Insensate versus painful diabetic neuropathy: the effects of height, gender, ethnicity and glycaemic control

Abstract 

Aims/hypothesis: To study similarities and differences between people with insensate or painful diabetic peripheral neuropathy, particularly in relation to height, gender, ethnicity and glycaemic control. Methods: We studied prospectively 2610 patients with Type 2 diabetes attending our Diabetes Centre. Subjects were compared according to degree of sensory loss, and presence or absence of neuropathic pain. The effects of gender and ethnicity were evaluated by studying patients in different height bands. Results: Insensate neuropathy and painful neuropathy was present in 11.4 and 3.3% of subjects, respectively. Age, duration of diabetes, height, vibration perception and HbA_1c (P<0.0001) were independent determinants of insensate neuropathy, whereas only duration of diabetes and vibration perception (P<0.0001) were predictive of pain. There was more insensate neuropathy in males (OR 1.9) and anglo-celtics (OR 1.4) but stratification by height showed that these effects were due to height. Height has no influence on the development of pain. Conclusions: There is significant overlap but also considerable dichotomy in the two major forms of diabetic sensory peripheral neuropathy. The insensate type is more explainable by duration, degree of hyperglycaemia and length of peripheral nerves, factors that are likely to reflect severity of underlying structural nerve damage. Glycaemic control was not a predictor of painful neuropathy.

Keywords:  Pain, Neuropathy, Complications, Gender, Diabetic foot