MONTREAL, Oct. 15, 2023 – Type 2 diabetes has reached epidemic proportions, and diabetic peripheral neuropathy (DPN), a major diabetes complication, is now a leading cause of global disability. Eva L. Feldman, MD, PhD, James W. Albers Distinguished University Professor and Russell N. DeJong Professor of Neurology at Michigan Medicine, shined a light on the growing global burden of DPN and revealed evidence that diet and lifestyle modifications can improve diabetic neuropathy at the 26th World Congress of Neurology.
DPN causes damage to the nerves in the hands, arms, legs and feet, and it can eventually lead to ulcers, amputation and other long-term disability. "More than 50% of individuals with type 2 diabetes develop DPN symptoms," said Feldman. "Additionally, one-third of people with type 2 diabetes develop foot ulcers, with the highest rates occurring in those with DPN."
The Global Burden of Diabetic Peripheral Neuropathy
The global burden of DPN extends beyond concerns about individual health outcomes. DPN cases now impose considerable economic strain on health care systems worldwide. The annual cost of DPN-related care is $6 billion in the U.S. alone.
There are over 32 million people with diabetes in the U.S., and Feldman estimates 27% to 42% are living with DPN. This wide range demonstrates another challenge in addressing the global burden of DPN: It is very difficult to accurately report the number of current cases. This is due in part to inconsistent definitions of the condition as well as a lack of community-based data (as opposed to data gathered from hospital-based studies).
The estimated global DPN prevalence is 27%, with some of the highest rates by country found in Ukraine (80%), Russia (55%), Pakistan (40%), Serbia (39%), Bangladesh (38%) and Mexico (35%).
Calling for Increased Education on Lifestyle Modifications and Risk Factors
To effectively address this growing burden, doctors need to supplement medication-based treatments with additional education and lifestyle modifications to better address the specific and varied risk factors that can lead to DPN.
For example, recent studies have shown that aerobic exercise can improve DPN in people with type 2 diabetes, possibly due to its effect on boosting metabolism. Additionally, switching from a high-saturated-fat diet to a balanced diet containing saturated fat improved DPN symptoms in mouse models.
"Only by effectively communicating the importance of prevention to our patients, can we decrease the global burden of disease,” said Feldman. “We advocate for at least 30 minutes of aerobic exercise 5 times per week, or daily if possible. With respect to diet, monounsaturated and polyunsaturated fats should replace saturated fats, and individuals should adopt diets rich in fiber, vegetables and fish."
Obesity Identified as Major Risk Factor for DPN
Additionally, new research shows that high blood sugar (hyperglycemia) is not the sole risk factor causing DPN, as doctors have thought in the past. Feldman presented research showing that obesity is another major risk factor and can increase the likelihood of developing DPN independent of blood sugar levels. This means the current standard of treatment—controlling blood sugar levels—isn’t always enough to treat disabling complications like ulcers and amputations.
“The current evidence now recommends a more holistic approach for slowing or preventing DPN [by] targeting obesity as well as blood sugar levels,” said Feldman. “This has led to an update in the American Diabetes Association guidelines for DPN, advocates for lifestyle changes, such as diet and exercise.”
Feldman also advocated for more research to identify the root causes of nerve damage in DPN cases. She argued this will help doctors treat DPN directly rather than simply treating risk factors, ultimately lessening the increasing global burden of the condition.
"It is critical for health care providers to understand that treating diabetes alone is not enough to prevent or stop the progression of DPN,” said Feldman. “We must treat in parallel the conditions that typically go hand-in-hand with the condition, especially obesity, hypertension and hyperlipidemia."
Visit wcn-neurology.com to learn more about Dr. Feldman and all the featured research at this year’s WCN.
About the World Congress of Neurology
The World Federation of Neurology’s World Congress of Neurology brings together leading neuroscientists and public health experts to turn research into action and emphasize the importance of brain health across the globe. The 26th biennial conference was held in Montreal from October 15 to 19, 2023, and was co-hosted by the Canadian Neurological Society (CNS).
About the World Federation of Neurology
With support from its 124 national Member Societies, the World Federation of Neurology fosters quality neurology and brain health worldwide by promoting neurological education and training, emphasizing under-resourced areas of the world. As a non-state actor in official relations, WFN supports the World Health Organization (WHO) efforts to give everyone an equal chance to live a healthy life. With Member Societies around the globe, WFN unites the world’s neurologists to ensure quality neurology and advocate for people to have better brain health. Learn more about the World Federation of Neurology at wfneurology.org.
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