Effects of one year of near-normoglycemia on peripheral nerve function in type 1 (insulin-dependent) diabetic patients

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Abstract
Ninety poorly controlled C-peptide negative type 1 (insulin-dependent) diabetic patients with chronic complications were allocated to intensified insulin treatment with either continuous subcutaneous insulin infusion or multiple insulin injections; 83 were studied over 1 year (seven patients dropped out of the study). Peripheral nerve function was assessed by clinical examination, malleolar vibration perception threshold, and motor and sensory nerve conduction velocities (MNCV; SNCV) in the median, ulnar, peroneal, and sural nerves. In order to assess the effect of metabolic control on peripheral nerve function, the results in patients with normal mean HbA1 levels during months 3–12 of the study n=50) were compared with those with abnormal mean HbA1 ≥8.6% (poor control (pc);n=33). Mean blood glucose was significantly higher in pc than in tc at months 2–9 and 11 (PPP<0.05). There were no differences in nerve function between well- and poorly-controlled patients who had normal nerve tests at baseline. These results provide evidence that near-normoglycemia over 1 year does not have uniform effects on peripheral nerve function in type 1 diabetic patients. Impaired motor and sensory nerve conduction seems to be more susceptible to improvement under strict glycemic control in the upper than in the lower extremities.

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