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Published on: July 14, 2023

Incidence and predictors of distal symmetrical polyneuropathy in prediabetes: A 24-month prospective cohort study

Georgia Anastasiou1, Nikolaos Papanas2, Fotios Barkas3

  • 1Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Diabetes Research and Clinical Practice
|August 13, 2026
PubMed

Insights

Prediabetes increases the risk of developing distal symmetrical polyneuropathy (DSPN). Age, male sex, smoking, central obesity, and insulin resistance are key predictors of DSPN in individuals with prediabetes.

Area of Science:

  • Endocrinology
  • Neurology
  • Metabolic Syndrome

Background:

  • Distal symmetrical polyneuropathy (DSPN) is a common diabetes complication, increasingly recognized in earlier dysglycemia stages.
  • Prediabetes is linked to insulin resistance, central adiposity, and dyslipidemia, but DSPN incidence and cardiometabolic associations are understudied.

Purpose of the Study:

  • To prospectively determine the incidence of DSPN in prediabetes patients.
  • To identify predictors of incident DSPN within this population.

Main Methods:

  • 160 prediabetes adults were followed for 24 months.
  • DSPN assessed using neuropathy symptom score (NSS), neuropathy disability score (NDS), and vibration perception threshold (VPT).
  • Multivariable regression analyzed predictors of incident DSPN.

Main Results:

  • 27% of participants had DSPN at baseline; 9.8% developed DSPN over 24 months.
  • Independent predictors included older age, male sex, smoking, larger waist circumference, and higher HOMA-IR (homeostatic model assessment of insulin resistance).
  • Both baseline HOMA-IR and its change over time were significant predictors.

Conclusions:

  • A 9.8% 24-month incidence of DSPN was observed in prediabetes.
  • Age, male sex, smoking, central obesity, and insulin resistance (baseline and change) predict DSPN.
  • Findings suggest potential for screening and prevention strategies in prediabetes.
Abstract

Keywords:
Arterial stiffnessDistal symmetrical polyneuropathyInsulin resistanceObesityPrediabetesSmoking

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