A study of people with type 2 diabetes shows that having an A1C greater than 7% for at least three years increases the risk of diabetes-related neuropathy. A1C goals may need to be tailored to each person. However, for most adults, the American Diabetes Association recommends an A1C lower than 7.0%. The goal may be higher for older adults or for people with other medical conditions.
If your blood sugar levels are higher than your goal, you may need to change the way you manage diabetes. Your healthcare professional may change your medications or add them to your treatment plan. Or you may be asked to change your diet or physical activity. An official website of the United States government They use official websites.gov A.
The gov website belongs to an official government organization of the United States. This is an open access article under the terms of the Creative Commons attribution and non-commercial license, which allows use, distribution and reproduction in any medium, provided that the original work is duly cited and is not used for commercial purposes. Peripheral neuropathy is one of the main causes of disability around the world. Diabetes is the most common cause of neuropathy, accounting for 50% of cases.
More than half of people with diabetes develop neuropathy, and diabetic peripheral neuropathy (DPN) is a major cause of decreased quality of life due to pain, loss of sensation, unsteadiness in gait, fall-related injuries, and foot ulcers and amputations. Most patients with non-diabetic neuropathy have cryptogenic sensory peripheral neuropathy (CSPN). There is an increasing amount of literature relating prediabetes, obesity and metabolic syndrome with the risk of suffering from both DPN and CSPN. This association may be particularly strong in patients with type 2 diabetes.
There are no effective medical treatments for CSPN or DPN, and aggressive glycemic control is an effective approach to reducing the risk of neuropathy in type 1 diabetes alone. Several studies suggest that lifestyle-based treatments that integrate dietary counseling with exercise could be a promising therapeutic approach for type 2 diabetes in the early stages of type 2 diabetes and NCP associated with prediabetes, obesity and metabolic syndrome. Diagnostic criteria for prediabetes and diabetes3 Criteria for the clinical diagnosis of metabolic syndrome Peripheral neuropathy is a broad term that refers to damage to various components of the peripheral nerve, extending from the cell body (the dorsal root ganglion or the anterior horn cell) to the cell projection itself, with its outer myelin layer and axonal projection. Peripheral neuropathy can affect motor, sensory, or autonomic fibers, depending on the underlying cause. Diabetes is associated with a wide spectrum of peripheral nerve complications.
The most common are distal symmetric polyneuropathy and autonomic neuropathy. A) A skin biopsy stained with PGP 9.5 shows a normal density of intraepidermal nerve fibers in the distal part of the leg of a control participant. B) The density of intraepidermal nerve fibers is significantly reduced in a patient with distal symmetric polyneuropathy and type 2 diabetes mellitus. Images courtesy of the Cutaneous Nerves Laboratory at the University of Utah.
MetS is also a risk factor for DPN among patients with established diabetes. The Utah diabetic neuropathy study involved 218 patients with type 2 diabetes who had no symptoms of diabetic neuropathy or who had symptoms of diabetic neuropathy (DPN) and cryptogenic peripheral sensory neuropathy associated with metabolic syndrome that they are likely to share common pathological mechanisms. Insulin resistance is a fundamental metabolic feature of type 2 diabetes. Both obesity and insulin resistance lead to overlapping and self-reinforcing mechanisms and converging on direct axonal injury, as well as endothelial injury and abnormal vascular reactivity, each of which, in turn, leads to axonal injury.
AGEs, advanced glycosylation end products FA, fatty acid; FFA, free fatty acids; eNOS, endothelial nitric oxide synthase; NADPH, nicotinamide adenine dinucleotide phosphate hydrogen; NO, nitric oxide; ROS, reactive oxygen species; TNFα, tumor necrosis factor alpha. Are you living with type 1 diabetes in Canada? Take part in the BETTER registry. Diabetic neuropathy is a complication of type 1 and type 2 diabetes. It is usually the result of nerve damage caused by hemoglobin A1c (HbA1c) values that remain high for a long period of time. The symptoms of neuropathy usually include pain, loss of feeling, or tingling in the extremities.
However, there are some cases of diabetic neuropathy caused by a very rapid drop in HbA1c levels (e.g., this type of neuropathy, called treatment-induced diabetes neuropathy (TIND), is still largely unknown and rarely studied. In a study carried out in a neurological clinic, we sought to quantify the number of cases of chronic urinary disease among the diagnosed cases of neuropathy. The researchers found that about 10% of all cases of neuropathy diagnosed at this clinic met the diagnostic criteria for TIND. They also found that about 60% of people whose HbA1c dropped by 2% or more over a three-month period they developed this disease.
Researchers found that people with type 1 diabetes (T1D) and those with a history of eating disorders were at greater risk of developing this type of neuropathy. The causes of nerve damage have not yet been fully established, but the study suggests that intrauterine colorectal disease may result from inflammation caused by episodes of hypoglycemia, which in turn are associated with a rapid drop in HbA1c levels. The researchers also reported that limb pain or central pain are common to all people with this type of neuropathy. Most experienced severe pain two to six weeks after the improvement in their blood sugar levels.
Other reported symptoms included dizziness and loss of consciousness. The study authors noted that TIND may be reversible in some people, especially those with type 1 diabetes. A 2% or greater decrease in HbA1c levels over a three-month period usually involves significant lifestyle changes. If you and your health care team want to lower your HbA1c levels, be sure to discuss safe and long-lasting strategies to achieve this goal.
First record of people living with Type 1 diabetes in Canada. The Type 1 BETTER project is led by researchers, health professionals and people living (or whose children are living) with type 1 diabetes in Canada. Subscribe now to keep reading and get access to the full archive. Long-term glycemic variability, or HbA1c variability, may be a better predictor of some macrovascular and microvascular complications of diabetes than average HbA1c levels, although its relationship with the development of the DPN has not yet been established.
The average HbA1c levels that discriminated between patients with and without DPN records were 6.5% (unadjusted) and 7.1% (adjusted). The index date was defined as the date of the first diabetic peripheral neuropathy (DPN) diagnosis record in the DPN group and the date of the last hemoglobin A1c (HbA1c) record in the control group. The operating characteristic curve of the hemoglobin A1c receptor averages as an indicator of diabetic peripheral neuropathy. AUC area under the curve, coefficient of variation CV, diabetic peripheral neuropathy with DPN, dipeptidyl peptidase-4 DPP-4, glucagon-like peptide-1 GLP-1, hemoglobin A1c HbA1c, high-density lipoprotein HDL, low-density lipoprotein LDL, standard deviation SD, sodium-glucose cotransporter 2 SGLT2, type 2 diabetes mellitus.
The model included the average HbA1c level (continuous value) selected from several HbA1c metrics, in addition to all the baseline variables, except for the matching factors (age, sex and duration since the first record of type 2 diabetes mellitus), the DPN test and the body mass index. Therefore, DPN in prediabetes, including its relationship with HbA1c values and other factors, such as smoking, alcohol abuse and metabolic syndrome during this stage, should be investigated in future studies. Diabetic peripheral neuropathy was defined using the Japanese codes 8845100 (diabetic peripheral neuropathy type 2), 2505018 (diabetic peripheral neuropathy) or 8848768 (diabetic neuropathic pain). These findings link obesity to neuropathy, imply that altered epidermal growth factor biology may contribute to neuropathic pain, and suggest that exercise is a promising therapeutic strategy that, when used in the early stages of the course of the disease, can improve neuropathy, not just delay progression. The average HbA1c levels over the 3-year observation period were 7.2 ± 1.0% in the DPN group and 6.9 ± 1.1% in the control group; 48.0% and 62.5% of the patients had an average HbA1c level of.
Keeping your A1C at 7% or lower will control your blood glucose level and increase your chances of avoiding neuropathy. The optimal cutoff values for HbA1c as prevention indices for DPN were 6.54% and 6.55%, respectively. The former had a sensitivity and specificity of 73.8% and 43.3%, and the latter had a sensitivity and specificity of 73.4% and 43.6%, respectively. After 8 years of follow-up, patients in the intervention group had a more marked reduction in hemoglobin A1c, systolic and diastolic blood pressure, serum cholesterol and triglycerides, and albumin excretion in the urine, with a reduction of almost 50% in the risk of cardiovascular and microvascular events.
