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Therapy Insight: neurological complications of prediabetes

Nature Clinical Practice Neurology volume 2, pages 276–282 (2006)Cite this article

Abstract

Stroke and peripheral neuropathy are recognized neurological complications of diabetes. Increasing epidemiological evidence also implicates the prediabetic state of impaired glucose tolerance (IGT) as a risk factor for cerebrovascular events and peripheral neuropathy. Data linking IGT to cognitive decline or deficits, however, are less robust. IGT is one component of metabolic syndrome, together with central obesity, hypertension, hypertriglyceridemia and reduced HDL. Each component of metabolic syndrome is an independent risk factor for stroke, but hyperglycemia might be more important than other components in the pathogenesis of neuropathy. Goal-driven diet and exercise regimens, together with pharmacological treatment of hyperlipidemia and hypertension, reduce stroke risk, but the effect of these interventions on neuropathy has not been fully explored.

Key Points

  • The American Diabetes Association defines prediabetes as either impaired fasting glucose or impaired glucose tolerance (IGT)

  • Hyperglycemia, along with central obesity, hypertension, increased triglycerides and reduced HDL cholesterol, comprise the metabolic syndrome

  • Patients discovered to have IGT or impaired fasting glucose should receive prompt and intensive treatment to normalize blood glucose and treat other features of metabolic syndrome

  • An association between prediabetes and neuropathy has been established through several epidemiological lines of evidence

  • Compared with age-matched normoglycemic controls, patients with IGT are at a greater risk of death from all causes; most of this excess mortality can be attributed to consequences of macrovascular disease

  • Cross-sectional and longitudinal studies have convincingly demonstrated an association between diabetes and dementia, but evidence for a link between cognitive defects and IGT has been mixed

  • Further studies are needed to examine the direct metabolic effects of hyperglycemia, insulin resistance and hyperinsulinemia on peripheral nerves and the brain

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Acknowledgements

JR Singleton and AG Smith are supported in part by NIH NS40458, NIH DK064814 and NIH-NCRR M01 RR 00064. The authors acknowledge the many investigators whose work could not be cited owing to a limit on the number of references.

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Authors and Affiliations

  1. associate professor of neurology,

    J Robinson Singleton & A Gordon Smith

  2. associate professor of neurology and pathology at the University of Utah, Salt Lake City, UT, USA

    J Robinson Singleton & A Gordon Smith

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  1. J Robinson Singleton
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Correspondence to J Robinson Singleton.

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Singleton, J., Smith, A. Therapy Insight: neurological complications of prediabetes. Nat Rev Neurol 2, 276–282 (2006). https://doi.org/10.1038/ncpneuro0172

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