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The co-existence of sensory and autonomic neuropathy in type 1 diabetes with and without pain

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Abstract

Aims

To investigate the co-existence of diabetic peripheral neuropathy (DPN), painful diabetic peripheral neuropathy (PDPN), and cardiac autonomic neuropathy (CAN) and to establish a model to predict CAN based on peripheral measurements.

Methods

Eighty participants (20 type 1 diabetes (T1DM) + PDPN, 20 T1DM + DPN, 20 T1DM-DPN (without DPN), and 20 healthy controls (HC)) underwent quantitative sensory testing, cardiac autonomic reflex tests (CARTs), and conventional nerve conduction. CAN was defined as ≥ 2 abnormal CARTs. After the initial analysis, the participants with diabetes were re-grouped based on the presence or absence of small (SFN) and large fibre neuropathy (LFN), respectively. A prediction model for CAN was made using logistic regression with backward elimination.

Results

CAN was most prevalent in T1DM + PDPN (50%), followed by T1DM + DPN (25%) and T1DM-DPN and HC (0%). The differences in prevalence of CAN between T1DM + PDPN and T1DM-DPN/HC were significant (p < 0.001). When re-grouping, 58% had CAN in the SFN group and 55% in the LFN group, while no participants without either SFN or LFN had CAN. The prediction model had a sensitivity of 64%, a specificity of 67%, a positive predictive value of 30%, and a negative predictive value of 90%.

Conclusion

This study suggests that CAN predominantly co-exists with concomitant DPN.

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Acknowledgements

No specific grant was received for the conduction of the study and the authors declare no conflicts of interest. JR wrote the manuscript, conducted the examinations, researched data, and contributed to the idea and study design. NE, CM, JF and TH contributed to the idea and study design, reviewed the manuscript, and conducted critical editing of written text. SS assisted in conducting examinations, contributed to the idea and study design, reviewed the manuscript, and conducted critical editing of written text. CB reviewed the manuscript, gave expert advice, and conducted critical editing of written text. Each author is accountable for his own contribution, disclosure of potential interests and approved the final version of the manuscript. NE is responsible for all aspects of the manuscript.

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Authors and Affiliations

  1. Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 18-22. 9000, Aalborg, Denmark

    Johan Røikjer, Suganthiya Santhiapillai Croosu, Christina Brock & Niels Ejskjaer

  2. Department of Health Science and Technology, Aalborg University, Aalborg, Denmark

    Johan Røikjer

  3. Department of Radiology, Aalborg University Hospital, Aalborg, Denmark

    Suganthiya Santhiapillai Croosu, Tine Maria Hansen & Jens Brøndum Frøkjær

  4. Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark

    Tine Maria Hansen, Jens Brøndum Frøkjær, Christina Brock & Niels Ejskjaer

  5. Mech-Sense, Aalborg University Hospital, Aalborg, Denmark

    Christina Brock

  6. Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark

    Christina Brock

  7. Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg, Denmark

    Carsten Dahl Mørch

  8. Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark

    Carsten Dahl Mørch

  9. Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark

    Niels Ejskjaer

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  1. Johan Røikjer
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Correspondence to Johan Røikjer.

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No specific grant was received for the conduction of the study, and the authors declare no conflicts of interest.

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Ethical approval

The study was approved by the local ethics committee (N-20190003) and followed the Declaration of Helsinki.

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Røikjer, J., Croosu, S.S., Hansen, T.M. et al. The co-existence of sensory and autonomic neuropathy in type 1 diabetes with and without pain. Acta Diabetol 60, 777–785 (2023). https://doi.org/10.1007/s00592-023-02062-7

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  • DOI: https://doi.org/10.1007/s00592-023-02062-7

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