Diabetic neuropathy

Area of Science:

• Endocrinology and Metabolism
• Neurology
• Diabetology

Background:

• Diabetic neuropathy is linked to significant morbidity and mortality.
• Aldose reductase inhibitors were considered potential treatments.
• The efficacy of strict insulin treatment for neuropathy was uncertain.

Purpose of the Study:

• To evaluate the actual occurrence of severe neuropathy in insulin-dependent diabetes mellitus (IDDM) patients.
• To assess the long-term effects of intensified insulin treatment on nerve conduction.
• To compare the therapeutic effects of intensified insulin treatment versus aldose reductase inhibitors.

Main Methods:

• Analysis of population-based studies on neuropathy occurrence in IDDM.
• Longitudinal assessment of nerve conduction velocity in IDDM patients undergoing intensified insulin treatment.
• Review of studies investigating the therapeutic efficacy of aldose reductase inhibitors.

Main Results:

• Population studies revealed only 6% occurrence of severe neuropathy in IDDM patients.
• Intensified insulin treatment preserved nerve conduction velocity for 5 years.
• Intensified insulin treatment reduced neuropathy development by 60%; aldose reductase inhibitors showed no convincing effect.

Conclusions:

• Contrary to previous beliefs, intensified insulin treatment is highly effective in preventing and managing diabetic neuropathy.
• Strict glycemic control via intensified insulin therapy offers a superior therapeutic strategy compared to aldose reductase inhibitors.
• These findings challenge existing paradigms and highlight the importance of optimal insulin management in diabetic neuropathy.