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Newswise — Adult onset, or type 2 diabetes, is a growing problem in the United States. Researchers estimate that about 10 percent of Americans will develop diabetes during their lifetime and about twice that number will develop a milder form of diabetes called impaired glucose tolerance, or pre-diabetes. Diabetes and pre-diabetes often do not present any symptoms until a complication arises, making the disease difficult for patients to detect.

Physicians already know that people with pre-diabetes can prevent or delay the onset of diabetes with lifestyle changes such as weight loss and exercise. Likewise, people with pre-diabetic neuropathy may be able to reduce their risk for developing severe nerve disease. They may even be able to reverse the neuropathy.

Researchers at the University of Michigan Health System are investigating neuropathy, or nerve damage characterized by a persistent tingling, burning or numbness in the hands and feet, as an early warning sign of pre-diabetes. Their preliminary research also suggests that lifestyle modifications, including weight loss and regular exercise, may be able to prevent further nerve damage among patients with pre-diabetes and " very possibly " reverse the damage.

"Adult onset, or type 2 diabetes, is a considerable problem in the United States, as well as in many western countries," says James Russell, M.D., a U-M associate professor of Neurology. "We estimate that about 16 to 20 million Americans already have pre-diabetes but, in fact, this may be an underestimate."

UMHS, which is very active in diabetes research, is conducting a study, along with universities such as the University of Utah and Yale, that looks at neuropathy associated with impaired glucose tolerance.

"People may notice they have an increased tingling or burning in their arms or legs, or even significant pain in their feet. This may be one of the earliest warning signs," Russell says.

According to Russell, patients with pre-diabetes have a higher rate of developing neuropathy. Many of his clinic's patients who don't seem to have a cause for their neuropathy have abnormalities of their glucose regulation - approximately 30 percent to 50 percent. "We will have to wait for the final results to be published from this study in about two years, but it is exciting to see that the prospect of reversing nerve damage may be validated in the final results," Russell says.

Study participants are asked to reduce their body weight by about 7 percent and have a goal of exercising 150 minutes a week.

"In this study, we encourage people who are struggling with the exercise part to do whatever is appropriate to them. We're not trying to make them into marathon runners, we're simply trying to have them adopt a healthier lifestyle. And the benefits, even with fairly small changes in daily routine, are very, very important to patients' overall health," Russell says.

He advises people with persistent tingling or prickling in the arms, legs or feet " particularly if the sensation in the feet is a burning pain " to talk to their health care provider, especially if the pain is persistent.

Know your risk factors

Obesity is a known risk factor for pre-diabetes and diabetes. There has been a 60 percent increase over the past 20 years in the number of people in the United States who are obese. The number of children with obesity has tripled in the same time period. Experts believe that this increase in obesity is also helping to fuel the increasing numbers of people with diabetes and pre-diabetes.

Lack of exercise, high blood pressure, elevated triglycerides and other types of body fats are also contributors. Diabetes and pre-diabetes are more common in people who are middle aged or older, and in certain Native American, Hispanic or African American groups.

Signs and symptoms

The majority of people who develop diabetes or pre-diabetes probably won't know they have the condition until a noticeable symptom or complication arises. According to the National Diabetes Information Clearinghouse, once you have developed type 2 diabetes, symptoms can include:

"¢ increased thirst "¢ increased hunger "¢ fatigue "¢ increased urination, especially at night "¢ weight loss "¢ blurred vision "¢ sores that do not heal

"If you are at risk of developing diabetes, we want to prevent you from developing these symptoms of diabetes before they occur. In other words, by the time you have the symptoms, you already have the disease. That's why it's important for people to understand how much lifestyle factors can influence the delay, or even prevention of diabetes and pre-diabetes. For those at risk, it's never too early to make a change," Russell says.

For more information, visit the following Web sites:

Health Topics A " Z: Complications of diabetes: nerve damage (neuropathy)

UMHS: A new cocktail treatment for diabetic neuropathy

UMHS: Diabetic neuropathy

National Institute of Neurological Disorders and Stroke: Diabetic neuropathy information page

National Diabetes Information Clearinghouse: Diabetic Neuropathies

National Diabetes Information Clearinghouse: Prevent diabetes problems

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