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Increased Prevalence of Impaired Glucose Tolerance in Patients With Painful Sensory Neuropathy
Open accessAbstract
OBJECTIVE—To characterize a cohort of patients with neuropathy and impaired glucose tolerance (IGT) but no other identifiable cause of neuropathy. Of patients with diabetes, 10% have peripheral neuropathy at the time of their diagnosis, suggesting that axonal injury may occur early in the course of glucose intolerance. The American Diabetes Association (ADA) revised diagnostic criteria to recognize IGT (a serum glucose between 140 and 200 mg/dl in a 2-h oral glucose tolerance test [OGTT]) as a risk factor for cardiovascular disease independent of development of diabetes. RESEARCH DESIGN AND METHODS—Using revised ADA criteria for diabetes and IGT, we prospectively evaluated 107 sequential patients with idiopathic neuropathy. RESULTS—A total of 13 of the 107 patients had diabetes, whereas 36 (34%) had IGT, nearly three times the prevalence in age-matched control subjects (P < 0.01). OGTT was often elevated, whereas both fasting plasma glucose and HbA1c were normal. Comparing patients with diabetes, IGT, or normal OGTT, age and BMI were similar. However, painful sensory symptoms were more common in patients with IGT and diabetes, and family history of neuropathy was significantly more common in normoglycemic patients. Electrodiagnostic findings of axonal injury were less severe in patients with IGT and were more likely to be confined to sensory fibers than in patients with diabetes. CONCLUSIONS—Our results suggest that IGT may cause or contribute to small-fiber neuropathy, which is similar in phenotype to the painful sensory neuropathy commonly encountered in diabetes. Two-hour OGTT is more sensitive than other measures of glucose handling in screening these patients.
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“There is controversy regarding the effect of glucose dysmetabolism on small nerve fibers34,42 and symptom severity16,48,56 in FMS.”
From Pain and small fiber pathology in men with fibromyalgia syndrome (2024) · cites this paper as [42]
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“Other forms of diabetic neuropathies are mononeuritis such as cranial nerve palsies or entrapment neuropathies (eg, carpal tunnel syndrome, ulnar entrapment, and peroneal entrapment, among others).632–635”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [635]
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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 [75]
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ResultSmall‐fiber sensory neuropathies: Clinical course and neuropathology of idiopathic cases
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Metadata
- Authors
- Singleton, J. R., Smith, A. G., & Bromberg, M. B.
- Affiliations
- University of Utah (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2001-08-01
- Volume
- 24
- Issue
- 8
- Pages
- 1448-1453
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2095995150
- Cited by
- 364
- References
- 32
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 9 · 2023: 7 · 2022: 12 · 2021: 7 · 2020: 21 · 2019: 9 · 2018: 17 · 2017: 20 · 2016: 14 · 2015: 22 · 2014: 28 · 2013: 25 · 2012: 21
- FWCI
- 4.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- 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
- impaired glucose tolerance, small fiber neuropathy, peripheral neuropathy, diabetes mellitus, oral glucose tolerance test, axonal injury, electrodiagnostic findings
- MeSH terms
- Adult, Aged, Arsenic, Blood Glucose, Cardiovascular Diseases, Diabetic Neuropathies, Electromyography, Glucose Tolerance Test, Glycated Hemoglobin, Humans, Lead, Mercury, Middle Aged, Neural Conduction, Neuralgia, Peripheral Nervous System Diseases, Prospective Studies, Risk Factors, Body Mass Index, Prevalence, Glucose Intolerance
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