AIMS/INTRODUCTION: To elucidate whether axonal changes arise in the prediabetic state and to find a biomarker for early detection of neurophysiological changes. MATERIALS AND METHODS: We enrolled asymptomatic diabetic patients as well as prediabetic and normoglycemic subjects to test sensory nerve excitability, and we analyzed those findings and their correlation with clinical profiles. RESULTS: In nerve excitability tests, superexcitability in the recovery cycle showed increasing changes in the normoglycemic, prediabetic and diabetic cohorts (-19.09+/-4.56% in normoglycemia, -22.39+/-3.16% in prediabetes, and -23.71+/-5.15% in diabetes, P=0.002). Relatively prolonged distal sensory latency was observed in the median nerve (3.12+/-0.29 msec in normoglycemia, 3.23+/-0.38 msec in prediabetes, and 3.45+/-0.43 msec in diabetes, P=0.019). Superexcitability was positively correlated with fasting plasma glucose (r=0.291, P=0.009) and HbA1c (r=0.331, P=0.003) in all subjects. CONCLUSIONS: Sensory superexcitability and latencies are the most sensitive parameters for detecting preclinical physiological dysfunction in prediabetes. In addition, changes in favor of superexcitability are positively correlated with HbA1c within all subjects. These results suggest that early axonal changes start in the prediabetic stage and that the monitoring strategy for polyneuropathy should start as early as prediabetes.
Date:
2020-03
Relation:
Journal of Diabetes Investigation. 2020 Mar;11 (2):458-465.
