Higher disease burden and greater small fibre impairment in women with painful diabetic neuropathy.

OBJECTIVE

Although the incidence of Painful-Diabetic Peripheral Neuropathy (Painful-DPN) is higher in women, the underlying reasons for this are not known. This study investigated sex differences in pain and neurological phenotypes in 2 cohorts of patients with Painful-DPN.

METHODS

Two cohort analyses were performed in this retrospective analysis of participants with Painful-DPN recruited to cross-sectional studies: (1) Patient-Reported Outcomes Measures Cohort analysis (n = 184), which assessed neuropathic pain intensity (Numeric Rating Score), neuropathic symptoms (Neuropathic Pain Scale), mood (Hospital Anxiety and Depression Scale), quality of life (Norfolk QoL-DN), and sleep (Medical Outcomes Sleep Study); (2) Neurological Phenotyping Cohort analysis (n = 100), which assessed large- (Neuropathy Impairment Score of the Lower Limb plus Seven Neurophysiological Tests) and small-nerve fibre function. Participants were also divided into irritable (IR) and nonirritable nociceptor phenotypes.

RESULTS

In the first cohort analysis, women reported greater neuropathic pain symptom burden, poorer sleep, and higher anxiety prevalence than men. In the second cohort analysis, men had greater large-nerve fibre impairment, whereas women exhibited more severe small-fibre dysfunction. In addition, IR nociceptor phenotypes were more prevalent in women.

CONCLUSION

Women with Painful-DPN experience a greater disease burden, increased small-fibre impairment, and are more likely to have the IR nociceptor phenotype, suggesting potential sex-specific disease mechanisms.