Hemoglobin A1c and Neuropathic Pain in Type 2 Diabetes: A Case-Control Study with the Self-Administered Leeds...

BACKGROUND:  Neuropathic pain is a frequent and disabling complication of type 2 diabetes mellitus. Although poor glycemic control is known to contribute to diabetic neuropathy, its specific relationship with painful manifestations remains incompletely characterized.

OBJECTIVE:  The aim of this study was to evaluate the association between hemoglobin A1c levels and the presence of neuropathic pain in patients with type 2 diabetes mellitus.

METHODS:  A cross-sectional analytical study was conducted in 172 adults with type 2 diabetes mellitus attending outpatient clinics at a tertiary hospital in northern Peru. Neuropathic pain was assessed using the validated Spanish version of the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs questionnaire. Glycemic control was evaluated using hemoglobin A1c, analyzed both as a continuous variable and a dichotomous variable at 7%. Clinical, metabolic, and demographic variables were compared between patients with and without neuropathic pain. Associations were examined using Poisson regression with robust variance and logistic regression, estimating crude and adjusted effect measures with 95% confidence intervals.

RESULTS:  Neuropathic pain was identified in 50% of participants. Patients with neuropathic pain showed higher hemoglobin A1c values and a greater proportion of values equal to or above 7%. In adjusted models, elevated hemoglobin A1c levels remained independently associated with neuropathic pain, when analyzed both as a dichotomous variable and as a continuous variable. Dyslipidemia and hypertension also showed independent associations.

CONCLUSIONS:  Higher hemoglobin A1c levels are independently associated with neuropathic pain in patients with type 2 diabetes mellitus, underscoring the importance of sustained glycemic control.