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. 2016 May;133(5):384-90.
doi: 10.1111/ane.12474. Epub 2015 Sep 8.

Role of inflammation in sensory neuropathy in prediabetes or diabetes

T Duksal  1 , B I Tiftikcioglu  1 , S Bilgin  1 , S Kose  2 , Y Zorlu  1
Affiliations

Role of inflammation in sensory neuropathy in prediabetes or diabetes

T Duksal et al. Acta Neurol Scand. 2016 May.

Abstract

Objectives: Prediabetes includes individuals with impaired glucose metabolism, and it has been associated with various complications of diabetes mellitus (DM), including peripheral neuropathy. We aimed to investigate the associations between pro-inflammatory (TNF-α) and anti-inflammatory (IL-10) cytokines and neuropathy of very distal sensory nerves in patients with prediabetes or type 2 DM.

Materials and methods: We included 50 patients with prediabetes, 50 patients with type 2 DM, and 44 controls in the study. Plasma levels of HbA1c, TNF-α, and IL-10 were analyzed. Electrodiagnostic testing was performed on dorsal sural and medial plantar sensory nerves, which are the very distal sensory nerves of the feet.

Results: Abnormalities in nerve conduction studies (NCS) of the dorsal sural and medial plantar sensory nerves were substantially higher in patients with prediabetes or type 2 DM. In addition, plasma levels of TNF-α were significantly higher in patients with type 2 DM than in controls, whereas IL-10 levels were significantly lower in patients with both prediabetes and diabetes. However, we found no correlation between the levels of HbA1c, TNF-α, IL-10, and abnormalities in NCS of the dorsal sural or medial plantar sensory nerves in either patient group.

Conclusions: To our knowledge, this is the first study to assess the relationships between TNF-α, IL-10, and NCS of the most distal sensory nerves in patients with prediabetes or type 2 DM. The mechanisms involved in the pathogenesis of DM and diabetic peripheral neuropathy are complex. The pro-inflammatory stage and the high incidence of neuropathy in patients with prediabetes may suggest a possible causative effect; however, the potential role of inflammation in the pathogenesis of peripheral neuropathy needs further clarification.

Keywords: Diabetes Mellitus; IL-10; TNF-alpha; dorsal sural nerve; inflammation; medial plantar sensory nerve; peripheral neuropathy; pre-diabetes.

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