Diabetic neuropathy is one of the most common long-term complications of diabetes. As symptoms often interfere with walking, balance and coordination, it is harder for people with this condition to exercise. For National Diabetes Week we chat with Dr Brooke Coombes about her team’s work to understand the impact of chronic pain on quality of life and physical activity in people with diabetes. This work will help them to develop new approaches to managing exercise in people with diabetic neuropathy. And if you, or anyone you know, have been diagnosed with type 2 diabetes and peripheral neuropathy, please consider volunteering for Dr Coombes’ new study. By doing so, you can help develop better treatments to improve the health and wellbeing of Australians with diabetes.
‘I’ve become more interested in people with chronic diseases because they are a group that need greater support to lead active lifestyles.’
Q & A:
What led to your study of diabetic neuropathy and the recent Physical Activity Intelligence (PAIn) trial?
With musculoskeletal problems such as neck pain, back pain and tendon injuries, the challenge is to understand why some people recover from these problems whilst other people develop more persistent symptoms that interfere with daily activities, including work and physical activity. People with chronic diseases such as diabetes suffer these problems and also develop other, more unique neuropathic symptoms that arise from damage to the nervous system. So, I’ve become more interested in people with chronic diseases because they are a group that need greater support to lead active lifestyles.
The most consistent and well-known feature of diabetic neuropathy is the loss of feeling in the toes and the fingertips, but there is evidence that our central nervous system is also impacted. Some individuals may have painful or unusual sensations like feeling there is something crawling over their feet, or experience sensitivity such as the bed sheets triggering pain in the feet. These symptoms can make it more challenging to be active and sometimes it is their fears and self-talk that can impede their progress. As a result, I have adopted a biopsychosocial approach for my research—not only measuring nerve function but also looking at lifestyle behaviours and psychological factors.
Due to the complexity of peripheral neuropathy, people with the condition often are not able to take part in exercise trials. So, in 2019, we started the Physical Activity Intelligence (PAIn) Study using digital technology, wearable devices and exercise counselling to assist people suffering from diabetic neuropathy to increase physical activity. The good news was we found that people with diabetic neuropathy could meet the physical activity goals during the four-week program. The wearable devices not only helped us track people’s progress but provided user friendly metrics to each participant, enabling them to monitor their progress and achievements. However, despite some benefits of the program on painful foot symptoms, we learned that more support is needed to sustain these positive lifestyle changes. These findings are driving new avenues of research for our team at Griffith.
Looking at how physical activity and pain are related is only one aspect. The behavioural and psychological aspects of getting people to commit to and sustain their increases in activity are very challenging. To support this, our program has been interdisciplinary. Health and clinical psychologist Associate Professor Nicola Burton, an expert in behavioural change, has been integral to making the message really clear and to ensuring our program is based on what we know about behaviour change.
Is there a higher risk to mental and emotional health in people living with diabetes?
The evidence certainly suggests that mental and emotional health struggles, including depression and anxiety, are common issues faced by people with diabetes. Listening to individual stories of people with diabetes—from first diagnosis to more chronic stages of the disease—has given me a deeper understanding and appreciation of the burden arising from a new regime of daily decisions around their lifestyle, their diet and what they can and cannot do. We hope to make the message clear that increasing physical activity can benefit the physical and mental health of all Australians, including those with diabetic neuropathy.
With COVID-19 and lockdowns, access to gyms and supervised training programs was reduced or even stopped. For us, this highlighted the importance of teaching people the skills to manage their activities—to understand what they are doing and whether they are doing enough. And just as importantly, the value of talking through what to do when relapses or another lockdown occurs. We all know it is hard to get back into exercise once you have had a break, but it is even more challenging if you have physical or mental health problems or chronic pain.
‘We hope to make the message clear that increasing physical activity can benefit the physical and mental health of all Australians, including those with diabetic neuropathy.’
What is the aim of your new study into diabetic neuropathy?
The challenge with our original trial was that our interventions finished just as lockdown started in Brisbane, so we weren’t able to look at any physical outcomes or blood glucose (sugar) control. But the trial gave us good feasibility data to apply for funding for a larger trial. And our results have sparked new questions about how short bouts of physical activity affect symptoms of diabetic neuropathy. Our new study is seeking to identify whether a broader group of people with diabetic neuropathy have a similar response to exercise.
For the next six weeks, we are asking anyone in Australia with diagnosed type 2 diabetes, peripheral neuropathy and a smartphone to complete our open survey. It isn’t onerous, just one week of brief surveys five times a day, and each participant receives a $50 Coles voucher. The information from this survey will help us build on our understanding of how foot symptoms change throughout the day, how they affect a person’s desire to exercise and the person’s quality of sleep. From this study we will be able to develop better treatments to improve the health and wellbeing of Australians with diabetes.
To participate, please contact [email protected]
As diabetes and chronic pain are two common problems affecting many Australians, our mission is to develop low-cost ways of delivering information and supporting people with diabetes to access health programs and advice from health professionals. Any interested students or clinicians who would like to help with developing or testing these approaches, please contact [email protected]
Where do you see yourself in the next five years?
The area of diabetes is only part of my research. I also research how musculoskeletal injuries impact on the health and productivity of workers. I have been working closely with occupational groups who perform manual work or hold sustained kinds of postures, for example ultrasound sonographers, to try and address the burden of musculoskeletal problems. The approach is very similar to my diabetes research. It is about getting people physically active, helping them to monitor how much they are doing and building an understanding of all the interplaying factors, including psychological or work-related factors. We are working toward evaluating a multidisciplinary intervention that uses new technology to help people become more active and to track all of the benefits—individual, social and economic.