Treatment with C-peptide improves sensory
nerve function in patients with type 1 diabetes.
Intensified insulin
treatment can slow the progression of various diabetic complications, the
authors explain, but nothing has been shown to prevent the development of
diabetic neuropathy.
Dr. John Wahren and
colleagues from Karolinska Institutet in Stockholm, examined whether 3 months of
C-peptide treatment could exert a beneficial effect on early peripheral nerve
function abnormalities in 26 patients with type 1 diabetes.
Sensory and motor
nerve conduction velocities, as well as compound muscle action potential (CMAP)
and sensory nerve action potential (SNAP) amplitudes, were similar at baseline
for the C-peptide-treated patients and 20 placebo-treated patients. Metabolic
control of diabetes was also similar in the two groups, they report in the
February issue of Diabetes.
After 6 weeks of
treatment, the C-peptide group showed a significant increase in sensory nerve
conduction velocity, which persisted as a 5% improvement after 12 weeks, the
authors report. This change resulted in a restoration of sensory nerve
conduction velocity to 80% of normal values.
"The significance of
the 5% improvement in sensory nerve conduction velocity stems from the fact that
C-peptide could and, for the first time in humans, did improve nerve conduction
velocity in type 1 diabetic patients," Dr. Wahren told Reuters Health. "No other
treatment has been able to achieve that."
Motor nerve conduction
velocity also improved after 6 weeks of C-peptide treatment, the report
indicates, but this improvement had disappeared by 12 weeks.
CMAP did not change in
either patient group, the researchers note, but SNAP increased significantly in
the placebo group. On the other hand, vibration threshold decreased
significantly (compared with placebo) after 12 weeks of C-peptide treatment.
"C-peptide is after
all a biologically active peptide hormone of potential importance for the
therapy and/or the prevention of long-term complications of type 1 diabetes,"
Dr. Wahren concluded. "Molecular and cellular mechanisms of C-peptide action are
becoming increasingly understood, and supportive in vivo data from patients and
animals accumulate."
"Phase 2 B clinical trials to establish proof of this concept in patients with diabetic neuropathy are now under way," Dr. Wahren added.
Source: Diabetes In Control Dot Com:
Diabetes 2003;52:536-541.
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