All Eyes on Research That May Provide Cure for Diabetic Neuropathy

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An Australian optometrist researching how contact lenses affect the eye accidentally discovered a new way to study diabetic neuropathy. The discovery holds the key to monitor nerve degeneration over time.

The extreme magnification of a special microscope, called a corneal confocal microscope, allowed Nathan Efron, a professor at the Queensland University of Technology's School of Optometry at Brisbane, Australia, to see fine nerves in the cornea that had never been seen before.

Efron found that the nerves affected by neuropathy are an exact match to nerves found in front of the eye, and is testing whether looking at their level of degeneration in these nerves over a period of time would match the nerve degeneration found in arms and legs.

"We want to see how well the degeneration of the nerves in the cornea matches the degeneration of nerves throughout the body, and if it matches it will mean that we can monitor diabetic neuropathy using a simple eye test," Efron says.

The breakthrough is so profound and important that Efron was honored last November with the Glenn A. Fry Lecture Award from the American Academy of Optometry for his research into non-invasive ophthalmic diagnosis of diabetic nerve damage.

As the principal researcher of a five-year study ‒ Expanding the Role of Optometry in Diabetes Management: Determining the Discrimination Capacity of a Novel New Ophthalmic Marker of Diabetic Neuropathy ‒ Efron says early indications are promising and he is presenting his findings at the Asia Pacific Academy of Opthamology Congress in Sydney this week.

When he first saw the nerves, Efron, who has type 2 diabetes, knew at once that what he was seeing was something unique. One of the serious consequences of the disease is diabetic neuropathy – a condition that causes nerve damage and can result in ulcers and amputations ‒ that affects about half of diabetics in varying degrees of severity, which causes the degeneration of nerves, mostly in the arms and leg. (See my post ‘Don’t Ignore Diabetic Nerve Pain’ here.)

"I wondered if my own diabetes specialist might be interested in the technology and it turned out he was a world authority on diabetic neuropathy. He thought it was astonishing,” recalls Efron. It was ideas generated by discussions with his diabetes specialist that led Efron to investigate linkages between the nerves in the eyes and nerves elsewhere in the body with the aim of developing a relatively simple and non-invasive eye test to identify neuropathy (or diabetic nerve disease).

Neuropathy is typically measured by taking skin biopsies from the foot and running a series of specialized tests that can take up to a week to complete. In many cases, this debilitating condition is not identified until serious, and irreparable, damage has already been done.

On the other hand, the quick and non-invasive eye tests would see results in a matter of minutes. In short, the importance of Efron’s discovery lies in the fact that since the eye is a transparent structure, it is the only place in the body where you can look directly at nerves and their degeneration over time.

Efron and his team have established a four-year clinical trial assessing the optimal method of ophthalmic neuropathy diagnosis. This will hopefully lead to a standard protocol for optometrists and ophthalmologists to quickly and simply identify people at risk of neuropathy, anticipate the level of damage and assess treatment outcomes.

There are multiple benefits of being able to measure the onset of neuropathy, one being that there are drugs in development that aim to cure diabetic neuropathy. "When these drugs are ready to come onto the market, we will, using our method, be able to detect nerve degeneration early and then hopefully cure it," he says.

For the tests, patients would receive a drop of anesthetic in the eye, then a corneal confocal microscope would capture a 20 second "movie" of their eye for analysis.

There are also three more tests being looked at - the first, called non-contact corneal aesthesiometry, measures how nerve degeneration is affecting the function of the cornea, by projecting tiny puffs of air into the eye, growing progressively stronger until the patient can feel it.

Two more eye tests will look at the effect of nerve degeneration on the retina.

"Diabetic patients currently go for yearly eye tests anyway, so we are saying that these tests could be done at the same time, and only take a few minutes," Efron says.

Efron hopes his discoveries will lead to early testing for diabetic neuropathy that will motivate sufferers to better manage their disease. Testing could be carried out at the same time as diabetes patients are tested for other eye problems caused by the disease.

The test has been used to monitor nerve regeneration in patients who have undergone kidney and pancreas transplants, and it could help track the effects of new treatments.

Based on a news report in Sunday Star Times

Diabetes: Don't Ignore Diabetic Nerve Pain

Fact: About 50% of people with diabetes have some form of nerve damage known as diabetic neuropathy

Fact: 64% of Diabetic Nerve Pain sufferers report that their pain interferes with the daily activities that matter to them

Fact: 71% of Diabetic Nerve Pain sufferers say their pain interferes with the daily activities and makes it hard for them to fall asleep

Fact: 49% of diabetics had not had a discussion with their doctor about Diabetic Nerve Pain or its symptoms in the last 12 months, according to one survey

Fact: 65% of Diabetic Nerve Pain sufferers say the pain decreases their general motivation

Does Diabetic Nerve Pain get in the way of doing things that you like to do or need to do? Do you find it difficult to work, care for your family, travel, and enjoy hobbies? For many people with Diabetic Nerve Pain, the answer is yes.

When a person has pain that is caused by nerve damage from diabetes, it is simply called Diabetic Nerve Pain or, to use the medical term, painful Diabetic Peripheral Neuropathy (pDPN). Approximately 26% of patients with diabetes have pDPN.

The most common cause of Diabetic Nerve Pain is poorly controlled blood sugar levels. Over time, high blood sugar levels can result in nerve damage. Controlled blood sugar levels may help prevent, stabilize, and delay further nerve damage.

The most common type of diabetic neuropathy is peripheral neuropathy (burning, throbbing, or painful tingling in your hands or feet). In the early stages of peripheral neuropathy, some people have no signs. Some may have numbness or tingling in the feet. Because nerve damage can occur over several years, these cases may go unnoticed. The patient may only become aware of neuropathy if the nerve damage gets worse and becomes painful.

Most diabetic neuropathy is caused by peripheral artery disease, in which the small blood vessels are obstructed or partially obstructed and cannot carry oxygenated blood to areas of the body. These areas have pain or other difficulties due to the lack of oxygen.

Diabetic Nerve Pain may make it hard to do what is needed to manage your diabetes. It can create a cycle where one problem just leads to another problem, which makes the first problem even worse.

• Pain may make it difficult to stay physically active and focus on other areas of diabetes care
• If you are not physically active and focusing on diabetes care, it may be hard to keep your blood sugar levels close to the normal range
• In turn, if your blood sugar levels are raised for long periods of time (many months or years), you may be more likely to develop more health problems. This may include more nerve damage
• Finally, people with Diabetic Nerve Pain also have more risk for symptoms of depression, which can further lower the drive to focus on the day-to-day parts of good diabetes care

Nerve pain is different from other types of pain, like pain from a muscle ache or sprained ankle. Common pain medicines like aspirin may not work for nerve pain. Nerve pain is unique and feels different than muscle pain. Since all pain is not the same and nerve pain treatment is different from muscle pain treatment, it’s important to understand the source of your pain.

Muscle pain is a "protective" form of pain which sends a warning signal that an injury occurred. The pain tells you that more activity might be harmful. Nerve pain, on the other hand, is a "non-protective" form of pain which will not necessarily be improved by changing or limiting your activities.

In fact, with Diabetic Nerve Pain, decreasing your activity level is a problem, making it harder to manage your diabetes. (We all know it’s important to be physically active to keep your blood sugar level under control.) With nerve pain, your nerves repeatedly send extra electrical signals to the brain. These extra signals can cause pain when you do something that is not normally painful, e.g. putting on shoes. If this pain is not properly diagnosed and treated, it can cause difficulties with walking, working, or even being in social situations.

Over time, elevated blood sugar levels could potentially lead to different diabetes complications, like kidney and eye (retinopathy) conditions besides leading to nerve damage, especially in the feet. Therefore annual foot exams are crucial to check for diabetic peripheral neuropathy. Indeed, regular examinations are important because a diabetes patient can have peripheral neuropathy without pain, especially in the early stages of the neuropathy.

Many Diabetic Nerve Pain sufferers try to ignore the symptoms. They may not tell their doctors right away. Or even if they do bring up their pain, the discussion can easily veer toward other important aspects of diabetes management—such as blood sugar control. The sufferer may not get around to asking about pain relief.

Unfortunately, nerve pain can be one of the most intense pains that people feel. Diabetic Nerve Pain can make normal daily activities more difficult.

It is therefore important to discuss ways to reduce your pain at your next doctor’s visit. You may have many topics you want to discuss with your doctor. This list probably includes the very important issue of your blood sugar level control and it may be tempting to put your pain at the bottom of your list. Not a good idea. Avoiding the subject doesn’t make this common complication go away. Indeed, even if your pain seems just bothersome now, the nerve damage can get worse over time.

To be sure, Diabetic Nerve Pain care is an important part of overall diabetes care. And it is a part you may be able to actively improve. With less pain, you’ll feel better and may even increase your physical activity level. This is a key component of good diabetes care.

If you have Diabetic Nerve Pain, it’s very important to keep your blood sugar levels as close to the normal range as possible. This may help stabilize and prevent further nerve damage. It’s also important to keep your pain under control. Then you may be able to return to activities that are important to you.

Diabetes: Understanding Charcot Foot

For diabetics, foot care is one of the most important aspects of managing the disease. Four out of ten people with diabetes are thought to have lost some feeling in their feet, and nearly half will suffer a foot wound or ulceration in their lifetime. But there are some conditions that are out of the ordinary and one of them is the Charcot foot.

The Charcot foot is a rare condition that can occur in some people with diabetes. The underlying factor that contributes to the development of this condition is a loss of sensation in your feet—nerve damage that is referred to as peripheral sensory neuropathy.

Neuropathy is a common complication of diabetes, seen in people with both type 1 and type 2. The earliest sign of the Charcot foot may be a sudden and unexpected change in the appearance of your foot or ankle, characterized by redness, swelling, and warmth. You may have no recollection of injury.

X-rays of the foot may initially look perfectly normal, or there may be very subtle changes that can be easily missed. This is the most important stage of the Charcot foot for the physician to recognize the problem and to start treatment immediately. The treatment involves rest, elevation of your foot, and, most important, staying off of the affected foot until inflammation subsides and the foot is stable.

Sometimes there is collapse of the arch with the development of bony deformity, a “rocker-bottom foot,” with formation of an open sore (ulcer) on the bottom of the foot. Your doctor will first need to confirm the diagnosis by eliminating other conditions that might have a similar appearance, such as infection or gout.

Most diabetic foot specialists will apply a short non-weight-bearing cast and monitor the condition closely. Serial X-rays are taken to evaluate the healing of fractures and dislocations of one or more joints.

Although we have not yet learned how to prevent the development of a Charcot foot, we can sometimes minimize the extent of deformity with early recognition and prompt treatment. The likelihood of success decreases as the patient passes through the chronic stage of this condition.

Immobilization in a cast can sometimes take three months or longer. Patients are often transitioned from a cast to a removable walking brace, and then to a special shoe. In most cases, patients can be treated with non-surgical care; in the most difficult cases, surgery may be necessary.

Treatment of the Charcot foot is often prolonged, challenging, and frustrating. If you are at high risk—if you have peripheral neuropathy and loss of protective sensation—you should learn the implications of sensory loss, as well as the importance of diabetes self-management.

Foot inspection should be an important part of your daily routine. Compare one foot to the other and look for changes in size or shape. Is one foot swollen? Are there changes in the color or temperature of the skin? If you notice any of these changes, call your podiatrist, diabetes specialist, or family physician, and request an appointment as soon as possible.

Source: American Diabetes Associaltion