Commentary on “Diminished levels of insulin-like growth factor-1 may be a risk factor for peripheral neuropathy in type 2 diabetes patients”

Abstract

Dear Editor,

We read with interest the article “Diminished levels of insulin-like growth factor-1 may be a risk factor for peripheral neuropathy in patients with type 2 diabetes,” published in your esteemed journal. The study found that the diminished levels of insulin-like growth factor-1 may be a risk factor for peripheral neuropathy in patients with type 2 diabetes¹. The aims of this study were to determine the risk factors related to diabetic peripheral neuropathy (DPN) and to investigate the association of insulin-like growth factor-1 (IGF-1) with DPN in patients with type 2 diabetes. Barbarella et al. (2016) observed a significant decrease in IGF-1 levels in patients with DPN, pinpointing the idea that IGF-1 is a protective factor against injury that impacts the effect of the large fiber nerve in type 2 DM. We commend the authors for their contribution to this important area of research. However, the study has some potential limitations, which, if addressed, could improve the applicability and relevance of the work.

First, these findings could be significantly enhanced by the addition of relevant laboratory parameters. Without such data, the results would generally be less valid. Adding biomarkers like erythrocyte sedimentation rate (ESR), albumin, platelet count, interleukin-1 (IL-1) receptor antagonist (IL-1RA), IL-6, IL-18, vitamin B12, vitamin D3, serum zinc and potassium levels, the platelet-to-lymphocyte ratio (PLR), and the neutrophil-to-lymphocyte ratio (NLR) can you can find more information about the probability of poor results^{2, 3}. Second, the analysis is further limited by a failure to adjust for critical comorbid conditions such as both psychological disorders and diabetic retinopathy, both of which will have a marked impact on overall patient outcomes.

Moreover, the lack of detail in the demographic variables, including smoking habit (heavy smoker, current smoker, former smoker), alcohol use (mild, moderate, or severe), education level, socioeconomic status, nutritional intake, and toxins, does render this study non-definitive at least. The inclusion of these variables in future studies is crucial for a more comprehensive understanding of the disease. Other necessary limits are opacity in the assessments of bone malformations, physical activity levels, hyperinsulinemia, and insulin resistance⁴.

Overall, the present study has highlighted the correlation between IGF-1 and the prevalence of DPN in patients with T2D. While the points raised earlier could be addressed in future studies, their resolution could lead to significant advancements in patient care. We hope that the adoption of our recommendations will ultimately result in improved patient outcomes.

The authors declare no conflict of interest.

No ethical approval was required as this letter-to-the-editor article has no original research data.