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Neuropathic Pain With and Without Diabetic Peripheral Neuropathy in Type 1 Diabetes
Barbara H Braffett1, Laure El Ghormli1, James W Albers2
1Biostatistics Center, The George Washington University, Rockville, MD.
Neuropathic pain (NP) is common in type 1 diabetes (T1D), often appearing without clear nerve damage signs. Many patients experience pain remission, but effective management strategies for this common diabetic peripheral neuropathy complication are still needed.
Area of Science:
- Endocrinology and Metabolism
- Neurology
- Diabetology
Background:
- Diabetic peripheral neuropathy (DPN) is a common complication of diabetes.
- Neuropathic pain (NP) features and burden in type 1 diabetes (T1D) remain poorly understood.
- Long-term incidence, prevalence, and remission of NP in T1D require further investigation.
Purpose of the Study:
- To evaluate the incidence, annual prevalence, remission, and risk factors of NP in a long-term T1D cohort.
- To differentiate NP with and without clinical signs of DPN.
- To understand the characteristics of NP in T1D over an extended follow-up period.
Main Methods:
- Annual assessment of 1,324 T1D participants in the EDIC study (1994-2020) using the Michigan Neuropathy Screening Instrument (MNSI).
- Definition of NP with clinical signs of DPN (NP DPN+) and NP without clinical signs (NP DPN-).
- Analysis of cumulative incidence, prevalence, and remission rates over 26 years.
Main Results:
- Cumulative incidence of NP reached 57% after 26 years, with 36% NP DPN+ and 46% NP DPN-.
- Annual prevalence of NP was 20% at 26 years (11% NP DPN+, 9% NP DPN-), indicating frequent remission.
- Higher HbA1c and female sex were associated with NP DPN-, while pain medication use did not explain remission.
Conclusions:
- High incidence of NP in T1D, often without clinical neuropathy signs (MNSI).
- Frequent pain remission observed, independent of pain medication.
- Need for improved clinical strategies for NP identification and management in T1D patients.
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