Can diabetic nerve damage be reversed?
According to this study, yes.
It’s been a common understanding that nerve damage from diabetes is irreversible and the best way to avoid nerve damage is through prevention and tight blood glucose control.
Nerve damage occurs when there are consistently high levels of glucose in the blood, causing damage to the smaller blood vessels that bathe the nerve. Without a good blood supply, the nerve is deficient in oxygen and nutrients and ends up dysfunctional. Some people may experience intense nerve pain while others may experience numbness.
Nerve damage is a debilitating condition that can affect balance, and healing and decrease one’s quality of life. So therapies aimed to restore the microvascular environment is an emerging technology that I’m excited to share with you.
How we typically view the lack of blood supply to the feet that leads to pain and foot ulcerations is on the macro level. So our vascular colleagues are often called on to help restore circulation with surgical intervention such as with stents or a bypass on the bigger blood vessels. However, we see that this restoration often does not necessarily affect the smaller vessels that reach the toes, where diabetic foot ulcerations tend to occur.
For someone with a diabetic foot ulcer that is slower to heal despite appropriate measures like off-loading, padding, protection, glucose control, advanced wound therapies, and vascular intervention, the microvascular element is receiving more attention.
The hypothesis for a poor healing diabetic foot ulcer is that the microvascular structures surrounding the wound have leaky capillaries, so the right kind of nutrient isn’t reaching vital areas. So although major plumbing may be restored, the smaller vessels are not healthy enough to heal despite the presence of adequate blood flow.
If the microvascular environment can be restored, then someone suffering from nerve damage and a poor healing wound would benefit from something that can restore that physiology as it would improve healing conditions.
Now, taking a step back, when there is a gap in a broken bone, we restore the structure with a bone graft, and over time the new bone graft gets incorporated into the host body, which restores function. The bone graft may be sourced from the same person or from a donor.
The thing that is being presented in the study is a microvascular graft that contains fragments of microvascular structures from a donor. Once this is transplanted into a diabetic foot ulcer, it receives the appropriate signals to generate new healthy micro blood channels (angiogenesis) that allow the area to receive oxygen and nutrients essential to healing. The product is a ready off the shelf injectable or topical application that can easily be performed in the office in under 5 minutes.
The secondary finding in this study found those who received this product also had restoration in sensation (their neuropathy reversed). So 21 people demonstrated an additional positive result from healing a diabetic foot ulcer with this microvascular graft, noticing an improvement in sensation by 2 weeks.
If people with diabetes can feel their feet again, this would reduce the incidence of diabetic foot ulcers because sensation is a protective sensory. Diabetic foot ulcers happen in people who cannot feel their feet to pay attention to it when an injury occurs, like a thick callus forming or stepping on a needle. Sensory restoration would also improve the quality of life of individuals with balance issues.
What we once believed is now being challenged, that diabetic nerve damage cannot be reversed but this level 1 study has shown that it is actually possible by restoring the microvascular environment. This is exciting technology to share with my patients and I will be keeping a very close eye on what future studies show.
If you have diabetes and are interested in being part of an investigational study with this product, schedule a consultation to see if you’re a candidate.
