Restricted accessResearch articleFirst published online 2025
The interrelationship between the frequency and severity of entrapment neuropathies and HbA1c in patients with diabetes in short and long term: A retrospective cohort study
Diabetes mellitus (DM) is a significant risk factor for peripheral nervous system disorders, particularly for polyneuropathy and carpal tunnel syndrome (CTS). In this study, we aimed to find whether there was an association between the severity of peripheral neuropathies and blood sugar regulation in diabetics.
Method
We included 347 diabetic patients who were evaluated in our EMG laboratory. We divided the study population into four subgroups based on the glycemic control as in American Diabetes Association (ADA) classification and three classes in Michigan severity stages of diabetic polyneuropathy (DPNP). Possible associations between demographics, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and the severity of DPNP and CTS were analyzed.
Results
Patients with DPNP had higher levels of FBG and HbA1c (p = 0.002 and p < 0.001, respectively). Similarly, patients with entrapment neuropathy also had higher levels of FBG and HbA1c than those without (p = 0.003 and p = 0.004, respectively). Moreover, higher grades of DPNP and CTS were associated with higher mean levels of FBG and HbA1c (p < 0.05 for all analyses). Patients with more impaired glycemic control, categorized according to the ADA classification of HbA1c, had more severe grades of DPNP and CTS (p < 0.05).
Conclusion
Patients with more impaired glycemic control experienced more frequent and severe grades of DPNP and/or CTS. This suggests that achieving individualized treatment targets early may help prevent the onset and progression of these peripheral nervous system complications.
We recommend using HbA1c as a predictor of the electrophysiological severity of peripheral compression neuropathies in diabetic patients.
DyckPJAlbersJWAndersenH, et al.Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity. Diabetes Metabolism Research and Review2011; 27: 620–628.
2.
TesfayeSBoultonAJDyckPJ, et al.Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care2010; 33: 2285–2293.
3.
DyckPJKratzKMKarnesJL, et al.The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester diabetic neuropathy study. Neurology1993; 43: 817–824.
4.
HerderCLankischMZieglerD, et al.Subclinical inflammation and diabetic polyneuropathy: MONICA/KORA survey F3 (Augsburg, Germany). Diabetes Care2009; 32: 680–682.
5.
ZieglerDRathmannWDickhausT, et al.KORA Study Group. Prevalence of polyneuropathy in pre-diabetes and diabetes is associated with abdominal obesity and macroangiopathy: the MONICA/KORA augsburg surveys S2 and S3. Diabetes Care2008; 31: 464–469.
6.
JendeJMEGroenerJBRotherC, et al.Diabetic Neuropathy Study Group of the German Diabetes Association. Diabetic neuropathy: influence of diabetes type and duration, insulin, and glycemic control. Diabetes Metab Res Rev2020; 36: e3279.
7.
AtroshiIGummessonCJohnssonR, et al.Prevalence of carpal tunnel syndrome in a general population. JAMA1999; 282: 153–158.
8.
BuchbergerWSchönGStrasserK, et al.High-resolution ultrasonography of the carpal tunnel. J Ultrasound Med1991; 10: 531–537.
9.
OndeMEOzgeASenolMG, et al.The sensitivity of clinical diagnostic methods in the diagnosis of diabetic neuropathy. J Int Med Res2008; 36: 63–70.
10.
PourmemariMHShiriR. Diabetes as a risk factor for car-pal tunnel syndrome: a systematic review and meta-analysis. Diabet Med2016; 33: 10–16.
11.
Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med1993; 329: 977–986.
12.
TesfayeSChaturvediNEatonSE, et al.EURODIAB Prospective Complications Study Group. Vascular risk factors and diabetic neuropathy. N Engl J Med2005; 352: 341–350.
13.
MartinCLAlbersJWPop-BusuiR. DCCT/EDIC Research Group. Neuropathy and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care2014; 37: 31–38.
14.
SherwaniSIKhanHAEkhzaimyA, et al.Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomark Insig2016; 11: 95–104.
15.
American Diabetes Association Professional Practice Committee. Standards of care in diabetes—2024. Improving care and promoting health in populations. Diabetes Care2024; 47: S1–S300.
16.
American Diabetes Association. Standards of medical care in diabetes—2020. Diabetes Care2020; 43: S66–S76.
17.
SumnerCJShethSGriffinJW, et al.The spectrum of neuropathy in diabetes and impaired glucose tolerance. Neurology2003; 60: 108–111.
18.
CallaghanBCLittleAAFeldmanEL, et al.Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane Database Syst Rev2012; 6: CD007543.
19.
Pop-BusuiRBoultonAJFeldmanEL, et al.Diabetic neuropathy: a position statement by the American diabetes association. Diabetes Care2017; 40: 136–154.
20.
American Diabetes Association. Standards of medical care in diabetes-2010 diabetes care. 2010; 33: S11–S61
21.
LeveyASCoreshJBalkE, et al.National Kidney Foundation. National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med2003; 139: 137–147.
22.
GarberJRCobinRHGharibH, et al.American Association Of Clinical Endocrinologists And American Thyroid Association Taskforce On Hypothyroidism In Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American association of clinical endocrinologists and the American thyroid association. Thyroid2012; 22: 1200–1235.
23.
RossDSBurchHBCooperDS, et al.2016 American thyroid association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid2016; 26: 13431421.
MacDermidJCWesselJ. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther2004; 17: 309–319.
26.
BasiriKKatirjiB. Practical approach to electrodiagnosis of the carpal tunnel syndrome: a review. Adv Biomed Res2015; 4: 50.
27.
SaggarSKThamanRGMohanG, et al.Mapping neurophysiological patterns in carpal tunnel syndrome: correlations with tinel's and phalen's signs. Cureus2024; 16: e58168.
28.
FeldmanELStevensMJThomasPK, et al.A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care1994; 17: 1281–1289.
29.
JableckiCKAndaryMTFloeterMK, et al.Practice parameter: electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation Neurology2002; 58: 1589–1592.
30.
BischoffCFuglsang-FredriksenAVendelboL, et al.Standards of instrumentation of EMG. The International Federation of Clinical Neurophysiology Electroencephalogr Clin Neurophysiol Suppl1999; 52: 199–211.
31.
TankisiHBurkeDCuiL, et al.Standards of instrumentation of EMG. Clin Neurophysiol2020; 131: 243–258.
SuljicEKulasinIAlibegovicV. Assessment of diabetic polyneuropathy in inpatient care: fasting blood glucose, HbA1c, electroneuromyography and diabetes risk factors. Acta Inform Med2013; 21: 123–126.
34.
PanJYanXLiF, et al.Association of glycemic variability assessed by continuous glucose monitoring with subclinical diabetic polyneuropathy in type 2 diabetes patients. J Diabetes Investig2021; 13: 328–335.
35.
JangJYMoonSChoS, et al.Visit-to-visit HbA1c and glucose variability and the risks of macrovascular and microvascular events in the general population. Sci Rep2019; 9: 1374.
36.
KarpitskayaYNovakCBMackinnonSE. Prevalence of smoking, obesity, diabetes mellitus, and thyroid disease in patients with carpal tunnel syndrome. Ann Plast Surg2002; 48: 269–273.
37.
KotbMABedewiMAAldossaryNM, et al.Sonographic assessment of carpal tunnel syndrome in diabetic patients with and without polyneuropathy. Medicine (Baltimore)2018; 97: e11104.
38.
HorinouchiSDeguchiTArimuraK, et al.Median neuropathy at the wrist as an early manifestation of diabetic neuropathy. J Diabetes Investig2014; 5: 709–713.
39.
HuangH-WJouI-MWangC-K, et al.Power spectral analyses of index finger skin blood perfusion in carpal tunnel syndrome and diabetic polyneuropathy. Exp Diabetes Res2011; 2011: 465910–465918.
40.
DahlinLBSandénHDahlinE, et al.Low myelinated nervefibre density may lead to symptoms associated with nerve entrapment in vibration-induced neuropathy. J Occup Med Toxicol2014; 9: 7.
41.
GoldinABeckmanJASchmidtAM, et al.Advanced glycation end products: sparking the development of diabetic vascular injury. Circulation2006; 114: 597–605.
42.
EspositoKNappoFMarfellaR, et al.Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress. Circulation2002; 106: 2067–2072.
43.
MojaddidiMAAhmedMSAliR, et al.Molecular and pathological studies in the posterior interosseous nerve of diabetic and non-diabetic patients with carpal tunnel syndrome. Diabetologia2014; 57: 1711–1719.
44.
YagihashiSMizukamiHSugimotoK. Mechanism of diabetic neuropathy: where are we now and where to go? Diabetic neuropathy and its mechanism. J Diabetes Investig2011; 2: 18–32.
45.
NahaUMillerAPatettaMJ, et al.The interaction of diabetic peripheral neuropathy and carpal tunnel syndrome. HAND2023; 18: 43S–47S.
46.
Mauvais-JarvisF. Gender differences in glucose homeostasis and diabetes. Physiol Behav2018; 187: 20–23.
47.
WildSRoglicRGreenA, et al.Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care2004; 27: 1047–1053.
48.
PerampalamMPugdahlKFuglsang-FrederiksenA, et al.Are patients with polyneuropathy more liable to have CTS?Clin Neurophysiol2019; 130: e21–e116.
