03/07/2016    

RESPONSES/COMMENTS (RESEARCH)

RE: Pre-diabetes and Peripheral Neuropathy: The Promise Cohort Study (Richard H. Mann) DPM)

From: Robert Creighton, DPM

 

Kudos to Dr. Mann for posting on "The PROMISE Cohort." I am sure we all regularly see patients presenting with neuropathy symptoms, who upon further questioning, report they were once told they were "pre-diabetic" or "borderline." 

 

Neuropathy in the face of the increasing metabolic dysfunction leading to pre-diabetes is interesting. The pathogenesis appears to be different than that of T1DM. There is an intriguing paper on this topic, "Diabetic Neuropathy: One disease or two?" In this paper, the authors present evidence that "obesity, hypertension, dyslipidemia, inflammation, and insulin resistance are contributory to T2DM diabetic neuropathy to an equal if not greater degree than hyperglycemia." It appears that insulin resistance degrades myelin. 

 

We podiatrists know all-too-well the life-changing pathology that diabetes can cause. In light of this, I believe we are especially well-positioned to speak to pre-diabetics and those with metabolic dysfunction. After all, we are the keepers of the structures directly facilitating movement which is so integral to a healthy metabolism. I believe our profession should be playing a more vocal, proactive public health role in the context of pre-diabetes and metabolic dysfunction in the context of lower extremity health.

 

Robert Creighton, DPM, St. Petersburg, FL