Eye Disease  |  Kidney Disease  |  Nerve Damage  |  Cardiovascular Disease

OPPORTUNITIES IN DIABETIC NERVE DAMAGE
Although general pain medications can be used to treat neuropathy (nerve damage) in some cases, there is a severe shortage of therapies that are specifically targeted to diabetic neuropathy and that consistently relieve patients from this painful and debilitating condition.

Evidence that neuropathy can be reversed after islet transplantation provides hope that nerves can indeed regenerate under the right conditions. If investigators can tease out how the transplant setting encourages nerve regeneration, then it might be possible to develop drugs that replicate that effect even in type 1 diabetes patients who are not eligible for an islet transplant.

Several potential treatments for diabetic neuropathy have shown promise in early clinical trials: a dietary supplement, benfotiamine; combinations of anti-oxidants or vitamins; and aldose reductase inhibitors. Large, long-term clinical trials must be conducted to fully assess the efficacy of these treatments in type 1 diabetes patients.

Large-scale, collaborative clinical trials will be required to test potential new drugs for preventing or reversing diabetic nephropathy that come out of the basic and preclinical research.

Transplantation of stem cells from a patient's own bone marrow could stimulate growth of new blood vessels that feed nerves and improve nerve function. Research to test and develop this hypothesis is important.

Researchers in Britain have observed that diabetes patients of Asian descent appear to have fewer foot ulcers and less nerve damage due to diabetes. Further study is warranted to understand the mechanisms underlying this apparent protection from diabetic neuropathy and exploit this knowledge for the development of new therapies.

Ongoing research focusing on positive leads that arise from the screening program is needed to validate lead compounds and refine these compounds through medicinal chemistry to more precisely target diabetes-related nerve damage.

Federal funding supports the Animal Models of Diabetic Complications Consortium (AMDCC) to develop and validate new animal models for the study of complications. Innovative models are needed that accurately mimic nerve damage that occurs in human diabetes. Such model systems would accelerate the pace of preclinical testing of new agents that can then be translated into human studies.

In most studies of diabetic neuropathy, pain is used as a primary endpoint for the effectiveness of new therapies. However, pain does not necessarily reflect the reversal or arrest of disease progression. A focused research effort is needed to validate new clinical endpoints that can be used in future clinical trials of new therapeutics. Potential endpoints currently being investigated include skin biopsy to measure the number of nerves or corneal imaging.

BENEFITS OF THIS RESEARCH
Chronic pain and other symptoms of diabetic neuropathy severely reduce patients' quality of life and contribute to the significant human and economic costs of this disease. Research on the underlying causes of neuropathy and new approaches to treating nerve damage is vital to combating this devastating complication. Patients with either type 1 or type 2 diabetes will receive the benefits of this research.