Public Release: 

Diabetic neurological disease could affect central nervous system

Lancet

Damage to the nervous system associated with diabetes could influence the central nervous system in addition to the peripheral nervous system, suggest authors of a pilot study published in this week's issue of THE LANCET.

The origins of the neurological disorder diabetic neuropathy (distal symmetrical polyneuropathy), that affects a third of all people with diabetes, is poorly understood. There is no treatment for the disorder which is characterised by numbness and/or pain in the feet that can result in foot ulceration and amputation. However, there is some evidence that the disease process may extend beyond the peripheral nervous system. Simon Eaton and colleagues from the Royal Hallamshire Hospital and Sheffield University, UK, used magnetic resonance imaging (MRI) to measure spinal cord cross-sectional area to assess central nervous system impairment. Analysis of 19 diabetic patients with diabetic neuropathy was compared with 10 diabetic patients without diabetic neuropathy, and a group of 10 healthy controls.

There were significant differences in spinal cord area between the groups in specific cervical and thoracic regions (C4/5 and T3/4), with a lower cord area in those with diabetic neuropathy compared to controls.

Solomon Tesfaye (one of the investigators) comments: "This research is a pilot study with small numbers of participants, so there is a limit to the conclusions that can be drawn. Further work is required to improve the sensitivity of the measures and prove conclusively that the changes we found are due to a neuropathic process rather than simply the diabetes itself. Additionally, relating the cord area to the severity of neuropathy may help to understand the time course of spinal cord involvement. Our observation of extensive, and potentially irreversible, nerve damage in diabetic neuropathy suggests an important new direction for further research, concentrating on detecting the neuropathic process at an earlier stage, where potential new therapies are more likely to succeed."

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Contact: Dr Solomon Tesfaye, Royal Hallamshire Hospital, Glossop Rd, Sheffield S10 2JF, UK; T) +44 (0)114 271 3479; F) +44 (0)114 271 3708; E) solomon.tesfaye@csuh.nhs.uk

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