Early Involvement of the Spinal Cord in Diabetic Peripheral Neuropathy

• Published in: Diabetes care Vol. 29; no. 12; pp. 2664 - 2669
• Main Authors: Selvarajah, Dinesh, Wilkinson, Iain D, Emery, Celia J, Harris, Nigel D, Shaw, Pamela J, Witte, Daniel R, Griffiths, Paul D, Tesfaye, Solomon
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.12.2006
• Subjects: Adult; Aged; Analysis; Associated diseases and complications; atrophy; Biological and medical sciences; Blood Flow Velocity; blood supply; cervical spine; Data analysis; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 1 - physiopathology; Diabetes. Impaired glucose tolerance; Diabetic Neuropathies; Diabetic Neuropathies - physiopathology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Glycated Hemoglobin; Glycated Hemoglobin - analysis; Heart Rate; Hereditary Sensory and Autonomic Neuropathies; Hereditary Sensory and Autonomic Neuropathies - physiopathology; History; Humans; Hyperglycemia; Informed consent; magnetic resonance imaging; Male; Medical sciences; Middle Aged; Nervous system; pathogenesis; Patients; peripheral nervous system diseases; Peripheral Nervous System Diseases - physiopathology; Peroneal Nerve; Peroneal Nerve - blood supply; Physiological aspects; physiopathology; Reference Values; Sensory perception; Spinal cord; Spinal Cord - physiopathology; Studies; United Kingdom; Endocrinopathy; Atrophy; Human; Nervous system diseases; Spinal cord; Diabetes mellitus; Central nervous system; Complication; Early; Peripheral nerve disease; Peripheral neuropathy
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc06-0650

OBJECTIVE:--The pathogenesis of diabetic peripheral neuropathy (DPN) is poorly understood. We have recently reported a significant reduction in spinal cord cross-sectional area at the stage of clinically detectable DPN. In this study, we investigated whether spinal cord atrophy occurs in early (subclinical) DPN. RESEARCH DESIGN AND METHODS--Eighty-one male type 1 diabetic subjects, 24 nondiabetic control subjects, and 8 subjects with hereditary sensory motor neuropathy (HSMN) type 1A underwent detailed clinical and neurophysiological assessments. Diabetic subjects were subsequently divided into three groups based on neuropathy severity (19 with no DPN, 23 with subclinical DPN, and 39 with clinically detectable DPN). All subjects underwent magnetic resonance imaging of the cervical spine and cord area measurements at disc level C2/C3. RESULTS:--Mean corrected spinal cord area index (SCAI) (corrected for age, height, and weight) was 67.5 mm [95% CI 64.1-70.9] in diabetic subjects without DPN. Those with subclinical (62.4 mm [59.5-65.3]) and clinically detectable DPN (57.2 mm [54.9-59.6]) had lower mean SCAIs compared with subjects with no DPN (P = 0.03 and P < 0.001, respectively). No significant difference was found between diabetic subjects without DPN and nondiabetic control subjects (69.2 mm [66.3-72.0], P = 0.47). Mean SCAIs in subjects with HSMN type 1A (71.07 mm [65.3-76.9]) were not significantly different from those for nondiabetic control subjects and diabetic subjects without DPN. Among diabetic subjects, SCAI was significantly related to sural sensory conduction velocities and the Neuropathy Composite and Symptom Scores. CONCLUSIONS:--Spinal cord involvement occurs early in DPN. There is also a significant relation between reduction in SCAI and neurophysiological assessments of DPN.