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Gene Type Forecasts Diabetic Nerve Damage

May 6, 2002

Diabetics with certain genes were more likely to develop diabetic neuropathy Diabetics with certain polymorphisms the apolipoprotein E (APOE) gene may be more likely than others with diabetes to develop diabetic neuropathy, according to findings presented at the 127th annual meeting of the American Neurological Association.

Study author Dr. Richard S. Bedlack, from Duke University Medical Center in Durham, North Carolina said, “Preventing nerve damage before it occurs is possible, but expensive”. Consequently, identifying the people who are most at risk for neuropathy later in their disease will help physicians allocate intensive treatment to those who need it most.

"The day you’re diagnosed with diabetes, we want a profile that’s going to tell me: do you need to go to the aggressive management regimen, or the standard management regimen," Dr. Bedlack explained.

Treatments to prevent neuropathy include glucose control with an insulin pump and aggressive foot care and ulcer surveillance. Unfortunately, these expensive interventions are not possible for all patients.

Over the years, researchers have discovered that certain APOE variations are linked with diseases of the nervous system. In particular, people who carry two copies of the APOE4 form of the gene, or one copy of APOE4 and another of APOE3, are more likely than others to develop Alzheimer’s disease at an early age.

To determine how APOE4 and APOE3 relate to neuropathy risk, Dr. Bedlack and his colleagues determined which form of the gene was present in 187 diabetics, and compared the results to the severity of each patient’s neuropathy.

Nineteen percent of the participants were found to carry either two copies of APOE4 or one APOE4 and an APOE3, the authors note. Diabetics with either of these types also tended to have more symptoms of neuropathy or the same symptoms as other diabetics, but more severe.

Dr. Bedlack explained that neuropathy symptoms tend to worsen over time, and that the difference in the severity of neuropathy between diabetics with the "high-risk" type of APOE and others matched the difference seen when comparing older to younger patients.

"The size of the effect that we found is equivalent to having 15 extra years of age, or 15 extra years of diabetes duration," he said.

Dr. Bedlack added that his team is currently conducting a larger study to see how other forms of APOE relate to neuropathy risk, and whether other genetic factors can also be used to forecast the condition before it occurs.

Dr. Bedlack said, “There would be no benefit of knowing if we didn’t know how to treat these things. But we do–with intensive treatment of diabetes and intensive screening, we can make a lot of these complications a lot less prominent.”