Ponirakis Georgios, Al-Janahi Ibrahim, Elgassim Einas, Hussein Rawan, Petropoulos Ioannis N, Gad Hoda, Khan Adnan, Zaghloul Hadeel B, Siddique Mashhood A, Ali Hamda, Mohamed Fatima F S, Ahmed Lina H M, Dakroury Youssra, El Shewehy Abeer M M, Saeid Ruba, Mahjoub Fadwa, Al-Thani Shaikha N, Ahmed Farheen, Homssi Moayad, Mahmoud Salah, Hadid Nebras H, Obaidan Aisha Al, Salivon Iuliia, Mahfoud Ziyad R, Zirie Mahmoud A, Al-Ansari Yousuf, Atkin Stephen L, Malik Rayaz A
Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar.
National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
J Peripher Nerv Syst. 2024 Dec;29(4):406-414. doi: 10.1111/jns.12664. Epub 2024 Oct 22.
Obesity is a major risk factor for diabetic peripheral neuropathy (DPN) in type 2 diabetes (T2D). This study investigated the effect of glucose lowering medication associated with weight change on DPN.
Participants with T2D were grouped based on whether their glucose lowering medications were associated with weight gain (WG) or weight loss (WL). They underwent clinical, metabolic testing and assessment of neuropathic symptoms, vibration perception threshold (VPT), sudomotor function and corneal confocal microscopy (CCM) at baseline and follow-up between 4 and 7 years.
Of 76 participants, 69.7% were on glucose lowering medication associated with WG, and 30.3% were on glucose lowering medication associated with WL. At baseline, participants in the WG group had a significantly longer duration of diabetes (p < .01), higher douleur neuropathique en 4 (DN4) score (p < .0001) and VPT (p = .01) compared with those in the WL group. Over a 56-month period, participants in the WG group showed no significant change in body weight (p = .11), HbA1c (p = .18), triglycerides (p = .42), DN4 (p = .11), VPT (p = .15) or Sudoscan (p = .43), but showed a decline in corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL) (p < .0001). Participants in the WL group showed a reduction in weight (p = .01) and triglycerides (p < .05), no change in DN4 (p = .30), VPT (p = .31) or Sudoscan (p = .17) and a decline in the corneal nerve branch density (p < .01).
Participants treated with glucose lowering medication associated with weight gain had worse neuropathy and greater loss of corneal nerves during follow-up, compared to patients treated with medication associated with weight loss.
肥胖是2型糖尿病（T2D）患者发生糖尿病周围神经病变（DPN）的主要危险因素。本研究调查了降糖药物与体重变化对DPN的影响。
根据降糖药物是否与体重增加（WG）或体重减轻（WL）相关，将T2D患者分组。在基线以及4至7年的随访期间，他们接受了临床、代谢测试以及神经病变症状、振动觉阈值（VPT）、泌汗功能和角膜共聚焦显微镜检查（CCM）评估。
76名参与者中，69.7%使用与体重增加相关的降糖药物，30.3%使用与体重减轻相关的降糖药物。基线时，与体重减轻组相比，体重增加组参与者的糖尿病病程显著更长（p < 0.01），神经病变疼痛评分4（DN4）更高（p < 0.0001），振动觉阈值（VPT）更高（p = 0.01）。在56个月的时间里，体重增加组参与者的体重（p = 0.11）、糖化血红蛋白（HbA1c）（p = 0.18）、甘油三酯（p = 0.42）、DN4（p = 0.11）、VPT（p = 0.15）或Sudoscan（p = 0.43）均无显著变化，但角膜神经纤维密度（CNFD）、角膜神经分支密度（CNBD）和角膜神经纤维长度（CNFL）有所下降（p < 0.0001）。体重减轻组参与者体重（p = 0.01）和甘油三酯下降（p < 0.05），DN4（p = 0.30）、VPT（p = 0.31）或Sudoscan（p = 0.17）无变化，角膜神经分支密度下降（p < 0.01）。
与使用与体重减轻相关药物治疗的患者相比，使用与体重增加相关降糖药物治疗的参与者在随访期间神经病变更严重，角膜神经损失更大。
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