Diabetic neuropathy in hands: An endemic complication waiting to unfold?
This cross-sectional study aimed to quantify the somatosensory dysfunction in the hand in people with diabetes with distal symmetrical polyneuropathy (DSPN) in hands; and explore early signs of nerve dysfunction in people with diabetes without DSPN in hands. The clinical diagnosis of DSPN was confirmed with electrodiagnosis and corneal confocal microscopy. Thermal and mechanical nerve function in the hand was assessed using Quantitative Sensory Tests. Measurements were compared between healthy participants (n=31), people with diabetes without DSPN (n=35), people with DSPN in feet but not hands (DSPN FEET ONLY; n=31); and people with DSPN in hands and feet (DSPN HANDS & FEET; n=28) using one-way between-group analyses of variance. The somatosensory profile of the hand in people with DSPN HANDS & FEET showed widespread loss of thermal and mechanical detection. This profile in hands is comparable to the profile in the feet of people with DSPN in feet. Remarkably, people with DSPN FEET ONLY already showed a similar profile of widespread loss of nerve function in their hands. People with diabetes without DSPN in feet already had some nerve dysfunction in their hands. These findings suggest that nerve function assessment in hands should become more routine in people with diabetes.