Therapy Insight: neurological complications of prediabetes

Abstract

Stroke and peripheral neuropathy are recognized neurological complications of diabetes, and epidemiological evidence is now emerging to implicate the prediabetic state of impaired glucose tolerance as a risk factor for these conditions. Singleton and Smith assess this evidence, and also consider the possibility of a link between impaired glucose tolerance and cognitive dysfunction. Stroke and peripheral neuropathy are recognized neurological complications of diabetes. Increasing epidemiological evidence also implicates the prediabetic state of impaired glucose tolerance (IGT) as a risk factor for cerebrovascular events and peripheral neuropathy. Data linking IGT to cognitive decline or deficits, however, are less robust. IGT is one component of metabolic syndrome, together with central obesity, hypertension, hypertriglyceridemia and reduced HDL. Each component of metabolic syndrome is an independent risk factor for stroke, but hyperglycemia might be more important than other components in the pathogenesis of neuropathy. Goal-driven diet and exercise regimens, together with pharmacological treatment of hyperlipidemia and hypertension, reduce stroke risk, but the effect of these interventions on neuropathy has not been fully explored.