Glucose not sole risk for diabetic nerve problem

Many patients with diabetes develop numbness, tingling, pain, or weakness in their hands or feet, a condition called diabetic neuropathy. While good control of blood sugar levels is known to lower the risk of neuropathy, new research suggests that there are other measures patients can take.

In particular, maintaining a healthy weight, quitting smoking, and receiving treatment for high blood pressure may reduce the risk of diabetic neuropathy, the findings indicate.

The new information, which appears in The New England Journal of Medicine, is based on a study of 1172 patients with insulin-dependent (that is, type 1) diabetes. The subjects were followed for over 7 years to assess the development of neuropathy and any relevant risk factors.

During follow-up, nearly one quarter of the patients developed neuropathy, Dr. Solomon Tesfaye, from the Royal Hallamshire Hospital in Sheffield, UK, and colleagues report.

In agreement with previous studies, the glycosylated hemoglobin value - a blood test that gauges long-term sugar control, - and the duration of diabetes were associated with the risk of neuropathy.

However, after adjusting for these parameters, the authors found that a number of other factors were also linked to neuropathy risk, such as smoking, body weight, and high blood pressure.

In a related editorial, Dr. Bruce A. Perkins and Dr. Vera Bril, from the University of Toronto, comment that "we are rapidly learning through clinical and epidemiologic research" that risk factors traditionally associated with problems in patients with type 2 diabetes are also relevant to patients with type 1 diabetes.

The current findings suggest that controlling blood sugar levels is not the only way to stave off diabetic neuropathy in patients with type 1 diabetes, they add.

SOURCE: The New England Journal of Medicine, January 27, 2005.