posted 10/24/02
Diabetics with certain genes were more likely to develop diabetic neuropathy.
Diabetics with certain
polymorphisms the apolipoprotein E (APOE) gene may be more likely than others
with diabetes to develop diabetic neuropathy, according to findings presented at
the 127th annual meeting of the American Neurological Association.
Study author Dr.
Richard S. Bedlack, from Duke University Medical Center in Durham, North
Carolina said, “Preventing nerve damage before it occurs is possible, but
expensive”. Consequently, identifying the people who are most at risk for
neuropathy later in their disease will help physicians allocate intensive
treatment to those who need it most.
"The day you're
diagnosed with diabetes, we want a profile that's going to tell me: do you need
to go to the aggressive management regimen, or the standard management regimen,"
Dr. Bedlack explained.
Treatments to
prevent neuropathy include glucose control with an insulin pump and aggressive
foot care and ulcer surveillance. Unfortunately, these expensive interventions
are not possible for all patients.
Over the years,
researchers have discovered that certain APOE variations are linked with
diseases of the nervous system. In particular, people who carry two copies of
the APOE4 form of the gene, or one copy of APOE4 and another of APOE3, are more
likely than others to develop Alzheimer's disease at an early age.
To determine how
APOE4 and APOE3 relate to neuropathy risk, Dr. Bedlack and his colleagues
determined which form of the gene was present in 187 diabetics, and compared the
results to the severity of each patient's neuropathy.
Nineteen percent of
the participants were found to carry either two copies of APOE4 or one APOE4 and
an APOE3, the authors note. Diabetics with either of these types also tended to
have more symptoms of neuropathy or the same symptoms as other diabetics, but
more severe.
Dr. Bedlack
explained that neuropathy symptoms tend to worsen over time, and that the
difference in the severity of neuropathy between diabetics with the "high-risk"
type of APOE and others matched the difference seen when comparing older to
younger patients.
"The size of the
effect that we found is equivalent to having 15 extra years of age, or 15 extra
years of diabetes duration," he said.
Dr. Bedlack added
that his team is currently conducting a larger study to see how other forms of
APOE relate to neuropathy risk, and whether other genetic factors can also be
used to forecast the condition before it occurs.
Dr. Bedlack said,
“There would be no benefit of knowing if we didn't know how to treat these
things. But we do--with intensive treatment of diabetes and intensive screening,
we can make a lot of these complications a lot less prominent.”
Source: Diabetes In Control Dot Com.
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