[PHNUTR-L] Value of the Oral Glucose Tolerance Test in the
Evaluation of Chronic Idiopathic Axonal Polyneuropathy
Kathrynne Holden, MS, RD
fivestar at nutritionucanlivewith.com
Mon Jun 12 17:14:46 PDT 2006
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Early Release Article, posted June 12, 2006
Value of the Oral Glucose Tolerance Test in the Evaluation of Chronic
Idiopathic Axonal Polyneuropathy
Charlene Hoffman-Snyder, MSN, NP-BC; Benn E. Smith, MD; Mark A. Ross,
MD; Jose Hernandez, BA; E. Peter Bosch, MD
Arch Neurol. 2006;63:(doi:10.1001/archneur.63.8.noc50336).
Background An underlying cause is found in only 7% to 30% of patients
with chronic idiopathic axonal polyneuropathy (CIAP). Diabetes mellitus,
inherited disorders, toxin exposure, and primary amyloidosis are the
most common identified causes of sensory neuropathies affecting both
large and small myelinated fibers. Undiagnosed impaired fasting glucose
metabolism has been associated with CIAP at a higher frequency rate than
in the general population. This increased prevalence rate was identified
using the 2-hour oral glucose tolerance test (2h-OGTT) and a previous
version of the American Diabetes Association (ADA) guidelines.
Objectives To determine the prevalence of abnormal fasting glucose
metabolism in patients with CIAP and to compare the value of determining
fasting plasma glucose levels using revised (2003) ADA criteria with the
2h-OGTT for predicting abnormal fasting glucose metabolism.
Patients In this 24-month retrospective study, 100 consecutive patients
were identified with no known cause for CIAP, including diabetes
mellitus, between January 2003 and January 2005. All had both a fasting
plasma glucose test and a 2h-OGTT in addition to a complete neurological
examination. Neurophysiological studies, computer-assisted sensory
examination, and quantitative sudomotor axonal reflex testing were used
to classify CIAP into subtypes according to nerve fiber involvement.
Results The prevalence of undiagnosed abnormal fasting glucose
metabolism was found to be nearly 2-fold higher (62%) in patients with
CIAP than in similar age-matched general population groups (33%). Using
the 2003 revised ADA criteria, 39 patients (39%) had abnormal fasting
plasma glucose metabolism (36 with impaired fasting glucose, 3 with
diabetes mellitus), while the 2h-OGTT provided an even higher diagnostic
rate of 62% (62 patients; P<.001) of impaired fasting glucose metabolism
(38 with impaired glucose tolerance, 24 with diabetes mellitus). The
abnormal glucose metabolism rates were found to be similar across the 3
subtypes (sensorimotor, pure sensory, and small-fiber neuropathy) of
CIAP (P = .60, .72, and .61).
Conclusions This study adds to emerging evidence that abnormal glucose
metabolism may be a risk factor for CIAP. Even with revised (2003) ADA
criteria, the 2h-OGTT provides additional diagnostic information to the
health care professional in the evaluation of CIAP. Subtypes of CIAP are
equally likely to have abnormal glucose metabolism.
Published online June 12, 2006 (doi:10.1001/archneur.63.8.noc50336).
Author Affiliations: Departments of Neurology (Ms Hoffman-Snyder and Drs
Smith, Ross, and Bosch) and Biostatistics (Mr Hernandez), Mayo Clinic
Scottsdale, Scottsdale, Ariz.
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
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