Nerve Damage from Prediabetes More Severe Than Previously Thought?

In a small study of patients with small fiber neuropathy, researchers from Johns Hopkins University School of Medicine observed an unexpected pattern of nerve fiber deterioration, and conclude that prediabetes may cause more nerve damage than was previously thought. The neurologists reported that subjects showed deterioration over the entire length of sensory nerve fibers, rather than at the longest ends first, as has been conventionally understood. They also noted that the 13 study subjects who had prediabetes exhibited generalized damage to nerve fibers. Senior author Michael Polydefkis, MD, commented, “I liken small fiber neuropathy to the canary in the coal mine. It signals the beginning of nerve deterioration that with time involves other types of nerve fibers and becomes more apparent and dramatically affects people’s quality of life. The results of this new study add urgency to the need for more screening of those with the condition and faster intervention.”

The most common cause of small fiber neuropathy is diabetes, but it can also be caused by lupus, HIV, Lyme disease, celiac disease, or alcoholism. Damage to nerve fibers is frequently made apparent by development of burning pain in the feet. At the start of the study, it was noted that subjects with either diabetes or prediabetes had only one-half the number of small nerve fibers in their ankles as did patients with neuropathy from other causes, and that diabetic subjects continued to lose about 10% of nerve density over the 3-year study period. But the cohort with prediabetes experienced a similar rate of degradation, a result that, if confirmed in further research, suggests that more intensive screening and faster intervention is warranted. The findings appeared online earlier this month in JAMA Neurology.

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The study abstract may be read here.

 

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