Neuropathy in prediabetes: does the clock start ticking early?

Area of Science:

• Neurology
• Endocrinology
• Metabolic Disorders

Background:

• Idiopathic peripheral neuropathy (IPN) is frequently associated with prediabetes.
• Prevalence of neuropathy and neuropathic pain is significant among individuals with prediabetes.
• A gradient of neuropathy prevalence exists, highest in diabetes, followed by impaired glucose tolerance, impaired fasting glucose, and normoglycemia.

Purpose of the Study:

• To review the current evidence on the association between prediabetes and peripheral neuropathy.
• To highlight the prevalence, pathogenesis, diagnosis, and management of neuropathy in prediabetes.

Main Methods:

• Review of population-based studies and current evidence.
• Clinical examination and oral glucose tolerance test (OGTT) for diagnosis.
• Assessment of pathogenesis involving hyperglycemia, microvascular issues, dyslipidemia, and metabolic syndrome.

Main Results:

• 25-62% of IPN patients have prediabetes; 11-25% of prediabetics have neuropathy.
• Sensory modalities are more affected than motor; small fiber impairment may be an early sign.
• Neuropathy in prediabetes is less severe than in manifest diabetes.

Conclusions:

• Prediabetes is a significant risk factor for peripheral neuropathy.
• Early diagnosis via clinical evaluation and OGTT is crucial.
• Lifestyle modification is the primary treatment, though long-term efficacy requires further study.