Yonsei Med J.  2014 May;55(3):700-708. 10.3349/ymj.2014.55.3.700.

The Role of Insulin Resistance in Diabetic Neuropathy in Koreans with Type 2 Diabetes Mellitus: A 6-Year Follow-Up Study

• Cho YN
• Lee KO
• Jeong J
• Park HJ
• Kim SM
• Shin HY
• Hong JM
• Ahn CW
• Choi YC

• KMID: 2068680
• DOI: http://doi.org/10.3349/ymj.2014.55.3.700

Abstract

PURPOSE
We previously reported that insulin resistance, low high-density lipoprotein (HDL) cholesterol, and glycaemic exposure Index are independently associated with peripheral neuropathy in Korean patients with type 2 diabetes mellitus. We followed the patients who participated in that study in 2006 for another 6 years to determine the relationship between insulin resistance and neuropathy.
MATERIALS AND METHODS
This study involved 48 of the original 86 Korean patients with type 2 diabetes mellitus who were referred to the Neurology clinic for the assessment of diabetic neuropathy from January 2006 to December 2006. These 48 patients received management for glycaemic control and prevention of diabetic complications in the outpatient clinic up to 2012. We reviewed blood test results and the nerve conduction study findings of these patients, taken over a 6-year period.
RESULTS
Low HDL cholesterol and high triglycerides significantly influenced the development of diabetic neuropathy. Kitt value (1/insulin resistance) in the previous study affected the occurrence of neuropathy, despite adequate glycaemic control with HbA1c <7%. Insulin resistance affected the development of diabetic neuropathy after 6 years: insulin resistance in 2006 showed a positive correlation with a change in sural sensory nerve action potential in 2012.
CONCLUSION
Diabetic neuropathy can be affected by previous insulin resistance despite regular glycaemic control. Dyslipidaemia should be controlled in patients who show high insulin resistance because HDL cholesterol and triglycerides are strongly correlated with later development of diabetic neuropathy.

Keyword

Insulin resistance; type 2 diabetes mellitus; diabetic neuropathy; metabolic syndrome

MeSH Terms

Adult
Diabetes Mellitus, Type 2/*metabolism/*physiopathology
Diabetic Neuropathies/*metabolism/*physiopathology
Female
Humans
Insulin Resistance/*physiology
Logistic Models
Male
Middle Aged

Figure

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  Fig. 1 Enrollment and follow-up of the study patients. DMPN, diabetes mellitus induced polyneuropathy; NCS, nerve conduction study; NCV, nerve conduction velocity.

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  Fig. 2 A significant difference in Kitt value was observed between groups I and II, and between groups I and III. Kitt values=1/insulin resistance.

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  Fig. 3 Insulin resistance in 2006 showed a positive correlation (r=0.629, p=0.001) with changes in sural SNAP in group III between 2006 and 2012. r, Pearson's correlation coefficient; SNAP, sensory nerve action potential.

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