HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Smith, A. G. Articles by Singleton, J. R. Search for Related Content PubMed PubMed Citation Articles by Smith, A. G. Articles by Singleton, J. R. Social Bookmarking                What's this?

Lifestyle Intervention for Pre-Diabetic Neuropathy

¹ Department of Neurology, University of Utah, Salt Lake City, Utah
² Department of Pathology, University of Utah, Salt Lake City, Utah
³ Department of Neurology, University of Michigan, Ann Arbor, Michigan
⁴ Department of Neurology, Yale University, New Haven, Connecticut

Address correspondence and reprint requests to A. Gordon Smith, MD, Associate Professor of Neurology and Pathology, University of Utah School of Medicine, 50 N. Medical Dr. SOM 3R152, Salt Lake City, UT 84132. E-mail: gordon.smith{at}hsc.utah.edu

OBJECTIVE—The purpose of this study was to evaluate intraepidermal nerve fiber density (IENFD) as a sensitive measure of neuropathy change in patients with neuropathy associated with impaired glucose tolerance (IGT) receiving lifestyle intervention based on that used in the Diabetes Prevention Program.

RESEARCH DESIGN AND METHODS—We performed 3-mm skin biopsies with measurement of IENFD at the distal leg and proximal thigh at baseline and after 1 year in 32 subjects with IGT. Each received individualized diet and exercise counseling as a standard of care. Nerve conduction studies, quantitative sensory testing, quantitative sudomotor axon reflex testing, and the Michigan Diabetic Neuropathy score were performed, and a visual analog pain scale was completed. Two-hour oral glucose tolerance tests (OGTTs) following the American Diabetes Association guidelines were performed, and serum lipid levels were measured at baseline and 1 year later.

RESULTS—Baseline distal IENFD was 0.9 ± 1.2 fibers/mm and proximal IENFD was 4.8 ± 2.3 fibers/mm. Baseline distal IENFD correlated with fasting glucose (P < 0.001) and OGTT (P < 0.01). After 1 year of treatment, there was a 0.3 ± 1.1-fiber/mm improvement in distal IENFD and a 1.4 ± 2.3-fiber/mm improvement in proximal IENFD (P < 0.004). The change in proximal IENFD correlated with decreased neuropathic pain (P < 0.05) and a change in sural sensory amplitude (P < 0.03).

CONCLUSIONS—These findings indicate that diet and exercise counseling for IGT results in cutaneous reinnervation and improved pain. Skin biopsy was the most sensitive measure of neuropathy change over 1 year. IENFD should be included as an end point in future neuropathy trials.

Abbreviations: DPP, Diabetes Prevention Program • IENFD, intraepidermal nerve fiber density • IGT, impaired glucose tolerance • IGTN, Impaired Glucose Tolerance Neuropathy • NCS, nerve conduction study • OGTT, oral glucose tolerance test • QST, quantitative sensory testing • QSART, quantitative sudomotor axon reflex testing • VAS, visual analog pain scale

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				G. Devigili, V. Tugnoli, P. Penza, F. Camozzi, R. Lombardi, G. Melli, L. Broglio, E. Granieri, and G. Lauria The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology Brain, July 1, 2008; 131(7): 1912 - 1925. [Abstract] [Full Text] [PDF]

				Z. T. Bloomgarden Diabetic Neuropathy Diabetes Care, March 1, 2008; 31(3): 616 - 621. [Full Text] [PDF]

				C. Quattrini, M. Jeziorska, A. J.M. Boulton, and R. A. Malik Reduced Vascular Endothelial Growth Factor Expression and Intra-Epidermal Nerve Fiber Loss in Human Diabetic Neuropathy Diabetes Care, January 1, 2008; 31(1): 140 - 145. [Abstract] [Full Text] [PDF]

				A. J.M. Boulton Whither Clinical Research in Diabetic Sensorimotor Peripheral Neuropathy?: Problems of end point selection for clinical trials Diabetes Care, October 1, 2007; 30(10): 2752 - 2753. [Full Text] [PDF]

				I. G. Obrosova, O. Ilnytska, V. V. Lyzogubov, I. A. Pavlov, N. Mashtalir, J. L. Nadler, and V. R. Drel High-Fat Diet Induced Neuropathy of Pre-Diabetes and Obesity: Effects of "Healthy" Diet and Aldose Reductase Inhibition Diabetes, October 1, 2007; 56(10): 2598 - 2608. [Abstract] [Full Text] [PDF]

				C. Quattrini, M. Tavakoli, M. Jeziorska, P. Kallinikos, S. Tesfaye, J. Finnigan, A. Marshall, A. J.M. Boulton, N. Efron, and R. A. Malik Surrogate Markers of Small Fiber Damage in Human Diabetic Neuropathy Diabetes, August 1, 2007; 56(8): 2148 - 2154. [Abstract] [Full Text] [PDF]

				A. A Little, J. L Edwards, and E. L Feldman Diabetic neuropathies Practical Neurology, April 1, 2007; 7(2): 82 - 92. [Full Text] [PDF]