Non-invasive evaluation of neural impairment in subjects with impaired glucose tolerance
- Zsuzsanna Putz, MD (zsuzsannaputz{at}yahoo.com)1,4,
- Ádám G Tabák, MD, PhD1,2,
- Nelli Tóth, MD1,
- Istenes Ildikó, MD1,
- Nóra Németh1,
- Rajiv A Gandhi, MD3,
- Zsolt Hermányi, MD1,4,
- Katalin Keresztes, MD, PhD1,
- György Jermendy, MD, PhD, DSc4,
- Solomon Tesfaye, MD, FRCP3 and
- Péter Kempler, MD, PhD, DSc1
- 1stDepartment of Medicine, Semmelweis University, Budapest, Hungary 1
- Department of Epidemiology and Public Health, University College London, London, UK2
- Royal Hallamshire Hospital, Sheffield, UK3
- 3rdDepartment of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary4
Abstract
Objectives: Evaluation of neural dysfunction in impaired glucose tolerance (IGT).
Research Design and Methods: 46 subjects with IGT and 45 healthy volunteers underwent detailed neurological assessment. Cardiovascular autonomic function was assessed by standard cardiovascular reflex tests and heart rate variability characterised by the triangle index (HRVti). Sensory nerve function was assessed using Neurometer (current perception threshold [CPT]) and Medoc devices. Peak plantar pressure was measured by dynamic pedobarography and symptoms graded using Neuropathy Total Symptom Score.
Results: Subjects with IGT had significantly greater abnormalities detected in 4 of 5 cardiovascular reflex tests and HRVti. They had a higher frequency of both hyperaesthesia and hypaesthesia as detected by CPT testing at 5 Hz, as well as increased heat detection thresholds.
Conclusions: This study provides evidence that sub-clinical neural dysfunction is present in IGT and can be detected non-invasively. Cardiovascular autonomic neuropathy may contribute to the increased cardiovascular risk in IGT.
Footnotes
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- Received July 30, 2008.
- Accepted September 17, 2008.
- Copyright © American Diabetes Association
