VOLUME 7 NUMBER 4 • NOVEMBER 2010
175
SA JOURNAL OF DIABETES & VASCULAR DISEASE
JOURNAL UPDATE
relief. The six homeopathic substances
included were St John’s Wort, Wolfsbane,
Club moss, phosporus, Poison ivy, and rye
ergot. The five essential oils in the formula-
tion are geranium, lavender, bergamot, tea
tree and eucalyptus oils. The oils assist the
penetration of the homeopathic ingredients
through the skin.
The study was a double-blind, ran-
domised, placebo-controlled cross-over
study in 60 patients. The pain reduction was
measured using the McGill pain question-
naire. Pain relief was obtained within 30
minutes but did not last beyond five to nine
hours. There was no difference in response
between the diabetic and non-diabetic sub-
group.
Source: Li Li. The effect of Neuragen PN
®
on neuropathic
pain: A randomised, double-blind, placebo controlled
clinical trial.
BMC Complement Altern Med
2010;
10
: 22.
DOI 10.1186/1472-6882-10-22.
The peripheral neuropathy benefits
of good glucose control are durable
in type 1 diabetic patients (DCCT
and EDIC studies)
Clinical and nerve conduction studies per-
formed during the DCCT were repeated
by the Epidemiology of Diabetes Interven-
tions and Complications (EDIC) study on
some 600 former intensive- and 600 former
conventional-treatment subjects 13 to 14
years after DCCT close-out. (Examiners were
blinded as to whether the patients were
in the intensive or conventional treatment
arm).
While the overall prevalence of neu-
ropathy increased in both groups, the inci-
dence of neuropathy remained lower in
the intensive-treatment group (22%) than
in the conventionally treated group. There
was a significant association between the
mean HbA
1c
scores and the occurrence of
neuropathy.
Overall, the benefits of former ‘intensive’
insulin therapy and good HbA
1c
control in
type 1 diabetes persisted for 13 to 14 years
after termination of the DCCT study, under-
scoring the durable benefits of prior inten-
sive treatment.
Source: Albers JW,
et al
. Effect of prior intensive insulin
treatment during the Diabetes Control and Complications
Trial (DCCT) on peripheral neuropathy in type 1 diabetes
during the Epidemiology of Diabetes Interventions and
Complications (EDIC) study.
Diabetes Care
2010;
33
(5):
1090–1096.
Improvements in glycaemic control
and serum triglyceride levels
help to restore nerve function in
mild-to-moderate sensorimotor
polyneuropathy
This study focused on determining improve-
ment in diabetic sensorimotor polyneuropa-
thy following placebo administration, an
effect that deteriorates with time. Patients
who had been randomised to placebo in a
multi-centre, double-blind study were evalu-
ated for the primary outcome of a one-year
change in the nerve conduction velocity of
the bilateral sural and non-dominant median
nerves. The association of nerve function
was examined in relation to monthly clinical
and biochemical measurements.
Change in HbA
1c
and serum triglycerides
from baseline to two months demonstrated
the strongest association with improved
nerve function. In those with improvements
in HbA
1c
and serum triglyceride levels, nerve
conduction velocity improved by 5.1 m/s,
whereas those whose HbA
1c
and triglyceride
levels deteriorated showed a loss of 4.9 m/s.
Source: Perkins PA,
et al
. Short-term metabolic change
is associated with improvement in measures of diabetic
neuropathy: a 1-year placebo cohort analysis.
Diabet
Med
2010;
27
(11): 1271–1279.
Pre-clinical trials of agents
addressing heat-shock proteins and
cellular stress may offer protection
from diabetic-induced neuropathy
Agents that induce neuroprotective heat-
shock proteins (HSP70) and reduce levels of
destructive heat-shock proteins may provide
a novel therapeutic target for neuropathy
– not focusing on pathogenic mechanisms
but rather helping the cells to tolerate oth-
erwise toxic stress.
The efficacy of KU-32, a small molecule
based on novobiocin, and the elucidation of
how it works on HSPs in a mouse model of
diabetic neuropathy could open the path to
clinical trials of this agent in humans. KU-32
has also been shown to improve motor
nerve conduction velocity.
Source: Calcutt NA. Tolerating diabetes: an alternative
therapeutic approach for diabetic neuropathy.
ASN
Neuro
2010;
2
(4):e00042. DOI 10.1042/an20100026.
J Aalbers, Special Assignments Editor
