Ehab F. Mustafa¹, Aktham I. Alemam², Emad F. Hamid¹

Departments of Internal Medicine¹, Zagazig University; Neurology², Minoufiya University; Egypt

 Background: Studies suggests that individuals with elevated glycosylated hemoglobin (HbA_1c) have a higher rate of microvascular complications, especially peripheral neuropathy. Objective: To  search  for a relation  between  elevated   (HbA_1c) and the  presence of  peripheral  nerve dysfunction in pre-diabetic individuals and to investigate any role of the  inflammatory  markers,  like  C-reactive  protein (CRP),  in  the  development  of  diabetic peripheral neuropathy. Methods: Screening was done for 123 individuals presenting to the internal medicine clinics, Zagazig University Hospitals; Egypt, from July 2009 to January 2011. The prediabetic individuals (HBA1c: 6.0-6.5%) were divided into 2 groups; group-1: Subjects with subclinical neuropathy; group-2 with no subclinical neuropathy and a control group of 83 subjects with HbA_1c < 6%. All subjects underwent neurological examination, nerve conduction study of both peroneal and sural nerves, and measurement of HbA_1c and CRP. Results: The amplitude of sensory nerve action potential (SNAP) of sural nerve was significantly lower in prediabetics than in control group and was significantly lower in prediabetics with subclinical neuropathy than those without. Compound muscle action potential (CMAP) of the peroneal nerve was significantly lower in prediabetics with subclinical neuropathy than in those without, but no significant difference between prediabetics and controls. The peroneal and sural nerve amplitudes were significantly correlated to CRP, but not to HbA_1c. Conclusion: Axonal subclinical neuropathy occurs significantly more in prediabetics than in non-diabetic individuals. The CRP is significantly correlated with the presence of this neuropathy which may suggest an underlying inflammatory mechanism. Although the subclinical neuropathy was associated with elevated HbA_1c, this was statistically insignificant. [Egypt J Neurol Psychiat Neurosurg.  2012; 49(3): 295-301]

Key Words: Diabetic peripheral neuropathy, glycosylated hemoglobin, C-reactive protein