There is very little data for a direct comparison of the incidence and prevalence of neuropathy in the two major types of diabetes. Comparison between studies is very difficult because of the different methods used for defining neuropathy. The DCCT, which studied subjects with type 1 diabetes, showed after 5 years follow-up that abnormal nerve conduction in at least two nerves occurred in 15-30% of subjects that were tightly controlled, and in 40-52% of controls (37). In the UKPDS, which studied subjects with type 2 diabetes, after 6 years follow-up, biosthesiometer readings in both toes were abnormal in 19% of intensively treated subjects and in 21% of conventionally treated controls (19). These two studies cannot be directly compared because the methods of defining neuropathy, and the time intervals at which results were described, are both different. However, the frequency with which the control subjects in the DCCT trial developed abnormal nerve conduction is striking. Broadly speaking, it is possible that tight control may have a greater effect on reducing incidence of diabetic neuropathy in type 1 diabetes compared with type 2 diabetes.
IS IMPAIRED GLUCOSE TOLERANCE A RISK FACTOR FOR DIABETIC NEUROPATHY?
The San Luis Valley Diabetes Study demonstrated a higher prevalence of distal sensory neuropathy among subjects with IGT in comparison with NGT (11.2% vs 3.5%) (4). This finding was not supported in a study of 51 Swedish subjects with persistent IGT for 12 to 15 years who were in comparison with 62 age-matched nondiabetic controls (59). Nerve conduction velocities did not significantly differ between the IGT and the NGT groups. Abnormal heart rate variation with breathing was more common in IGT vs NGT subjects (29% vs 8%, p < 0.01), suggesting that IGT may increase the risk of developing autonomic neuropathy. The Framingham Heart Study found that heart rate variability was lower in subjects with impaired fasting glucose, in comparison with subjects with normal fasting glucose, but this result was not statistically significant after adjusting for clinical variables (35). Whether IGT increases risk of diabetic sensory or autonomic neuropathy cannot be determined from available data.
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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...