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The spectrum of neuropathy in diabetes and impaired glucose tolerance
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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“Finally, evidence is accumulating on increased prevalence of idiopathic polyneuropathy (eg, idiopathic sensory/painful neuropathy,73–78 and sensory/small fibre only neuropathy)73,75,78 among prediabetic individuals with IGT being more strongly related to painful than non-painful neuropathy.73,75,78”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [78]
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Prediabetes: a high-risk state for diabetes development
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“The neuropathy associated with IGT is milder than the neuropathy associated with newly diagnosed diabetes, and small nerve fiber involvement may be the earliest detectable sign of neuropathy (39).”
BackgroundThe diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology
Devigili, G., Tugnoli, V., Penza, P., Camozzi, F., Lombardi, R., Melli, G., Broglio, L., Granieri, E., & Lauria, G. (2008) · Brain · doi:10.1093/brain/awn093 · Cited by 796
“…hypothyroidism, hyperlipidemia, statin and anti-retroviral therapy (McManis et al., 1994; Moore et al., 2000; Smith et al., 2001; Lo et al., 2003; Sumner et al., 2003; Orstavik et al., 2006), immunemediated and connective tissue disorders (Hoitsma et al., 2002; Brannagan et al., 2005; Gondim et…”
Background
Metadata
- Authors
- Sumner, C. J., Sheth, S., Griffin, J. W., Cornblath, D. R., & Polydefkis, M.
- Affiliations
- Johns Hopkins University (US)
- Venue
- Neurology
- Published
- 2003-01-14
- Volume
- 60
- Issue
- 1
- Pages
- 108-111
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- 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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