Lifestyle Changes Can Regenerate Nerve Fibers in Prediabetics

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NEW YORK (Reuters Health) Apr 05 - In patients with diabetes, nerve fiber

damage that causes diabetic neuropathy is irreversible. Now, in a new study

sponsored by the National Institutes of Health, researchers have found that

with weight loss and exercise in patients with impaired glucose tolerance

neuropathy -- so-called prediabetes -- the affected nerve fibers can be

reinervated, causing a reduction in the patients' pain.

" It's been clear that aggressive control of blood glucose levels slows the

risk of neuropathy, but no treatment has ever before resulted in improved

neuropathy, " presenter Dr. A Gordon told Reuters Health. " We certainly

never thought that reinvervation would be possible at the prediabetic

state. "

Dr. and his associates, from the University of Utah in Salt Lake City,

enrolled 32 subjects with impaired glucose tolerance neuropathy, and

performed skin biopsies at the distal leg and in the proximal thigh to

measure intraepidermal nerve fiber density.

" Then we set a weight loss goal of 7%, along with 150 minutes of moderate

exercise per week, " the researcher said. " Every 3 months the patients also

had individual counseling with a nutritionist. "

He presented their findings at the American Academy of Neurology 58th Annual

Meeting here in San Diego.

Baseline intraepidermal nerve fiber density was 0.9 fibers/mm in the distal

leg and 4.8 fibers/mm in the thigh. After 1 year of dieting and regular

exercise, the investigators measured a 0.3 fiber/mm improvement in the

distal leg and 1.4/mm in the thigh (p < 0.004).

Moreover, the change in fiber density in the thigh was inversely correlated

with neuropathic pain (p < 0.05). However, patients with the most reduced

intraepidermal nerve fiber density were unlikely to experience relief of

their symptoms, Dr. said.

" If you see a patient with symptoms of neuropathy - numbness, tingling pain,

or absence of sensation -- you should conduct an oral glucose tolerance test

and confirm nerve fiber loss by such measures as nerve conduction testing,

quantitative sensory testing, and quantitative sudomotor axon reflex

testing, " Dr. advised

" If they turn out to be glucose intolerant with peripheral neuropathy, you

should treat them as aggressively as possible with diet and exercise, " Dr.

concluded. " Simply treating them with antihyperglycemic drugs appears

to not allow damaged nerve fibers to recover, " he added.