An average hemoglobin A1c level of approximately 6.5—7.0% was the optimal cutoff, discriminating between with and without the development of. An official website of the United States government Official websites use. 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 leading causes of disability worldwide. 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 ulceration and amputation.
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 to the risk of suffering from both NPD 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 only in type 1 diabetes.
Several studies suggest that lifestyle-based treatments that integrate dietary counseling with exercise could be a promising therapeutic approach for early DPN in type 2 diabetes and CSPN 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 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. If you have diabetes, you can develop nerve problems at any time. Sometimes, neuropathy may be the first sign of diabetes. Significant nerve problems (clinical neuropathy) can occur within the first 10 years after a diagnosis of diabetes.
The risk of developing neuropathy increases the longer you have diabetes. About half of people with diabetes have some form of neuropathy. The average HbA1c levels that discriminated between patients with and without a history of DPN were 6.5% (unadjusted) and 7.1% (adjusted). A study conducted on people with type 2 diabetes shows that having an A1C greater than 7% for at least three years increases the risk of suffering from related neuropathy with diabetes. The index date was defined as the date of the first diagnostic record for diabetic peripheral neuropathy (DPN) for the DPN group and the date of the last hemoglobin A1c (HbA1c) record for the control group.
If you and your healthcare team want to lower your HbA1c levels, be sure to discuss safe and durable strategies to achieve this goal. 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. Operational characteristic curve of the hemoglobin A1c receptor average as an indicator of diabetic peripheral neuropathy. 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.
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. In addition, to identify an objective average HbA1c target for the prevention of NPN, the potential of the average HbA1c level to discriminate against patients with and without a DPN record was evaluated by plotting a receptor operating characteristics (ROC) curve and calculating the AUC. Similarly, the incidence of retinopathy, diabetic kidney disease and neuropathy increases as HbA1c values increase. This sample size was obtained by extracting the maximum data from the database used according to pre-specified criteria and methods, such as the availability of long-term HbA1c data and the comparison with the baseline variables.
Long-term glycemic variability, or HbA1c variability, may be a better indicator of some macrovascular and microvascular complications of diabetes than average HbA1c levels, although its relationship with the development of DPN has not yet been established. The optimal cutoff levels of HbA1c as indices for preventing DPN were 6.54% and 6.55%, respectively, with the former having a sensitivity and specificity of 73.8% and 43.3%, and the latter with a sensitivity and specificity of 73.4% and 43.6%, respectively.
