Diet, Excercise and Neuropathy

Diet and Exercise Changes May Reverse Impaired Glucose Tolerance Neuropathy

By Joene Hendry

Individuals with impaired glucose tolerance neuropathy showed improved nerve function and decreased levels of pain after following the diet and exercise recommendations of the Diabetes Prevention Program for one year.

A. Gordon Smith, MD, associate professor of neurology and pathology at the University of Utah School of Medicine in Salt Lake City, and colleagues compared nerve conduction, sensory and reflex tests, visual analog pain scale scores and intraepidermal nerve fiber density with skin biopsies at the proximal thigh and distal leg in 32 individuals with impaired glucose tolerance neuropathy at baseline and after one year of following the diet and exercise recommendations.

The patients, aged from 41 to 75 years, received individualized diet and exercise counseling based on the goals of the Diabetes Prevention Program.

The Diabetes Prevention Program calls for 30 minutes of exercise daily for at least five days each week and reducing body weight by 7% for individuals with higher-than-normal blood glucose levels, since this group is at a high risk of developing type 2 diabetes.

The investigators monitored adherence through patient-completed dietary logs and a six-minute walk test conducted quarterly during the year-long study.

Skin biopsy was the most sensitive measure of neuropathy change over the one year period, and when comparing baseline and one-year proximal thigh biopsies the investigators observed proximal thigh reinnervation in 70% of the patients. This reinnervation was associated with decreased neuropathic pain and sensory changes.

At the distal leg site, many subjects had absent nerve fibers at baseline, Smith explained. "They, in general, did not have reinnervation at the distal site unless they had preservation of the dermal plexus, in which case several did experience reinnervation," he said.

"I think the most significant finding is that the earliest stage of hyperglycemic neuropathy may be reversible," Smith told Podiatry Online, adding "diet and exercise may result in improvement in pain and small nerve fiber function," in those with impaired glucose tolerance neuropathy.

Smith presented these findings during a scientific session on peripheral nerves at the 58th annual meeting of the American Academy of Neurology in April.