University of Delaware Office of Public Relations The Messenger Vol. 6, No. 1/1996 Research on risk factors may benefit individuals with diabetes UD epidemiologist Raelene Maser's most recent research, which centers on the early detection of nerve damage to the feet, could help individuals with diabetes avoid infections and amputations. Neuropathy, the clinical term for nerve damage, may cause numbness in the lower extremities and hands of diabetic individuals. If a numbed foot is injured, a person with diabetes may be unaware of the wound until infection or ulceration occurs. "Fifteen percent of all people with diabetes will get foot ulcers in their lifetimes," Maser, an associate professor of medical technology, says. "And, 50 percent of all non-traumatic amputations occur in individuals with diabetes." Using quantitative sensory testing devices, Maser studies the newest methods of detection and prevention of such diabetic complications. Her research is coordinated with physicians specializing in diabetes-Dr. Stephen DeCherney of the Clinical Pharmacology Research Center and the Diabetes and Metabolic Disease Center, Medical Center of Delaware, and Dr. James Lenhard, clinical director of the Delaware diabetes center-as well as with researchers at Pennsylvania State University and the University of Pittsburgh Graduate School of Public Health. Their joint research has involved hundreds of individuals with diabetes of both Type I (insulin-dependent) and Type II (non-insulin- dependent) diabetes mellitus. "Our first focus is to assess new methods of determining whether individuals have nerve damage (neuropathy) and the second is to discover what are the risk factors for developing neuropathy," she says. "Traditionally, doctors detect obvious cases with a standard neurological exam, but we have been evaluating new methods to discover nerve damage earlier so that the physican can intervene sooner," she says. Using an instrument that evaluates one particular type of sensory nerve fiber, the researcher can determine an individual's level of sensory perception, placing the response on a quantitative scale. Participants in the research are reexamined over time to see if the nerve damage has progressed, but, meanwhile, more intensive clinical education can begin. A recent study of 77 insulin-dependent individuals with diabetes, coauthored by Maser, indicated that those who had an elevated threshold to this test had a five-fold risk of developing diabetic neuropathy later on. "Patients at risk should be instructed to check their feet every day, break in new shoes gradually (one to two hours a day) and try to achieve good blood sugar control. If you can prove to them that they are more at risk for ulcers or infections, perhaps they will take more preventative care," Maser says. Results from the national Diabetes Control and Complications Trial demonstrated that intensive treatment of high blood sugars reduced the risk of developing diabetic neuropathy by 60 percent. "But, there is no magic number. No one can say that if you keep blood sugar below a certain number, you won't develop neuropathy," she says. Meanwhile, Maser, DeCherney and Lenhard continue to work on the risk factors beyond the established ones of blood sugar control, age, duration of diabetes and height. "Our studies have shown that there seems to be little association of nerve fiber function with certain lipids (high- and low-density cholesterols and triglycerides) in the blood, but there may be a connection with blood pressure," she says. This team currently is conducting a study to determine how the blood sugar levels at the time of nerve function testing may affect the test results. Anyone interested in learning more about diabetes research in Delaware may call Maser at (302) 831-8400. -Cornelia Weil