Diabetes is defined as high sugar levels in the blood. There are two forms of the disease. In type 1 diabetes, the body does not produce enough insulin. In type 2 diabetes, the body becomes less responsive to insulin. Regardless of the type of diabetes, many people develop a disabling neuropathy.Neuropathy is a condition that results in numbness, tingling, pain, or weakness that typically starts in the feet and progresses up the legs.The distribution is often described as a stocking glove pattern since the feet are affected first followed by the legs and fingers.The most common treatment for diabetes is control of blood sugar levels in an attempt to prevent the many complications, including neuropathy.This review identified 17 randomized studies that addressed whether more aggressive attempts to lower blood glucose levels prevent people from developing neuropathy.Seven of these studies were conducted in people with type 1 diabetes, eight in type 2 diabetes, and two in both types. However, only two studies in type 1 diabetes including 1228 participants and four studies in type 2 diabetes including 6669 participants investigated our primary outcome. In type 1 diabetes, there was a significant effect of more aggressive therapies in preventing neuropathy compared with standard treatment.In type 2 diabetes, more aggressive therapy was also beneficial in preventing symptoms and signs of clinical neuropathy, but the result was not statistically significant as measured by the primary method selected for this review. However, there was a significant positive effect on the amount of nerve damage measured with electrical nerve conduction tests and a special machine to measure the threshold of detection of vibration in both types of diabetes. Overall, the evidence indicates that more aggressive treatments of sugar levels delay the onset of neuropathy in both types of diabetes. No other treatments have proven effective to date. However, the beneficial effect has to be balanced against the significantly increased risk of dangerously low blood sugar levels that can occur in both types of diabetes and which can lead to brain injury amongst other issues.
