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Enhanced glucose control for preventing and treating diabetic neuropathy
Brian C Callaghan1, Ann A Little, Eva L Feldman
1Department of Neurology, University ofMichigan, Ann Arbor,Michigan, USA. bcallagh@med.umich.edu.
The Cochrane Database of Systematic Reviews
|June 15, 2012
Summary
Enhanced glucose control significantly reduces the risk of developing diabetic neuropathy in type 1 and type 2 diabetes. However, intensive glucose management increases the risk of severe hypoglycemia, necessitating a careful risk-benefit assessment.
Area of Science:
- Neurology
- Endocrinology
- Clinical Medicine
Background:
- Diabetic neuropathy affects a significant portion of individuals with diabetes mellitus, with incidence increasing over time.
- Enhanced glucose control is a potential intervention for preventing diabetic neuropathy, but evidence requires systematic review.
- Distal symmetric polyneuropathy is a common and disabling complication of diabetes.
Purpose of the Study:
- To systematically review evidence on the efficacy of enhanced glucose control in preventing distal symmetric polyneuropathy in patients with type 1 and type 2 diabetes.
- To analyze the impact of intensive glycemic management on the development and progression of diabetic neuropathy.
Main Methods:
- A systematic search of multiple databases (Cochrane, CENTRAL, MEDLINE, EMBASE) was conducted for randomized controlled trials.
- Studies included were randomized, controlled trials of enhanced glycemic control with at least one year of intervention and reported neuropathy outcomes.
- Primary outcome was the annual development of clinical neuropathy; secondary outcomes included nerve conduction velocity and vibration testing. Data were analyzed using risk differences and mean differences.
Main Results:
- Seventeen randomized studies were included, involving participants with type 1, type 2, or both types of diabetes.
- Enhanced glucose control significantly reduced the risk of developing clinical neuropathy in type 1 diabetes (annualized RD -1.84%) and showed a trend in type 2 diabetes (annualized RD -0.58%).
- Most secondary outcomes favored intensive treatment, but severe adverse events, including hypoglycemia, increased significantly in both groups.
Conclusions:
- High-quality evidence supports that enhanced glucose control significantly prevents clinical neuropathy and improves nerve function in type 1 diabetes.
- In type 2 diabetes, enhanced glucose control reduces neuropathy incidence and improves nerve function, though not always statistically significant.
- The increased risk of severe hypoglycemia with intensive glucose control requires careful consideration in the risk-benefit evaluation for neuropathy prevention.
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