Diabetic peripheral neuropathy is an abnormality of the nervous system in diabetics which results in a loss of sensation in the feet and the legs. The exact cause of peripheral neuropathy in diabetics is not clearly understood, but many theories exist. One popular theory is based on the loss of small vessel blood flow to the nerves, which impairs the nerves and results in nerve dysfunction. A new study, published online in the journal Diabetes, found that elevated triglycerides were associated with the progression of diabetic neuropathy (1). Researchers at the University of Michigan and Wayne State University evaluated 427 diabetic patients with neuropathy. The sural nerve, which travels on the outside of the leg down to the foot, was used to measure fiber density, the nerve signal speed and vibration threshold. After one year, those individuals with high triglycerides at baseline had significant progression of their neuropathy in comparison to those with normal triglyceride levels at baseline. The duration of diabetes, active treatment of diabetes or body mass index were not associated with neuropathy progression. The authors concluded that triglyceride levels are an active predictor of neuropathy progression in diabetics.
The authors stated that the study findings reinforced the link between cardiovascular disease and peripheral neuropathy. Triglycerides are a type of fat the body uses to store energy. When food consumed exceeds calories exerted, the body stores the excess calories in fat cells as triglycerides. Triglycerides are part of the blood lipid panel used to evaluate cardiovascular disease risk. Elevated triglycerides are a well-known cardiovascular disease risk factor.
The idea that lipids are associated with small blood vessel disease (microangiopathy) is not new. Previous studies have found associations between high levels of triglycerides in the blood and microangiopathy in diabetics (2). The lack of blood flow to the nerves, as a result of microangiopathy, causes changes within the nerves (demyelination and axonal degeneration) and results in nerve dysfunction. Microangiopathy causes the blood vessel lining to thicken which results in a narrowing of the vessel lumen, reducing blood flow (3). Without adequate blood flow, the nerves undergo changes, which ultimately result in nerve dysfunction. This recent research reinforces the link between small blood vessel disease and diabetic peripheral neuropathy.
1. Wiggin TD et al. Elevated Triglycerides Correlate with Progression of Diabetic Neuropathy. Diabetes published online, May 1, 2009, as db08-1771.
2. Eckel RH et al. Plasma lipids and microangiopathy in insulin-dependent diabetes mellitus. Diabetes Care. 1981 Jul-Aug;4(4):447-53.
3. Powell HC. Microangiopathy in human diabetic neuropathy. Acta Neuropathologica. Volume 68, Number 4 / December, 1985.
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Artilcle written by Christine Dobrowolski, DPM