Clinical Diabetic Neuropathy
- Zachary T. Bloomgarden, MD
- ADA, American Diabetes Association
- AGE, advanced glycation end product
- ALA, α lipoic acid
- ARI, aldose reductase inhibitor
- CMT, Charcot Marie Tooth
- CTGF, connective tissue growth factor
- ED, erectile dysfunction
- IL, interleukin
- MMP, matrix metalloproteinase
- MRI, magnetic resonance imaging
- NF-κB, nuclear factor κB
- PARP, poly(ADP)-ribose polymerase
- RAGE, receptor for AGEs
- STZ, streptozotocin
- UKPDS, U.K. Prospective Diabetes Study
This is the first in a series of articles on presentations at the American Diabetes Association Annual Meeting, San Diego, California, 10–14 June 2005.
A number of presentations at the American Diabetes Association (ADA) Annual Meeting discussed aspects of diabetic neuropathy. At a joint European Association for the Study of Diabetes/ADA Symposium, Rury Holman (Oxford, U.K.) reminded the audience that the U.K. Prospective Diabetes Study (UKPDS) included >5,000 individuals with newly diagnosed diabetes, followed from 1977 to 1991. Trial results were reported in 1998, with 30-year follow-up in progress to further understand the natural history of type 2 diabetes. Holman summarized clinical characteristics of diabetic neuropathy in the UKPDS population. Vibration sensory threshold was measured with a bioesthesiometer, with a cutoff of 25 V; erectile dysfunction (ED) and foot sensation were assessed by history; ankle and knee tendon reflexes, basal heart rate, and lying and standing blood pressure were determined on examination; and the shortest electrocardiographic RR interval, near the 15th heartbeat after standing from resting, and the longest, around the 30th heartbeat, were measured to give information about autonomic neuropathy. A total of 3,867 individuals had been randomized to conventional versus intensive glucose control from the time of diagnosis of type 2 diabetes, with an HbA1c (A1C) difference of 0.9% between the two groups over 9 years. At 12 years, there were modest although significant differences, with absence of ankle tendon reflexes in 37 vs. 35%, absence of knee reflexes in 12 vs. 11%, and a basal heart rate of 74 vs. 70 bpm. There was a trend to lower risk of sensory neuropathy with better glycemic control. Treatment allocation in the UKPDS blood pressure substudy had no effect on neuropathy.
In an observational analysis of neuropathy progression in 4,867 people, an elevated threshold for bioesthesiometer perception was …
