Effect of Uncontrolled Type-II Diabetes Mellitus and Its Duration on Nerve Conduction Parameters in Adult Sudanese Patients in Khartoum State


Background: Peripheral neuropathy is a serious complication of diabetes, which has socioeconomic consequences as well as a reduced quality of life. Early neuropathic process recognition and management could alter its course and considerably reduce the associated morbidity and mortality. This study determines the effect of long-term glycemic control on diabetic peripheral neuropathy in people with type 2 diabetes (T2DM).

Methods: A hospital-based study was carried out at the National Centre of Neurosciences and Ibrahim Malik Hospital in Khartoum. All individuals who were older than 18 years and have had T2DM for less than 10 years were recruited. Using accepted techniques, the BMI, HbA1c level, and nerve conduction studies (NCS) were measured. Data were analyzed using the Statistical Package for Social Sciences (SPSS), version 25.0 software. P-value ≤ 0.05 was considered significant.

Results: Of the 95 patients with T2DM, 52 were male patients. Our findings showed that as the duration of diabetes increased, the sensory velocity reduced from 64.07 ± 3.22 to 54.00 ± 5.34 and the motor nerve from 63.39 ± 2.38 to 53.87 ± 2.08 (P = 0.05, P = 0.003, respectively). Additionally, with increased duration of diabetes, a significant decrease was seen in both motor nerve amplitude from 8.79 ± 3.11 to 6.94 ± 1.84 (P = 0.05) and sensory nerve amplitude from 25.71 ± 5.70 to 19.51 ± 6.51 (P = 0.003). Also, all parameters of NCS (velocity and amplitude) decreased when Hb A1c was >6 – sensory velocity from 63.96 ± 2.36 to 55.49 ± 2.43 (P = 0.03) and motor velocity from 63.00 ± 2.59 to 51.44 ± 1.66 (P = 0.02). And sensory amplitude decreased from 26.91 ± 1.26 to 20.85 ± 2.1 (P = 0.05), while motor amplitude decreased from 6.88 ± 3.55 to 6.61 ± 3.29 (P = 0.05). Additionally, there is a substantial (P = 0.05) correlation between sensory and motor amplitudes and the BMI.

Conclusion: High BMI and poorly controlled (high HbA1c) long-term diabetes had a negative impact on all nerve conduction study parameters.


diabetes mellitus, peripheral nerve neuropathy, body mass index

[1] Zaccardi, F., Webb, D. R., Yates, T., Davies, M. J., & Melanie, J. (2016). Pathophysiology of type 1 and type 2 diabetes mellitus: A 90-year perspective. Postgraduate Medical Journal, 92(1084), 63–69. https://doi.org/10.1136/postgradmedj-2015-133281

[2] Khawaja, N., Abu-Shennar, J., Saleh, M., Dahbour, S. S., Khader, Y. S., & Ajlouni, K. M. (2018). The prevalence and risk factors of peripheral neuropathy among patients with type 2 diabetes mellitus; The case of Jordan. Diabetology & Metabolic Syndrome, 10, 8. https://doi.org/10.1186/s13098-018-0309-6

[3] Bhutani, J., & Bhutani, S. (2014). Worldwide burden of diabetes. Indian Journal of Endocrinology and Metabolism, 18(6), 868–870. https://doi.org/10.4103/2230-8210.141388

[4] Bos, M., & Agyemang, C. (2013). Prevalence and complications of diabetes mellitus in Northern Africa, a systematic review. BMC Public Health, 13(1), 387. https://doi.org/10.1186/1471-2458-13-387

[5] Awadalla, H., Noor, S. K., Elmadhoun, W. M., Almobarak, A. O., Elmak, N. E., Abdelaziz, S. I., Sulaiman, A. A., & Ahmed, M. H. (2017). Diabetes complications in Sudanese individuals with type 2 diabetes: Overlooked problems in sub-Saharan Africa? Diabetes & Metabolic Syndrome, 11(Suppl 2), S1047–S1051. https://doi.org/10.1016/j.dsx.2017.07.039

[6] Feldman, E. L., Callaghan, B. C., Pop-Busui, R., Zochodne, D. W., Wright, D. E., Bennett, D. L., Bril, V., Russell, J. W., & Viswanathan, V. (2019). Diabetic neuropathy. Nature Reviews. Disease Primers, 5(1), 41. https://doi.org/10.1038/s41572-019-0092-1

[7] Goyal, K. (2023). Maximum strength in people with type 2 diabetes. Medical Case Reports, 9(4), 289.

[8] Albers, J. W., Brown, M. B., Sima, A. A., Greene, D. A., & the Tolrestat Study Group for the Early Diabetes Intervention Trial. (1996). Nerve conduction measures in mild diabetic neuropathy in the Early Diabetes Intervention Trial: The effects of age, sex, type of diabetes, disease duration, and anthropometric factors. Neurology, 46, 85–91. https://doi.org/10.1212/WNL.46.1.85

[9] Vinik, A., Ullal, J., Parson, H. K., & Casellini, C. M. (2006). Diabetic neuropathies: Clinical manifestations and current treatment options. Nature Clinical Practice. Endocrinology & Metabolism, 2, 269–281. https://doi.org/10.1038/ncpendmet0142

[10] Tesfaye, S., Boulton, A. J., Dyck, P. J., Freeman, R., Horowitz, M., Kempler, P., Lauria, G., Malik, R. A., Spallone, V., Vinik, A., Bernardi, L., Valensi, P., & the Toronto Diabetic Neuropathy Expert Group. (2010). Diabetic neuropathies: Update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care, 33, 2285–2293. https://doi.org/10.2337/dc10-1303

[11] Joshi, D., Khan, M. A., & Singh, A. (2020). A clinical study of the association and risk factors for lower limb neuropathy in patients with diabetic retinopathy. Journal of Family Medicine and Primary Care, 9, 1891–1895. https://doi.org/10.4103/jfmpc.jfmpc_231_20

[12] Park, J. H., & Won, J. C. (2018). Patterns of nerve conduction abnormalities in patients with type 2 diabetes mellitus according to the clinical phenotype determined by the current perception threshold. Diabetes & Metabolism Journal, 42, 519–528. https://doi.org/10.4093/dmj.2018.0068

[13] Khawaja, N., Abu-Shennar, J., Saleh, M., Dahbour, S. S., Khader, Y. S., & Ajlouni, K. M. (2018). The prevalence and risk factors of peripheral neuropathy among patients with type 2 diabetes mellitus; The case of Jordan. Diabetology & Metabolic Syndrome, 10, 8. https://doi.org/10.1186/s13098-018-0309-6

[14] Amelia, R., Wahyuni, A. S., & Yunanda, Y. (2019). Diabetic neuropathy among type 2 diabetes mellitus patients at Amplas Primary Health Care in Medan City. Open Access Macedonian Journal of Medical Sciences, 7(20), 3400–3403. https://doi.org/10.3889/oamjms.2019.433

[15] Zhang, Y., Li, J., Wang, T., & Wang, J. (2014). Amplitude of sensory nerve action potential in earlystage diabetic peripheral neuropathy: An analysis of 500 cases. Neural Regeneration Research, 9(14).

[16] Mayeda, L., Katz, R., Ahmad, I., Bansal, N., Batacchi, Z., Hirsch, I. B., Robinson, N., Trence, D. L., Zelnick, L., & de Boer, I. H. (2020). Glucose time in range and peripheral neuropathy in type 2 diabetes mellitus and chronic kidney disease. BMJ Open Diabetes Research & Care, 8, e000991. https://doi.org/10.1136/bmjdrc-2019-000991

[17] Muley, P. A., Muley, P. P., Sambre, A. D., & Ambad, R. S. (2022). A cross-sectional study of electrophysiological changes occurring in type ii diabetes mellitus. Cureus, 14(9): e28994. https://doi.org/10.7759/cureus.28994

[18] Partanen, J., Niskanen, L., Lethanen, J., Mervaala, E. Sitonen, O., & Uusitupa, M. (1995). Natural History of peripheral Neuropathy in patient with non-insulin dependent diabetes mellitus. The New England Journal of Medicine, 333(2), 89–94.

[19] Galbat, E. A. E. A., Youssef, S. S., Mai, M. A. S., Latif, A. A. R. A., Elgendy, D. S., & Maha, M. A. S. (2022, October). Is there a relation between peripheral nerves conduction study and cardiovascular assessment in men with type 2 diabetes mellitus? (A Cross-Sectional Study). The Egyptian Journal of Hospital Medicine, 89(2), 7302– 7308. https://doi.org/10.21608/ejhm.2022.274414