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Demyelinating Neuropathy in Diabetes Mellitus
Khema R. Sharma, MD;
John Cross, MD;
Oscar Farronay, MD;
D. Ram Ayyar, MD;
Robert T. Shebert, MD;
Walter G. Bradley, DM, FRCP
Arch Neurol. 2002;59:758-765.
Background Recent studies have reported that patients with diabetes mellitus (DM)
have a predisposition to develop chronic inflammatory demyelinating polyneuropathy
(CIDP).
Objectives To determine whether patients with DM have a polyneuropathy fulfilling
electrophysiologic criteria for CIDP, and whether CIDP is more frequent in
patients with type 1 than in patients with type 2 DM.
Methods We prospectively studied the frequency of electrophysiologic changes
meeting the criteria for CIDP in patients with DM seen in our electrophysiology
laboratory during a 51-month period (period 1). To evaluate the relationship
between DM and CIDP, we prospectively determined during a 14-month period
(period 2) the frequency of DM in patients seen in our electrophysiology laboratory
with other neuromuscular diseases, and the frequency of idiopathic CIDP.
Results During period 1, 120 patients with DM met the electrophysiologic criteria
for CIDP (DM-CIDP). The most frequent clinical features of DM-CIDP were those
of a predominantly large-fiber sensorimotor neuropathy, with recent motor
deterioration and a moderately increased cerebrospinal fluid protein concentration.
Twenty-six of the 120 patients were given intravenous immunoglobulin (400
mg/kg per day for 5 days), and 21 patients (80.8%) had significant improvement
in the neurologic deficit at the end of 4 weeks of therapy. The DM-CIDP occurred
equally in type 1 and type 2 DM. During period 2, 1127 patients were seen.
Of these, 189 (16.8%) had DM with various neurologic disorders, including
32 patients (16.9%) with DM-CIDP. Among the remaining 938 patients without
DM, 17 (1.8%) had idiopathic CIDP. The odds of occurrence of DM-CIDP was 11
times higher among diabetic than nondiabetic patients (P<.001).
Conclusions Demyelinating neuropathy meeting the electrophysiologic criteria for
CIDP occurred in both types of DM, and its occurrence was significantly higher
in diabetic than in nondiabetic patients.
From the Department of Neurology, University of Miami School of Medicine,
Miami, Fla.
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