Glucose‐lowering medication associated with weight loss may limit the progression of diabetic neuropathy in type 2 diabetes

Abstract Aim Obesity is a major risk factor for diabetic peripheral neuropathy (DPN) in type 2 diabetes (T2D). This study investigated the effect of glucose lowering medication associated with weight change on DPN. Methods Participants with T2D were grouped based on whether their glucose lowering medications were associated with weight gain (WG) or weight loss (WL). They underwent clinical, metabolic testing and assessment of neuropathic symptoms, vibration perception threshold (VPT), sudomotor function and corneal confocal microscopy (CCM) at baseline and follow‐up between 4 and 7 years. Results Of 76 participants, 69.7% were on glucose lowering medication associated with WG, and 30.3% were on glucose lowering medication associated with WL. At baseline, participants in the WG group had a significantly longer duration of diabetes ( p < .01), higher douleur neuropathique en 4 (DN4) score ( p < .0001) and VPT ( p = .01) compared with those in the WL group. Over a 56‐month period, participants in the WG group showed no significant change in body weight ( p = .11), HbA1c ( p = .18), triglycerides ( p = .42), DN4 ( p = .11), VPT ( p = .15) or Sudoscan ( p = .43), but showed a decline in corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL) ( p < .0001). Participants in the WL group showed a reduction in weight ( p = .01) and triglycerides ( p < .05), no change in DN4 ( p = .30), VPT ( p = .31) or Sudoscan ( p = .17) and a decline in the corneal nerve branch density ( p < .01). Conclusions Participants treated with glucose lowering medication associated with weight gain had worse neuropathy and greater loss of corneal nerves during follow‐up, compared to patients treated with medication associated with weight loss.