In a new study, researchers found that not all diabetes is created equally and high blood sugar isn’t the only culprit of significant complications.
They found that different factors, including blood sugar, body mass index, age, and other complications, play different roles in the development of diabetic neuropathy and cardiac autonomic neuropathy.
The findings may provide physicians better guidance on how they can differentiate patients and give effective personalized care.
The research was conducted by a team at Michigan Medicine.
Diabetic peripheral neuropathy is nerve damage that affects sensations of pain, pressure, and temperature. The condition also affects movement and strength, typically in the lower legs and feet.
This greatly affects a person’s quality of life. The unsteadiness can result in injuries from falls.
The pain can disrupt sleep and affect mental health. And, as the condition progresses, a patient may even lose their foot.
Symptoms of cardiovascular autonomic neuropathy are less obvious, or may not be present at all.
However, these abnormal heart rhythms increase the risk of an arrhythmia, which damages the heart and can lead to heart failure.
In the study, the team followed almost 6,000 adults with type 1 diabetes for more than 23 years through comprehensive questionnaires.
Nearly 11% of the participants had diabetic peripheral neuropathy and the majority of that subgroup had burning foot pain.
Those with diabetic peripheral neuropathy were older (average age of 51 versus 37 for those without the condition).
In fact, diabetic peripheral neuropathy prevalence increased drastically with age, from 4% for those aged 18-25 to 8% for those aged 26-29 and 21% by age 50.
This population, compared to those without this complication, also had a higher frequency of other diabetes complications like cardiovascular disease, retinopathy, and gastroparesis, which is when the nerves to the stomach are damaged or don’t work anymore, prolonging digestion.
These patients were also more likely to be female and have a longer duration of diabetes and were less likely to have a college education and private insurance.
Consequently, effective diabetes self-management becomes more difficult.
Despite two-thirds of participants using an insulin pump, those with diabetic peripheral neuropathy were twice as likely to have life-threatening conditions like severe hypoglycemia or diabetic ketoacidosis.
The teams’ next endeavor is to develop a better understanding of the mechanism driving the increased risk of diabetes complications towards developing chronic complications in diabetes.
The hope is to understand the influence of biopsychosocial factors and intervene in order to halt the progression of this complication before a patient has to resort to using pain medications.
One author of the study is Rodica Pop-Busui, M.D., Ph.D.
The study is published in Diabetes.
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