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June 13, 2017; 88 (24) Article

Effect of omega-3 supplementation on neuropathy in type 1 diabetes

A 12-month pilot trial

Evan J.H. Lewis, Bruce A. Perkins, Leif E. Lovblom, Richard P. Bazinet, Thomas M.S. Wolever, Vera Bril
First published May 17, 2017, DOI: https://doi.org/10.1212/WNL.0000000000004033
Evan J.H. Lewis
From the Department of Nutritional Sciences (E.J.H.L., R.P.B., T.M.S.W.), Faculty of Medicine, University of Toronto; Leadership Sinai Centre for Diabetes (B.A.P., L.E.L.), Mount Sinai Hospital, Toronto; and Ellen and Martin Prosserman Centre for Neuromuscular Diseases (V.B.), Division of Neurology, University Health Network, Toronto, Canada.
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Bruce A. Perkins
From the Department of Nutritional Sciences (E.J.H.L., R.P.B., T.M.S.W.), Faculty of Medicine, University of Toronto; Leadership Sinai Centre for Diabetes (B.A.P., L.E.L.), Mount Sinai Hospital, Toronto; and Ellen and Martin Prosserman Centre for Neuromuscular Diseases (V.B.), Division of Neurology, University Health Network, Toronto, Canada.
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Leif E. Lovblom
From the Department of Nutritional Sciences (E.J.H.L., R.P.B., T.M.S.W.), Faculty of Medicine, University of Toronto; Leadership Sinai Centre for Diabetes (B.A.P., L.E.L.), Mount Sinai Hospital, Toronto; and Ellen and Martin Prosserman Centre for Neuromuscular Diseases (V.B.), Division of Neurology, University Health Network, Toronto, Canada.
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Richard P. Bazinet
From the Department of Nutritional Sciences (E.J.H.L., R.P.B., T.M.S.W.), Faculty of Medicine, University of Toronto; Leadership Sinai Centre for Diabetes (B.A.P., L.E.L.), Mount Sinai Hospital, Toronto; and Ellen and Martin Prosserman Centre for Neuromuscular Diseases (V.B.), Division of Neurology, University Health Network, Toronto, Canada.
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Thomas M.S. Wolever
From the Department of Nutritional Sciences (E.J.H.L., R.P.B., T.M.S.W.), Faculty of Medicine, University of Toronto; Leadership Sinai Centre for Diabetes (B.A.P., L.E.L.), Mount Sinai Hospital, Toronto; and Ellen and Martin Prosserman Centre for Neuromuscular Diseases (V.B.), Division of Neurology, University Health Network, Toronto, Canada.
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Vera Bril
From the Department of Nutritional Sciences (E.J.H.L., R.P.B., T.M.S.W.), Faculty of Medicine, University of Toronto; Leadership Sinai Centre for Diabetes (B.A.P., L.E.L.), Mount Sinai Hospital, Toronto; and Ellen and Martin Prosserman Centre for Neuromuscular Diseases (V.B.), Division of Neurology, University Health Network, Toronto, Canada.
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Citation
Effect of omega-3 supplementation on neuropathy in type 1 diabetes
A 12-month pilot trial
Evan J.H. Lewis, Bruce A. Perkins, Leif E. Lovblom, Richard P. Bazinet, Thomas M.S. Wolever, Vera Bril
Neurology Jun 2017, 88 (24) 2294-2301; DOI: 10.1212/WNL.0000000000004033

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Abstract

Objective: To test the hypothesis that 12 months of seal oil omega-3 polyunsaturated fatty acids (ω-3 PUFA) supplementation will stop the known progression of diabetic sensorimotor polyneuropathy (DSP) in type 1 diabetes mellitus (T1DM).

Methods: Individuals with T1DM and evidence of DSP as determined by a Toronto Clinical Neuropathy Score ≥1 were recruited to participate in a single-arm, open-label trial of seal oil ω-3 PUFA supplementation (10 mL·d−1; 750 mg eicosapentaenoic acid, 560 mg docosapentaenoic acid, and 1,020 mg docosahexaenoic acid) for 1 year. The primary outcome was the 1-year change in corneal nerve fiber length (CNFL) measured by in vivo corneal confocal microscopy, with sensory and nerve conduction measures as secondary outcomes.

Results: Forty participants (53% female), aged 48 ± 14 years, body mass index 28.1 ± 5.8 with diabetes duration of 27 ± 18 years, were enrolled. At baseline, 23 participants had clinical DSP and 17 did not. Baseline CNFL was 8.3 ± 2.9 mm/mm2 and increased 29% to 10.1 ± 3.7 mm/mm2 (p = 0.002) after 12 months of supplementation. There was no change in nerve conduction or sensory function.

Conclusions: Twelve months of ω-3 supplementation was associated with increase in CNFL in T1DM.

ClinicalTrials.govidentifier: NCT02034266.

Classification of evidence: This study provides Class IV evidence that for patients with T1DM and evidence of DSP, 12 months of seal oil omega-3 supplementation increases CNFL.

GLOSSARY

BMI=
body mass index;
CNBD=
corneal nerve branch density;
CNFA=
corneal nerve fiber area;
CNFD=
corneal nerve fiber density;
CNFL=
corneal nerve fiber length;
DHA=
docosahexaenoic acid;
DM=
diabetes mellitus;
DSP=
diabetic sensorimotor polyneuropathy;
HRV=
heart rate variability;
IVCCM=
in vivo corneal confocal microscopy;
LDIFLARE=
laser Doppler imaging flare technique;
mTCNS=
modified Toronto Clinical Neuropathy Score;
NPD1=
neuroprotectin D1;
T1DM=
type 1 diabetes mellitus;
TCNS=
Toronto Clinical Neuropathy Score;
ω-3 PUFA=
omega-3 polyunsaturated fatty acid

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Received October 14, 2016.
  • Accepted in final form March 21, 2017.
  • © 2017 American Academy of Neurology
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