Jin H Y, Kang S M, Liu W J, Song C H, Lee K A, Baek H S, Park T S
Department of Internal Medicine, Division of Endocrinology and Metabolism, Research Institute of Clinical Medicine of Chonbuk National University-chonbuk National University Hospital, Jeonju, South Korea.
Exp Clin Endocrinol Diabetes. 2012 Sep;120(8):451-9. doi: 10.1055/s-0032-1306350. Epub 2012 Jun 11.
In addition to tight glucose control, early intensive therapy has been reported to be more important for the prevention of diabetic micro- and macro-vascular complications. What is not known exactly is the quantitative difference according to timing delay in glucose control and whether early period control is really better than late control in terms of diabetic peripheral neuropathy. In this study, we investigated the effect of timing differences in glucose control on the peripheral nerves in an experimental diabetic model.
5 groups (6-8 rats in each group) were comprised of normal glucose rats (designated control), rats with hyperglycemia (designated DM), rats with glucose control for the entire 28-week study period (designated DM + INS [W0-28]), rats with glucose control for the early 14-week period followed by hyperglycemia for the late 14-week period (designated DM + INS [W0-14]), and rats with hyperglycemia for the early 14-week period followed by glucose control in the late 14-week period (designated DM + INS [W15-28]).
We found that the current perception threshold (CPT) was lower in the DM + INS (W0-28) and DM + INS (W15-28) groups than in the DM + INS (W0-14) or DM groups (P<0.05). The mean myelinated fiber area of the sciatic nerve was significantly greater in the DM + INS (W0-28) and DM + INS (W15-28) groups (63.5±2.32 and 60.1±2.14 um, respectively) than in the DM + INS (W0-14) or DM groups (55.5±2.81 or 51.5±2.64 um, respectively) (P<0.05), and the intraepidermal nerve fiber (IENF) density was significantly higher in the DM + INS (W0-28) and DM + INS (W15-28) groups (6.9±0.46 and 6.8±0.11, respectively) than in the DM + INS (W0-14) or DM groups (59.5±0.32 and 5.3±0.39/mm, respectively) (P<0.05).
Our results indicate that continuous glucose control is necessary to alleviate peripheral nerve damage and that glycemic control during the later period may be more important than early period management. The importance of continuous glucose control, including the later period of diabetes, should therefore be emphasized in diabetic peripheral neuropathy.
除严格控制血糖外，早期强化治疗据报道对预防糖尿病微血管和大血管并发症更为重要。确切未知的是血糖控制时间延迟的定量差异，以及就糖尿病周围神经病变而言，早期控制是否真的优于晚期控制。在本研究中，我们在实验性糖尿病模型中研究了血糖控制时间差异对周围神经的影响。
5组（每组6 - 8只大鼠）包括正常血糖大鼠（指定为对照组）、高血糖大鼠（指定为糖尿病组）、在整个28周研究期间进行血糖控制的大鼠（指定为糖尿病 + 胰岛素 [W0 - 28]组）、在最初14周进行血糖控制随后14周为高血糖的大鼠（指定为糖尿病 + 胰岛素 [W0 - 14]组），以及在最初14周为高血糖随后14周进行血糖控制的大鼠（指定为糖尿病 + 胰岛素 [W15 - 28]组）。
我们发现，糖尿病 + 胰岛素 [W0 - 28]组和糖尿病 + 胰岛素 [W15 - 28]组的电流感觉阈值（CPT）低于糖尿病 + 胰岛素 [W0 - 14]组或糖尿病组（P<0.05）。糖尿病 + 胰岛素 [W0 - 28]组和糖尿病 + 胰岛素 [W15 - 28]组坐骨神经的平均有髓纤维面积（分别为63.5±2.32和60.1±2.14μm）显著大于糖尿病 + 胰岛素 [W0 - 14]组或糖尿病组（分别为55.5±2.81或51.5±2.64μm）（P<0.05），且糖尿病 + 胰岛素 [W0 - 28]组和糖尿病 + 胰岛素 [W15 - 28]组的表皮内神经纤维（IENF）密度（分别为6.9±0.46和6.8±0.11）显著高于糖尿病 + 胰岛素 [W0 - 14]组或糖尿病组（分别为5.95±0.32和5.3±0.39/mm）（P<0.05）。
我们的结果表明，持续血糖控制对于减轻周围神经损伤是必要的，并且后期的血糖控制可能比早期管理更重要。因此，在糖尿病周围神经病变中应强调持续血糖控制的重要性，包括糖尿病后期。
