Lifestyle Interventions for Diabetic Peripheral Neuropathy

Diabetic peripheral Neuropathy (DPN) occurring more often than any other complication of diabetes and it is more so in DM2 than DM1. The good news is that it is the most preventable complication. DPN is low in nearly diagnosed and early DM1 (<10 years duration). It increases as years go by, up to 34% by disease duration of 24 years.

In contrast, 50% of DM2 will show signs and symptoms of DPN during their lifetime, with it occurring 20-30% among newly diagnosed DM2. Unfortunately, there are no good treatments that work well for this complication, but some lifestyle habits do help to deal with this complication.

Exercise is perhaps the only intervention shown to improve the regenerative capacity of the nerves in people with metabolic syndrome and those with diabetes. Exercise improves measures of mobility, balance and gait and reduces fall risk in DPN. Different modes of exercise show great results such as aerobic, resistance and Tai Chi. Aerobic training has shown to improve mobility, balance and gait outcomes. “In a controlled trial of multimodal aerobic training, moderate-intensity (5% heart rate reserve) or vigorous (75% heart rate reserve) exercise yielded equivalent benefits, suggesting that both training intensities promoted these improvements.” Studies vary in length from 12 weeks to 4 years.
Low intensity exercise also shows benefit in neuropathic pain. Passive whole body vibration is a new exercise mode in which participants stand on a vibrating platform and resist its effect to maintain an upright posture. This category also include Tai Chi.

Other modalities that have shown limited success include:

• Acupuncture
• Photon Stimulation
• Systematic Surgical Decompression
• Transcutaneous Electrical Nerve Stimulation (TENS)
• Spinal Cord Stimulation

Oral, non-pharmacologic therapies also having limited affects include Alpha-lipoic acid, Benfotiamine (cofactor of thiamine), Vitamin B12, Acetyl-L-carnitine, y-Linolenic acid, Magnesium, Vitamin D, Vitamin E. Many of these products help reduce inflammation which is the hallmark of diabetes. Many studies researching these products are limited and don’t work for everyone. Mainly, people who are deficient in any of these, that is who will see the most noticeable improvements.

Final Thoughts:
The best way to treat PDN is to keep blood sugars under the best control possible.

Source: ADA Clinical Compendia Series, 2022