Characteristics of urinary microflora in women with type 2 diabetic peripheral neuropathy without lower urinary tract symptoms

Objective To investigate the relationship between retinal nerve fiber layer thickness and peripheral neuropathy in elderly patients with type 2 diabetes. Methods Clinical data of elderly patients with T2DM in Endocrinology Department in Beijing Hospital were retrospectively collected.Global and sectorial retinal nerve fiber layer(RNFL)thicknesses were measured by using optical coherence tomography(OCT), and never conduction velocity measurements were performed in all patients.Diabetic peripheral neuropathy was diagnosed by the criteria in diabetic neuropathies update(2010, American Diabetes Association). RNFL thickness was compared between diabetic non-peripheral neuropathy group(control group, n=30)and diabetic peripheral neuropathy group(DPN group, n=17)and between different sub-groups. Results The RNFL thicknesses of temporal, nasal, superior and inferior visual fields and the mean RNFL thickness were less in DPN group than in control group, among which there were significant differences in the RNFL thicknesses of superior, inferior visual fields and the mean RNFL thickness 〔(107.7±27.4)μm vs.(128.1±17.3)μm, (112.9±20.8)μm vs.(130.8±21.8)μm, (88.2±15.5)μm vs.(100.5±11.3)μm, F=7.446, 7.468, 7.988, respectively, P=0.009, 0.009 and 0.007〕. RNFL thickness was decreased along with the aggravation of DPN from the control group, the subclinical DPN group to the DPN group successively(all P<0.05). Conclusions Retinal nerve fiber layer thickness is associated with diabetic peripheral neuropathy in elderly patients with type 2 diabetes, and the relationship is more significant in patients with serious DPN. Key words: Diabetic retinopathy; Retinal neurons; Tomography, optical coherence

Objective To evaluate the sleep and mood of patients with type 2 diabetes and peripheral neuropathy, and to explore whether the results were related to the level of interleukin-17 (IL-17). Methods 130 cases of type 2 diabetes diagnosed in Department of Endocrinology, First Affiliated Hospital of Medical University of Anhui from September 2015 to July 2016 were selected, 46 diabetes mellitus patients without peripheral neuropathy (NDPN group ) and 84 patients with peripheral neuropathy (DPN group ) were selected in the study.According to Toronto score (TCSS), DPN patients were divided into mild DPN group (DPN1 group, 54 cases), medium and severe DPN group (DPN2 group, 30 cases). The severity of insomnia and depressive symptoms were assessed by Pittsburgh Sleep Quality Index (PSQI) and 17-term Hamilton's Depression Scale (HAMD-17). The serum levels of IL-17 were measured. Results The scores of PSQI and HAMD-17 in the DPN group were significantly higher than those in the NDPN group, The score was (9.74±2.87), (10.85±2.20), and (12.03±2.71) respectively, the differences was statistically significant(F=7.43, P=0.001), and the scores of PSQI and HAMD-17 in the DPN2 group were significantly higher than those in the DPN1 group, the scores were (6.80±2.74), (7.52±2.49), and (8.97±3.22) respectively, the differences was statistically significant(F=5.73, P=0.004). The level of IL-17 in the DPN group was significantly higher than that in the NDPN group, the differences was statistically significant(F=5.27, P=0.006). There was no statistically significant difference in IL-17 between the DPN1 group and the DPN2 group.IL-17 level of patients with PSQI>10 was significantly higher than that of patients with PSQI≤10 (t=5.52, P=0.021). The level of IL-17 in patients with HAMD-17≥7 and patients with HAMD-17<7 had no statisticallysignificant difference. Conclusion Sleep and mood is closely related to the condition of patients with type 2 diabetes and peripheral neuropathy.Sleep condition may affect the level of IL-17 and the development of neuropathy. Key words: Diabetes mellitus, type 2; Diabetic Neuropathies; Sleep disorders; Mood disorders; Interleukin-17

One hundred and sixty-five patients with type 2 diabetes mellitus (T2DM) aged 60 years or older admitted to Beijing Tiantan Hospital from September 2017 to May 2018 were enrolled. There were 90 patients with diabetic peripheral neuropathy (DPN group) and 75 patients without DPN (NDPN group). The clinical data, laboratory tests and other indicators of the two groups were recorded, and the univariate and multivariate logistic analyses were performed. Univariate analysis showed that there was a significant difference in age, duration of diabetes, hemoglobin (Hb), glycosylated hemoglobin (HbA1c), 2-h post-prandial blood glucose (2 hPBG), high-density lipoprotein (HDL-C), treatment compliance and the relation-ship with family members between DPN and NDPN groups (P<0.05). Multivariate regression analysis revealed that the duration of diabetes, HbA1c, HDL-C, Hb and treatment compliance were independent risk factors for DPN in elderly patients with T2DM (P<0.05). Key words: Aged; Diabetes mellitus, type 2; Diabetic neuropathy; Risk factor

The World Health Organisation estimated that in the year 2000, 150 million people had diabetes mellitus, and it is predicted that this number will rise to 366 million by the year 2030.[1][1] Neuropathy is a common complication of diabetes and is characterised by a progressive loss of peripheral

Objective To investigatethe relationship between urinary catecholamine levels and type Ⅱ diabetic nephropathy and neuropathy. Methods Allsubjects were collected fromTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology,and were divided into two groups: type Ⅱ diabetic patients (For 24 h urine, n=130, aged 27-81 years old, 75 men, 55 female; for random urine, n=115, aged 27-77 years old, 75 men, 40 female) and healthy control (For 24 h urine, n=118, aged 27-76 years old, 67 men, 51 female; for random urine, n=93, aged 25-74 years old, 57 men, 36 female).Based on the results of urinary albumin excretion, type Ⅱ diabetic patients were prospectively divided into two independent groups: patients with nephropathy (For 24 h urine, n=37; for random urine, n=32) and patients without nephropathy (For 24 h urine, n=32; for random urine, n=35). According to questionnaires, quantitative sensory testing and autonomic function test, type Ⅱ diabetic patients were divided into two different groups: patients with neuropathy (For 24 h urine, n=31; for random urine, n=23) and patients without neuropathy (For 24 h urine, n=30; for random urine, n=35). Urinary catecholamines(CAs) levels, including epinephrine (E), norepinephrine (NE), dopamine (DA) and total catecholamines (total CAs) levels, were measured using liquid chromatography tandem mass spectrometry (LC-MS/MS). The CAs levels in different groups have been discussed. The results were analyzed using χ2 test, independent t test and Mann-Whitney non-parametric test. Results Type Ⅱ diabetic patients with nephropathy show lower E (0.74±0.24) μg/24 h, NE(9.22±4.02) μg/24 h, DA(64.77±21.68) μg/24 h and total CAs(74.72±25.65) μg/24 h in 24-hour urine in comparison with the group without nephropathy(For E, 4.23±0.50 μg/24 h, U=10, P<0.001; for NE, (32.31±1.74) μg/24 h, t=-2.72, P=0.011; for DA, (219.58±27.51) μg/24 h, t=-2.88, P=0.007; fro CAs, (256.02±30.65) μg/24 h, t=-3.02, P=0.005) and the differences were statistically significant (P<0.05). The differences of NE, DA and total CAs between type Ⅱ diabetic patients with nephropathyand without nephropathy were statistically significant in random urine(P<0.05). Conclusion These results suggested that urine CAs levels in diabetic patients with nephropathy is lower than that in patients without nephropathy, which may be related to the occurrence and development of diabetic nephropathy. Key words: Diabetic nephropathies; Diabetic neuropathies; Diabetes mellitus, type 2; Catecholamines; Chromatography, liquid; Tandem mass spectrometry

Objective To evaluate the clinical significance of quantitative sensory testing (QST) in screening diabetic peripheral neuropathy of the early stage. Methods One hundred patients with type 2 diabetes mellitus were examined by nerve conduction velocity (NCV) and QST examination. With the NCV positive as the gold criterion for screening diabetic peripheral neuropathy of the early stage, the sensitivity and specificity of QST was further analyzed for diagnosis of the early stage diabetic peripheral neuropathy. Results Among the 100 patients with type 2 diabetes mellitus,there were 41 cases positive and 59 cases negative in NCV examination. On the other hand,there were 74 cases positive,and 26 cases negative in QST. The sensitivity and specificity of QST for the diagnosis of early stage diabetic peripheral neuropathy was 97.56% (40/41) and 42.37% (25/59). Conclusions In the screening of early stage diabetic peripheral neuropathy,QST shows higher detection sensitivity,but lower specificity than NCV examination. Therefore, QST may be an examination for the supplement of the routine electromyography. Key words: Diabetic neuropathies; Sensitivity and specificity; Electromyography; Quantitative sensory testing

Objective To evaluate the relationship between 25-(OH) vitamin D [25-(OH) D] level and peripheral neuropathy in patients with type 2 diabetes mellitus.Methods Eighty patients with type 2 diabetes mellitus were enrolled in this cross-sectional study,including 37 subjects with and 43 without diabetic neuropathy.Anthropometric data was collected and serum levels of 25-(OH) D,HbA1c,blood lipid,and hepatic and renal functions were determined in all patients.Results Serum 25-(OH) D level was significantly lower in patients with diabetic neuropathy compared to those without neuropathy [(12.73 ± 4.68 vs 17.56 ± 5.28) ng/ml,P＜0.01].Logistic regressions demonstrated that vitamin D level was associated with diabetic neuropathy (OR=1.222,95％ CI 1.095-1.364).Conclusions Vitamin D insufficiency is associated with diabetic peripheral neuropathy.25-(OH) D level seems to be an independent risk factor of diabetic neuropathy in patients with type 2 diabetes mellitus. Key words: Diabetes mellitus, type 2 ; Diabetic peripheral neuropathy; Vitamin D

Objective To evaluate the efficacy of a pure Chinese herbal product, Rong Dan oral liquid, in intervention of diabetic peripheral neuropathy (DPN). Methods This was a prospective study from July 2013 to February 2014. Thirty-one patients with DPN-complicating type 2 diabetes, who visited Endocrinology clinic at the First Affiliated Hospital, Guangzhou Medical University and met the inclusion criteria, were included. In addition to their dietary modification, exercise program and hypoglycemic scheme, the patients received Rong Dan oral liquid (20 ml, 3 times daily) for 12 weeks. Michigan Neuropathy Screening Instrument (MNSI) symptom scores and nerve conduction velocity (NCV) were assessed to evaluate the efficacy of Rong Dan oral liquid in improving subjective symptoms and objective measures of DPN. Meanwhile, the body weight, blood pressure, heart rate, fasting plasma glucose (FPG) , glycosylated hemoglobin (HbA1c) , liver and kidney functions, ECG, lipid profile, fundus and albuminuria excretion of the patients were compared before and after treatment. Correlation analysis was used to determine the relationship between MNSI scores and NCV. Results After 12 weeks of intervention, patients showed various degree of symptomatic improvents in drying cracks skin, toe numbness, tingling, burning sensation and hyperesthesia compared with before the intervention. In particular, there were statistically significant differences in reduction of drying cracks skin (32.2% vs 87.1%) and hypersensitivity (3.2% vs 25.8% ) (both P 0.05). Urinary albumin excretion rate was reduced compared with that before the intervention [(1.09±0.62) μg/min vs (1.27±0.67) μg/min, P=0.001]. Correlation analysis showed that MNSI scores were negatively correlated with and NCV (r=-0.429, P=0.05). Conclusion Rong Dan oral liquid may help improve a number of symptoms related to DPN, especially in dry/cracking skin and hyperesthesia of the feet. To a certain extent, Rong Dan oral liquid may also effectively improve the nerve conduction velocity at affected sites of the body, and reduce urinary albumin excretion rate. Rong Dan oral liquid is well-tolerated. Key words: Dan Rong oral liquid; Diabetic neuropathy; Michigan neuropathy screening instrument; Nerve conduction velocity

Objective To evaluate the efficacy and clinical value of the neuropathy symptom score/neuropathy disability score (NSS/NDS) compared with nerve conduction velocities (NCV) in the diagnosis of diabetic peripheral neuropathy (DPN). Methods Observational study of 679 patients diagnosed with type 2 diabetes mellitus (404 males and 275 females, the average age was (59±11) years) was performed using the standard NSS/NDS and NCV criteria for the diagnosis of DPN. Taking NCV as the gold standard, we compared NCV against NSS/NDS using the following parameters: sensitivity, specificity, positive and negative predictive values, Youden index, Kappa value and correlation. Correlation analysis was done by using Spearman correlation and multivariate logistic regression. Results The sensitivity, specificity, positive and negative predictive values, Youden index, Kappa value and correlation of NSS/NDS compared with NCV was 68.0%, 77.2%, 86.5%, 53.5%, 71.0%, 45.2%, 0.405, 0.424, respectively. The abnormal rate of NCV of patients was more remarkable when NSS score ≥5 or NDS score ≥6 (77.8%-100%). NSS and NDS demonstrated an obvious positive association with NCV(r=0.292, 0.358, both P<0.01). The NCV values for each nerve showed a negative correlation with the severity of symptoms and signs. Logistic regression analysis showed that the risk factors of DPN were disease duration, age and urinary albumin-to-creatinine ratio when NSS/NDS were considered as the diagnostic criteria(odds rations(OR)=1.085, 1.051, 1.002, all P<0.01). A similar result was observed with NCV. Conclusions NSS/NDS demonstrates a positive association with NCV, especially when neurological symptoms and neurological signs became more serious. NSS/NDS analysis is a simple, rapid, cheap and powerful screening tool for the diagnosis of DPN. Key words: Diabetes mellitus, type 2; Diabetic neuropathies; Neuropathy symptom score/neuropathy disability score; Nerve conduction velocities

Objective To study the effect of alprostadil combined with epalrestat and methylcobalamin in the treatment of type 2 diabetic peripheral neuropathy. Methods From January 2014 to June 2016, 120 patients with type 2 diabetic peripheral neuropathy in the First People′s Hospital of Baiyin were randomly divided into two groups according to the random number table method.64 patients of the observation group were given the treatment of alprostadil, epalrestat combined with methylcobalamin.56 patients of the control group were given the treatment of alprostadil and methylcobalamin.And the two groups were treated for 4 weeks.The blood glucose, clinical symptoms, adverse reaction, nerve conduction velocity index were compared between the two groups before and after treatment. Results The fasting blood glucose and 2-hour postprandial blood glucose of the two groups after treatment were significantly decreased(t=18.20, 17.61, 15.75, 23.69, all P 0.05). Conclusion Alprostadil combined with epalrestat and methylcobalamin in the treatment of type 2 diabetic peripheral neuropathy has good effect. Key words: Diabetic neuropathies; Alprostadil; Epalrestat; Methylcobalamin

Objective To investigate the relationship between retinal nerve fibre layer (RNFL) thickness and peripheral neuropathy in patients with type 2 diabetes. Methods Ninety-eight cases diagnosed with type 2 diabetes in the Department of Endocrinology in Beijing Hospital from March 2014 to June 2015 were enrolled in this study. Global and sectoral RNFL thicknesses were measured at 3.45 mm diameter around the optic nerve head using optical coherence tomography(OCT), and conduction velocity of peripheral nerve was measured in all cases. According to the diagnosis of diabetic neuropathies, participants were divided into 3 groups: non-diabetic peripheral neuropathy group(NDPN, n=36), subclinical diabetic peripheral neuropathy group(SDPN, n=37) and define diabetic peripheral neuropathy group(DDPN, n=25). RNFL thickness in different group was compared by analysis of variance and least-significant difference pairwise comparison. Results All sectoral RNFL thickness was thinning from NDPN group, SDPN group to DDPN group, specially inferior quadrant RNFL thickness, and there was significant difference among the three groups((132±19), (124±18) vs (116±17)μm, F=5.848, P=0.004). And significant difference was found in inferior quadrant RNFL thickness between NDPN and SDPN group(mean difference=8.67 μm, t=1.975, P=0.048), NDPN and DDPN group (mean differenc=16.59 μm, t=3.412, P=0.001). No significant difference was found in inferior quadrant RNFL thickness between SDPN and DDPN group(mean difference=7.93 μm, t=1.661, P=0.104). Covariance analysis showed that age and diabetes duration had no significant influence on RNFL thickness. Conclusions RNFL thickness maybe associated with diabetic peripheral neuropathy in patients with type 2 diabetes, especially in serious cases. Key words: Diabetes mellitus, type 2; Retinal nerve fibre layer; Diabetic peripheral neuropathy

Objective To observe the effect of alpha lipoic acid on quality of life in patients with type 2 diabetic peripheral neuropathy. Methods 76 cases diagnosed with type 2 diabetic peripheral neuropathy,in accordance with the random number table,were divided into the control group(37cases) and treatment group(39cases).All the patients received diabetic diet,exercise guidance and blood glucose control.The control group was treated with methycobal 500μg muscle injection once a day for 2 weeks.The treatment group was treated besides above treatment with intravenous drip alpha lipoic acid 600mg once a day was added for 2 weeks.Then,the changes of motor nerve conduction velocity,sensory nerve conduction velocity and quality of life(QoL) score(somatic symptoms,cognitive function, health happy feeling,social participation,emotional state,work performance,life satisfaction and total score)of the two groups after treatment were observed. Results After treatment,the motor nerve conduction velocity of the control group were as follows:median nerve(40.7±4.5)cm/s,common peroneal nerves(41.3±4.9)cm/s,The sensory nerve conduction velocity of the control group were as follows:median nerve(38.6±4.3)cm/s,common peroneal nerves (38.3±4.5)cm/s.After treatment,the motor nerve conduction velocity of the treatment group were as follows:Median nerve(45.4±5.7)cm/s,common peroneal nerves(44.9±6.4)cm/s,The sensory nerve conduction velocity of the treatment group were as follows:Median nerve(45.0±2.0)cm/s,common peroneal nerves(43.6 ±3.2)cm/s.Both the two groups' motor nerve conduction velocity and sensory nerve conduction velocity were significantly increased after treatment(P< 0.05).Compared with control group,the motor nerve conduction velocity and sensory nerve conduction velocity in the treatment group were significantly improved after treatment,which had statistically significance,(t= 2.63,2.51,2.85,2.79,all P< 0.05).After treatment,the somatic symptoms,cognitive function,health happy feeling,job performance,social participation,emotional state,life satisfaction and the total score of control group were(52.4±9.6)points,(27.0±7.8) points,(35.7±10.3) points,(19.6±7.3) points,(17.4±3.1) points,(16.5±3.9) points,(185.4±40.7)points,respectively.After treatment,the somatic symptoms,cognitive function,health happy feeling,job performance,social participation,emotional state,life satisfaction and total score of treatment group were(41.9±7.4) points,(24.1±8.6) points,(28.3±9.2) points,(14.5±5.5) points,(12.6±5.6) points,(11.9±4.7)points,(135.0±38.7)points,respectively.The quality of life score of the treatment group was obviously lower than the control group,which had statistically significance,(t= 5.14,2.54,2.96,2.87,2.69,3.05,6.25, all P<0.05). Conclusion Alpha lipoic acid can improve the nerve conduction function of patients with type 2 diabetes peripheral neuropathy,and improve the quality of life. Key words: Diabetic neuropathies; Quality of life; Alpha lipoic acid

Associations between lower urinary tract dysfunction and glycemic control in women with type 2 diabetes: A cross-sectional study

Objective To investigate the clinical effect and safety of alpha lipoic acid injection combined mecobalamin and prostaglandin E on type 2 diabetic patients complicated with diabetic peripheral neuropathy(DPN).Methods One hundred and sixty type 2 diabetic patients complicated with DPN in the General Hospital of Benxi Iron and Steel Group Corporation from Jan.2011 to Dec.2012 were randomly divided into the treatment group(n =80) and the control group (n =80).Three cases of the treatment group and 5 cases of the control group discharged early from the study because of their own reasons.There were 77 cases in the treatment group and 75 cases in the control group.On the basis of controlling blood glucose,patients in the two groups were given 500 μg mecobalamin combined with intramuscular injection once two days,as well as prostaglandinE 10 μg injection once a day.Patients in treatment group were added with 600 mg alpha lipoic acid for intravenous injection once a day for 10-14 days.Total symptom score (TSS),nerve conduction velocity,satisfaction and adverse reactions were evaluated before and after treatment.Results TSS score,tingling score,burning sensation score and hypoesthesia score,numb score in treatment group were (3.5 ± 2.5),(1.1 ± 0.4),(0.9 ± 0.7),(1.3 ± 0.4),(1.3 ± 0.9),significantly lower than those in control group (4.3 ± 2.1,t =2.11,P ＜0.05;1.5 ±0.5,t =1.86,P＜0.05;1.3 ±0.5,t =1.83,P ＜0.05;1.7 ±0.5,t =1.87,P ＜0.05; 1.9 ± 0.4,t =1.91,P ＜ 0.05).The median nerve conduction velocity,peroneal nerve motor conduction velocity,median nerve sensory conduction velocity,common peroneal nerve sensory conduction velocity of patients in treatment group were (53.6 ± 1.4) m/s,(49.6 ± 1.1) m/s,(47.3 ± 1.1) m/s,(48.2 ± 1.9) m/s,lower than those in control group((48.5 ±2.7) m/s,t =-4.94,P ＜0.05;(43.9 ±2.1) m/s,t =-5.36,P ＜0.05; (41.6 ± 1.8) m/s,t =-5.09,P ＜0.05;(43.2 ±2.5) m/s,t =-4.27,P ＜ 0.05,P ＜0.05).In the treatment group,97.4％ (75/77) physicians and 92.2％ (71/77) patients were satisfied with treatment effect,while in the control group,84.0％ (63/75) physicians and 78.7％ (59/75) patients were satisfied with treatment effect.During the study periods,there were 3 cases with facial flushing and 1 cases of dizziness in the treatment group,and 2 cases of facial flushing and 1 cases of dizziness in the control group.All adverse reactions were spontaneous remission without any special treatment.Conclusion Alpha lipoic acid intravenous drip is effective in term of treating type 2 diabetic peripheral neuropathy,and with high safety. Key words: Type 2 of diabetic mellitus; Diabetic peripheral neuropathy; Alpha lipoic acid; Mecobalamin; Prostaglandin E

Objective To analyze the characteristics of nerve damage in diabetic peripheral neuropathy by ultrasound and neuroelectrophysiological techniques and provide a basis for early diagnosis and treatment of diabetic peripheral neuropathy. Methods From January 2016 to May 2018, 225 patients with type 2 diabetes admitted to the hospital were divided into DPN group (110 cases) and non-diabetic peripheral neuropathy (NDPN) group (115 cases),and 120 healthy volunteers were as controls. Ultrasound and nerve conduction velocity(NCV) were used to analyze the characteristics of nerve damage in diabetic peripheral neuropathy(DPN). Results Among the three study groups, the sensory nerves conduction velocity and motor nerves conduction velocity of the ulnar nerve, median nerve, and common peroneal nerve were significantly reduced in the DPN group. But in the same group,the ulnar nerve, median nerve, and common peroneal nerve cross-sectional area (CSA) was significantly increased [(8.68 ± 1.89) mm2 vs. (6.79 ± 1.69) and (5.82 ± 1.57) mm2, (10.59 ± 1.82) mm2 vs. (7.98 ± 1.97) and (7.25 ± 1.71) mm2, (21.24 ± 2.53)mm2 vs. (16.54 ± 2.49) and (15.40 ± 2.20) mm2]. In the measurement of sensory nerve conduction velocity, the abnormalities of ulnar nerve, median nerve and common peroneal nerve were significantly higher than thoseof motor nerve [34.54%(38/110) vs. 18.18%(20/110), 36.36%(40/110)vs. 20.90%(23/110), 52.72%(58/110) vs. 20.00%(22/110)]. In ultrasound and SCV, the proportion of ulnar nerve and median nerve injury was higher in patients aged 45 years or older or patients over 10 years of course (P 4 mmol/L. Conclusions DPN affects sensory nerves first, and the proportion of injury is significantly higher than that of motor nerves; lower limb nerves are more susceptible to damage, compared with upper limb nerves; patients aged 45 years or older or patients with course over 10 years have a higher proportion of ulnar nerve and median nerve damage; patients with larger MAGE (> 4 mmol/L) have a higher proportion of median nerve damage. The characteristics above can provide an effective basis for the prevention, diagnosis and treatment of DPN. Key words: Ultrasonography; Diabetic neuropathies; Mean amplitude of glycemic excursions; Nerve conduction velocity; Cross sectional area