Prevalence of peripheral neuropathy in pre-diabetes: a systematic review

There is growing evidence of excess peripheral neuropathy in pre-diabetes. We aimed to determine its prevalence, including the impact of diagnostic methodology on prevalence rates, through a systematic review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses g...

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Main Authors: Varo Kirthi, Sarah Nevitt, Emily Brown, Ioannis N Petropoulos, Rayaz A Malik, Rebecca Roylance, Anugraha Perumbalath, Jamie Burgess
Format: Article
Language:English
Published: BMJ Publishing Group 2021-03-01
Series:BMJ Open Diabetes Research & Care
Online Access:https://drc.bmj.com/content/9/1/e002040.full
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author Varo Kirthi
Sarah Nevitt
Emily Brown
Ioannis N Petropoulos
Rayaz A Malik
Rebecca Roylance
Anugraha Perumbalath
Jamie Burgess
author_facet Varo Kirthi
Sarah Nevitt
Emily Brown
Ioannis N Petropoulos
Rayaz A Malik
Rebecca Roylance
Anugraha Perumbalath
Jamie Burgess
author_sort Varo Kirthi
collection DOAJ
description There is growing evidence of excess peripheral neuropathy in pre-diabetes. We aimed to determine its prevalence, including the impact of diagnostic methodology on prevalence rates, through a systematic review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive electronic bibliographic search was performed in MEDLINE, EMBASE, PubMed, Web of Science and the Cochrane Central Register of Controlled Trials from inception to June 1, 2020. Two reviewers independently selected studies, extracted data and assessed risk of bias. An evaluation was undertaken by method of neuropathy assessment. After screening 1784 abstracts and reviewing 84 full-text records, 29 studies (9351 participants) were included. There was a wide range of prevalence estimates (2%–77%, IQR: 6%–34%), but the majority of studies (n=21, 72%) reported a prevalence ≥10%. The three highest prevalence estimates of 77% (95% CI: 54% to 100%), 71% (95% CI: 55% to 88%) and 66% (95% CI: 53% to 78%) were reported using plantar thermography, multimodal quantitative sensory testing and nerve conduction tests, respectively. In general, studies evaluating small nerve fiber parameters yielded a higher prevalence of peripheral neuropathy. Due to a variety of study populations and methods of assessing neuropathy, there was marked heterogeneity in the prevalence estimates. Most studies reported a higher prevalence of peripheral neuropathy in pre-diabetes, primarily of a small nerve fiber origin, than would be expected in the background population. Given the marked rise in pre-diabetes, further consideration of targeting screening in this population is required. Development of risk-stratification tools may facilitate earlier interventions.
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spelling doaj-art-5cff70ae77b4453f89a31cfc2d067afc2024-12-12T17:50:10ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2020-002040Prevalence of peripheral neuropathy in pre-diabetes: a systematic reviewVaro Kirthi0Sarah Nevitt1Emily Brown2Ioannis N Petropoulos3Rayaz A Malik4Rebecca Roylance5Anugraha Perumbalath6Jamie Burgess7Ophthalmology Research Unit, King’s College Hospital NHS Foundation Trust, London, UKDepartment of Health Data Science, University of Liverpool, Liverpool, UKDepartment of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UKResearch Division, Weill Cornell Medicine, Doha, QatarResearch Division, Weill Cornell Medicine-Qatar, Doha, QatarEdge Hill University Library, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UKDepartment of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UKDepartment of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UKThere is growing evidence of excess peripheral neuropathy in pre-diabetes. We aimed to determine its prevalence, including the impact of diagnostic methodology on prevalence rates, through a systematic review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive electronic bibliographic search was performed in MEDLINE, EMBASE, PubMed, Web of Science and the Cochrane Central Register of Controlled Trials from inception to June 1, 2020. Two reviewers independently selected studies, extracted data and assessed risk of bias. An evaluation was undertaken by method of neuropathy assessment. After screening 1784 abstracts and reviewing 84 full-text records, 29 studies (9351 participants) were included. There was a wide range of prevalence estimates (2%–77%, IQR: 6%–34%), but the majority of studies (n=21, 72%) reported a prevalence ≥10%. The three highest prevalence estimates of 77% (95% CI: 54% to 100%), 71% (95% CI: 55% to 88%) and 66% (95% CI: 53% to 78%) were reported using plantar thermography, multimodal quantitative sensory testing and nerve conduction tests, respectively. In general, studies evaluating small nerve fiber parameters yielded a higher prevalence of peripheral neuropathy. Due to a variety of study populations and methods of assessing neuropathy, there was marked heterogeneity in the prevalence estimates. Most studies reported a higher prevalence of peripheral neuropathy in pre-diabetes, primarily of a small nerve fiber origin, than would be expected in the background population. Given the marked rise in pre-diabetes, further consideration of targeting screening in this population is required. Development of risk-stratification tools may facilitate earlier interventions.https://drc.bmj.com/content/9/1/e002040.full
spellingShingle Varo Kirthi
Sarah Nevitt
Emily Brown
Ioannis N Petropoulos
Rayaz A Malik
Rebecca Roylance
Anugraha Perumbalath
Jamie Burgess
Prevalence of peripheral neuropathy in pre-diabetes: a systematic review
BMJ Open Diabetes Research & Care
title Prevalence of peripheral neuropathy in pre-diabetes: a systematic review
title_full Prevalence of peripheral neuropathy in pre-diabetes: a systematic review
title_fullStr Prevalence of peripheral neuropathy in pre-diabetes: a systematic review
title_full_unstemmed Prevalence of peripheral neuropathy in pre-diabetes: a systematic review
title_short Prevalence of peripheral neuropathy in pre-diabetes: a systematic review
title_sort prevalence of peripheral neuropathy in pre diabetes a systematic review
url https://drc.bmj.com/content/9/1/e002040.full
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