title: Does prediabetes cause small fiber sensory polyneuropathy? Does it matter?
abstract: OBJECTIVE
  The association between prediabetes and distal polyneuropathy (DPN) remains controversial. Here we test whether the prevalence of small fiber sensory distal polyneuropathy is increased in prediabetes.
  
  
  METHODS
  Prospectively recruited cohorts of healthy subjects and those with prediabetes from Olmsted County, Minnesota, were assessed for positive neuropathic sensory symptoms, or pain symptoms characteristic of small fiber sensory DPN. Hyperalgesia and hypoalgesia were assessed by "smart" quantitative sensation testing (QST). The prevalence of symptoms and QST abnormalities were compared among the groups.
  
  
  RESULTS
  There was no significant increase in the prevalence of positive neuropathic sensory or pain symptoms, nor of hyper- or hypoalgesia in the prediabetes group. There was an increased prevalence of hypoalgesia of the foot only in newly diagnosed diabetes.
  
  
  CONCLUSIONS
  Based on positive sensory and pain symptoms and QSTs, we did not find an increase in small fiber sensory DPN in prediabetes. Recognizing that obesity and diabetes mellitus are implicated in macro- and microvessel complications, physicians should encourage healthy living and weight loss in patients with prediabetes. In medical practice, alternate causes should be excluded before concluding that small fiber sensory distal neuropathy is secondary to prediabetes.
authors.affiliation: Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Kassardjian
authors.affiliation: Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: P J B
authors.initials: PJ
authors.lastname: Dyck
authors.affiliation: Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Davies
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Rickey E
authors.initials: RE
authors.lastname: Carter
authors.affiliation: Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: dyck.peter@mayo.edu.
authors.forename: P J
authors.initials: PJ
authors.lastname: Dyck
mesh_terms: D015331:Cohort Studies; D004916:Erythromelalgia / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology; D011236:Prediabetic State / Q000150:complications*
keywords: Diabetes mellitus (DM); Distal polyneuropathy (DPN); Prediabetes; Small fiber sensory DPN