Arterial stenosis and electrophysiological nerve dysfunction in type 2 diabetes: clinical evidence from GEE models and transcriptomic pathway analysis

Background Diabetic peripheral neuropathy (DPN) is a common disabling complication of type 2 diabetes (T2D), yet the contribution of systemic arterial stenosis to electrophysiological nerve dysfunction remains incompletely characterized. Objective To examine whether carotid arterial stenosis (CASD) and lower-limb arterial stenosis (LWASD) are associated with multi-nerve conduction abnormalities in T2D, and to explore supportive molecular signatures using transcriptomic analysis. Methods In this retrospective cross-sectional study, 202 patients with T2D underwent bilateral carotid and lower-limb ultrasonography and standardized nerve conduction testing. Nerve dysfunction was quantified using 16 binary electrophysiological abnormality indicators. Generalized estimating equation (GEE) models estimated marginal associations between stenosis grades and nerve abnormality, adjusting for age and sex, with an expanded model additionally adjusting for HbA1c, LDL-cholesterol, and triglycerides to assess robustness to metabolic confounding. Patient-level abnormality burden was evaluated using a binomial model (abnormal indicators out of those assessed). Transcriptomic differential expression and pathway enrichment were performed using the public microarray dataset GSE95849 to provide supportive systemic molecular context. Results LWASD was significantly associated with increased odds of nerve conduction abnormality and remained robust after metabolic adjustment (OR ≈ 1.5 per grade increase, p< 0.001), whereas CASD showed weaker and non-significant associations in the primary nerve-level models. Nerve-specific analyses suggested stronger signals in distal lower-limb measures consistent with a length-dependent pattern. Transcriptomic analyses highlighted enrichment of pathways related to hypoxia responses, inflammatory signaling, mitochondrial dysfunction, and neuronal maintenance. Conclusion Lower-limb arterial stenosis is independently associated with a greater burden of electrophysiological nerve abnormalities in T2D beyond key metabolic parameters. Transcriptomic signatures support a vascular–hypoxic–inflammatory context consistent with mechanisms implicated in diabetic complications; however, causal direction cannot be inferred from cross-sectional data.