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