Lifestyle intervention for prediabetic neuropathy can result in cutaneous reinnervation and improved pain.

According to a study from the United States, “The purpose of this study was to evaluate intraepidermal nerve fiber density (IENFD) as a sensitive measure of neuropathy change in patients with neuropathy associated with impaired glucose tolerance (IGT) receiving lifestyle intervention based on that used in the Diabetes Prevention Program.”

A.G. Smith and colleagues at the University of Utah performed “3-mm skin biopsies with measurement of IENFD at the distal leg and proximal thigh at baseline and after 1 year in 32 subjects with IGT. Each received individualized diet and exercise counseling as a standard of care.

“Nerve conduction studies, quantitative sensory testing, quantitative sudomotor axon reflex testing, and the Michigan Diabetic Neuropathy score were performed, and a visual analog pain scale was completed. Two-hour oral glucose tolerance tests (OGTTs) following the American Diabetes Association guidelines were performed, and serum lipid levels were measured at baseline and 1 year later.”

The results showed, “Baseline distal IENFD was 0.9(plusminus)1.2 fibers/mm and proximal IENFD was 4.8(plusminus)2.3 fibers/mm. Baseline distal IENFD correlated with fasting glucose (p< 0.001) and OGTT (p< 0.01). After 1 year of treatment, there was a 0.3 (plusminus)1.1-fiber/mm improvement in distal IENFD and a 1.4(plusminus)2.3-fiber/mm improvement in proximal IENFD (p< 0.004). The change in proximal IENFD correlated with decreased neuropathic pain (p< 0.05) and a change in sural sensory amplitude (p< 0.03).”

“These findings indicate,” concluded the authors, “that diet and exercise counseling for IGT results in cutaneous reinnervation and improved pain. Skin biopsy was the most sensitive measure of neuropathy change over 1 year. IENFD should be included as an end point in future neuropathy trials.”

Smith and colleagues published their study in Diabetes Care (Lifestyle intervention for pre-diabetic neuropathy. Diabetes Care, 2006;29(6):1294-1299).

For more information, contact A.G. Smith, University of Utah, School Medical, Dept. of Neurology, 50 N Med Dr., SOM 3R152, Salt Lake City, UT 84132, USA.

Publisher contact information for the journal Diabetes Care is: American Diabetes Association, 1701 N Beauregard St., Alexandria, VA 22311-1717, USA.