Cath Lab Digest

Study Cites Link Between Higher Triglycerides And Diabetic Neuropathy

By Brian McCurdy, Senior Editor

   A recently published study in Diabetes suggests a correlation between elevated triglyceride levels and diabetic neuropathy, lending credence to the idea that hyperlipidemia is a factor in the progression of diabetic neuropathy.

   The study involved 427 patients with diabetic neuropathy. Researchers analyzed patients’ sural nerve myelinated fiber density (MFD), nerve conduction velocities, vibration perception thresholds, clinical symptom scores and visual analogue scale for pain.

   The study defined a loss of greater than or equal to 500 fibers/mm² in sural nerve MFD over 52 weeks as progressing diabetic neuropathy. A MFD loss of less than or equal to 100 fibers/mm² during the same time interval signified non-progressing neuropathy, according to the study.

   At the 52-week follow-up, the cohort with progressing neuropathy demonstrated a 25 percent decrease in MFD from baseline while those with non-progressing neuropathy remained unchanged, according to the study. Researchers added that among all the variables they tested, elevated triglycerides and decreased peroneal motor nerve conduction velocity at baseline had a significant correlation with a loss of MFD at 52 weeks.

   The study authors concluded that in patients with mild/moderate diabetic neuropathy, there was a correlation between elevated triglycerides and MFD loss, which was independent of disease duration, age and control of diabetes. Researchers say the study results suggest that hyperlipidemia is “instrumental” in the progression of diabetic neuropathy.

A Closer Look At The Possible Impact Of Triglycerides

   David Armstrong, DPM, PhD, says monitoring triglyceride levels will not be effective in identifying the day-to-day progression of diabetic neuropathy. However, he says the study data do appear to indicate that the presence of higher triglycerides signifies an elevated risk of developing neuropathy as well as a higher risk of the condition becoming worse.

   In regard to lowering triglyceride levels, the most effective methods are likely the same as those for lowering the risk of other cardiovascular events, according to Dr. Armstrong, a Professor of Surgery and Director of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona College of Medicine in Tucson, Ariz. He says a healthy diet, certain statins, omega 3 fatty acids and fibrates might be helpful in reducing triglycerides.

   Anthony Yung, DPM, notes the Diabetes study raises awareness of managing the other aspects of the disease process in patients with diabetic neruropathy and not just with regards to hyperglycemia. He emphasizes that diabetic neuropathy develops from multifactorial causes and most treatments have a relatively poor success rate of 30 to 60 percent.

    “Elucidating the underlying cause of one person’s diabetic neuropathy, whether it be hyperglycemia or hypercholestermia, would be an exciting step in the treatment of diabetic neuropathy and perhaps lead to better treatment outcomes,” says Dr. Yung, who practices at Kitsap Podiatry and at Harrison Memorial Hospital, both in Silverdale, Wash.

   Dr. Armstrong feels that further research should investigate the specific causal link between diabetic neuropathy and triglycerides. He says studies should answer the question of whether inflammation and oxidative stress are involved in the equation, and if both are related factors.

   Dr. Yung says the Diabetes study is a data set analysis and a prospective study could further validate these findings by specifically looking at the effect of triglycerides on diabetic neuropathy.

For further reading or to get reprint information, visit www.podiatrytoday.com.

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