Glycemic Variability and Electrophysiological Severity of Diabetic Peripheral Neuropathy: A Prospective Multicenter Study in Bangladesh

Abstract

Background: Diabetic peripheral neuropathy (DPN) is a common complication of diabetes and may cause pain, sensory loss, gait impairment, ulceration and amputation. Although HbA1c reflects average glycemic exposure, it does not adequately capture short-term glucose fluctuations. Glycemic variability (GV) may contribute to nerve injury through oxidative stress, inflammation, endothelial dysfunction and metabolic damage. This study evaluated the relationship between GV and electrophysiological severity of DPN among Bangladeshi patients with diabetes.

Methods: This prospective observational study was conducted at the Department of Neuromedicine, Uttara Adhunik Medical College & Popular Diagnostic Centre, Uttara Branch, Dhaka, Bangladesh, from January 2023 to December 2025. One hundred adults with diabetes and clinical evidence or suspicion of distal symmetric DPN were enrolled. GV was assessed using continuous glucose monitoring-derived glucose coefficient of variation (CV) with mean glucose and glucose SD also recorded. HbA1c and relevant clinical and biochemical variables were documented. Motor and sensory nerve conduction studies were performed, and an electrophysiological severity score was calculated from abnormal nerve-conduction parameters. Correlation and multivariable regression analyses were performed.

Results: The mean age of participants was 56.4 ± 10.8 years, and 58% were male. The mean duration of diabetes was 9.1 ± 5.4 years, and the mean HbA1c was 8.1 ± 1.4%. The mean glucose CV was 34.8 ± 7.0%. Participants with higher glycemic variability demonstrated significantly greater electrophysiological abnormalities than those with lower variability. The mean electrophysiological severity score was 4.9 ± 2.1 in the higher-GV group compared with 2.3 ± 1.5 in the lower-GV group (p < 0.001). Glucose CV showed a significant positive correlation with electrophysiological severity (r = 0.58, p < 0.001). In multivariable linear regression adjusting for age, sex, diabetes duration, HbA1c, body mass index, hypertension and serum creatinine, glucose CV remained independently associated with greater neuropathy severity (adjusted β = 0.41, p < 0.001). HbA1c was also independently associated with electrophysiological severity, although the strength of association was lower.

Conclusion: Greater GV was independently associated with more severe electrophysiological DPN. GV assessment may provide additional risk information beyond HbA1c.