Thaisetthawatkul P, et al. - Researchers intended to determine if there is a connection between prediabetes (PD), elements of the metabolic syndrome (MetS) and small fiber neuropathy (SFN). Two hundred sixty-eight individuals with SFN symptoms and normal electrophysiology underwent tests to evaluate small fibers. According to results, no difference was found in intraepidermal nerve fiber density (IEFND) or abnormal skin biopsy frequency between PD and normoglycemia (NG). In diabetics (DM), however, IENFD was lower than NG. An association between HbA1c and IENFD was noted only with the inclusion of DM patients. In those with an abnormal skin biopsy, MetS attributes were more common but not among those with autonomic dysfunction or meeting SFN criteria. DM is related to SFN but not to PD alone. Other MetS elements seem to have a preferential impact on the structure of small fiber over function.