Some followers of the pessimist
philosopher Arthur Schopenhauer like to think that their
own actions count for nothing, so they just bide their
time lounging around in black turtlenecks waiting for
the sun to burn out and the earth to become a giant lifeless
snowball. However, a study in the January 27 issue of
the New England Journal of Medicine says one's
actions can indeed alter one's destiny — at least
when battling diabetic neuropathy.
The study's results suggest that
lifestyle changes such as losing excess weight, quitting
smoking and lowering blood pressure can greatly reduce
the risk of diabetic neuropathy. Currently, treatments
focus almost solely on controlling hypertension and
blood glucose levels. The NEJM study unearths
more solutions that could help stave off this disease
in diabetics and puts risk reduction into their own
hands.
A study team, headed by Dr Solomon
Tesfaye of the Royal Hallamshire Hospital in Sheffield,
UK, examined the risk factors for diabetic neuropathy
in 1,172 patients with type I diabetes. The subjects
were recruited from 31 European medical centres. All
patients were assessed at the time of their entry into
the study (1989-1991) and about seven years later (1997-1999)
using a host of established biochemical tests and evaluations.
RISK
FACTORS UP CLOSE
Dr Tesfaye and his colleagues reported that 276 patients
(23.5%) developed neuropathy during the followup period.
Risk factors that were strongly linked to this nerve
damage — other than blood glucose levels —
were high triglycerides, body mass index, smoking and
hypertension. The authors also found that cardiovascular
disease was a big contributor too; those with this ailment
were twice as likely to develop neuropathy. The silver
lining is that these risk factors can be diminished
through lifestyle changes.
In an accompanying editorial, Drs
Bruce A Perkins and Vera Bril of the University of Toronto
wrote that the results provide "convincing evidence
that even slight improvements in lipid variables, blood
pressure and body mass are associated with a significantly
lower risk of the onset of diabetic neuropathy." Authors
of the NEJM paper agree. "The results of the
present study make a case for clinical trials to confirm
the efficacy of hypertensive agents and possibly other
strategies for cardiovascular risk reduction in slowing
the progression of neuropathy."
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