Diabetes: Tighter control of blood sugar prevents nerve condition, but at what risk?

June 12, 2012

Aggressive control of blood sugar levels in diabetes can help to prevent a painful condition affecting patients' nerves, according to a new systematic review in the Cochrane Library. However, the review suggests that optimal target levels need to be established to prevent serious complications.

People with their blood sugar levels through insulin injections, diet and drugs, to compensate for their bodies producing too little insulin () or becoming resistant to insulin (type 2 diabetes). Up to half of people with diabetes develop a disabling condition called , which affects nerves in the feet and legs, making them feel tingly, numb, painful or weak. It is possible to prevent neuropathy by strict control of through a number of ways including different insulin regimens and diet modification, but evidence for the effects of this approach, known as enhanced , has not been systematically reviewed until now.

The results analysed in the review are drawn from six studies investigating the risk of neuropathy in people who received enhanced glucose control treatments including extra , antidiabetic drugs, and diet changes. The review looked at evidence in type 1 and type 2 diabetes separately. In two studies involving 1,228 people with type 1 diabetes significantly fewer people developed neuropathy each year with enhanced glucose control treatment compared with routine care. In four studies involving 6,669 people with type 2 diabetes the reduction in new cases of neuropathy was small and not statistically significant.

"Overall, this evidence suggests that a more aggressive approach to controlling sugar levels can be effective in delaying the onset of neuropathy in diabetes," said lead author of the review, Brian Callaghan, M.D., Assistant Professor in the Department of Neurology at the University of Michigan in Ann Arbor, Michigan, US. "The results also highlight the differences between type 1 and type 2 diabetes. The less dramatic effect of enhanced glucose control in type 2 diabetes may indicate that other factors, besides high glucose levels, may be important in causing nerve damage in these patients."

However, the risk of adverse effects associated with the treatment, including hypoglycaemia, was higher with enhanced glucose control. The researchers say further research is needed to optimise target levels for safe treatments that will both prevent neuropathy and minimise serious side effects.

"Although these results show clear benefits for preventing neuropathy in people with diabetes, they should be weighed against potential adverse effects," said Callaghan. "Future studies must establish target levels for glucose control that will balance benefits and side effects."

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

More information: Callaghan BC, Little AA, Feldman EL, Hughes RAC. Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD007543. DOI: 10.1002/14651858.CD007543.pub2

Related Stories

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. ...

New inflammation hormone link may pave way to study new drugs for Type 2 diabetes

May 15, 2012
A new link between obesity and type 2 diabetes found in mice could open the door to exploring new potential drug treatments for diabetes, University of Michigan Health System research has found.

Type 2 diabetes: 'Intensive' versus 'conventional' blood glucose control -- no clear picture

August 1, 2011
Research published in The Cochrane Library found that the risk of death and cardiovascular disease, such as stroke, was unchanged whether glucose control was intense or conventional. They did find, however, that when aiming ...

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.

Recommended for you

Pre-diabetes discovery marks step towards precision medicine

November 20, 2017
Researchers from the University of Sydney's Charles Perkins Centre have identified three specific molecules that accurately indicate insulin resistance, or pre-diabetes - a major predictor of metabolic syndrome, the collection ...

Scientists reverse diabetes in a mouse model using modified blood stem cells

November 15, 2017
Researchers at Boston Children's Hospital have successfully reversed type 1 diabetes in a mouse model by infusing blood stem cells pre-treated to produce more of a protein called PD-L1, which is deficient in mice (and people) ...

Pregnancy-related conditions taken together leave moms—and dads—at risk

November 14, 2017
Research has already shown that women who develop either diabetes or high blood pressure during pregnancy are at risk of getting type 2 diabetes, high blood pressure or heart disease years later. Now, a new study from a team ...

Study reveals how a very low calorie diet can reverse type 2 diabetes

November 9, 2017
In a new study, a Yale-led research team uncovers how a very low calorie diet can rapidly reverse type 2 diabetes in animal models. If confirmed in people, the insight provides potential new drug targets for treating this ...

Targeting a microRNA shows potential to enhance effectiveness of diabetes drugs

November 7, 2017
Over the past 15 years, University of Alabama at Birmingham endocrinologist Anath Shalev, M.D., has unraveled a crucial biological pathway that malfunctions in diabetes.

Researchers link Western diet to vascular damage and prediabetes

October 31, 2017
Could short-term exposure to the average American diet increase one's risk for developing diabetes and cardiovascular disease? According to a recent study funded by the American Heart Association (AHA), researchers from New ...

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.