Diabetic neuropathy in elderly Type 2 diabetic patients: effects of insulin treatment

Tovi, Jonas; Svanborg, Eva; Nilsson, Bengt-Yngve; Engfeldt, Peter

doi:10.1111/j.1600-0404.1998.tb01746.x

Cited by 21 publications

(8 citation statements)

References 33 publications

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“…57 105 In contrast, enhanced glucose control has a minimal effect on the prevention of neuropathy in patients with type 2 diabetes. [106][107][108][109] These results highlight the fact that type 1 and type 2 diabetes are different diseases that probably have different mechanisms of nerve injury.…”

Section: Challenging Assumptions In Diabetic Neuropathymentioning

confidence: 75%

Painful diabetic neuropathy

Peltier

Goutman

Callaghan

2014

BMJ

185

153

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Section: Challenging Assumptions In Diabetic Neuropathymentioning

confidence: 75%

Painful diabetic neuropathy

Peltier

Goutman

Callaghan

2014

BMJ

185

153

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“…The primary outcome for this review was reported in only two of the studies of type 1 diabetes (DCCT 1993a; DCCT 1993b; Linn 1996) and in four studies of type 2 diabetes (Accord 2010; Azad 1999; Duckworth 2009; Tovi 1998). Secondary outcomes measured in more than one trial included peroneal nerve motor conduction velocity (MCV), ulnar nerve MCV, median MCV, and vibration threshold in the feet.…”

Section: Resultsmentioning

confidence: 99%

Enhanced glucose control for preventing and treating diabetic neuropathy

Callaghan

Little

Feldman

et al. 2012

Cochrane Database of Systematic Reviews

399

334

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Background There are two types of diabetes. Type 1 diabetes affects younger people and needs treatment with insulin injections. Type 2 diabetes affects older people and can usually be treated by diet and oral drugs. Diabetic neuropathy affects 10% of patients with diabetes mellitus at diagnosis and 40% to 50% after 10 years. Enhanced glucose control is the best studied intervention for the prevention of this disabling condition but there have been no systematic reviews of the evidence. Objectives To examine the evidence for enhanced glucose control in the prevention of distal symmetric polyneuropathy in people with type 1 and type 2 diabetes. Search methods We searched the Cochrane Neuromuscular Disease Group Specialized Register (30 January 2012), CENTRAL (2012, Issue 1), MED-LINE (1966 to January 2012) and EMBASE (1980 to January 2012) for randomized controlled trials of enhanced glucose control in diabetes mellitus. Selection criteria We included all randomized, controlled studies investigating enhanced glycemic control that reported neuropathy outcomes after at least one year of intervention. Our primary outcome measure was annual development of clinical neuropathy defined by a clinical scale. Secondary outcomes included motor nerve conduction velocity and quantitative vibration testing. Data collection and analysis Two authors independently reviewed all titles and abstracts identified by the database searches for inclusion. Two authors abstracted data from all included studies with a standardized form. A third author mediated conflicts. We analyzed the presence of clinical neuropathy with annualized risk differences (RDs), and conduction velocity and quantitative velocity measurements with mean differences per year. Main results This review identified 17 randomized studies that addressed whether enhanced glucose control prevents the development of neuropathy. Seven of these studies were conducted in people with type 1 diabetes, eight in type 2 diabetes, and two in both types. A meta-analysis of the two studies that reported the primary outcome (incidence of clinical neuropathy) with a total of 1228 participants with type 1 diabetes revealed a significantly reduced risk of developing clinical neuropathy in those with enhanced glucose control, an annualized RD of −1.84% (95% confidence interval (CI) −1.11 to −2.56). In a similar analysis of four studies that reported the primary outcome, involving 6669 participants with type 2 diabetes, the annualized RD of developing clinical neuropathy was −0.58% (95% CI 0.01 to −1.17). Most secondary outcomes were significantly in favor of intensive treatment in both populations. However, both types of diabetic participants also had a significant increase in severe adverse events including hypoglycemic events. Authors’ conclusions According to high-quality evidence, enhanced glucose control significantly prevents the development of clinical neuropathy and reduces nerve conduction and vibration threshold abnormalities in type 1 diabetes mellitus. In type 2 diab...

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“…In contrast to the robust results seen in subjects with type 1 diabetes, the 8 randomized, controlled trials in type 2 diabetes have produced less definitive results 21, 22, 24, 25, 28, 30, 33, 36, 37 . Only four of these studies investigated the effects of glucose control on clinical impairment secondary to neuropathy.…”

Section: Glucose Control In Type 1 and Type 2 Diabetesmentioning

confidence: 96%

“…Seventeen randomized, controlled clinical trials have studied the effects of enhanced glucose control over at least a 12 month period on neuropathy 20–37 . Seven of these studies focused on patients with type 1 diabetes, but only two of these reported on outcomes related to clinical impairment 20, 23, 26, 29, 31, 32, 34 .…”

Section: Glucose Control In Type 1 and Type 2 Diabetesmentioning

confidence: 99%

“…In 2009, Duckworth et al followed 1791 military veterans for a median of 5.6 years and found a non-significant 5% reduction in the development of neuropathy 24 . Studies by Azad et al and Tovi et al followed much smaller numbers of patients and their results produced relative risks (RR) with large confidence intervals (no statistically significant differences) 22, 37 . However, three of the four studies that investigated nerve conduction studies and/or quantitative sensory testing revealed statistically significant results in favor of glucose control.…”

Section: Glucose Control In Type 1 and Type 2 Diabetesmentioning

confidence: 99%

See 1 more Smart Citation

Diabetic neuropathy: clinical manifestations and current treatments

Callaghan¹,

Cheng²,

Stables³

et al. 2012

The Lancet Neurology

938

739

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Diabetic peripheral neuropathy is a prevalent, disabling condition. The most common manifestation is a distal symmetric polyneuropathy (DSP), but many patterns of nerve injury can occur. Currently, the only effective treatments are glucose control and pain management. While glucose control dramatically decreases the development of neuropathy in those with type 1 diabetes, the effect is likely much smaller in those with type 2 diabetes. High levels of evidence support the use of certain anticonvulsants and antidepressants for pain management in diabetic peripheral neuropathy. However, the lack of disease modifying therapies for diabetic DSP makes the identification of new modifiable risk factors essential. Intriguingly, growing evidence supports an association between metabolic syndrome components, including pre-diabetes, and neuropathy. Future studies are needed to further explore this relationship with implications for new treatments for this common disease.

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Diabetic neuropathy in elderly Type 2 diabetic patients: effects of insulin treatment

Cited by 21 publications

References 33 publications

Painful diabetic neuropathy

Painful diabetic neuropathy

Enhanced glucose control for preventing and treating diabetic neuropathy

Diabetic neuropathy: clinical manifestations and current treatments

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