Abstract
Aims. The relationship between nonalcoholic fatty liver disease (NAFLD) and diabetic polyneuropathy (DPN) has been demonstrated in many studies, although results were conflicting. This meta-analysis aims to summarize available data and to estimate the DPN risk among NAFLD patients. Materials and methods. We performed a comprehensive literature review until 4 June 2021. Clinical trials analyzing the association between NAFLD and DPN were included. Results. Thirteen studies (9614 participants) were included. DPN prevalence was significantly higher in patients with NALFD, compared to patients without NAFLD (OR (95%CI) 2.48 (1.42–4.34), p = 0.001; I2 96%). This finding was confirmed in type 2 diabetes (OR (95%CI) 2.51 (1.33–4.74), p = 0.005; I2 97%), but not in type 1 diabetes (OR (95%CI) 2.44 (0.85–6.99), p = 0.100; I2 77%). Also, body mass index and diabetes duration were higher in NAFLD subjects compared to those without NAFLD (p < 0.001), considering both type 2 and type 1 diabetes. Conclusion. Despite a high heterogeneity among studies, a significantly increased DPN prevalence among type 2 diabetes subjects with NAFLD was observed. This result was not found in type 1 diabetes, probably due to the longer duration of disease. Physicians should pay more attention to the early detection of DPN, especially in patients with NAFLD.
Highlights
Peripheral diabetic polyneuropathy (DPN) is a microvascular complication of diabetes mellitus (DM), representing the most clinically relevant manifestation of typical forms of diabetic neuropathy (DN)
We demonstrate that DPN is more frequent when nonalcoholic fatty liver disease (NAFLD) is associated to DM, evaluating more than 9000 diabetic subjects
We clearly demonstrate that a diabetic patient must be carefully evaluated for the onset of peripheral neurological complications, especially when NAFLD is associated with diabetes
Summary
Peripheral diabetic polyneuropathy (DPN) is a microvascular complication of diabetes mellitus (DM), representing the most clinically relevant manifestation of typical forms of diabetic neuropathy (DN). DPN has been defined by the Toronto Expert Panel on Diabetic Neuropathy as a symmetrical, length-dependent sensorimotor polyneuropathy attributable to metabolic and microvascular alterations, resulting from the chronic hyperglycemia typical of diabetes and cardiovascular risk covariates [1]. DPN occurs in at least 20% of people with type 1 DM (T1DM) after 20 years of disease duration, as suggested by large observational cohorts [2,3] and the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study [4,5]. From a clinical point of view, the DPN diagnosis is extremely relevant in DM management, since it confers a predisposition to pain, numbness, ulceration, and amputation of the distal extremities, increasing the risk of all-cause and cardiovascular disease mortality [11,12,13]
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