Those with Type 1 diabetes saw a 2% annual reduction in their risk for neuropathy, while those with Type 2 diabetes saw only a .58% reduction, which is not statistically significant.
"Overall, the evidence indicates that more aggressive treatment of sugar levels delay the onset of neuropathy in both types of diabetes. No other treatments have proven effective to date," wrote Brian C. Callaghan, MD, the University of Michigan in Ann Arbor in the June 2012 issue of Cochrane Database of Systemic Reviews.
"However, the beneficial effect has to be balanced against the significantly increased risk of dangerously low blood sugar levels that can occur in both types of diabetes and which can lead to brain injury amongst other issues," Callaghan added.
At time of diagnosis, about 10% of diabetic patients have neuropathy, increasing to 40% to 50% after 10 years. According to the authors of the study, glucose control is the only approach to preventing and managing diabetic neuropathy with proven efficacy.
The risks associated with this type of care have not been scrutinized by a systemic review of the evidence. This lack of information allowed study authors to review the available data, which identified 17 randomized clinical trials that examined whether stringent glucose control prevented diabetic neuropathy. The studies ranged from only including just Type 1 patients, just Type 2 patients, or both types.
The outcome of interest was the annual rate of development of neuropathy, with a secondary outcome of motor nerve conduction and quantitative vibration testing.
"Taken together, the overall evidence supports a significant increase in serious hypoglycemia in intensive participants. However, given the substantial benefit in not only neuropathy outcomes, but in other clinical outcomes, including nephropathy and retinopathy, the risk-benefit ratio is likely still in favor of treatment," Callaghan wrote.
"In contrast to participants with Type 1 diabetes, the effect of intensive glycemic control on neuropathy is much less impressive. Unfortunately, the risk of hypoglycemia still remains substantial and needs to be taken into account along with the effects on other clinical outcomes in determining the risk-benefit ratio of enhanced glucose control," the authors wrote.
If you are a diabetic and do not currently see a podiatrist, call our Bristol office to make an appointment.
Richard E. Ehle, DPM
Connecticut Foot Care Centers
Diabetic Foot Care in CT
Podiatrist in Bristol, CT
Visit our website, friend and like our page on Facebook, and follow my tweets on Twitter.
No comments:
Post a Comment