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Better time in range eases painful diabetic neuropathy

20 Sep 2020

Greater time-in-range (TIR), as assessed by continuous glucose monitoring (CGM), may lessen pain in patients with diabetic peripheral neuropathy (DPN), a new study has found.

A total of 364 DPN patients (mean age, 53 years) were enrolled and used sensor-based flash glucose monitoring systems to track glucose levels. Variability metrics, including TIR, as well as standard deviation, coefficient of variation, and mean amplitude of excursions, were calculated. Pain was self-reported over 2 weeks of monitoring, and a daily numerical rating scale (NRS) was accomplished.

Most of the participants (n=175) had an average NRS score of 0, indicating no pain, while 125 had mild pain (NRS 1–3), and 64 had moderate/severe pain (NRS 4–10).

Grouping the patients into quartiles of TIR values, the researchers saw that the prevalence of mild and moderate/severe pain decreased with increasing TIR quartiles (p<0.001).

A similar interaction was reported for NRS score. Participants in the bottom quartile, who had ≤65.0 percent TIR, earned a median NRS score of 3.0. In comparison, the second, third, and fourth TIR quartiles all scored 0 (p<0.001). Pearson correlation analysis revealed a statistically significant and inverse relationship between NRS and TIR (r, –0.506; p<0.001).

Logistic regression models confirmed that a declining first-quartile TIR was associated with a significantly higher risk of any pain, particularly of moderate/severe intensity, relative to the top quartile. This held true even after adjusting for confounders, such as age, sex, duration of diabetes, blood chemistry, and glucose variability metrics.

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