Serum triglyceride levels may allow clinicians to predict which patients with type 2 diabetes will develop neuropathy, while fenofibrate therapy can reduce the risk of diabetes-related amputations by more than a third, a pair of recent studies conclude.
In the first project, researchers from the University of Michigan Medical School (U-M MS) and Wayne State University in Detroit analyzed data from 427 diabetics with mild-to-moderate neuropathy who had participated in a previous year-long clinical trial.
Measuring myelinated fiber density (MFD), they defined progressing diabetic neuropathy as a loss of ≥500 fibers/mm2 in sural nerve MFD over the course of 52 weeks. They found that those patients with progressing neuropathy showed a 25% decrease (P <0.0001) from baseline MFD (Diabetes. 2009 May 1. [Epub ahead of print]) (abstract only; subscription required).
Among several variables tested, only elevated triglycerides and deficits in nerve conduction studies correlated with MFD loss (P=0.04). The loss was not affected by active drug treatment (P=0.87), diabetes duration (P=0.48), age (P=0.11), or BMI (P=0.30).
“These results set the stage for clinicians to be able to address lowering lipid counts with their diabetes patients with neuropathy as vigilantly as they pursue glucose control,” says Eva L. Feldman, MD, PhD, senior author, Professor of Neurology at U-M MS. “Aggressive treatment can be very beneficial.”
Neuropathy, which affects about 60% of the 23 million diabetics in America, is the leading cause of diabetes-related hospital admissions and amputations. According to researchers at the University of Sydney, “one in 10 diabetes patients will eventually need at least one amputation.” But fenofibrate therapy can reduce the risk of a first diabetes-related amputation by 36%.
The Sydney team conducted a five-year clinical trial involving 9,795 diabetic patients aged 50-75 who received either fenofibrate 200 mg/day or placebo for five years (Lancet. 2009;373:1780-1788) (abstract only; subscription required). Over the course of the trial, 115 people had at least one amputation. Compared to those on placebo, patients in the fenofibrate arm had a lower risk of first amputation (45 vs. 70 events; hazard ratio [HR] 0.64).
“The risk of having an amputation is a real threat for diabetes patients,” concludes Professor Anthony C. Keech, MD, of the Australian national clinical trials center at the University of Sydney, “even when their blood pressure and blood glucose are kept under control. Fenofibrate treatment appears to substantially reduce this risk.”