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L'ipertrigliceridemia è associata alla progressione della neuropatia diabetica

Oltre all'iperglicemia, anche il livello dei trigliceridi è predittivo della neuropatia nel diabete. La trigliceridemia si correla infatti con il peggioramento del danno nervoso, indipendentemente da durata del diabete, controllo metabolico, età e altre variabili implicate nella progressione della neuropatia. I motivi non sono chiari e si suppone che siano in qualche modo legati ad alterazioni del metabolismo dei grassi nelle fibre nervose sensitive e motorie.

Elevated triglycerides correlate with progression of diabetic neuropathy

Wiggin TD, Sullivan KA, Pop-Busui R, Amato A, Sima AA, Feldman EL.

Diabetes 2009;58:1634-1640

OBJECTIVE: To evaluate mechanisms underlying diabetic neuropathy progression using indexes of sural nerve morphometry obtained from two identical randomized, placebo-controlled clinical trials. RESEARCH DESIGN AND METHODS: Sural nerve myelinated fiber density (MFD), nerve conduction velocities (NCVs), vibration perception thresholds, clinical symptom scores, and a visual analog scale for pain were analyzed in participants with diabetic neuropathy. A loss of > or =500 fibers/mm(2) in sural nerve MFD over 52 weeks was defined as progressing diabetic neuropathy, and a MFD loss of < or =100 fibers/mm(2) during the same time interval as nonprogressing diabetic neuropathy. The progressing and nonprogressing cohorts were matched for baseline characteristics using an O'Brien rank-sum and baseline MFD. RESULTS: At 52 weeks, the progressing cohort demonstrated a 25% decrease (P < 0.0001) from baseline in MFD, while the nonprogressing cohort remained unchanged. MFD was not affected by active drug treatment (P = 0.87), diabetes duration (P = 0.48), age (P = 0.11), or BMI (P = 0.30). Among all variables tested, elevated triglycerides and decreased peroneal motor NCV at baseline significantly correlated with loss of MFD at 52 weeks (P = 0.04). CONCLUSIONS: In this cohort of participants with mild to moderate diabetic neuropathy, elevated triglycerides correlated with MFD loss independent of disease duration, age, diabetes control, or other variables. These data support the evolving concept that hyperlipidemia is instrumental in the progression of diabetic neuropathy.

Diabetes 2009;58:1634-1640