Comparison of diabetic and idiopathic sensory polyneuropathies with respect to nerve fibre affection and risk factors

Mustapha Itani; Sif Gylfadottir; Thomas Krøigård; Laura Gaist; Jakob Vormstrup Holbech; Alexander Gramm Kristensen; Pall Karlsson; Sören Möller; Hatice Tankisi; David Gaist; Troels S Jensen; Nanna Brix Finnerup; Søren Hein Sindrup

doi:10.1136/bmjno-2021-000247

Comparison of diabetic and idiopathic sensory polyneuropathies with respect to nerve fibre affection and risk factors

BMJ Neurol Open. 2022 Mar 14;4(1):e000247. doi: 10.1136/bmjno-2021-000247. eCollection 2022.

Authors

Mustapha Itani^{1

2}, Sif Gylfadottir^{3

4}, Thomas Krøigård^{1

2}, Laura Gaist¹, Jakob Vormstrup Holbech¹, Alexander Gramm Kristensen⁵, Pall Karlsson⁶, Sören Möller^{7

8}, Hatice Tankisi⁵, David Gaist^{1

2}, Troels S Jensen^{3

4}, Nanna Brix Finnerup^{4

9}, Søren Hein Sindrup^{1

2}

Affiliations

¹ Research Unit for Neurology, Department of Neurology, Odense University Hospital, Odense, Denmark.
² Clinical Medicine, University of Southern Denmark, Odense, Denmark.
³ Danish Pain Research Center, Clinical Medicine, Aarhus University, Aarhus, Denmark.
⁴ Neurology, Aarhus Universitetshospital, Aarhus, Denmark.
⁵ Clinical Neurophysiology, Aarhus Universitetshospital, Aarhus, Denmark.
⁶ Danish Pain Research Centre, Department of Clinical Medicine, Core Center for Molecular Morphology, Aarhus Universitet, Aarhus, Denmark.
⁷ OPEN, Odense University Hospital, Odense, Denmark.
⁸ Clinical Research, University of Southern Denmark, Odense, Denmark.
⁹ Danish Pain Research Center, Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark.

Abstract

Background and purpose: Chronic distal sensory or sensorimotor polyneuropathy is the most common pattern of polyneuropathy. The cause of this pattern is most often diabetes or unknown. This cross-sectional study is one of the first studies to compare the demographics, cardiovascular risk factors and clinical characteristics of diabetic polyneuropathy (DPN) with idiopathic polyneuropathy (IPN).

Methods: Patients with DPN were included from a sample of 389 patients with type 2 diabetes mellitus (T2DM) enrolled from a national cohort of patients with recently diagnosed T2DM (Danish Centre for Strategic Research in Type 2 Diabetes cohort). Patients with IPN were included from a regional cohort of patients with symptoms of polyneuropathy referred for workup at a combined secondary and tertiary neurological centre (database cohort).

Results: A total of 214 patients with DPN were compared with a total of 88 patients with IPN. Patients with DPN were older (67.4 vs 59 years) and had a longer duration of neuropathy symptoms. Patients with DPN had greater body mass index (32 vs 27.4 kg/m²) and waist circumference (110 cm vs 97 cm); higher frequency of hypertension diagnosis (72.9% vs 30.7%); lower total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol levels; and a higher prevalence of use of statins (81.8% vs 19.3%). DPN was associated with a slightly higher autonomic score and total score on the Neuropathy Symptom Score; lower frequency of hyperalgesia, allodynia and decreased vibration on quantitative sensory testing; lower intraepidermal nerve fibre density count and higher frequency of small-fibre neuropathy.

Conclusion: DPN and IPN showed clear differences in neuropathy characteristics, indicating that these two entities are to be regarded as aetiologically and pathogenetically distinct.

Keywords: diabetes; diabetic neuropathy; neuropathy; neurophysiol, clinicaL.