Abstract
Objectives: To investigate the relationship between neurophysiological sensory and motor nerve function parameters, assessed by nerve conduction studies (NCS) with parasympathetic autonomic function and by heart rate variability (HRV) tests in patients with type 2 diabetes mellitus (T2DM). Material and Methods: A total of 161 T2DM patients underwent NCS. Cardiac autonomic response was assessed by HRV tests to deep breathing (HRV DB), to Valsalva manoeuvre, and during postural change from lying to standing. Results: The amplitude of motor response in the median nerve, tibial nerve, and peroneal nerve was associated with reduced HRV DB (p = 0.0001). The amplitude of motor response in the median nerve, tibial nerve, and peroneal nerve was associated with reduced HRV Valsalva (p = 0.0001). The correlation between the amplitude of response in all sensory nerves (sural, median, and ulnar) and HRV DB was statistically significant (p = 0.0001). Conclusion: The results indicate that there is a correlation in T2DM patients between the damage of small myelinated and unmyelinated nerve fibres from cardiac autonomic nerves, assessed by HRV tests and damage of large motor and sensory fibres, assessed by NCS. Based on the above results, a combination of NCS and HRV tests should be considered in the neurophysiological approach to diabetic neuropathy.
Highlights
Disorders of the peripheral nervous system in diabetes are common and complex conditions
We found that the highest positive correlation between motor nerve function tests and parasympathetic function tests was between the amplitude of motor response in peroneal nerves and heart rate variability (HRV)
Neurophysiology is an important tool in assessing the function of peripheral nerves in diabetes, providing a conclusive diagnosis of distal symmetric polyneuropathy (DSPN)
Summary
Disorders of the peripheral nervous system in diabetes are common and complex conditions. Disorders may involve sensory fibres, motor fibres, small myelinated fibres, and autonomic fibres, producing a heterogeneous group of clinical manifestations. The most common forms of diabetic neuropathies in clinical practice are distal symmetric polyneuropathy (DSPN), which affects somatic sensory fibres in the early stages, followed by motor fibre involvement from peripheral nerves and autonomic neuropathies [1,2]. Up to 50% of diabetic peripheral neuropathies can be clinically asymptomatic. Clinical electrodiagnostic studies, assessed by nerve conduction studies (NCS), have become an indispensable tool for the discovery of peripheral nerve abnormalities. NCS is a noninvasive, accurate, sensitive, and reliable method that provides objective and quantitative data concerning somatic motor and sensory nerve fibre function. NCS can detect subclinical abnormalities [1,3]
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