Various metabolic risk factors could be linked to diabetes-related pain with major implications for treatment

May 17, 2012

Around 1 in 50 people in the general population and 1 in 6 of those aged over 40 years experience neuropathy (damage to the nerves of the peripheral nervous system), which can cause numbness, tingling, pain, or weakness. The most common cause of neuropathy is diabetes, and up to half of diabetes patients can be affected. Currently, among the only treatments for neuropathy are glucose control (which often only delays it) and pain management. Yet less than half of patients are treated for pain, despite the availability of many effective therapies . Growing evidence suggests that various metabolic risk factors, including prediabetes, could be linked with neuropathy and thus be targets for new disease-modifying drugs. The issues are discussed in a Review in the June issue of The Lancet Neurology, by Dr Brian C Callaghan and colleagues, all of the University of Michigan, Ann Arbor, MI, USA.

Diabetes can cause various patterns of so-called , but the most common presentation is a distal symmetrical polyneuropathy (DSP), in which symptoms begin in the feet and spread up the limbs. Patients experience decreased quality of life, both physically and mentally. DSP can cause , which may lead to falls. Neuropathy is one of three main for falls in patients with diabetes, along with and vestibular dysfunction. Patients with diabetic DSP are two to three times more likely to fall than those with diabetes and no neuropathy. Additionally, patients with severe DSP are at risk of ulcerations and lower-extremity amputations, with 15% developing an ulcer during the course of their disease. Diabetes is the leading cause of lower-extremity amputations, roughly 80 000 of which are undertaken in the USA every year in patients with the disorder. Indeed, patients with diabetes are 15 times more likely than people without diabetes to have this life-changing complication.

Overall, costs associated with diabetic neuropathy in the USA are estimated to be between 4•6 and 13•7 billion dollars, with most of the expense attributed to those with type 2 diabetes. Therefore, neuropathy is associated with a quarter of the total costs of diabetes care in the USA.

Since the data linking prediabetes (a condition with higher than normal blood sugar levels, but not yet high enough for a diabetes diagnosis) with neuropathy are conflicting, a comprehensive study is needed to establish whether or not it is one of the metabolic drivers that underlie the onset and progression of neuropathy. The answer has direct implications for potential therapies for many patients with neuropathy. Currently one third of adult Americans meet criteria for prediabetes, but less than 5% of these people have received a formal diagnosis of prediabetes from their health-care providers and only a small percentage are being treated .Establishing a causal relation between prediabetes and neuropathy would change the clinical management of a substantial number of patients.

Research suggests that various metabolic factors (components of 'metabolic syndrome') other than blood —such as levels of LDL (bad) cholesterol and high blood pressure—might have a role in the development of neuropathy. The authors say that there are promising lines of investigation that could lead to improved prevention and treatment of the disorder. The magnitude of the effect of glucose control on neuropathy is much smaller in patients with type 2 diabetes than in those with type 1 diabetes. In view of this small effect size and the fact that many patients with type 2 diabetes continue to develop neuropathy despite adequate glucose control, discovery of modifiable risk factors for neuropathy is essential. Callaghan and colleagues are currently conducting such a study.

The authors conclude: "Components of the metabolic syndrome, including prediabetes, are potential risk factors for neuropathy, and studies are needed to establish whether they are causally related to neuropathy. These lines of enquiry will have direct implications for the development of new treatments for diabetic neuropathy."

Explore further: Neuropathy patients more likely to receive high-cost, screening instead of more effective tests

More information: Paper online: www.thelaneur.com/journals/lan … (12)70065-0/abstract

Related Stories

Neuropathy patients more likely to receive high-cost, screening instead of more effective tests

January 23, 2012
Researchers at the University of Michigan analyzed the tremendous cost of diagnosing peripheral neuropathy and found that less expensive, more effective tests are less likely to be used.

Researchers uncover source of mystery pain

June 22, 2011
An estimated 20 million people in the United States suffer from peripheral neuropathy, marked by the degeneration of nerves and in some cases severe pain. There is no good treatment for the disorder and doctors can find no ...

CV autonomic neuropathy risk for CVD despite albumin status

April 19, 2012
(HealthDay) -- Cardiovascular autonomic neuropathy (CAN) appears to affect the risk of cardiovascular disease even in type 1 diabetes patients with normal albumin excretion rates, according to a study published online April ...

To fix diabetic nerve damage, blood vessels and support cells may be the real targets of treatment

June 23, 2011
Blood vessels and supporting cells appear to be pivotal partners in repairing nerves ravaged by diabetic neuropathy, and nurturing their partnership with nerve cells might make the difference between success and failure in ...

Erectile dysfunction study shows high prevalence of peripheral neuropathy

November 15, 2011
Spanish researchers have uncovered clear links between erectile dysfunction (ED) and peripheral neuropathy, according to a paper in the December issue of the urology journal BJUI.

Recommended for you

Investigating patterns of degeneration in Alzheimer's disease

November 17, 2017
Alzheimer's disease (AD) is known to cause memory loss and cognitive decline, but other functions of the brain can remain intact. The reasons cells in some brain regions degenerate while others are protected is largely unknown. ...

Brain activity buffers against worsening anxiety

November 17, 2017
Boosting activity in brain areas related to thinking and problem-solving may also buffer against worsening anxiety, suggests a new study by Duke University researchers.

Study may point to new treatment approach for ASD

November 17, 2017
Using sophisticated genome mining and gene manipulation techniques, researchers at Vanderbilt University Medical Center (VUMC) have solved a mystery that could lead to a new treatment approach for autism spectrum disorder ...

Neuroscience research provides evidence the brain is strobing, not constant

November 17, 2017
It's not just our eyes that play tricks on us, but our ears. That's the finding of a landmark Australian-Italian collaboration that provides new evidence that oscillations, or 'strobes', are a general feature of human perception.

Neuroscientists find chronic stress skews decisions toward higher-risk options

November 16, 2017
Making decisions is not always easy, especially when choosing between two options that have both positive and negative elements, such as deciding between a job with a high salary but long hours, and a lower-paying job that ...

Paraplegic rats walk and regain feeling after stem cell treatment

November 16, 2017
Engineered tissue containing human stem cells has allowed paraplegic rats to walk independently and regain sensory perception. The implanted rats also show some degree of healing in their spinal cords. The research, published ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.