Peripheral neuropathy (PN) is a common complication of diabetes that develops in up to 50% of people with diabetes. Obesity and the metabolic syndrome are risk factors for PN in patients with type 2 diabetes (T2D). However, the lipid metabolites associated with PN development are unknown. We compared the metabolomic profile of plasma from T2D patients with and without PN compared to lean control patients to identify metabolic changes that underlie PN associated with T2D. PN was evaluated in a cohort of T2D patients from the Danish portion of the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION). The Toronto criteria was used to assess PN based on symptoms of neuropathy and abnormal nerve conduction studies. To identify metabolomic signatures that associate with PN, plasma samples from 9 lean control, 49 T2D, and 48 T2D patients with PN were submitted to Metabolon® for a global metabolomics analysis. We used least absolute shrinkage and selection operator (LASSO) and Welch’s two-sample t-test to identify metabolites that differed between PN and non-PN subjects. Metabolomics identified plasma lipid metabolites that were dysregulated in T2D including cholesterol, sphingolipids, and acylcarnitines. Cholesterol and three classes of sphingolipid metabolites (dihydrosphingomyelin, glucosylceramide, and sphingomyelin) were significantly lower in plasma from T2D patients irrespective of PN compared to lean controls. Interestingly, long-chain and very long-chain acylcarnitines were also reduced in T2D patients while short-chain acylcarnitines were unchanged. Only a small number of metabolites were uniquely regulated by PN; of these, two very long-chain acylcarnitine species (C26:1 and C24) were significantly diminished in T2D patients with PN compared to those without. These results suggest an association with lipid markers of impaired mitochondrial β-oxidation and PN in T2D.


A.E. Rumora: None. F. Alakwaa: None. S.T. Andersen: None. M.E. Jørgensen: Research Support; Self; Amgen, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi-Aventis. Stock/Shareholder; Self; Novo Nordisk A/S. M. Charles: Other Relationship; Self; Novo Nordisk A/S. B.C. Callaghan: None. T.S. Jensen: None. E.L. Feldman: Consultant; Self; Novartis Pharmaceuticals Corporation.


American Diabetes Association (7-12-BS-045 to E.L.F.); Novo Nordisk Foundation (NNF14OC0011633); National Institutes of Health (1R24082841, 1DP3DK094292); National Institute of Diabetes and Digestive and Kidney Diseases (T32DK101357, F32DK112642, K99DK119366); NeuroNetwork for Emerging Therapies; A. Alfred Taubman Medical Research Institute

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