Diabetic neuropathy is a generalized phenomenon with impact on hand functional performance and quality of life

• Published in: European journal of neurology Vol. 29; no. 10; pp. 3081 - 3091
• Main Authors: Kender, Zoltan, Groener, Jan B., Jende, Johann M. E., Kurz, Felix T., Fleming, Thomas, Sulaj, Alba, Schuh‐Hofer, Sigrid, Treede, Rolf‐Detlef, Bendszus, Martin, Szendroedi, Julia, Nawroth, Peter P., Kopf, Stefan
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.10.2022
• Subjects: Blood glucose; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetic neuropathy; diabetic polyneuropathy; electrophysiology; Grasping; Grip force; Hand tools; Manual dexterity; Motor ability; Peripheral neuropathy; Phenotypes; Quality of life; quantitative sensory testing; Sensorimotor system; Sex; upper extremity; electrophysiology; diabetic polyneuropathy; quality of life; quantitative sensory testing; upper extremity
• ISSN: 1351-5101; 1468-1331; 1468-1331
• DOI: 10.1111/ene.15446

Background and purpose Diabetic sensorimotor peripheral neuropathy is usually considered to affect predominantly the lower limbs (LL‐N), whereas the impact of upper limb neuropathy (UL‐N) on hand functional performance and quality of life (QoL) has not been evaluated systematically. This study aims to investigate the prevalence and characteristics of UL‐N and its functional and psychosocial consequences in type 2 diabetes. Methods Individuals with type 2 diabetes (n = 141) and an age‐ and sex‐matched control group (n = 73) underwent comprehensive assessment of neuropathy, hand functional performance, and psychosocial status. Results The prevalence of UL‐N was 30.5% in patients with diabetes and that of LL‐N was 49.6%, with 25.5% exhibiting both. Patients with diabetes showed similar sensory phenotype regarding both large and small fiber functions in hands and feet. Patients with UL‐N showed reduced manual dexterity, but normal hand grip force. Additionally, there was a correlation between reduced dexterity and sensory deficits. Patients with UL‐N had reduced estimates of psychosocial health including health‐related QoL compared to control subjects and patients without UL‐N. UL‐N correlated with the severity of LL‐N, but not with duration of diabetes, glycemia, age, or sex. Conclusions This study points to a substantial prevalence of UL‐N in type 2 diabetes. The sensory phenotype of patients with UL‐N was similar to LL‐N and was characterized by loss of sensory function. Our study demonstrated an association of UL‐N with impaired manual dexterity and reduced health‐related QoL. Thus, upper limb sensorimotor functions should be assessed early in patients with diabetes.