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. 2024 Sep 1;47(9):1559-1567.
doi: 10.2337/dc23-1749.

Neuropathic Pain With and Without Diabetic Peripheral Neuropathy in Type 1 Diabetes

Barbara H Braffett  1 , Laure El Ghormli  1 , James W Albers  2 , Eva L Feldman  2 , William H Herman  2 , Rose A Gubitosi-Klug  3 , Catherine L Martin  2 , Trevor J Orchard  4 , Neil H White  5 , John M Lachin  1 , Bruce A Perkins  6 , Rodica Pop-Busui  2 ; DCCT/EDIC Research Group
Affiliations

Neuropathic Pain With and Without Diabetic Peripheral Neuropathy in Type 1 Diabetes

Barbara H Braffett et al. Diabetes Care. .

Abstract

Objective: Diabetic peripheral neuropathy (DPN) is common; however, the features and burden of neuropathic pain (NP) in type 1 diabetes (T1D) are poorly understood. We evaluated the incidence of first occurrence, annual prevalence, remission, and risk factors for NP during long-term follow-up of participants with T1D.

Research design and methods: The Michigan Neuropathy Screening Instrument (MNSI) was administered annually (1994-2020) for 1,324 participants in the Epidemiology of Diabetes Interventions and Complications (EDIC) study. NP with clinical signs of DPN (NP DPN+) was defined according to self-reported NP plus an examination score >2, while NP without clinical signs of DPN (NP DPN-) was defined according to self-reported NP and an examination score ≤2.

Results: At EDIC year 1, median age for participants was 36 years (interquartile range 30, 41), diabetes duration 13 years (10, 18), and HbA1c 7.9% (7.2, 8.9). At year 26 (median diabetes duration 39 years), cumulative incidence of NP was 57%, regardless of concomitant clinical signs of DPN (36% NP DPN+ vs. 46% NP DPN-). NP prevalence was 20% at 26 years (11% NP DPN+ and 9% NP DPN-), suggesting frequent remission. Annualized remission rates were similar regardless of pain medication use. In addition to HbA1c, female sex was associated with NP DPN-.

Conclusions: NP incidence in T1D was high and frequently occurred in the absence of clinical signs of neuropathy, as assessed with the MNSI. Pain remission was not explained by pain medication use. Effective clinical strategies for identification and management are needed.

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Conflict of interest statement

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

Figures

None
Graphical abstract
Figure 1
Figure 1
A: Cumulative incidence of the first occurrence of any NP overall, any NP DPN+, and any NP DPN− during EDIC years 1–26. Cumulative incidence curves were generated separately for three different risk sets and overlaid. B: Cumulative incidence of the first occurrence of any NP overall, any NP DPN+, and any NP DPN− during EDIC years 1–26 by treatment group. Cumulative incidence curves were generated separately for three different risk sets and overlaid. C: Annual prevalence of NP with and without clinical signs of DPN. The number of participants at risk is shown below the x-axes.
Figure 1
Figure 1
A: Cumulative incidence of the first occurrence of any NP overall, any NP DPN+, and any NP DPN− during EDIC years 1–26. Cumulative incidence curves were generated separately for three different risk sets and overlaid. B: Cumulative incidence of the first occurrence of any NP overall, any NP DPN+, and any NP DPN− during EDIC years 1–26 by treatment group. Cumulative incidence curves were generated separately for three different risk sets and overlaid. C: Annual prevalence of NP with and without clinical signs of DPN. The number of participants at risk is shown below the x-axes.
See this image and copyright information in PMC

References

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