Protection from neuropathy in extreme duration type 1 diabetes

Shazli Azmi, Maryam Ferdousi, Alise Kalteniece, Ioannis N. Petropoulos, Georgios Ponirakis, Uazman Alam, Omar Asghar, Andrew Marshall, Adhithya Sankar, Andrew J. M. Boulton, Handrean Soran, Nathan Efron, Rayaz A. Malik

Research output: Contribution to journalArticlepeer-review


A proportion of individuals with type 1 diabetes mellitus for more than 50 years (medallists) may be protected from developing nephropathy, retinopathy and neuropathy. Detailed neuropathy phenotyping was undertaken in a cohort of 33 medallists aged 63.7 ± 1.4 years with diabetes for 58.5 ± 0.8 years and HbA1c of 65.9 ± 2.1 mmol/mmol. Medallists had a significantly higher HbA1c (P < .001), lower estimated glomerular filtration rate (eGFR) (P = .005) and higher albumin creatinine excretion ratio (ACR) (P = .01), but a lower total cholesterol (P < .001), triacylglycerols (P = .001), low density lipoprotein‐cholesterol (P < .001) and higher high density lipoprotein‐cholesterol (P = .03), compared to controls. Twenty‐four percent of participants were identified as “escapers” without confirmed diabetic neuropathy. They had a lower neuropathy symptom profile (P = .002), vibration perception threshold (P = .02), warm threshold (P = .05), higher peroneal amplitude (P = .005), nerve conduction velocity (P = .03), heart rate variability (P = .001), corneal nerve fibre density (P = 0.001), branch density (P < .001) and length (P = .001), compared to medallists with diabetic neuropathy. Escapers had a shorter duration of diabetes (P = .006), lower alcohol consumption (P = .04), lower total cholesterol (P = .04) and LDL (P = .02), higher eGFR (P = .001) and lower ACR (P < .001). Patients with extreme duration diabetes without diabetic neuropathy have a comparable HbA1c, blood pressure and body mass index, but a more favourable lipid profile and consume less alcohol compared to those with diabetic neuropathy.
Original languageEnglish
JournalJournal of the Peripheral Nervous System
Early online date24 Nov 2020
Publication statusE-pub ahead of print - 24 Nov 2020


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