The Sweet Sting—Momentary Neuropathic Pain and Glucose Elevations

Abstract

Introduction and Objective: Poor glycemic control as assessed by glycated hemoglobin (A1c) is a strong risk factor for painful diabetic peripheral neuropathy (pDPN) in type 1 diabetes (T1D). However, the relationship between momentary glucose elevations and momentary increased neuropathic pain (NP) is unclear. In this study, glucose elevations prior to and following momentary NP was evaluated in T1D.

Methods: Continuous glucose monitoring-derived (CGM) elevations prior to and following momentary NP symptoms were evaluated in 40 participants with T1D (62.5% with known pDPN, mean age 56 years (SD 14), 45% female, mean A1c 7.3% (SD 1.3)) who completed a 14-day ecological momentary assessment (EMA) battery of neuropathic and overall pain symptoms 4 times daily (morning, afternoon, evening, bedtime) while simultaneously wearing a personal CGM. Linear mixed models adjusted for age, sex, smoking, and 14-day mean glucose were used to evaluate inter- and intra-person associations between glucose elevations (defined as mean of the 4-hour glucose > mean of the 14-day CGM period) prior to and following EMA neuropathic and generalized pain prompts to determine if glucose elevations precede or follow elevations in pain (defined as momentary neuropathic or generalized pain scores >14-day mean).

Results: Regression models revealed higher NP levels associated with subsequent CGM-derived glucose elevations (point estimate [PE]: 0.03 (95% CI 0.01-0.07)). In contrast, there were no associations between CGM-derived glucose elevations and subsequent momentary NP (PE: 0.07 (95% CI -0.02-0.17)). Similarly, there were no associations between CGM-derived glucose elevations and momentary generalized pain in either direction.

Conclusion: This study suggests that, within T1D individuals, increased momentary NP precedes glucose elevations. Further studies are needed to understand the mechanisms linking NP to glucose elevations as well as whether pain reduction leads to improvements in momentary glucose.

Document Type

Meeting Abstract

Publication Date

6-20-2025

Publication Title

Diabetes

First Page

465-P

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