Abstract: Objective To explore the clinical value of glucose fluctuation combined with nerve injury markers in predicting peripheral neuropathy in the elderly patients with type 2 diabetes mellitus (T2DM). Methods In this case-control study, 158 elderly T2DM patients with peripheral neuropathy (case group) and 158 elderly T2DM patients without peripheral neuropathy (control group) were selected from Hai’an Traditional Chinese Medicine Hospital from April 2021 to September 2024. The clinical data of the two groups were compared, and the independent influencing factors for peripheral neuropathy in elderly T2DM patients were analyzed by logistic regression analysis, and a risk prediction model was subsequently constructed. Results The levels of glycosylated hemoglobin (HbA1c), diurnal maximum-minimum glucose (DMMG), and myelin basic protein (MBP) were significantly higher, while the time in range (TIR) was significantly lower in the case group compared to the control group (all P<0.05). Multivariate logistic regression analysis showed that HbA1c (OR=3.340, 95%CI: 1.499－7.441), DMMG (OR=3.725, 95%CI: 1.672－8.298), and MBP (OR=4.166, 95%CI: 1.869－9.277) were risk factors for peripheral neuropathy in elderly T2DM patients (P <0.05), while TIR (OR=0.334, 95%CI: 0.150－0.745) was a protective factor (P<0.05). The risk prediction model integrating these four factors achieved an area under the receiver operating characteristic (AUC) curve of 0.783 (95%CI: 0.686－0.880), with a sensitivity of 85.01%, and a specificity of 76.93%. Conclusions HbA1c, DMMG, MBP, and TIR are related to the occurrence of peripheral neuropathy in elderly T2DM patients. The prediction model combining these indicators demonstrates good discriminatory ability and may aid in the early identification of high-risk individuals.

Key words: aged, type 2 diabetes mellitus, peripheral neuropathy, risk factor, risk model