A Clinical and Neuropathological Study of Chinese Patients with Diabetic Peripheral Neuropathy

Guangren Li ,Yujia Liu,Ying Gao,Guixia Wang,Xianchao Xiao,Yanjun Wang,Chenglin Sun,Fĕi Li

doi:10.1371/journal.pone.0091772

Abstract

ObjectiveTo examine whether the neuropathological and metabolic changes of peripheral nerves are correlated to clinical features in diabetes mellitus type 2 patients with peripheral neuropathy.Methods147 type 2 diabetic patients with signs/symptoms of diabetic peripheralneuropathy (DPN) aged 53.4±12.3 years and 134 healthy volunteers aged 55.5±11.7 years were investigated for fasting plasma glucose (FPG), hemoglobin A1C (HbA1c), and red blood cell sorbitol (RBC sorbitol) in addition to nerve conduction velocity (NCV). Among the 147 diabetic patients, 10 patients underwent superficial peroneal nerve biopsy for light and electron microscopy.ResultsIn the experimental group, the levels of HbA1c and RBC sorbitol showed significant increase compared with the controlled group, whereas motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) both showed decline and SNCV decreased at a greater extent. Morphologically, there were various degrees of nerve fiber loss, associated with axon degeneration and capillary luminal narrowing in 10 patients undergone nerve biopsy.ConclusionThe metabolic change of sorbitol, the consequently observed changes in NCV and histopathology of peripheral nerves are positively correlated with the duration of diabetes and overall level of blood glucose.

Highlights

Diabetic peripheral neuropathy (DPN) is a common long-term complication of diabetes mellitus, which can affects at least 50% of patients with type 1 and type 2 diabetes and is a leading cause of foot amputation [1]
The experimental group included 147 type 2 diabetes patients with diabetic peripheral neuropathy, and 10 patients (Table 1, 2)received the morphological study of peripheral nerves.The study was approved by the China Research Ethic Committee, and all participants have provided their writteninformed consent before participating in this study
In the DPN group, HbA1C and RBC sorbitol have shown a statistical significant increase, while sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV) in both the median and common peroneal nerves have shown a statistical significant reduction compared with controlled group (Fig. 1)

Summary

Introduction

Diabetic peripheral neuropathy (DPN) is a common long-term complication of diabetes mellitus, which can affects at least 50% of patients with type 1 and type 2 diabetes and is a leading cause of foot amputation [1]. It may affect sensation, movement, and gland or organ function depending on the type of nerves involved [2]. We tried to find out whether the duration of diabetes and the long term unsatisfied blood glucose control have relationship with the metabolic and neuropathological changes in DPN patients

Methods

Results

Conclusion