Prevalence of peripheral neuropathy in pre-diabetes: a systematic review

Abstract

There is growing evidence of excess peripheral neuropathy in pre-diabetes. We aimed to determine its prevalence, including the impact of diagnostic methodology on prevalence rates, through a systematic review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive electronic bibliographic search was performed in MEDLINE, EMBASE, PubMed, Web of Science and the Cochrane Central Register of Controlled Trials from inception to June 1, 2020. Two reviewers independently selected studies, extracted data and assessed risk of bias. An evaluation was undertaken by method of neuropathy assessment. After screening 1784 abstracts and reviewing 84 full-text records, 29 studies (9351 participants) were included. There was a wide range of prevalence estimates (2%–77%, IQR: 6%–34%), but the majority of studies (n=21, 72%) reported a prevalence ≥10%. The three highest prevalence estimates of 77% (95% CI: 54% to 100%), 71% (95% CI: 55% to 88%) and 66% (95% CI: 53% to 78%) were reported using plantar thermography, multimodal quantitative sensory testing and nerve conduction tests, respectively. In general, studies evaluating small nerve fiber parameters yielded a higher prevalence of peripheral neuropathy. Due to a variety of study populations and methods of assessing neuropathy, there was marked heterogeneity in the prevalence estimates. Most studies reported a higher prevalence of peripheral neuropathy in pre-diabetes, primarily of a small nerve fiber origin, than would be expected in the background population. Given the marked rise in pre-diabetes, further consideration of targeting screening in this population is required. Development of risk-stratification tools may facilitate earlier interventions.

Prediabetes and risk of mortality, diabetes-related complications and comorbidities: umbrella review of meta-analyses of prospective studies

“…Given that the prevalence of retinopathy was initially used to refine threshold levels of fasting plasma glucose, 2 h plasma glucose and HbA 1c for the diagnosis of diabetes [39], it is not surprising that the association between prediabetes and retinopathy has been reported to be weak [40]. In contrast, evidence is accumulating for the presence of peripheral and cardiac autonomic neuropathy in people with prediabetes [41][42][43][44], so this field needs further prospective studies to quantify this relationship.…”

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“…It results in neuropathic pain which impacts on quality of life and may lead to foot ulceration and amputation, with an excess premature mortality rate. Peripheral neuropathy has also been demonstrated in approximately 10% of individuals with prediabetes [ 3 ]. Given that prediabetes is projected to affect up to 587 million people (8.3% of the global adult population) by 2040, this represents a major burden on healthcare.…”

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“…Prediabetes is a risk factor for chronic axonal polyneuropathy, which is consistent with the initial involvement of small nerve fibers. This is the main cause of neuropathic pain and incidence rate, and also the starting factor of diabetic foot ulcers ( 6 ).…”