Diabetic autonomic neuropathy

Article Abstract:

One of the complications of diabetes is neuropathy, or disease of the nervous system. Autonomic neuropathy is a common form of diabetic neuropathy, and can lead to symptoms of impotence, sweating, diarrhea, and gastroparesis, in which the motility of the stomach is impaired. Other symptoms of autonomic neuropathy are postural hypotension, which is a drop in blood pressure upon standing up, and bladder dysfunction. Fortunately, all of these symptoms are fairly rare and when they do occur, they are usually not so severe as to be devastating. Persons who have symptoms report that they come and go over a period of years, often without becoming worse. It is surprising that when diabetic individuals are tested for autonomic dysfunction, abnormalities are very common, and yet only a small proportion of patients actually experience symptoms. Researchers have investigated whether improving glycemic control (maintaining blood sugar as close to normal as possible) can arrest or even reverse the deterioration of the autonomic nervous system. The most effective means of normalizing blood sugars over the long term is a pancreatic transplant. A study by Kennedy et al. in the April 12, 1990 issue of The New England Journal of Medicine found that there was no significant return of autonomic function even after three years in 61 patients who underwent pancreatic transplantation. There was, however, a trend towards stability of autonomic function in the transplant patients, while control subjects experienced deterioration. In conclusion, good glycemic control may reduce the chances of developing autonomic neuropathy, but once signs of neuropathy occur they can only be treated symptomatically. (Consumer Summary produced by Reliance Medical Information, Inc.)

Nervous system diseases, editorial

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Effects of pancreatic transplantation on diabetic neuropathy

Article Abstract:

Neuropathy, or degeneration of the nervous system, is a common complication of advanced diabetes mellitus. Researchers are attempting to determine whether improving glycemic control by keeping blood sugars as close to normal as possible can arrest or even reverse diabetic neuropathy. One effective and presumably lasting means of normalizing blood sugars is pancreas transplantation. A study was done to compare neurologic function before and after pancreas transplantation in 61 diabetic patients. The subjects underwent nerve conduction studies and tests of autonomic nervous system function before the transplant and again at 12 months after surgery. A subset of 27 patients was again tested after 24 months, and 11 of these were tested at 42 months as well. Similar numbers of control patients, who were insulin-dependent diabetics who did not have a transplant, were also tested at these intervals. The controls showed worsening of neuropathy over the follow-up period; the deterioration was significant after the first 12 months, when the largest number of controls were evaluated. After 24 and 42 months, fewer controls remained and deterioration was not significant. The patients who received pancreas transplants showed a tendency to improve in their neurologic function. Significant improvement was measured after 12 months in the sensory and motor nerves, and again in sensory nerve function after 24 months. Other nerve function tests, such as those of autonomic function, showed slight but not significant improvement. The authors concluded that the progression of diabetic neuropathy can be stopped by pancreas transplantation and the normalization of blood glucose levels that results. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation

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Reversal of lesions of diabetic nephropathy after pancreas transplantation

Article Abstract:

Pancreas transplantation may reverse kidney damage in patients with insulin-dependent, or type 1, diabetes. Researchers followed eight type 1 diabetic patients who received a pancreas transplant for 10 years. Kidney biopsies done before the transplant and 5 and 10 years after showed that many signs of kidney damage had reversed. Many of the changes were only significant 10 years after the transplant.

Type 1 diabetes, Diabetic nephropathies

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