Singleton J R, Smith A G, Bromberg M B
Division of Neuromuscular Disease, Department of Neurology, University of Utah, Salt Lake City, Utah 84132, USA.
Diabetes Care. 2001 Aug;24(8):1448-53. doi: 10.2337/diacare.24.8.1448.
To characterize a cohort of patients with neuropathy and impaired glucose tolerance (IGT) but no other identifiable cause of neuropathy. Of patients with diabetes, 10% have peripheral neuropathy at the time of their diagnosis, suggesting that axonal injury may occur early in the course of glucose intolerance. The American Diabetes Association (ADA) revised diagnostic criteria to recognize IGT (a serum glucose between 140 and 200 mg/dl in a 2-h oral glucose tolerance test [OGTT]) as a risk factor for cardiovascular disease independent of development of diabetes.
Using revised ADA criteria for diabetes and IGT, we prospectively evaluated 107 sequential patients with idiopathic neuropathy.
A total of 13 of the 107 patients had diabetes, whereas 36 (34%) had IGT, nearly three times the prevalence in age-matched control subjects (P < 0.01). OGTT was often elevated, whereas both fasting plasma glucose and HbA(1c) were normal. Comparing patients with diabetes, IGT, or normal OGTT, age and BMI were similar. However, painful sensory symptoms were more common in patients with IGT and diabetes, and family history of neuropathy was significantly more common in normoglycemic patients. Electrodiagnostic findings of axonal injury were less severe in patients with IGT and were more likely to be confined to sensory fibers than in patients with diabetes.
Our results suggest that IGT may cause or contribute to small-fiber neuropathy, which is similar in phenotype to the painful sensory neuropathy commonly encountered in diabetes. Two-hour OGTT is more sensitive than other measures of glucose handling in screening these patients.
对一组患有神经病变和糖耐量受损（IGT）但无其他可识别神经病变病因的患者进行特征描述。在糖尿病患者中，10%在诊断时患有周围神经病变，这表明轴突损伤可能在糖耐量异常过程的早期就已发生。美国糖尿病协会（ADA）修订了诊断标准，将IGT（口服葡萄糖耐量试验[OGTT]2小时血清葡萄糖在140至200mg/dl之间）识别为独立于糖尿病发生的心血管疾病风险因素。
我们使用修订后的ADA糖尿病和IGT标准，对107例连续性特发性神经病变患者进行了前瞻性评估。
107例患者中共有13例患有糖尿病，而36例（34%）患有IGT，其患病率几乎是年龄匹配对照组的三倍（P<0.01）。OGTT常升高，而空腹血糖和糖化血红蛋白（HbA1c）均正常。比较患有糖尿病、IGT或OGTT正常的患者，年龄和体重指数相似。然而，疼痛性感觉症状在IGT和糖尿病患者中更为常见，而神经病变家族史在血糖正常的患者中明显更为常见。与糖尿病患者相比，IGT患者轴突损伤的电诊断结果较轻，且更可能局限于感觉纤维。
我们的结果表明，IGT可能导致或促成小纤维神经病变，其表型与糖尿病中常见的疼痛性感觉神经病变相似。在筛查这些患者时，2小时OGTT比其他葡萄糖处理指标更敏感。
