Sorbitol and myo-inositol levels and morphology of sural nerve in relation to peripheral nerve function and clinical neuropathy in men with diabetic, impaired, and normal glucose tolerance.
OBJECTIVE
Sorbitol and myo-inositol levels and morphology of sural nerve were compared with nerve function and clinical neuropathy in men with diabetic, impaired (IGT), and normal glucose tolerance.


METHODS
After neurography of sural nerve and determinations of sensory thresholds for vibration, warm and cold on the foot, whole nerve sural nerve biopsy was performed in 10 men with Type 1 diabetes mellitus, 10 with IGT, and 10 with normal glucose tolerance. Polyol levels were assessed by gas-liquid chromatography/mass spectrometry.


RESULTS
Sural nerve amplitudes were significantly lower and sorbitol levels significantly higher in diabetic patients (median (interquartile range)) (3.7 (3.5) microV and 643 (412) pmol/mg protein, respectively) both compared with IGT (11.3 (10.6)microV; P = 0.04 and 286 (83) pmol/mg protein; P = 0.0032, respectively) and normally glucose tolerant (10.0 (11.6); P = 0.0142 and 296 (250) pmol/mg protein; P = 0.0191, respectively) subjects. There were no differences in nerve morphology between the three groups. Nerve myo-inositol levels correlated, however, positively with cluster density (rs = 0.56; P = 0.0054). In diabetic and IGT subjects, sural nerve amplitudes (2.6 (3.8) vs. 12.1 (10.6) microV; P = 0.0246) and myelinated nerve fibre density (MNFD; 4,076 (1091) vs. 5,219 (668) nerve fibres/mm2; P = 0.0021) were significantly lower in nine subjects with clinical neuropathy than in 10 without.


CONCLUSIONS
Nerve degeneration (i.e. MNFD) correlated with clinical neuropathy but not with glucose tolerance status whereas nerve myo-inositol levels positively correlated with signs of nerve regeneration (i.e. increased cluster density).
Sundkvist
G
G
Department of Endocrinology, University of Lund, Malmö University Hospital, Sweden. goran.sundkvist@endo.mas.lu.se
Dahlin
L B
LB
Nilsson
H
H
Eriksson
K F
KF
Lindgärde
F
F
Rosén
I
I
Lattimer
S A
SA
Sima
A A
AA
Sullivan
K
K
Greene
D A
DA
D003922:Diabetes Mellitus, Type 1 / Q000473:pathology / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000473:pathology / Q000503:physiopathology*; D018149:Glucose Intolerance / Q000473:pathology / Q000503:physiopathology*; D005951:Glucose Tolerance Test; D006801:Humans; D007294:Inositol / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D009410:Nerve Degeneration; D009413:Nerve Fibers, Myelinated / Q000473:pathology / Q000648:ultrastructure; D011446:Prospective Studies; D012016:Reference Values; D012684:Sensory Thresholds; D013012:Sorbitol / Q000032:analysis*; D013497:Sural Nerve / Q000473:pathology / Q000503:physiopathology* / Q000648:ultrastructure; D014732:Vibration
D007294:Inositol; D013012:Sorbitol