Study reveals high incidence of neuropathic pain in patients with type 1 diabetes

The study also identified female sex and HbA1c levels to be linked with neuropathic pain without clinical signs of DPN. These findings call for an urgent need for effective clinical strategies to manage neuropathic pain in this patient population, the researchers stated.

Diabetic peripheral neuropathy is common; however, the burden and features of NP in type 1 diabetes are poorly understood. Therefore, Barbara H. Braffett, Biostatistics Center, The George Washington University, Rockville, MD, and colleagues evaluated the incidence of annual prevalence, first occurrence, remission, and risk factors for NP during long-term follow-up of patients with T1D.

For this purpose, the researchers administered the Michigan Neuropathy Screening Instrument (MNSI) (1994–2020) to 1,324 participants in the Epidemiology of Diabetes Interventions and Complications (EDIC) study. Neuropathic pain with clinical signs of DPN (NP DPN+) was identified according to self-reported NP plus an examination score >2, and NP without DPN's clinical signs was identified according to self-reported NP and an examination score ≤2.

The study led to the following findings:

• At EDIC year 1, the median age for participants was 36 years, diabetes duration 13 years, and HbA1c 7.9%.
• At year 26, the cumulative incidence of NP was 57%, regardless of concomitant clinical signs of DPN (36% NP DPN+ vs. 46% NP DPN−).
• NP prevalence was 20% at 26 years (11% NP DPN+ and 9% NP DPN−), suggesting frequent remission.
• Annualized remission rates were similar regardless of pain medication use.
• In addition to HbA1c, female sex was associated with NP DPN−.

"Our results showed a high incidence of neuropathic pain in type 1 diabetes that frequently occurred in the absence of clinical signs of neuropathy, as assessed with MNSI," the researchers wrote. "Pain remission was not explained by pain medication use."

"There is a need for effective clinical strategies for identification and management," they concluded.

Reference:

Braffett BH, El Ghormli L, Albers JW, Feldman EL, Herman WH, Gubitosi-Klug RA, Martin CL, Orchard TJ, White NH, Lachin JM, Perkins BA, Pop-Busui R; DCCT/EDIC Research Group. Neuropathic Pain With and Without Diabetic Peripheral Neuropathy in Type 1 Diabetes. Diabetes Care. 2024 Feb 1:dc231749. doi: 10.2337/dc23-1749. Epub ahead of print. PMID: 38300889.