Chronic infl ammatory demyelinating polyneuropathy and diabetes – a challenge for neurologists
Authors:
G. Hajaš
Authors‘ workplace:
Neurologická klinika
; FSVaZ UKF a FN Nitra, Slovensko
; Neurologická klinika FSVaZ UKF a FN Nitra, Slovensko
Published in:
Cesk Slov Neurol N 2025; 88(1): 32-38
Category:
Review Article
doi:
https://doi.org/10.48095/cccsnn202532
Overview
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired, immune-mediated neuropathy caused by inflammation of peripheral nerves and nerve roots. It is the most common chronic autoimmune polyneuropathy, which is still considered underdiagnosed. If it remains untreated or improperly treated for a long time, it can lead to severe disability with impairment of the patient‘s fine motor skills, walking, and general mobility. CIDP may be associated with several diseases such as diabetes mellitus, monoclonal gammopathy, HIV infection, malignancies, or several systemic diseases. Recently, there have been several references that the prevalence of CIDP tends to be higher in diabetics, especially in older patients. Diagnosing CIDP in a patient with diabetes is challenging, because superimposed axonal damage in possible diabetic neuropathy can obscure typical demyelinating electrophysiological findings. On the other hand, diabetic polyneuropathy can cause elevated protein in cerebrospinal fluid. There are still many controversies in explaining the association of these two diseases. We still do not have an adequate diagnostic tool to clearly define CIDP in diabetic patients. The identifying a potential biomarkers of CIDP in diabetic patients is a challenge for neurologists, as CIDP is a treatable disease.
Keywords:
diagnostic criteria – Electromyography – diabetes mellitus – biomarkers – treatment – chronic infl ammatory demyelinating polyneuropathy – diabetic polyneuropathy
Sources
1. Gogia B, Rocha Cabrero F, Khan Suheb MZ et al. Chronic inflammatory demyelinating polyradiculo- neuropathy. Treasure Island (FL): Statpearls Publishing 2024.
2. Overell S, Wilson HJ. Chronic inflammatory polyradiculoneuropathy: classification and treatment. Pract Neurol 2006; 6: 102–110.
3. Ehler E. Chronická zánětlivá demyelinizační polyradikuloneuropatie. Cesk Slov Neurol N 2018; 81 (3): 252–265. doi: 10.14735/amcsnn2018252.
4. Rajabally YA, Simpson BS, Beri S et al. Epidemiologic variability of chronic inflammatory demyelinating polyneuropathy with different diagnostic criteria: study of a UK population. Muscle Nerve 2009; 39 (4): 432–438. doi: 10.1002/mus.21206.
5. Broers MC, Bunschoten C, Nieboer D et al. Incidence and prevalence of chronic inflammatory demyelinating polyradiculoneuropathy: a systematic review and meta-analysis. Neuroepidemiology 2019; 52 (3–4): 161–172. doi: 10.1159/000494291.
6. Van den Bergh PYK, van Doorn PA, Hadden RDM et al. European academy of neurology/peripheral nerve society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force-second revision. Eur J Neurol 2021; 28 (11): 3556–3583. doi: 10.1111/ene. 14959.
7. Joint Task Force of the EFNS and the PNS. European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society – first revision. J Peripher Nerv Syst 2010; 15 (1): 1–9. doi: 10.1111/j.1529-8027.2010.00245.x.
8. Lewis RA, van Doorn PA, Sommer C. Tips in navigating the diagnostic complexities of chronic inflammatory demyelinating polyradiculoneuropathy. J Neurol Sci 2022; 443: 120478. doi: 10.1016/j.jns.2022.120478.
9. Jann S, Bramerio MA, Beretta S et al. Diagnostic value of sural nerve matrix metalloproteinase-9 in diabetic patients with CIDP. Neurology 2003; 61 (11): 1607–1610. doi: 10.1212/01.wnl.0000096174.86850.7f.
10. Latov N. Biomarkers of CIDP in patients with diabetes or CMT1. J Peripher Nerv Syst 2011; 16 (Suppl 1): 14–17. doi: 10.1111/j.1529-8027.2011.00299.
11. Sommer C, Toyka K. Nerve biopsy in chronic inflammatory neuropathies: in situ biomarkers. J Peripher Nerv Syst 2011; 16 (Suppl 1): 24–29. doi: 10.1111/j.1529- 8027.2011.00301.x.
12. Andrusiów S, Pawlak Z, Stańczykiewicz B et al. Chronic inflammatory demyelinating polyradiculoneuropathy in patients with diabetes mellitus – treatment with intravenous immunoglobulins: a systematic review. Biomed Pharmacother 2023; 164: 114974. doi: 10.1016/j.biopha.2023.114974.
13. Cocito D, Durelli L, Isoardo G. Different clinical, electrophysiological and immunological features of CIDP associated with paraproteinaemia. Acta Neurol Scand 2003; 108 (4): 274–280. doi: 10.1034/j.1600-0404.2003.00127.x.
14. Chen Y, Tang X. Chronic inflammatory demyelinating polyradiculoneuropathy in association with comcomitant diseases: identification and management. Front Immunol 2022; 13: 890142. doi: 10.3389/fimmu.2022.890142.
15. Tesfaye S, Stevens LK, Stephenson JM et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complication Study. Diabetologia 1996; 39 (11): 1377–1384. doi: 10.1007/s001250050586.
16. Russell JW, Zilliox LA. Diabetic neuropathies. Continuum 2014; 20 (5): 1226–1240. doi: 10.1212/01.CON.0000455884.29545.d2.
17. Thomas PK. Classification, differential diagnosis, and staging of diabetic peripheral neuropathy. Diabetes 1997; 46 (Suppl. 2): S54–S57. doi: 10.2337/diab.46.2.s54.
18. Pirart J. Diabetes mellitus and its degenerative complications: a prospective study of 4,400 patients observed between 1947 and 1973. Diabete Metab 1977; 3 (2): 97–107.
19. Gorson KC, Ropper AH, Adelman LS et al. Influence of diabetes mellitus on chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2000; 23 (1): 37–43. doi: 10.1002/ (sici) 1097-4598 (200001) 23: 1<37:: aid-mus5>3.0.co; 2-9.
20. Sharma KR, Cross J, Farronay O et al. Demyelinating neuropathy in diabetes mellitus. Arch Neurol 2002; 59 (5): 758–765. doi: 10.1001/archneur.59.5.758.
21. Bril V, Blanchette CM, Noone JM et al. The dilemma of diabetes in chronic inflammatory demyelinating polyneuropathy. J Diabetes Complications 2016; 30 (7): 1401–1407. doi: 10.1016/j.jdiacomp.2016.05.007.
22. Doneddu PE, Cocito D, Manganelli F et al. The Italian CIDP database study group. Frequency of diabetes and other comorbidities in chronic inflammatory demyelinating polyradiculoneuropathy and their impact on clinical presentation and response to therapy. J Neurol Neurosurg Psychiatry 2020; 91 (10): 1092–1099. doi: 10.1136/jnnp-2020-323615.
23. Dyck PJB, Engelstad JK, Norell JE et al. Inflammatory neuropathies in diabetes mellitus: the radiculoplexus neuropathies and diabetic CIDP. J Peripheral Nerv Syst 2010; 15: 241–293.
24. Dunnigan SK, Ebadi H, Breiner A et al. Comparison of diabetes patients with „demyelinating“ diabetic sensorimotor polyneuropathy to those diagnosed with CIDP. Brain Behav 2013; 3 (6): 656–663. doi: 10.1002/brb3.177.
25. Knopp M, Rajabally YA. Common and less common peripheral nerve disorders associated with diabetes. Curr Diabetes Rev 2012; 8 (3): 229–236. doi: 10.2174/157339912800564034.
26. Laughlin RS, Dyck PJ, Melton LJ 3rd et al. Incidence and prevalence of CIDP and the association of diabetes mellitus. Neurology 2009; 73 (1): 39–45. doi: 10.1212/WNL.0b013e3181aaea47.
27. McLeod JG, Tuck RR. Disorders of the autonomic nervous system: part 2. Investigation and treatment. Ann Neurol 1987; 21 (6): 519–529. doi: 10.1002/ana.410210602.
28. Rajabally YA, Stettner M, Kieseier BC et al. CIDP and other inflammatory neuropathies in diabetes – diagnosis and management. Nat Rev Neurol 2017; 13 (10): 599–611. doi: 10.1038/nrneurol.2017.123.
29. Rajabally YA, Peric S, Cobeljic M et al. Chronic inflammatory demyelinating polyneuropathy associated with diabetes: a European multicentre comparative reappraisal. J Neurol Neurosurg Psychiatry 2020; 91 (10): 1100–1104. doi: 10.1136/jnnp-2020-322971.
30. Abraham A, Breiner A, Katzberg HD et al. Treatment responsiveness in CIDP patients with diabetes is associated with unique electrophysiogical characteristics, and not with common criteria fo CIDP. Expert Rev Clin Immunol 2015; 11 (4): 537–546. doi: 10.1586/1744666X.2015.1018891.
31. Stewart JD, McKelvey R, Durcan L et al. Chronic inflammatory demyelinating polyneuropathy (CIDP) in diabetics. J Neurol Sci 1996; 142 (1): 59–64. doi: 10.1016/0022-510x (96) 00126-8.
32. Bednařík J, Ambler Z, Růžička E a kol. Klinická neurologie – speciální část II. Triton 2010.
33. Valentin M, Coultas R, Sottile E. Chronic inflammatory demyelinating polyneuropathy (CIDP) in diabetes mellitus: a diagnostic dilemma. Cureus 2022; 14 (5): e25332. doi: 10.7759/cureus.25332.
34. Albers JW, Jacobson RD, Smyth DL. Diabetic amyotrophy: from the basics to the bedside. Eur Med J 2020; 5 (1): 94–103. doi: 10.33590/emj/19-00163.
35. Shibuya K, Sugiyama A, Ito S et al. S. Reconstruction magnetic resonance neurography in chronic inflammatory demyelinating polyneuropathy. Ann Neurol 2015; 77 (2): 333–337. doi: 10.1002/ana.24314.
36. Padua L, Martinoli C, Pazzaglia C et al. Intra- and internerve cross-sectional area variability: new ultrasound measures. Muscle Nerve 2012; 45 (5): 730–733. doi: 10.1002/mus.23252.
37. Walker FO, Cartwright MS, Alter KE et al. Indications for neuromuscular ultrasound: expert opinion and review of the literature. Clin Neurophysiol 2018; 129 (12): 2658–2679. doi: 10.1016/j.clinph.2018.09.013.
38. Zaidman CM, Al-Lozi M, Pestronk, A. Peripheral nerve size in normals and patients with polyneuropathy: an ultrasound study. Muscle Nerve 2009; 40 (6): 960–966. doi: 10.1002/mus.21431.
39. Grimm A, Heiling B, Schumacher U et al. Ultrasound differentiation of axonal and demyelinating neuropathies. Muscle Nerve 2014; 50 (6): 976–983. doi: 10.1002/mus.24238.
40. Breiner A, Qrimli M, Ebadi H et al. Peripheral nerve high-resolution ultrasound in diabetes. Muscle Nerve 2017; 55 (2): 171–178. doi: 10.1002/mus.25223.
41. Cartwright MS, Lee H. Neuromuscular notes: neuromuscular ultrasound in polyneuropathy. Boston MA: Practical Neurology 2020
42. Fleischer M, Lee I, Erdlenbruch F et al. Corneal confocal microscopy differentiates inflammatory from diabetic neuropathy. J Neuroinflammation 2021; 18 (1): 89. doi: 10.1186/s12974-021-02130-1.
43. Lotan I, Hellman MA, Steiner I. Diagnostic criteria of chronic inflammatory demyelinating polyneuropathy in diabetes mellitus. Acta Neurol Scand 2015; 132 (4): 278–283. doi: 10.1111/ane.12394.
44. Research criteria for diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP). Report from an Ad Hoc Subcommittee of the American Academy of Neurology AIDS Task Force. Neurology 1991; 41 (5): 617–618.
45. Cocito D, Ciaramitaro P, Isoardo G et al. Intravenous immunoglobulin as first treatment in diabetics with concomitant distal symmetric axonal polyneuropathy and CIDP. J Neurol 2002; 249 (6): 719–722. doi: 10.1007/s00415-002-0698-0.
46. Jann S, Bramerio MA, Facchetti D et al. Intravenous immunoglobulin is effective in patients with diabetes and with chronic inflammatory demyelinating polyneuropathy: long term follow-up. J Neurol Neurosurg Psychiatry 2009; 80 (1): 70–73. doi: 10.1136/jnnp.2008. 149013.
47. Dunnigan SK, Ebadi H, Breiner A et al. The characteristics of chronic inflammatory demyelinating polyneuropathy in patients with and without diabetes – an observational study. PloS One 2014; 9 (2): e89344. doi: 10.1371/journal.pone.0089344.
48. Ayyar DR, Sharma KR. Chronic inflammatory demyelinating polyradiculoneuropathy in diabetes mellitus. Curr Diab Rep 2004; 4 (6): 409–412. doi: 10.1007/s11892-004-0048-y.
49. Sharma KR, Cross J, Ayyar DR et al. Diabetic demyelinating polyneuropathy responsive to intravenous immunoglobulin therapy. Arch Neurol 2002; 59 (5): 751–757. doi: 10.1001/archneur.59.5.751.
50. Špalek P, Kurča E, Cibulčík F et al. Epidemiológia, diagnostika a liečba CIDP v SR. Cesk Slov Neurol N 2018; 81/114 (6): 724.
51. Bednařík J. Chronická zánětlivá demyelinizační neuropatie. Neurol Praxi 2016; 17 (1): 16–21.
52. Eftimov F, Vermeulen M, van Doorn PA et al. Long-term remission of CIDP after pulsed dexamethasone or short-term prednisolone treatment. Neurology 2012; 78 (14): 1079–1084. doi: 10.1212/WNL.0b013e31824e8f84.
53. Münch C, Anagnostou P, Meyer R et al. Rituximab in chronic inflammatory demyelinating polyneuropathy associated with diabetes mellitus. J Neurol Sci 2007; 256 (1–2): 100–102. doi: 10.1016/ j.jns.2007.02.027.
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