Increased Prevalence of Impaired Glucose Tolerance in Patients With Painful Sensory Neuropathy

• Published in: Diabetes care Vol. 24; no. 8; pp. 1448 - 1453
• Main Authors: Singleton, J. Robinson, Smith, A. Gordon, Bromberg, Mark B.
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.08.2001
• Subjects: Adult; Aged; Arsenic - urine; Biological and medical sciences; Blood Glucose - metabolism; Body Mass Index; Cardiovascular Diseases - epidemiology; Diabetes; Diabetes. Impaired glucose tolerance; Diabetic Neuropathies - epidemiology; Diabetic Neuropathies - physiopathology; Diabetics; Electromyography; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Glucose; Glucose Intolerance - epidemiology; Glucose metabolism; Glucose Tolerance Test; Glycated Hemoglobin A - analysis; Health aspects; Humans; Lead - urine; Medical disorders; Medical sciences; Medical screening; Mercury - urine; Middle Aged; Neural Conduction; Neuralgia - blood; Neuralgia - complications; Neuralgia - physiopathology; Peripheral nerve diseases; Peripheral Nervous System Diseases - blood; Peripheral Nervous System Diseases - complications; Peripheral Nervous System Diseases - physiopathology; Physiological aspects; Prevalence; Prospective Studies; Risk Factors; Sensory perception; United States; Endocrinopathy; Human; Nervous system diseases; Prevalence; Idiopathic; Glucose tolerance test; Peripheral neuropathy; Epidemiology; Statistical study; Association; Pain; Peripheral nerve disease; Impaired glucose tolerance
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.24.8.1448

Increased Prevalence of Impaired Glucose Tolerance in Patients With Painful Sensory Neuropathy J. Robinson Singleton , MD , A. Gordon Smith , MD and Mark B. Bromberg , MD, PHD Division of Neuromuscular Disease, Department of Neurology, University of Utah, Salt Lake City, Utah Abstract 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 HbA 1c 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. ADA, American Diabetes Association FPG, fasting plasma glucose IFG, impaired fasting glucose IGT, impaired glucose tolerance NCS/EMG, nerve conduction studies and needle electromyography OGTT, oral glucose tolerance test Footnotes Address correspondence and reprint requests to Rob Singleton, MD, University of Utah, Department of Neurology, Room 3R-152, 50 N. Medical Dr., Salt Lake City, UT 84132. E-mail: rob.singleton{at}hsc.utah.edu . Received for publication 28 December 2000 and accepted in revised form 17 April 2001. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.