Incidence and predictors of distal symmetrical polyneuropathy in prediabetes: A 24-month prospective cohort study.
Abstract
Background
Distal symmetrical polyneuropathy (DSPN) is a prevalent complication of diabetes, with emerging evidence of onset in earlier stages of dysglycemia. Prediabetes is characterized by insulin resistance, central adiposity, and dyslipidemia. Data on the incidence of DSPN in prediabetes and possible association with cardiometabolic factors remain limited.
Aim
To prospectively assess the incidence of DSPN in individuals with prediabetes and identify possible predictors.
Methods
Adults with prediabetes attending the Outpatient Lipid and Obesity Clinic at the University Hospital of Ioannina, Greece were enrolled and followed for a median of 24 months. DSPN was assessed longitudinally by the neuropathy symptom score (NSS), the neuropathy disability score (NDS) and the vibration perception threshold (VPT). Predictors of incident DSPN were examined using multivariable regression analysis.
Results
Among 160 participants with prediabetes, 27 (16.9%) had DSPN at baseline. Among the remaining 133 participants,13 developed DSPN over 24 months (Interquartile Range [IQR] 20-27), yielding an incidence of 9.8%. In multivariable analysis, age (Odds Ratio [OR] per 1-year increase 1.11, 95% Confidence Interval [CI] 1.02-1.24), male sex (OR 1.07, 95% CI 1.01-3.28), current/previous smoking (OR 1.17, 95% CI 1.07-3.03),waist circumference (OR per 1-cm increase 1.04, 95% CI 1.02-1.28), homeostatic model assessment of insulin resistance (HOMA-IR) (OR per 0.1-increase 1.83, 95%CI 1.03-2.46), and ΔHOMA-IR (OR per 0.1 increase 1.46, 95% CI 1.07-2.46) were independently associated with incident DSPN (all p < 0.05).
Conclusions
We observed a 9.8% 24-month incidence of DSPN in people with prediabetes. Age, male sex, smoking, central obesity, as well as insulin resistance at baseline and change over time were independent predictors of incident DSPN. These findings may have screening and preventive implications if confirmed by larger studies.