NEURODIAB in Bucharest
Diabetic polyneuropathy is often not diagnosed or adequately treated – even if patients are suffering from pain.
Bucharest – Diabetic polyneuropathy is a widespread and serious sequela of diabetes. Nevertheless, it is often not diagnosed or adequately treated – even if patients are suffering from pain. This is shown by the latest results of the PROTECT Study, which were presented at the 26th Annual Meeting of the Diabetic Neuropathy Study Group of the European Association for the Study of Diabetes EASD (NEURODIAB) on September 10 in Bucharest.* Treatment of diabetic polyneuropathy should also be pathogenetically oriented – with the aim of reducing both the progression of the nerve damage and the pain.
“Painful distal sensory polyneuropathy (DSPN) is associated with considerable morbidity and an increased risk of mortality, although neuropathy screening is under-utilised in primary care practice,” explained Prof. Dr. Dan Ziegler, Deputy Director of the Institute for Clinical Diabetology of the German Diabetes Centre at Heinrich Heine University in Düsseldorf. The fact that DSPN is often diagnosed very late in spite of its serious consequences is also confirmed by the results of the PROTECT Study, the latest evaluation1 of which was presented by Prof. Ziegler at NEURODIAB*. Data was analysed from 1,589 study participants who underwent a foot examination which included bilateral assessment of vibration, pressure, and temperature perception and palpation of the pedal pulse as part of a nationwide educational initiative on diabetic neuropathy in Germany. This brought to light a staggering number of previously undiagnosed neuropathies: approximately every other diabetic individual examined was found to have distal symmetrical polyneuropathy. Although around two-thirds of them were even suffering from symptoms such as pain and a burning sensation in their feet, a large proportion of them did not know that they were affected by neuropathy: for example, 60 % of the study participants with known type 2 diabetes and painful neuropathy had stated before the examination that they had never been diagnosed with neuropathy. Among participants in whom nerve damage manifested itself not in the form of pain, but as paraesthesias, numbness or the absence of symptoms, the proportion of previously undiagnosed cases was even 20 % higher.
Even among the study participants who stated that they did not have diabetes (ND), almost every second individual showed indications of neuropathy. In many cases, previously undiagnosed (pre-)diabetes could be the cause, said Ziegler, as one-third of the ND group displayed an increased diabetes risk with HbA1c values of above 5.7 %. The expert therefore called for “the implementation of effective strategies to reveal both undetected diabetes and neuropathy”.
The therapy of diabetic polyneuropathy should include causal and pathogenetically oriented measures, as Prof. Dr. Peter Kempler, 1st Dept. of Medicine, Semmelweis University, Budapest, Hungary, explained. The key components of pathogenetically oriented, causal therapy include optimal glycaemic control, the management of risk factors as well as pathogenetically orientated treatment with benfotiamine and alpha-lipoic acid. The thiamine prodrug benfotiamine blocks four alternative metabolic pathways which cause hyperglycaemic damage. As an activator of the enzyme transketolase, benfotiamine promotes the breakdown of glucose via the harmless pentose-phosphate pathway, thereby inhibiting the pathogenic pathways such as the hexosamine pathway, the protein kinase C pathway, the polyol pathway and the formation of advanced glycation end products (AGEs). This effect is supported by alpha-lipoic acid as a powerful antioxidant.
“Pathogenetically oriented treatment has an impact on neuropathic damage/deficit and disability, while on the other hand it also has a documented effect on the improvement of neuropathic pain and quality of life”, was how Prof. Kempler summarised the benefits of this therapy. Although symptomatic therapy could also alleviate pain and improve the quality of life, it had no influence on the progression of the neuropathy.
1 Ziegler D, Strom A, Landgraf R, Lobmann R, Reiners KH, Rett K, Schnell O.: Painful polyneuropathy is common but largely undiagnosed in subjects with and without diabetes participating in a nationwide educational initiative (PROTECT Study); Data on file; September 10 th 2016, Bucharest
* WÖRWAG Symposium as part of the 26th Annual Meeting of the Diabetic Neuropathy Study Group of the European Association for the Study of Diabetes EASD (NEURODIAB)