Researchers at Semmelweis University discovered subtle signs of neuropathy in people with normal glucose metabolism but who are at higher risk of developing diabetes. Early detection of the signs of autonomic and sensory neuropathy may contribute to the prevention of this complication and to slow down its progression.

The study at Semmelweis University explored whether there’s a connection/correlation between a higher risk of developing Type 2 diabetes and the presence of neuropathy, even before prediabetes or diabetes has developed. Early signs of autonomic and sensory neuropathy were observed in both prediabetes and diagnosed diabetes cases.

However, definite signs of neuropathy in people who are at moderate to high risk of diabetes but otherwise healthy have not yet been observed.

Neuropathy is a common long-term complication of diabetes, and it can occur even in patients with prediabetes. Over time, high blood sugar levels can damage the small blood vessels that supply nutrients to nerves, leading to nerve damage and eventual nerve fiber loss. While neuropathy takes longer to develop in type 1 diabetes, it can be present in newly diagnosed type 2 diabetes and even in prediabetes. The symptoms of peripheral diabetic neuropathy include numbness, tingling, burning sensations, aching, cramps, and weakness. It generally affects both limbs, primarily the feet and hands, and can eventually spread to the legs and arms. Autonomic and sensory neuropathy can be assessed through functional tests.

“We were looking for signs of neuropathy in patients with normal blood glucose levels but with a higher risk of developing diabetes,” says the study’s first author, Anna Körei, Assistant Professor at the Department of Medicine and Oncology at Semmelweis University.

We took a step back in time and looked at an earlier stage, where risk factors might be present but there’s no clear indication of (pre-)diabetes

, she explains. Among these subjects, high blood pressure, obesity, and high cholesterol levels are common, which could be linked to the development of neuropathy even without abnormal glucose metabolism.

The researchers at Semmelweis University used the FINDRISC (Finnish Diabetes Risk Score) questionnaire, a widely recognized tool used by general practitioners and specialists, to identify individuals at risk of developing diabetes within the next decade.

Since nerve damage/neuropathy is a type of microvascular complication, the survey evaluates risk factors from a cardiovascular perspective. These include age, blood pressure, body mass index (BMI), abdominal circumference, exercise frequency, fruit and vegetable intake, and family history of type 2 diabetes.

“Since the questionnaire screens for diabetes without requiring lab tests, it is more cost-effective than a traditional laboratory test, and its accuracy is not inferior to them,” says Péter Kempler, professor at the Department of Medicine and Oncology at Semmelweis University and the study’s corresponding author.

The FINDRISC scale ranges from 0 to over 20: those with the highest score have a 50% chance of developing diabetes within 10 years. “The study focused on individuals with scores of 12 or higher, who were not diagnosed with diabetes or prediabetes,” explains the professor. “A score of 12 indicates an elevated risk, suggesting that further laboratory tests may be needed to confirm diabetes risk.”

In individuals with scores of 12 or higher, definitive signs of neuropathy were rare.

However, compared to a healthy control group, we observed slight narrowing mainly in autonomic parameters, which also correlated with higher blood sugar levels

, Körei says. Additional monitoring and follow-up with these patients will be necessary to track disease progression.

“It’s also important to consider what leads to a score above 12,” says Kempler. “Certain factors, like age or family history of diabetes, can’t be changed, but lifestyle choices such as regular exercise, eating more fruits and vegetables (fibers), and lowering blood pressure can,” he points out.

Neuropathy at an early stage responds well to lifestyle changes, and in some cases, it can even be reversed

“When it’s more advanced, treatment success depends on glucose metabolism. However, there are also treatments aimed at the underlying causes,” he adds. 

“Our aim is not just to identify individuals with carbohydrate metabolism disorders, but to detect those at risk as early as possible. It is also important to address risk factors like high blood pressure, obesity, and high cholesterol to reach optimal levels by encouraging lifestyle changes or, when needed, prescribing medication to prevent diabetes and its complications,” says Körei.