Associations between acute glucose control and peripheral nerve structure and function in type 1 diabetes

Area of Science:

• Neurology
• Endocrinology
• Ophthalmology

Background:

• Diabetic neuropathy is a common complication of type 1 diabetes.
• The relationship between short-term glycemic control metrics and peripheral nerve health requires further investigation.

Purpose of the Study:

• To investigate the association between continuous overlapping net glycaemic action (CONGA), percentage time in hyperglycaemia (%HG), and percentage time in normoglycaemia (%NG) with peripheral nerve structure and function in type 1 diabetes.

Main Methods:

• Twenty-seven type 1 diabetes participants underwent continuous glucose monitoring.
• Corneal confocal microscopy and nerve excitability assessments were performed.
• CONGA, %HG, and %NG were correlated with corneal nerve parameters and nerve excitability scores, controlling for age, sex, diabetes duration, and HbA1c.

Main Results:

• Increased CONGA and %HG were associated with worse nerve excitability scores and impaired nerve conduction.
• Greater %NG correlated with better nerve excitability scores and improved nerve conduction.
• Elevated %HG increased the likelihood of abnormal nerve function (OR 1.11, P=0.037).
• CONGA and %HG were linked to reduced corneal nerve fiber length and increased corneal microneuromas.

Conclusions:

• Short-term glycemic control measures are significantly associated with peripheral nerve dysfunction.
• Glycemic variability and hyperglycemia impact both nerve function and corneal nerve morphology in type 1 diabetes.