluential

Authors: Sumner, C. J., Sheth, S., Griffin, J. W., Cornblath, D. R., & Polydefkis, M.
Affiliations: Johns Hopkins University (US)
ORCID: Sumner, C.J.
Cornblath, D.R.
Polydefkis, M.
Venue: Neurology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2003-01-14
Volume: 60
Issue: 1
Pages: 108-111
ISSN: 0028-3878 (ISSN-L)
1526-632X
DOI: 10.1212/wnl.60.1.108
OpenAlex: W1978686107
Cited by: 708
References: 25
Citations by year: 2026: 9 · 2025: 18 · 2024: 11 · 2023: 13 · 2022: 19 · 2021: 21 · 2020: 30 · 2019: 26 · 2018: 27 · 2017: 35 · 2016: 37 · 2015: 42 · 2014: 53 · 2013: 43 · 2012: 40
FWCI: 21.43
Type: journal article
Language: en
Open access: closed
Locations: Neurology (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5k23ns041374-04)
National Institute of Neurological Disorders and Stroke (K23NS41374-01)
Topics: Health Sciences › Medicine › Clinical Neurology › Peripheral Neuropathies and Disorders
Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Hereditary Neurological Disorders
Keywords: diabetic peripheral neuropathy, impaired glucose tolerance, oral glucose tolerance test, small fiber neuropathy, intraepidermal nerve fiber density, nerve conduction velocity, sural nerve, neuropathic pain, neuropathy classification
MeSH terms: Adult, Aged, Aged, 80 and over, Blood Glucose, Cell Count, Diabetic Nephropathies, Electrodiagnosis, Electromyography, Epidermis, Female, Glucose Tolerance Test, Humans, Male, Middle Aged, Nerve Fibers, Neural Conduction, Pain Measurement, Peripheral Nervous System Diseases, Sural Nerve, Cell Size

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The spectrum of neuropathy in diabetes and impaired glucose tolerance

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