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Association between glycemic variability and peripheral nerve dysfunction in type 1 diabetes.

Natalie C G Kwai1, Ria Arnold2, Ann M Poynten3

  • 1Prince of Wales Clinical School, University of New South Wales Australia, NSW 2052, Sydney, Australia.

Muscle & Nerve
|July 29, 2016
PubMed
Summary

Glycemic variability (GV) significantly impacts peripheral nerve function in type 1 diabetes, independent of acute glucose levels. This suggests GV is a key factor in diabetic neuropathy development.

Keywords:
continuous glucose monitoringdiabetic neuropathyglycemic variabilitynerve excitabilitytype 1 diabetes mellitus

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Area of Science:

  • Neurology
  • Endocrinology
  • Metabolic Disorders

Background:

  • Glycemic variability (GV) is increasingly recognized as a potential factor in diabetic complications.
  • The specific impact of GV on peripheral nerve function remains under-explored.

Purpose of the Study:

  • To investigate the relationship between GV and acute glucose levels on motor and sensory nerve function in patients with type 1 diabetes mellitus (T1DM).
  • To explore the behavior of axonal voltage-gated ion channels in response to glycemic fluctuations.

Main Methods:

  • Assessed 17 T1DM patients using continuous glucose monitoring and nerve excitability techniques.
  • Quantified GV using the mean amplitude of glycemic excursions (MAGE).

Main Results:

  • MAGE strongly correlated with markers of altered motor and sensory axonal function, including superexcitability, S2 accommodation, minimum current threshold (I/V) slope, strength duration time constant, and latency.
  • Acute glucose levels showed no correlation with axonal function markers.

Conclusions:

  • GV appears to be a significant mediator of axonal dysfunction in T1DM.
  • GV may contribute to the development of diabetic neuropathy.