Percussion Entropy Analysis of Synchronized ECG and PPG Signals as a Prognostic Indicator for Future Peripheral Neuropathy in Type 2 Diabetic Subjects.

Hai-Cheng Wei,Sheng-Ying Wang,Na Ta,Wen-Rui Hu,Hsien-Tsai Wu,Ming-Xia Xiao,Jian-Jung Chen,Xiao-Jing Tang

doi:10.3390/diagnostics10010032

Abstract

Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes. It has become an essential public health crisis, especially for care in the home. Synchronized electrocardiogram (ECG) and photoplethysmography (PPG) signals were obtained from healthy non-diabetic (n = 37) and diabetic (n = 85) subjects without peripheral neuropathy, recruited from the diabetic outpatient clinic. The conventional parameters, including low-/high-frequency power ratio (LHR), small-scale multiscale entropy index (MEISS), large-scale multiscale entropy index (MEILS), electrocardiogram-based pulse wave velocity (PWVmean), and percussion entropy index (PEI), were computed as baseline and were then followed for six years after the initial PEI measurement. Three new diabetic subgroups with different PEI values were identified for the goodness-of-fit test and Cox proportional Hazards model for relative risks analysis. Finally, Cox regression analysis showed that the PEI value was significantly and independently associated with the risk of developing DPN after adjustment for some traditional risk factors for diabetes (relative risks = 4.77, 95% confidence interval = 1.87 to 6.31, p = 0.015). These findings suggest that the PEI is an important risk parameter for new-onset DPN as a result of a chronic complication of diabetes and, thus, a smaller PEI value can provide valid information that may help identify type 2 diabetic patients at a greater risk of future DPN.

Highlights

The prevention and early detection of diabetes mellitus (DM) in high-risk subjects such as those with metabolic syndrome have become important issues in preventive medicine and public health [1,2].As for type 2 diabetic patients, the outcomes of microvascular and macrovascular complications can be Diagnostics 2020, 10, 32; doi:10.3390/diagnostics10010032 www.mdpi.com/journal/diagnosticsDiagnostics 2020, 10, 32 grievous
From the viewpoint of data analysis, we propose that some of the above parameters (i.e., low-/high-frequency power ratio (LHR), MEISS, MEILS, PWVmean, and percussion entropy index (PEI)) could present highly significant differences between diabetic patients who underwent a synchronized ECG and PPG signals testing at baseline during the early stages of disease; these patients were followed for a further six years, with and without Diabetic peripheral neuropathy (DPN)
It is worth mentioning that PEI [21,22] has recently been introduced to assess the complexity of baroreflex sensitivity (BRS), while the significance of smaller PEI values concerning the identification of subjects with type 2 diabetes who are more prone to developing diabetic neuropathy is unknown

Summary

Introduction

The prevention and early detection of diabetes mellitus (DM) in high-risk subjects such as those with metabolic syndrome have become important issues in preventive medicine and public health [1,2].As for type 2 diabetic patients, the outcomes of microvascular and macrovascular complications can be Diagnostics 2020, 10, 32; doi:10.3390/diagnostics10010032 www.mdpi.com/journal/diagnosticsDiagnostics 2020, 10, 32 grievous. As for type 2 diabetic patients, the outcomes of microvascular and macrovascular complications can be Diagnostics 2020, 10, 32; doi:10.3390/diagnostics10010032 www.mdpi.com/journal/diagnostics. To avoid developing a severe condition, blood glucose control is the most important issue for type 2 diabetic patients [6,7,8]. This is not easy to achieve, which is the reason many researchers have tried to develop some non-invasive methods and instruments [9] for type 2 diabetic patients to avoid the increased risk of developing atherosclerosis and autonomic nervous dysfunction [10,11,12,13]

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