Early Neuropathy as a Predictor of Subclinical Diabetic Nephropathy in Well-Controlled Type 2 Diabetic Patients: A...

Diabetic neuropathy (DN) and nephropathy (DKD) are prevalent microvascular complications in Type 2 diabetes mellitus (T2DM), often evolving silently. Detecting early nephropathy remains a clinical challenge, especially in patients with preserved renal function.

The objective was to determine whether the Toronto Clinical Scoring System (TCS) for diabetic neuropathy can predict early nephropathy (albuminuria) in people with well-controlled T2DM who have a normal eGFR.

We conducted a cross-sectional study with 122 T2DM patients (HbA1c < 7%, eGFR > 90) to look for peripheral neuropathy using TCS and nephropathy using the urinary albumin-to-creatinine ratio (UACR). Patients were classified based on the presence of albuminuria (UACR ≥ 30 mg/g). Statistical analyses included t-tests, chi-square tests, Spearman correlation, and logistic regression.

Patients with diabetic nephropathy or neuropathy were significantly older and exhibited higher systolic blood pressure and albuminuria. A clear stepwise increase in albuminuria was observed with rising neuropathy severity, with nephropathy prevalence ranging from 42% in patients without neuropathy to 72% in those with severe neuropathy. A significant positive correlation between TCS and UACR (ρ = 0.29, p = 0.0012) supports a progressive link between nerve and kidney involvement.

Clinical diabetic neuropathy is significantly associated with early nephropathy in well-controlled T2DM patients. Routine neuropathy assessment may serve as a simple, cost-effective predictor of subclinical renal damage. Future prospective studies should investigate whether early intervention in patients with neuropathy can attenuate or delay renal injury and whether this predictive link holds true across diverse ethnic and age groups.