From glycemic instability to neuropathic risk: a propensity score-matched retrospective cohort study - PubMed

5 hours ago

Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (T2DM), not fully explained by HbA1c levels alone.
Glycemic variability (GV) may contribute to nerve injury through oxidative stress, inflammation, and neurotrophic factor dysregulation.
This study used propensity score matching (PSM) to compare 128 DPN and 128 non-DPN patients, controlling for confounders like age, sex, BMI, and HbA1c.
Higher GV parameters (MAGE, CV, SD) were significantly associated with DPN presence and severity (P < 0.001).
A dose-response relationship was observed: higher MAGE tertiles correlated with worse nerve conduction velocity (NCV) and elevated inflammatory markers (IL-6, TNF-α).
Multivariable analysis confirmed MAGE and CV as independent negative predictors of NCV, even after adjusting for HbA1c.
Inflammatory cytokines (IL-6, TNF-α) mediated approximately 32% of GV's negative effect on NCV.
ROC analysis identified optimal GV thresholds for DPN discrimination: MAGE ≥5.8 mmol/L (AUC = 0.84) and CV ≥32.5% (AUC = 0.81).
The study advocates for GV assessment in clinical practice to improve DPN risk stratification and suggests GV reduction as a potential therapeutic target.

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