Fats tied to diabetic neuropathy

Foot x-ray of a diabetic shows evidence of amputation of the distal portion of the first toe
Foot x-ray of a diabetic shows evidence of amputation of the distal portion of the first toe
Serum triglyceride levels may allow clinicians to predict which patients with type 2 diabetes will develop neuropathy, while fenofibrate therapy can reduce the risk of diabetes-related amputations by more than a third, a pair of recent studies conclude.

In the first project, researchers from the University of Michigan Medical School (UMMS) in Ann Arbor and Wayne State University in Detroit analyzed data from 427 diabetic patients with mild-to-moderate neuropathy who had participated in a previous yearlong clinical trial.

Measuring myelinated fiber density (MFD), the investigators defined progressing diabetic neuropathy as a loss of >500 fibers/mm2 in sural nerve MFD over the course of 52 weeks. Patients who had progressing neuropathy demonstrated a 25% decrease from baseline MFD (Diabetes. 2009; published online ahead of print]).

Among several variables tested, only elevated triglycerides and deficits in nerve conduction studies correlated with MFD loss. Loss was not affected by active drug treatment, diabetes duration, age, or BMI.

“These results set the stage for clinicians to be able to address lowering lipid counts with their diabetes patients with neuropathy as vigilantly as they pursue glucose control,” says senior author Eva L. Feldman, MD, PhD, Professor of Neurology at UMMS. “Aggressive treatment can be very beneficial.”

Neuropathy is the leading cause of diabetes-related hospital admissions and amputations. According to researchers at the University of Sydney, in Australia “one in 10 diabetes patients will eventually need at least one amputation” (Lancet. 2009;373:1780-1788). But fenofibrate therapy can reduce the risk of a first diabetes-related amputation by 36%.

The team conducted a clinical trial involving 9,795 diabetic patients aged 50-75 years who received fenofibrate 200 mg/day or placebo for five years. Over the course of the trial, 115 people had at least one amputation. Compared with those on placebo, patients in the fenofibrate arm had a lower risk of first amputation (45 vs. 70 events).
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