Abstract
Aim: Diabetic symmetrical peripheral neuropathy is a common complication of diabetes mellitus. Patients treated with transcutaneous CO2 application for chronic wounds reported an improvement in peripheral sensations. This study aimed to evaluate the effect of transcutaneous application of gaseous CO2 on diabetic symmetrical peripheral neuropathy. Methods: A prospective randomized, double-blind study was performed at the University Medical Center Ljubljana between September 2019 and September 2020. Sixty consecutive patients with diabetes with a unilateral chronic wound were randomized into either a study group that received transcutaneous CO2 therapy or a control group that received placebo treatment with air. Results: Vibration, monofilament sensation, and temperature of the big toe improved significantly in the study group (p < 0.001, for vibration sensation, monofilament test and temperature of the big toe), but not in the control group (p = ns for all evaluated outcomes). Conclusion: According to our results, a transcutaneous application of gaseous CO2 shows promising results in treating diabetic symmetrical peripheral neuropathy. Considering the major consequences of sensory loss leading to foot ulceration and possibly amputation, we believe this treatment approach deserves future attention and investigation as a treatment modality of diabetic symmetrical peripheral neuropathy.
Highlights
Diabetic symmetrical peripheral neuropathy (DSPN) is a well-known complication of diabetes mellitus types 1 and 2 [1,2,3,4]
Considering the major consequences of sensory loss leading to foot ulceration and possibly amputation, we believe this treatment approach deserves future attention and investigation as a treatment modality of diabetic symmetrical peripheral neuropathy
Results show that before the treatment, the mean values of vibration sensation, monofilament test and big toe temperature were comparable between the groups (p vibration ac = 0.841; p monofilament ac = 0.127; p temperature ac = 0.415)
Summary
Diabetic symmetrical peripheral neuropathy (DSPN) is a well-known complication of diabetes mellitus types 1 and 2 [1,2,3,4]. Symptoms may be diverse, depending on the affected nerve fibers [5]. As the impairment of nerve fibers progresses, patients typically complain of numbness, tingling, pain, weakness, and hypoand hyperesthesia; the latter two begin in the feet and spread in a stocking distribution. The major underlying cause of DSPN is hyperglycemia, dyslipidemia plays an important role in diabetes mellitus type 2 [7]. Nerve blood flow impaired due to hyperglycemia increases oxidative stress and inflammation, usually first affecting small-diameter sensory nerves responsible for temperature sensation and painless injury [5,6,8]. The impairment of large fiber sensory nerves responsible for kinesthetic senses of joints and vibration is exhibited in decreased ankle reflexes and a loss
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