PROXIMAL DIABETIC NEUROPATHY - IMMUNOTHERAPEUTIC POSSIBILITIES

A prospective study was undertaken to investigate and compare the effect of immunomodulating (human immunoglobulin intravenous (IVIG)) and immunosuppression therapy (prednisone with azathioprine p.o.) in patients with subacute PDN, characterized by pronounced pain in the upper legs, atrophy of upper legs muscles, loss of predominantly pelvifemoral muscle strength as well as a marked reduction in femoral nerve motor conduction velocity (FNCV).Fourteen type 2 diabetic patients (mean age 64.4 yr., duration of diabetes 10 yr., duration of PDN 4.7 months, HbA1c 7.62 %) were included in the study. The patients were randomised ; 9 patients received prednisone (1mg/kg ) and azathioprine (100 mg) whereas 5 patients received IVIG (2.0 g/kg). Response to treatment was evaluated using visual analogue scale (VAS) for pain, muscle strength manual test (MMT) after 4, 8, 12, 24 weeks and FNCV was measured at 12 and 24 weeks.Both therapies were found to be beneficial. Improvement was found for pain (baseline vs. follow- up VAS Z= 3.3, p=0.0001) muscle strength (baseline vs. follow/ up MMT Z= 3.3, p=0.0001) and FNCV (baseline vs. follow-up Z=3.2, p=0.0015). The most pronounced improvement occurred in the first 4 weeks. Immunosuppression caused greater improvement in FVCV after 3 months as well as VAS after 2 months, compared to immunomodulation but the difference was not statistically significant. Our results indicate that both immunosuppression and immunomodulation are efficient in subacute proximal diabetic neuropathy. Further studies are necessary to evaluate possible difference in long term outcomes between the therapies.