Erythrocyte aldose reductase protein: a clue to elucidate risk factors fordiabetic neuropathies independent of glycemic control

Prolonged hyperglycemia has been thought to be the primary cause of diabeti c complications, however, some diabetic patients develop severe complicatio ns early in duration of diabetes, while some patients have no or mild compl ications even after prolonged hyperglycemia. To investigate the risk factor s for diabetic severe neuropathy independent of glycemic control and durati on of diabetes, erythrocyte aldose reductase was determined in 43 non-insul in-dependent diabetic patients by a two-site ELISA using recombinant human aldose reductase. Among 20 patients with severe neuropathy which was develo ped within 5 years of diagnosis, the level of erythrocyte aldose reductase protein was significantly higher than that of 23 patients with no or mild n europathy who had more than 8 years duration of diabetes and prolonged hype rglycemia (11.9 +/- 5.7 vs. 8.3 +/- 1.3 ng/mgHb, P < 0.0001). There was a s ignificant stability of the erythrocyte aldose reductase (AR) in the 40 dia betic patients during 1-4 years. The logistic regression analysis revealed that the maximum body mass index (BMI) in the past minus present BMI and th e level of erythrocyte aldose reductase protein were the independent risk f actors for diabetic severe neuropathy. The measurement of erythrocyte AR le vel may be useful for predicting severe neuropathy in non-insulin-dependent diabetes mellitus (NIDDM) patients. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.