The Metabolic Drivers of Neuropathy in India

Abstract

Recent studies demonstrate that diabetes, prediabetes, and obesity are the main metabolic components associated with neuropathy. However, none of these studies were performed in India, where different waist circumference cutoffs exist. As part of an ongoing study, we are enrolling new patients from the M.V. Hospital for Diabetes in Chennai, India. Neuropathy was defined as a score of 2.5 or greater on the Michigan Neuropathy Screening Instrument (MNSI) Examination. Secondary neuropathy outcomes included the MNSI questionnaire, monofilament, biothesiometer, and sural device. Metabolic syndrome (MetS) components were defined using the International Diabetes Federation definition with South Asian waist circumference cutoffs. We determined the prevalence of neuropathy stratified by glycemic (ADA definition based on the glucose tolerance test). Multivariable logistic regression models were used to assess the association of metabolic components with neuropathy. To date, 264 patients have been recruited. Neuropathy was present in 8.7% of those with normoglycemia, 10.3% with prediabetes, and 23.7% with diabetes (p=<0.01) (Table). Diabetes (OR=3.87, 95% CI 1.05-14.28) was the only metabolic component associated with neuropathy. The prevalence of neuropathy increases with worsening glycemic status, but larger numbers are needed to determine which specific MetS components, other than diabetes, are the main drivers of neuropathy in India.Neuropathy status stratified by glycemic statusNeuropathy outcomeNormoglycemiaN (%)Pre-diabetesN (%)DiabetesN (%)MNSI exam4 (8.7%)9 (10.3%)31 (23.7%)MNSI questionnaire2 (4.4%)3 (3.5%)26 (20.3%)Monofilament0 (0.0%)3 (3.5%)6 (4.6%)Biothesiometer0 (0.0%)5 (6.1%)28 (22.6%)Sural device5 (17.9%)16 (23.5%)45 (43.3%) Disclosure B.C. Callaghan: Research Support; Self; Impeto Medical. Other Relationship; Self; American Academy of Neurology. Consultant; Self; Immune Tolerance Network. V. Viswanathan: None. E.L. Reynolds: None. E.L. Feldman: None.