Work

Longitudinal Mean HbA1c and Electrodiagnostic Severity of Distal Symmetric Sensorimotor Polyneuropathy in Type 2 Diabetes: Comparison With Index HbA1c

Year: 2026

Type: article

Abstract: Objective: To evaluate the association of longitudinal mean glycosylated hemoglobin (HbA1c) with electrodiagnostic severity of distal symmetric sensorimotor polyneuropathy (DSPN), using index HbA1c as a comparator. METHODS: We retrospectively reviewed patients with type 2 diabetes undergoing nerve conduction studies (NCS) during 2022-2024. Eligibility required ≥4 HbA1c measurements spanning ≥2 calendar years within a capped 4-year look-back window including the NCS month. Mean HbA1c averaged these measurements; index HbA1c was the measurement closest to NCS within ±3 months. The primary outcome was ordinal Baba stage (0-4). Separate ordinal models used parsimonious and full covariate adjustment. Paired bootstrap resampling and joint models directly compared associations. Exploratory paired receiver operating characteristic analyses assessed advanced electrodiagnostic DSPN (Baba stages 3-4). Penalized analyses assessed stability; additional analyses evaluated time-weighted means and HbA1c coefficient of variation (CV). RESULTS: Of 263 screened patients, 73 were included. Mean HbA1c correlated with Baba stage (ρ=0.320, p=0.006). Fully adjusted odds ratios were 1.51 for mean HbA1c (95% confidence interval [CI], 1.03-2.22) and 1.31 for index HbA1c (95% CI, 0.98-1.76). The paired bootstrap 95% CI for the difference in log-odds ratios included zero (-0.152 to 0.650). Mean HbA1c remained associated with advanced DSPN; areas under the curve were 0.701 and 0.618, respectively (DeLong p=0.153), with an exploratory threshold of 7.0%. Ordinal associations were attenuated with time-weighted means or CV adjustment. Conclusion: Mean HbA1c showed more consistent associations than index HbA1c across separate models, but superiority was not established. Sensitivity analyses indicated uncertainty in the ordinal association.

Source: Annals of Rehabilitation Medicine

DOI: 10.5535/arm.260110

Authors: Songi Han, Jongkyu Kim, Sujeong Choi, Eun Sang Yoon, Ho Kyung Yoo

Institution: Seoul Medical Center

Language: English

Topic: Peripheral Neuropathies and Disorders

Subfield: Clinical Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $153