title: Prediabetes/early diabetes-associated neuropathy predominantly involves sensory small fibres.
abstract: The aim of this study was to investigate the characteristics of prediabetes (preDM) and early (<3 years) diabetes mellitus type 2 (eDM2)-associated neuropathy and the value of recently proposed diagnostic criteria for diabetic sensorimotor polyneuropathy (DSPN). A prospective case-control study in a group of 48 consecutive patients with eDM2, 16 preDM patients and 40 age- and sex-matched normoglycaemic controls was performed. Clinical and laboratory diagnostic tests were used to detect neuropathic abnormalities; these were further classified in terms of recent diagnostic criteria. Criteria for confirmed DSPN based on abnormal nerve conduction (NC) studies were met in 7 (14.6%) eDM2 patients compared to no control (p < 0.05), and the proportion significantly increased to 37.5% compared to 2.5% controls (p < 0.001), if intraepidermal nerve fibre density (IENFD) was used as an alternative criterion in addition to NC. The subclinical DSPN criteria based on NC abnormalities were met in 4.2% eDM2 patients, while the proportion of preDM and eDM2 cases with subclinical sensory small-fibre involvement documented by IENFD reached 12.5% and 22.9% compared with 2.5% controls (p = 0.005 for eDM2). The absolute IENFD values from distal leg were significantly lower in both eDM2 (p < 0.0001) and preDM patients (p = 0.005) compared to controls. Neuropathy associated with preDM/eDM2 predominantly involves sensory small fibres.
authors.affiliation: Department of Neurology, University Hospital, University Hospital, Masaryk University Brno, Czech Republic.
authors.forename: Sarka
authors.initials: S
authors.lastname: Divisova
authors.forename: Eva
authors.initials: E
authors.lastname: Vlckova
authors.forename: Maria
authors.initials: M
authors.lastname: Hnojcikova
authors.forename: Miroslav
authors.initials: M
authors.lastname: Skorna
authors.forename: Martin
authors.initials: M
authors.lastname: Nemec
authors.forename: Petr
authors.initials: P
authors.lastname: Dubovy
authors.forename: Ladislav
authors.initials: L
authors.lastname: Dusek
authors.forename: Jiri
authors.initials: J
authors.lastname: Jarkovsky
authors.forename: Jana
authors.initials: J
authors.lastname: Belobradkova
authors.forename: Josef
authors.initials: J
authors.lastname: Bednarik
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000473:pathology*; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000473:pathology*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009431:Neural Conduction / Q000502:physiology; D010147:Pain Measurement / Q000379:methods; D011236:Prediabetic State / Q000175:diagnosis / Q000473:pathology*; D011446:Prospective Studies; D011984:Sensory Receptor Cells / Q000473:pathology*