Diabetic peripheral neuropathy: age-stratified glycemic control

Front Endocrinol (Lausanne). 2024 Apr 17:15:1377923. doi: 10.3389/fendo.2024.1377923. eCollection 2024.

Abstract

Background: We explore the effect of suboptimal glycemic control on the incidence of diabetic peripheral neuropathy (DPN) in both non-elderly and elderly patients with type 2 diabetes mellitus (T2DM).

Methods: A 6-year follow-up study (2013-2019) enrolled T2DM patients aged >20 without DPN. Participants were classified into two groups: those below 65 years (non-elderly) and those 65 years or older (elderly). Biochemical measurements, including glycated hemoglobin (HbA1C), were recorded regularly. DPN was diagnosed using the Michigan Neuropathy Screening Instrument examination. The outcome was DPN occurrence in 2019.

Results: In 552 enrollments (69% non-elderly), DPN occurred in 8.4% non-elderly and 24.0% elderly patients. A higher initial HbA1C level was significantly linked with a higher risk of future DPN in the non-elderly group (adjusted odds ratio [AOR] 1.46, 95% CI 1.13-1.89, p=0.004). In comparison, HbA1c at the end of the study period was not associated with DPN in the non-elderly group (AOR 1.17, 95% CI 0.72-1.90, p=0.526). In the elderly group, no statistical relationship was found between HbA1C levels and DPN, either in 2013 or in 2019.

Conclusion: Suboptimal glycemic control at baseline, rather than at the end of the study period, predicts an increased risk of future DPN in individuals with T2DM under age 65. This correlation is not seen in elderly patients. Therefore, we recommend implementing enhanced glycemic control early in middle-aged T2DM patients and propose individualized therapeutic strategies for diabetes in different age groups.

Keywords: age; diabetic peripheral neuropathy; glycemic control; risk factor; type 2 diabetes mellitus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Blood Glucose / analysis
  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 2* / blood
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / epidemiology
  • Diabetic Neuropathies* / blood
  • Diabetic Neuropathies* / epidemiology
  • Diabetic Neuropathies* / etiology
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin* / analysis
  • Glycated Hemoglobin* / metabolism
  • Glycemic Control*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Risk Factors

Substances

  • Glycated Hemoglobin
  • Blood Glucose
  • hemoglobin A1c protein, human

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the grant from the Taichung Veterans General Hospital (TCVGH 1093403C and 1103402C). The funding source had no role in the study’s design, conduct, and reporting.