Neuromuscular Service of the Department of Neurology, Tel Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.
J Diabetes Complications. 2018 Apr;32(4):424-428. doi: 10.1016/j.jdiacomp.2017.12.007. Epub 2017 Dec 21.
To determine the cross-sectional threshold at which hemoglobin A1c (HbA1c) is associated with polyneuropathy in healthy controls, and the values associated with the most pronounced decline in nerve function in patients with diabetes.
We used data from a cross-sectional cohort study of healthy controls and type 2 diabetes patients assessed between November 2010 and May 2013. Healthy controls and patients with diabetes were compared at different HbA1c ranges: <5.5%, 5.5-5.9%, and 6-6.4% for controls, and 6.5-7.4% and >7.5% for patients with diabetes.
The total cohort included 53 controls and 164 patients with diabetes. Subclinical small nerve fiber impairments were observed in controls at HbA1c levels of 5.5-6%, compared with HbA1c <5.5%, for example: lower Laser Doppler flare imaging area of 2.8 ± 1.4 versus 3.9 ± 2 mm. The most prominent decline in both small and large nerve fiber function was seen with less impaired glycemic control and shorter duration of diabetes, i.e. at HbA1c levels of 6.5-7.4%, compared with >7.5%.
These findings underscore the importance of early treatment at the prediabetes and early diabetes stages to prevent nerve fiber decline that is likely irreversible.
确定血红蛋白 A1c（HbA1c）与健康对照者中多发性神经病相关的横断面阈值，以及与糖尿病患者神经功能下降最明显相关的值。
我们使用了 2010 年 11 月至 2013 年 5 月间进行的一项横断面队列研究中健康对照者和 2 型糖尿病患者的数据。将健康对照者和糖尿病患者按不同的 HbA1c 范围进行比较：<5.5%、5.5-5.9%和 6-6.4%为对照组，6.5-7.4%和>7.5%为糖尿病患者。
总队列包括 53 名对照者和 164 名糖尿病患者。与 HbA1c<5.5%相比，在 HbA1c 水平为 5.5-6%的对照者中观察到亚临床小纤维神经损伤，例如：激光多普勒闪烁成像面积较低，为 2.8±1.4 毫米，而不是 3.9±2 毫米。小纤维和大纤维功能的最明显下降发生在血糖控制较好、糖尿病病程较短的情况下，即 HbA1c 水平为 6.5-7.4%，而不是>7.5%。
这些发现强调了在糖尿病前期和早期糖尿病阶段早期治疗的重要性，以预防神经纤维下降，这种下降可能是不可逆的。
