Emerging Role of HbA1c trend analysis in the Diagnosis of diabetic neuropathy
DOI:
https://doi.org/10.5281/zenodo.22812574Keywords:
HbA1c, glycaemic variability, diabetic peripheral neuropathy, glycaemic trend, diabetes complicationsAbstract
Background: Glycated haemoglobin (HbA1c) is used to diagnose diabetes and monitor glycaemic control, but diabetic peripheral neuropathy is still usually recognized only after symptoms appear, well after subclinical nerve injury has begun.
Objective: This review examines whether the longitudinal trend in HbA1c, its cumulative exposure, updated mean, and visit-to-visit variability, predicts diabetic neuropathy more informatively than a single HbA1c value, and how such trend analysis might be integrated with established diagnostic tools.
Methods: We synthesized evidence from major randomized glycaemic-control trials and their long-term follow-ups, large population cohorts, and variability meta-analyses, alongside consensus statements on neuropathy diagnosis and screening.
Findings: Cumulative glycaemic exposure and updated mean HbA1c predict confirmed clinical and electrophysiological neuropathy independently of any single reading, an effect that persists for over a decade after treatment groups' HbA1c values converge. HbA1c variability across visits adds further prognostic information beyond the mean, plausibly through fluctuation-driven oxidative stress.
Conclusions: Longitudinal HbA1c trend analysis, drawn from data already collected in routine care, offers a low-cost, scalable signal for prioritizing patients for earlier neuropathy screening with tools such as the Michigan Neuropathy Screening Instrument, nerve conduction studies, or corneal confocal microscopy, without replacing direct neurological assessment.
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