Clinic for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany.
German Center of Diabetes Research (DZD), Neuherberg, Germany.
Front Endocrinol (Lausanne). 2023 May 12;14:1143799. doi: 10.3389/fendo.2023.1143799. eCollection 2023.
Current strategies for preventing diabetic sensorimotor polyneuropathy (DSPN) are limited mainly to glucose control but rapid decrease of glycemia can lead to acute onset or worsening of DSPN. The aim of this study was to examine the effects of periodic fasting on somatosensory nerve function in patients with type 2 diabetes (T2D).
Somatosensory nerve function was assessed in thirty-one patients with T2D (HbA1c 7.8 ± 1.3% [61.4 ± 14.3 mmol/mol]) before and after a six-month fasting-mimicking diet (FMD; n=14) or a control Mediterranean diet (M-diet; n=17). Neuropathy disability score (NDS), neuropathy symptoms score (NSS), nerve conduction velocity and quantitative sensory testing (QST) were analyzed. 6 participants of the M-Diet group and 7 of the FMD group underwent diffusion-weighted high-resolution magnetic resonance neurography (MRN) of the right leg before and after the diet intervention.
Clinical neuropathy scores did not differ between study groups at baseline (64% in the M-Diet group and 47% in the FMD group had DSPN) and no change was found after intervention. The differences in sensory NCV and sensory nerve action potential (SNAP) of sural nerve were comparable between study groups. Motor NCV of tibial nerve decreased by 12% in the M-Diet group (P=0.04), but did not change in the FMD group (P=0.39). Compound motor action potential (CMAP) of tibial nerve did not change in M-Diet group (P=0.8) and increased in the FMD group by 18% (P=0.02). Motor NCV and CMAP of peroneal nerve remained unchanged in both groups. In QST M-diet-group showed a decrease by 45% in heat pain threshold (P=0.02), FMD group showed no change (P=0.50). Changes in thermal detection, mechanical detection and mechanical pain did not differ between groups. MRN analysis showed stable fascicular nerve lesions irrespective of the degree of structural pathology. Fractional anisotropy and T2-time did not change in both study groups, while a correlation with the clinical degree of DSPN could be confirmed for both.
Our study shows that six-month periodic fasting was safe in preserving nerve function and had no detrimental effects on somatosensory nerve function in T2D patients.
https://drks.de/search/en/trial/DRKS00014287, identifier DRKS00014287.
目前预防糖尿病感觉运动性多发性神经病（DSPN）的策略主要局限于血糖控制，但血糖的快速下降可导致 DSPN 的急性发作或恶化。本研究旨在探讨周期性禁食对 2 型糖尿病（T2D）患者感觉神经功能的影响。
在 31 例 T2D 患者（HbA1c 7.8±1.3%[61.4±14.3mmol/mol]）中，在接受为期 6 个月的禁食模拟饮食（FMD；n=14）或对照的地中海饮食（M-饮食；n=17）之前和之后，评估感觉神经功能。分析神经病残疾评分（NDS）、神经病症状评分（NSS）、神经传导速度和定量感觉测试（QST）。在饮食干预前后，M-饮食组的 6 名参与者和 FMD 组的 7 名参与者接受了右小腿的弥散加权高分辨率磁共振神经成像（MRN）。
基线时，两组的临床神经病评分无差异（M-饮食组 64%和 FMD 组 47%患有 DSPN），干预后无变化。两组间感觉神经传导速度和感觉神经动作电位（SNAP）的差异无统计学意义。M-饮食组的胫神经运动神经传导速度下降 12%（P=0.04），但 FMD 组无变化（P=0.39）。M-饮食组腓总神经复合运动动作电位（CMAP）无变化（P=0.8），FMD 组增加 18%（P=0.02）。M-饮食组和 FMD 组的腓肠神经运动神经传导速度均无变化。两组 QST 均显示热痛阈下降 45%（P=0.02），FMD 组无变化（P=0.50）。热觉、机械觉和机械痛觉的变化在两组间无差异。MRN 分析显示，束状神经病变稳定，与结构病理学程度无关。两组的各向异性分数和 T2 时间均无变化，而与 DSPN 的临床严重程度均呈正相关。
本研究表明，6 个月的周期性禁食对保护神经功能是安全的，对 T2D 患者的感觉神经功能没有不良影响。
https://drks.de/search/en/trial/DRKS00014287，标识符 DRKS00014287。
