World first diabetic study to limit neuropathy

Diabetes is the fastest growing chronic disease and the sixth largest cause of death in the country. A quarter of Australians are currently diabetic, with 2 million either showing pre-diabetic symptoms or at immediate risk of developing the condition. According to Diabetes Australia, an additional 275 people are being diagnosed daily, costing the national healthcare system an estimated $3 billion. The figures are alarming, no doubt.

In a world first, the Prince of Wales Hospital’s Institute of Neurological Sciences and Diabetes Centre has recently launched a study on diabetic neuropathy, using an innovative clinical technique known as nerve excitability testing.

A painful and debilitating condition, diabetic neuropathy is a common complication among diabetes sufferers, in which nerves are damaged as a result of high blood sugar levels and decreased blood flow. Approximately 50% of diabetics eventually develop partial or permanent nerve damage.

Developing in stages, peripheral nerve injuries can affect nerves in the skull or spinal chord as well as those that control vital organs, including the smooth muscles and heart. Symptoms include swallowing difficulty, pins and needles, tingling, cramps, numbness and general muscle weakness.

Apart from management of symptoms through pain relief and strict monitoring of blood sugar levels, there are currently no specific treatments for diabetic neuropathy and nerve dysfunction.

Led by neurologist Arun Krishnan, the landmark project will investigate whether the nerve excitability technique could detect the earliest stage of nerve damage in diabetic patients before it is evident externally. The results could help diagnose nerve damage prior to the onset of more severe symptoms.

To be conducted over a period of three years in four and six monthly intervals, Dr Krishnan and his team of researchers hope to use cutting-edge software to understand the ways that impulses are conducted down nerves in patients with diabetes.

The Prince of Wales Hospital is therefore seeking diabetics between ages of 18-65 to undertake nerve excitability and nerve conduction testing.

The entire procedure, which lasts no more than 15 minutes, involves electrodes being taped to the skin over a nerve or muscle while electrical pulses are delivered. The nerve response is then mapped against that for age-matched healthy controls, with a view to predicting neuropathy.

According to a hospital spokesperson, about 30 patients have already participated in the trail, many showing changes to nerve excitability stimuli, suggesting they may develop neuropathy.

Researching the causes of nerve dysfunction in diabetes will improve medical knowledge and facilitate future treatment of diabetic neuropathy, Dr Krishnan told Indian Link.

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“Currently, one of the biggest hurdles is the inability to detect early signs of nerve damage. This study could potentially lead to better ways of detecting the early signs of diabetic nerve disease and may lead to the development of new treatments,” Dr Krishnan added.

A senior lecturer in neuroscience at UNSW’s Translational Neuroscience Facility, Dr Krishnan’s primary research interest has been in the relatively new area of clinical neurophysiology, particularly in the use of nerve excitability techniques as a means of investigating the pathophysiology of neuropathic processes.

Abnormalities of ion channel function, which is a deciding factor in many neurological diseases including peripheral neuropathy, motor neurone disease, MS and epilepsy has been his core focus. Furthermore, he is also interested in novel methods for diagnosing and treating neurological complications of systemic diseases, including diabetes, renal disease and cancer.

“Measurements of excitability are cutting-edge techniques that provide information related to the activity of a variety of ion channels, energy-dependent pumps and ion exchange

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“These are novel techniques, which our group has applied to the study of mechanisms underlying the development of neuropathy and nerve injury,” he further explained.

Specifically, the team has applied these techniques to the study of metabolic and toxic neuropathies including those that occur secondary to diabetes, end-stage kidney disease (ESKD) and chemotherapy. Recently, excitability techniques have also been applied to the assessment of cortical excitability using trans-cranial magnetic stimulation and they propose to extend these techniques to the study of neurodegenerative processes and central channelopathies.

Dr Krishnan’s stellar career has been dotted with numerous awards and research citations including ANZAN Young Investigator Prize, J.G Golseth Young Investigator Prize of the American Academy of Neuromuscular and Electrodiagnostic Medicine, as well as ANZAN Overseas Fellowship to Queen Square.

He has since returned to Australia to take up an NHMRC Career Development Award at the Prince of Wales Medical Research Institute.

Usha Ramanujam Arvind

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