Prediabetes and Peripheral Neuropathy

Summary: The association between peripheral neuropathy and prediabetes, although not well known by clinicians, is well established in the scientific literature. It is estimated that up to 15 million prediabetics in the US may have peripheral neuropathy–making prediabetes, one of the least recognized and most common causes of peripheral neuropathy in the US.

After performing a literature review and meta-analysis of 23 relevant studies (n=6494), the  prevalence of peripheral neuropathy in prediabetics was found to be 18%–as reported in 2018 in the JournalDiabetes.  If accurate, these findings suggest that there may be as many as 15 million prediabetics in the US with peripheral neuropathy. Canadian and Indian researchers have published studies that have found the prevalence to be even higher.

Unfortunately, the association between prediabetes and peripheral neuropathy is not well appreciated by many clinicians.  A 2008 paper found that 40% of all patients diagnosed with idiopathic neuropathy actually had prediabetes

Peripheral neuropathy is often the first clinical sign of prediabetes. Early diagnosis of prediabetes affords patients the opportunity to adopt lifestyle changes and therapies in the preliminary stages of the disease–when they have the greatest impact on preventing or delaying the progression of prediabetes to diabetes.

The neuropathy associated with prediabetes is clinically similar to early diabetic peripheral neuropathy, with preferential injury to small nerve fibers resulting in pain and autonomic dysfunction.  To aid in making the diagnosis, clinicians should consider performing a skin biopsy, to determine intraepidermal nerve fiber density, and blood work including HbA1c and/or 2hrPP.

Dr. Mann bust-shot

Dr. Richard H Mann, DABPS, ret
Chief Scientific Officer & Founder, Realm Labs, Makers of the NeuRemedy
® Line of Nutritional Products for Improved Function of the Nerves in the Feet and Legs.

This Clinical Update is brought to you by Realm Labs, the most trusted name in nutritional supplementation of nerve dysfunction in the feet and legs.

If you would like to speak with Dr. Mann about how to improve your treatment outcomes on patients with nerve dysfunction in the feet and legs, call 866-634-2745 or email Dr. Mann at


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