DIABETIC NEUROPATHY - THERMAL SENSATION A ND METABOLIC CONTROL IN NON-INSULIN-DEPENDENT DIABETICS

Background: The early detection of peripheral neuropathy in diabetics is important since it is the main risk factor for lower limb trophic l esions in diabetics. Aim: To assess the relationship between feet ther mal sensation threshold and metabolic control in ambulatory non-insuli n-dependent diabetics. Patients and methods: A random sample of 34 non -insulin-dependent diabetics followed for more than five years in a sp ecial clinic, out of 368 patients, was selected. Warmth sensation thre sholds were measured in the dorsum of both feet using a MSTP-III therm ostimulator. The average value of all glycosylated hemoglobins obtaine d during the 9.7 +/- 5.3 years of follow up for each patient was calcu lated. A multiple stepwise regression analysis was performed between t hermal sensation as the dependent variable and glycosylated hemoglobin , fasting blood glucose, age and diabetes duration. Results: The regre ssion model disclosed glycosylated hemoglobin as the only independent predictor of warmth sensation threshold (partial r= 0.385; p=0.043). F ifteen diabetic Patients with good metabolic control, defined as those with a mean glycosylated hemoglobin of less than 9.5%, had a warmth s ensation threshold of 35.6 +/- 3.7 degrees C, whereas 19 diabetics wit h a bad control (glycosylated hemoglobin greater than or equal to 9.5% ) had a threshold of 39 +/- 3.8 degrees C (p=0.017). Conclusions: In t his group of diabetics, there is a relationship between the severity o f distal polyneuropathy and the metabolic control, assessed with glyco sylated hemoglobin levels.