Six-month periodic fasting does not affect somatosensory nerve function in type 2 diabetes patients

Zoltan Kender; Ekaterina von Rauchhaupt; Daniel Schwarz; Dimitrios Tsilingiris; Lukas Schimpfle; Hannelore Bartl; Valter D Longo; Martin Bendszus; Stefan Kopf; Stephan Herzig; Sabine Heiland; Julia Szendroedi; Alba Sulaj

doi:10.3389/fendo.2023.1143799

Six-month periodic fasting does not affect somatosensory nerve function in type 2 diabetes patients

Front Endocrinol (Lausanne). 2023 May 12:14:1143799. doi: 10.3389/fendo.2023.1143799. eCollection 2023.

Authors

Zoltan Kender^{1

2}, Ekaterina von Rauchhaupt^{1

2}, Daniel Schwarz³, Dimitrios Tsilingiris^{1

2}, Lukas Schimpfle^{1

2}, Hannelore Bartl¹, Valter D Longo^{4

5}, Martin Bendszus³, Stefan Kopf^{1

2}, Stephan Herzig^{2

6

7

8}, Sabine Heiland³, Julia Szendroedi^{1

2

9}, Alba Sulaj^{1

2}

Affiliations

¹ Clinic for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany.
² German Center of Diabetes Research (DZD), Neuherberg, Germany.
³ Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
⁴ Longevity Institute, School of Gerontology, and Department of Biological Sciences, University of Southern California, Los Angeles, CA, United States.
⁵ FIRC Institute of Molecular Oncology, Italian Foundation for Cancer Research Institute of Molecular Oncology, Milan, Italy.
⁶ Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg, Germany.
⁷ Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.
⁸ Chair Molecular Metabolic Control, Technical University Munich, Munich, Germany.
⁹ Joint Heidelberg-IDC Translational Diabetes Program, Helmholtz Center Munich, Neuherberg, Germany.

Abstract

Background and aim: Current strategies for preventing diabetic sensorimotor polyneuropathy (DSPN) are limited mainly to glucose control but rapid decrease of glycemia can lead to acute onset or worsening of DSPN. The aim of this study was to examine the effects of periodic fasting on somatosensory nerve function in patients with type 2 diabetes (T2D).

Study design and methods: Somatosensory nerve function was assessed in thirty-one patients with T2D (HbA1c 7.8 ± 1.3% [61.4 ± 14.3 mmol/mol]) before and after a six-month fasting-mimicking diet (FMD; n=14) or a control Mediterranean diet (M-diet; n=17). Neuropathy disability score (NDS), neuropathy symptoms score (NSS), nerve conduction velocity and quantitative sensory testing (QST) were analyzed. 6 participants of the M-Diet group and 7 of the FMD group underwent diffusion-weighted high-resolution magnetic resonance neurography (MRN) of the right leg before and after the diet intervention.

Results: Clinical neuropathy scores did not differ between study groups at baseline (64% in the M-Diet group and 47% in the FMD group had DSPN) and no change was found after intervention. The differences in sensory NCV and sensory nerve action potential (SNAP) of sural nerve were comparable between study groups. Motor NCV of tibial nerve decreased by 12% in the M-Diet group (P=0.04), but did not change in the FMD group (P=0.39). Compound motor action potential (CMAP) of tibial nerve did not change in M-Diet group (P=0.8) and increased in the FMD group by 18% (P=0.02). Motor NCV and CMAP of peroneal nerve remained unchanged in both groups. In QST M-diet-group showed a decrease by 45% in heat pain threshold (P=0.02), FMD group showed no change (P=0.50). Changes in thermal detection, mechanical detection and mechanical pain did not differ between groups. MRN analysis showed stable fascicular nerve lesions irrespective of the degree of structural pathology. Fractional anisotropy and T2-time did not change in both study groups, while a correlation with the clinical degree of DSPN could be confirmed for both.

Conclusions: Our study shows that six-month periodic fasting was safe in preserving nerve function and had no detrimental effects on somatosensory nerve function in T2D patients.

Clinical trial registration: https://drks.de/search/en/trial/DRKS00014287, identifier DRKS00014287.

Keywords: diabetic sensorimotor polyneuropathy; hypoalgesia; nerve conduction velocity; periodic fasting; type 2 diabetes mellitus.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Action Potentials
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / pathology
Diabetic Neuropathies* / diagnosis
Fasting
Humans
Pain

Grants and funding

This study was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation; project number 236360313–SFB 1118 and project number 255156212SFB 1158) as well as by the Deutsches Zentrum für Diabetesforschung (DZD; German Center for Diabetes Research; project number 82DZD07C2G). A.S. was supported from the Olympia Morata funding program of the Medical Faculty Heidelberg. The fasting-mimicking diet used in this study was funded by L-Nutra. All funding sources had no influence on design and conduct of this study, collection, analysis, and interpretation of the data or on the preparation, review, or approval of this article.