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Peripheral neuropathy may be more common in patients with pre-diabetes than previously thought, and early interventions may be warranted in this patient population, according to researchers from the University of Utah.
Currently, 86 million adults — more than one in three U.S. adults — have prediabetes, according to CDC estimates. Without weight loss and moderate physical activity, 15% to 30% of these people will develop full-blown type 2 diabetes within 5 years.1
“We know now a lot more than we did 3 or 5 years ago about neuropathic pain in patients with prediabetes. Neuropathy affects patients with prediabetes in a continuum,” said J. Rob Singleton, MD, who is a professor of neurology at the University of Utah in Salt Lake City. “We think it is more obesity and dysfunction of lipids (fats) that is causing the problem.”
In another study conducted by researchers from the University of Michigan, peripheral neuropathy was also common in obese patients, even if they had normal blood sugar levels, when compared with lean control participants. This same study also confirmed that rates of neuropathy were increased in participants with prediabetes and diabetes, leading the researchers to conclude that diabetes, prediabetes, and obesity are likely metabolic drivers of peripheral neuropathy. The findings were published in JAMA Neurology.1
Dr. Singleton and his team have been studying peripheral neuropathy associated with prediabetes and metabolic syndrome as well as what treatments may work best. Metabolic syndrome is the name for a group of risk factors that raise the risk for heart disease, diabetes and stroke. Risk factors include high blood pressure, elevated blood glucose, elevated cholesterol, and abdominal fat. Through their research, they have found that many patients with metabolic syndrome have pre-diabetes and peripheral neuropathy. Therefore, a multi-pronged approach to managing these patients is essential.
“We have shown that, in pre-diabetics with neuropathic pain, exercise reduces neuropathic pain and increases the intradermal nerve fibers in the thigh and ankle. We are in the process now of replicating that study,” Singleton said in an interview with Endocrinology Advisor. “You need to improve lipid (cholesterol) function and glucose levels. So, lifestyle issues have to be addressed.”
New studies evaluating the link between prediabetes and peripheral neuropathy are filling in some of the gaps in knowledge.
In a study recently published in Diabetes Care, C. Christine Lee, PhD, of the University of Toronto, and colleagues reported that prediabetes was associated with similar risks for nerve dysfunction and damage leading to peripheral neuropathy as one develops with ‘new-onset’ diabetes.2
While the exact mechanisms behind these associations are unclear, a growing body of evidence suggests that peripheral neuropathy begins in the early stages of diabetes pathogenesis, the researchers noted.
Lee and colleagues analyzed data on 467 individuals. The researchers found that the prevalence of peripheral neuropathy was 29% in adults with normal glucose levels, as compared with 49% in adults with prediabetes and 50% in adults with new-onset diabetes.
The researchers also found that progression of elevated glucose (pre-diabetes) over 3 years predicted a higher risk for peripheral neuropathy and nerve dysfunction.
Early intervention with lifestyle changes involving diet and exercise may be vital to preventing the severity of nerve damage, Dr. Lee stated. This had previously been backed up by another study published in 2006 in Diabetes Care, by Dr. Singleton. Singleton and his colleagues found that dietary changes and exercise can result in cutaneous reinnervation and improved pain in patients with prediabetes.3
It is imperative to realize that the nerve damage seen in peripheral neuropathy can actually occur long before diabetes sets in. In fact the most current research has shown that obesity, even with normal glucose (blood sugar) levels has been linked with causing peripheral neuropathy as well as pre-diabetes. Although it is important to strive for maintaining fasting glucose levels between 70 – 80 mg/dL, it is equally important to keep your weight down, lower LDL cholesterol and triglycerides. All of this can be accomplished without the use of medication or bariatric procedures.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
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