Lifestyle intervention for pre-diabetic neuropathy.

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Publication Type Journal Article
School or College School of Medicine
Department Pathology; Neurology
Creator Smith, A. Gordon; Singleton, J. Robinson
Other Author Russell, James; Feldman, Eva L.; Goldstein, Jonathan; Peltier, Amanda; Smith, Sheldon; Hamwi, Jouhaina; Pollari, Donald; Bixby, Billie; Howard, James
Title Lifestyle intervention for pre-diabetic neuropathy.
Date 2006-06-29
Description OBJECTIVE: 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. RESEARCH DESIGN AND METHODS: We 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. RESULTS: Baseline distal IENFD was 0.9 +/- 1.2 fibers/mm and proximal IENFD was 4.8 +/- 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 +/- 1.1-fiber/mm improvement in distal IENFD and a 1.4 +/- 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). CONCLUSIONS: These findings indicate 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.
Type Text
Publisher American Diabetes Association
Volume 29
Issue 6
First Page 1294
Last Page 1299
Subject Aged; Biopsy; Blood Pressure; Body Mass Index; Cholesterol; Diabetic Diet
Subject MESH Diabetic Neuropathies; Life Style; Nerve Fibers; Skin
Language eng
Bibliographic Citation Diabetes Care. 2006 Jun;29(6):1294-9. Smith AG, Russell J, Feldman EL, Goldstein J, Peltier A, Smith S, Hamwi J, Pollari D, Bixby B, Howard J, Singleton JR. Lifestyle intervention for pre-diabetic neuropathy. Retrieved on April 24, 2007 from
Rights Management Copyright © 2006 American Diabetes Association. All rights reserved.
Format Medium application/pdf
Identifier ir-main,993
ARK ark:/87278/s6gt65pf
Setname ir_uspace
Date Created 2012-06-13
Date Modified 2021-05-06
ID 705924
Reference URL
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