Up to 50% of individuals suffering from diabetes develop a nerve condition called diabetic neuropathy, which causes the feet and legs to feel tingly, numb, weak or painful. Now, researchers have found that aggressive control of blood glucose levels helps to prevent the condition. The systematic review is published in the Cochrane Library.

The authors explained that only with optimal target levels can serious complications be prevented.

People with type 2 diabetes are resistant to insulin, whereas those with type 1 diabetes do not produce enough or their bodies do not react to insulin properly. Diabetic people control their blood glucose levels through diet, drugs and insulin injections.

Although diet modification and different insulin regimens can help prevent neuropathy, enhanced glucose control has not been systematically reviewed until now.

The researchers examined data from six studies involving 7,897 individuals (1,228 people with type 1 diabetes, 6,669 people with type 2 diabetes), who received enhanced glucose control treatments including diet changes, drugs for treating diabetes, and extra insulin injections.

The authors found that significantly fewer people with type 1 diabetes developed neuropathy each year with enhanced glucose control treatment than with routine care. However, in individuals with type 2 diabetes the reduction of neuropathy cases was small and not statistically significant.

Brian Callaghan, M.D., Assistant Professor in the Department of Neurology at the University of Michigan in Ann Arbor, Michigan, US, explained:

“Overall, this evidence suggests that a more aggressive approach to controlling sugar levels can be effective in delaying the onset of neuropathy in diabetes. The results also highlight the differences between type 1 and type 2 diabetes. The less dramatic effect of enhanced glucose control in type 2 diabetes may indicate that other factors, besides high glucose levels, may be important in causing nerve damage in these patients.”

However, the team found that enhanced glucose control had more side effects, especially hypoglycemia. They state that further studies are required in order to optimize target levels for safe treatments that will minimize serious adverse effects, while at the same time prevent neuropathy.

Callaghan said:

“Although these results show clear benefits for preventing neuropathy in people with diabetes, they should be weighed against potential adverse effects. Future studies must establish target levels for glucose control that will balance benefits and side effects.”

Neuropathic heel ulcer diabetic
Diabetic neuropathy can lead to complications. A 47-year-old patient with profound diabetic neuropathy developed an ulcer on her right heel.

Written by Grace Rattue