Associations between acute glucose control and peripheral nerve structure and function in type 1 diabetes

T. Issar, S.S. Tummanapalli, N.C.G. Kwai, J.C.B. Chiang, R. Arnold, A.M. Poynten, M. Markoulli, A.V. Krishnan

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To examine the associations between continuous overlapping net glycaemic action (CONGA), percentage time in hyperglycaemia (%HG) or normoglycaemia (%NG) and peripheral nerve structure and function in type 1 diabetes.

Twenty-seven participants with type 1 diabetes underwent continuous glucose monitoring followed by corneal confocal microscopy and nerve excitability assessments. CONGA, %HG (> 10.0 mmol/l) and %NG (3.9–10.0 mmol/l) were correlated against corneal nerve fibre length and density in the central cornea and inferior whorl region, corneal microneuromas, and a nerve excitability score while controlling for age, sex, diabetes duration and HbA1c.

An increase in CONGA [median 2.5 (2.0–3.1) mmol/l] or %HG (mean 46 ± 18%) was associated with a worse nerve excitability score (r = –0.433, P = 0.036 and r = –0.670, P = 0.0012, respectively). By contrast, greater %NG (51 ± 17%) correlated with better nerve excitability scores (r = 0.672, P = 0.0011). Logistic regression revealed that increasing %HG increased the likelihood of abnormal nerve function [odds ratio (OR) 1.11, 95% confidence interval (CI) 1.01–1.23; P = 0.037). An increase in CONGA and %HG were associated with worsening nerve conduction measures, whereas longer %NG correlated with improved nerve conduction variables. CONGA and %HG were associated with inferior whorl corneal nerve fibre length (r = 0.483, P = 0.034 and r = 0.591, P = 0.021, respectively) and number of microneuromas (r = 0.433, P = 0.047 and r = 0.516, P = 0.020, respectively).

Short-term measures of glucose control are associated with impaired nerve function and alterations in corneal nerve morphology.
Original languageEnglish
JournalDiabetic medicine
Issue number9
Early online date16 Apr 2020
Publication statusPublished - Sept 2020


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