Neuropathy Complications Research Articles

Epidemiology of diabetes phenotypes and prevalent cardiovascular risk factors and diabetes complications in the National Health and Nutrition Examination Survey 2003–2014

AimsTo characterize unique diabetes phenotypes among National Health and Nutrition Examination Survey (NHANES) participants and assess associations with race/ethnicity, cardiovascular disease (CVD) risk factors, and prevalent complications. MethodsWe included participants (age ≥ 20 years) from NHANES exams 2003–04 through 2013–14 with diabetes (self-report of diabetes diagnosis or medication use, fasting glucose ≥7.0 mmol/L, random glucose ≥11.1 mmol/L, and glycated hemoglobin (HbA1c) ≥ 48 mmol/mol). We used k-means clustering to characterize unique diabetes subgroups based on data for age of diabetes diagnosis, body mass index (BMI), waist circumference, HbA1c, and years of insulin use. We estimated subgroup prevalence of CVD risk factors and microvascular complications, accounting for demographics and survey sampling. ResultsAmong 4300 adults with diabetes, we identified four unique subgroups of diabetes related to aging (AR, 51.3%), severe obesity (SO, 30.3%), severe hyperglycemia (SH, 12.5%), and young adulthood-onset (YA, 5.9%). We observed differences in subgroup proportion by race/ethnicity. Compared to the AR phenotype, all groups had higher HbA1c and BMI, the YA and SO groups had greater blood pressure, and the YA group had greater prevalence of renal, eye, and neuropathy complications. ConclusionsWhether consideration of diabetes phenotypes with treatment strategies reduce diabetes incidence, morbidity, and mortality merits evaluation.

Accelerated Cortical Osteolysis of Metatarsals in Charcot Neuroarthropathy: A Cross-Sectional Observational Study.

ABSTRACTMetatarsals are frequent sites of stress and fragility fractures in younger athletic populations and aging older adults. Metatarsal fractures are particularly common in Charcot neuroarthropathy (CN), a complication of diabetes mellitus (DM) and peripheral neuropathy (PN). Neuropathic metatarsal fractures may be caused by an accelerated cortical bone osteolysis and may be reflected as geometric‐derived strength estimates from standard foot radiographs. The purpose of this cross‐sectional study was to determine geometry and strength‐derived estimates of the metatarsals in individuals with DM, PN, and CN compared with younger and older adult controls who were nondiabetic and nonneuropathic. We studied 62 participants: 20 young adult controls (YACs), 22 older adult controls (OACs), and 20 diagnosed with DMPN&CN. From weight‐bearing radiographs, we measured the outer diaphysis diameter and inner marrow diameter at the distal, middle, and proximal diaphysis sites of the second and fifth metatarsal. From these diameters, we derived strength estimates of combined cortical width (CCt.Wi), percent cortical area (%Ct.rA), buckling ratio (BR), moment of inertia (MOI), and section modulus (SM) at each site in both metatarsals. DMPN&CN participants had an accelerated cortical thinning, decreased %Ct.Ar, increased BR, and lower MOI and SM compared with OACs and YACs. The OACs showed age‐related decreases in CCt.Wi and % Ct.Ar, and increased BR. The BR demonstrated significant group × bone × site interaction with the distal fifth metatarsal in the DMPN&CN group having the lowest bone strength. The BR in the distal fifth metatarsal of DMPN&CN participants was 36% and 49% greater than in the OAC and YAC groups, respectively. DMPN&CN participants have lower metatarsal bone strength estimates compared with younger and older adult controls. Standard foot radiographs demonstrate an accelerated cortical osteolysis in DMPN&CN individuals, particularly in the distal fifth metatarsal diaphysis. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Diabetic Muscle Infarction: A Rare End-Organ Vascular Complication of Diabetes

Diabetic muscle infarction (DMI) is a rare microvascular complication of spontaneous ischemic necrosis of skeletal muscle in patients with poorly controlled diabetes. We herein describe the case of a 26-year-old woman with a history of type I diabetes and accompanying diabetic microvascular complications of neuropathy, nephropathy and retinopathy, who presented with sudden onset of swelling and sharp pain in her bilateral thighs. T2-weighted MRI imaging revealed subcutaneous edema and sub-fascial, hyper-intense enhancement of proximal thigh musculature. DMI has a relatively non-specific clinical presentation; therefore, physician awareness is key for early diagnosis, as aggressive management has been associated with poor patient outcomes. With poor long-term prognosis and high reoccurrence, DMI acts as an indicator of vascular end-organ damage.

The Impact of Pregnancy and Parity on Type 1 Diabetes Complications.

The potential influence of pregnancy and parity on the risk of chronic diabetic complications is a matter of great concern and constant discussion. This aspect seems relevant and should be the subject of thorough discussion with the woman planning childbirth. Current data concerning the impact of pregnancy and parity covers primarily retinopathy and nephropathy, while the aspects of neuropathy and macrovascular complications are unsatisfactorily documented. Majority of studies focus on single complication only, while the number of papers assessing this problem in a complex setting is limited. The available body of evidence concerns mainly the short-term impact of pregnancy on diabetic chronic complications while the data concerning the longer perspective are scarce. Moreover, the results found in the available literature are conflicting. The aim of the study was to summarize all available data concerning the longer impact of parity on the chronic complications in the women with type 1 diabetes. PubMed database has been searched between October 2013 and September 2018 and all relevant papers were selected. This review summarizes data on the impact of pregnancy and parity on chronic complications in type 1 diabetic women. Current data assessing this matter in a complex way are limited, and the available results are controversial. It seems however that pregnancy itself may rather influence pre-existing diabetic complication than affect risk of its development. Additionally, evidence suggests that any deleterious changes appearing during pregnancy are transient and tend to remit after delivery. It seems that neither pregnancy nor parity affects the risk of diabetic chronic complications in the longer perspective.

An atypical and bilateral presentation of Charcot foot disease

BackgroundCharcot neuropathic osteoarthropathy (CNO) is one of the most devastating complications of neuropathy in patients with diabetes. Establishing diagnosis of CNO is difficult, due to the lack of clear clinical and radiological diagnostic criteria. Diagnosis is even more difficult when there is atypical and bilateral clinical presentation. Since CNO may lead to foot deformity, lower-extremity amputation and significant decrements in quality of life, it must be detected and treated without delay. Treatment focuses mainly on interruption of the inflammatory process and relief from pain using feet offloading devices. In more severe cases, surgical intervention may be needed. Additionally, the use of custom-made insoles and custom-made orthopaedic shoes is mandatory.Case presentationWe report a case of a young diabetic patient who presented to our clinic with bilateral and atypical presentation of Charcot foot disease. Patient was treated successfully upon diagnosis with bilateral aircast offloading. Unfortunately, due to depression and non-compliance, the disease progressed to severe and permanent lesions later on.ConclusionDespite the rareness of this disease, clinicians must include CNO into differential diagnosis of diabetic foot oedema, inflammation and deformity.

A cross-sectional study to evaluate diabetes management, control and complications in 1631 patients with type 2 diabetes mellitus in Vietnam (DiabCare Asia)

AimsTo assess diabetes care delivery and prevention of short- and long-term diabetes-related complications in patients with type 2 diabetes mellitus (T2DM) in Vietnam.MethodsDiabCare Asia is an observational, non-interventional, cross-sectional study of hospital-based outpatient care for patients diagnosed with T2DM.ResultsA total of 1631 patients (mean age 62.7 years; 58.9% female) participated in the study. The percentage of patients with HbA1c < 7.0% (< 53 mmol/mol) was 36.1% and mean (standard deviation) HbA1c was 7.9 ± 1.8% (63 ± 19 mmol/mol). The proportion of patients using insulin was 40%, at a mean total daily dose of 35.4 U. Apart from dyslipidemia (81.2%) and hypertension (78.4%), the most common diabetes-related complications were peripheral neuropathy (37.9%) and eye complications (39.5%). Current insulin therapy was associated with peripheral vascular disease (odds ratio [OR] = 2.28 [95% confidence interval (CI) 1.68; 3.09]) and eye complications (OR = 1.70 [95% CI 1.37; 2.11]).ConclusionIn this sample of patients with T2DM in Vietnam, the majority had poor glycemic and metabolic control. Concerted efforts are needed to optimize control and prevent complications in these patients. Trial registration: NCT02066766

Comparison of the effect of two therapeutic exercises on the inflammatory and physiological conditions and complications of diabetic neuropathy in female patients.

Introduction and aimThe purpose of this study was to compare the effect of 12 weeks of low-intensity resistance training and exercises for peripheral neuropathy (EPN) on the inflammatory and physiological conditions, balance, and complications of diabetic neuropathy in female patients.Materials and methods45 women with mild to moderate diabetic neuropathy and an average age of 55.46±3.06 years voluntarily participated in the study. They were randomly assigned to either control (n=15), resistance (n=15), and EPN (n=15) groups. Both experimental groups were trained for 12 weeks (three sessions per week). EPN group did peripheral neuropathic exercises (12 lower extremity movements), and the resistance group performed their exercises with a 30% repetition maximum. During the intervention period, the control group only performed their daily activities. Blood samples were taken in both pre-test and post-test to investigate the levels of Tumor necrosis-α (TNF-α), Interleukin-10 (IL-10), C Reactive Protein (CRP), fast blood glucose (FBG) and Glycated hemoglobin (HbA1c). Complications of diabetic neuropathy were measured using the Michigan questionnaire and the Monofilament 10 g. In order to measure the balance, De Morton mobility index (DEMMI) was used.ResultsThe statistical analyses showed a significant decrease of FBG and HbA1c in the two experimental groups, as compared to the control group. TNF-α and CRP levels were decreased in both EPN and resistance groups, as compared to the control group. The observed increase in the serum IL-10 levels of the two experimental groups was not, however, significant, as shown in intra-group and inter-group comparisons. On the other hand, the two complications of pain and tingling in the lower limb extremities were improved in both experimental groups (p<0.05). However, the numbness complication showed no significant change (p=0.10). Static and dynamic balance was improved in the EPN group as well (p<0.05).ConclusionSince EPN exercises, in contrast to resistance exercises, are focused on the lower limb extremities and designed for diabetic neuropathy patients, they can improve the imbalance, pain and tingling, by significantly reducing TNF-α and CRP and improving the physiological conditions.

Early diagnosis of diabetic cardiac autonomic neuropathy by method of high-frequency ultrasonic dopplerography

Introduction. Diabetic neuropathy is the most wide-spread complication of diabetes mellitus and neuropathy is steadily progressing even with compensation of the underlying disease. The search of the new methods of treatment and diagnosis of neuropathy is required. Diabetic autonomic neuropathy lies in the base of early morbidity and mortality of diabetic patients.We estimated the potential of High-frequency Ultrasonic Dopplerography for diagnosis of autonomic neuropathy. Material and methods. 26 diabetic patients with sensorimotor neuropathy were examined. Microvascular blood flow of finger skin was assessed at rest as well as in functional tests: with cold impact and occlusion (cuff). Cardiac autonomic neuropathy was assessed using several cardiovascular autonomic reflex tests as a gold standard of diagnosis. Diagnostic values of microvascular blood flow test in detecting of cardiac autonomic neuropathy staging were evaluated in comparing with traditional modalities.Results. Cardiac autonomic neuropathy was found for all patients and definite/confirmed staging in 61.5 % cases. Initial parameters of microvascular blood flow velocity were significantly decreased in all patients in comparing with control (Vam= = (1.9±0.22); (1.7±0.51) and (6.7±0.51) sm/s in patients with early cardiac autonomic neuropathy, definite/confirmed staging and control subjects respectively, p&lt;0.05). Microvascular blood flow functional testes had great informational content for diagnosis of autonomic neuropathy (sensitivity – 100 and 58 %, specify – 50 and 80 % respectively). The algorithm of diabetic patients examination was offered for early diagnosis of autonomic neuropathy staging.Conclusions. High-frequency Ultrasonic Dopplerography allowed to separate of cardiac autonomic neuropathy stages. This study is necessary to continue for revealing of all method possibilities.

Rehabilitation technology for self-care: Customised foot and ankle exercise software for people with diabetes.

AimsTo develop and validate the content of a free web-based software (desktop and mobile applications) for the self-management of and customised foot-ankle exercises for people with diabetes and diabetic neuropathy.MethodsThe development of the programme was based on gamification principles and addressed three main areas: foot care recommendations; self-assessment of feet according to the main complications of diabetic neuropathy; and customised foot-ankle exercises to strengthen muscles, increase the range of motion and improve functionality. The content was validated using the Delphi methodology and a quantitative approach in two rounds with diabetes specialists (n = 9) and users with diabetes (n = 20). A 70% approval rate was considered sufficient in the second round for final validation purposes. The data analysis was conducted using descriptive statistics, absolute and relative frequencies and the content-validity index (CVI).ResultsAmong specialists, the CVI was 0.812 after the first round, and final approval was 100% after the second round. Among users, the CVI was 0.902 in the first round, and the final approval was 97%.ConclusionThis free access web software was developed based on the high agreement rating between specialists and users and has the potential to prevent complications arising from diabetic polyneuropathy. It allows for self-monitoring and promotes personalised exercises, following a preventive model that can be applied in primary and secondary care services as a complementary treatment for chronic complications. However, further steps to validate the software in a larger population are recommended.

The Role of the Autonomic Nervous System on Cardiac Rhythm during the Evolution of Diabetes Mellitus Using Heart Rate Variability as a Biomarker.

Heart rate variability (HRV) is highly influenced by the Autonomic Nervous System (ANS). Several illnesses have been associated with changes in the ANS, thus altering the pattern of HRV. However, the variability of the heart rhythm is originated within the Sinus Atrial Node (SAN) which has its own variability. Still, although both oscillators produce HRV, the influence of the SAN on HRV has not yet been exhaustively studied. On the other hand, the complications of diabetes mellitus (DM), for instance, nephropathy, retinopathy, and neuropathy, increase cardiovascular morbidity and mortality. Traditionally, these complications are diagnosed only when the patient is already suffering from the negative symptoms these complications implicate. Consequently, it is of paramount importance to develop new techniques for early diagnosis prior to any deterioration on healthy patients. HRV has been proved to be a valuable, noninvasive clinical evidence for evaluating diseases and even for describing aging and behavior. In this study, several ECGs were recorded and their RR and PP intervals were analyzed to detect the interpotential interval (ii) of the SAN. Additionally, HRV reduction was quantified to identify alterations in the nervous system within the nodal tissue via measuring the SD1/SD2 ratio in a Poincaré plot. With 15 years of DM development, the data showed an age-dependent increase in HRV due to the axon retraction of ANS neurons from its effectors. In addition, these alterations modify the heart rhythm-producing fatal arrhythmias. Therefore, it is possible to avoid the consequences of DM identifying alterations in SAN previous to its symptomatic appearance. This could be used as an early diagnosis indicator.

Effect of voluntary exercise on intracellular signalling pathways of angiogenesis in the sciatic nerve of type 1 diabetic castrated male rats.

Impaired angiogenesis in sciatic nerve is a major complication of diabetic neuropathy. Protein kinase B (AKT) and extracellular signal regulated kinase (ERK) signaling pathways play critical roles during capillary-like network formation in the angiogenesis process. Twenty-four adult male Wistar rats (weight: 250-300g) were used in the research. The rats were randomly divided into four groups (n = 6): (1) diabetic (Dia), (2) diabetic + castration (Dia-Cas), (3) diabetic + exercise (Dia-E), and (4) diabetic + castration + exercise (Dia-Cas-E). Type 1 diabetes (T1D) was induced with streptozotocin (50mg/kg). After 6 weeks, sciatic nerve was separated and used for histological evaluation and determination of phosphorylated AKT (P-AKT) and phosphorylated ERK (P-ERK) levels by ELISA method. Glucose levels decreased in the Dia-E group compared to the Dia-Cas group (p < 0.01). In addition, our finding shows that exercise in the Dia-Cas group diminished blood glucose levels compared to the Dia-Cas group but this effect of exercise was not significant. Voluntary exercise in the diabetic castrated group decreased P-AKT protein and increased P-ERK 1/2 protein levels in the sciatic tissue compared to the diabetes group significantly (p < 0.05). Histopathological findings showed that Dia-Cas group with 6-week exercise training significantly raised the number of microvascular density in the sciatic tissue of diabetic rats compared to the diabetic group (p < 0.05). Voluntary exercise in diabetic rats increases angiogenesis in the sciatic nerve. The possible mechanism is the increase of P-ERK 1/2 but not P-AKT levels in the sciatic nerve of T1D rats.

Abstract P074: Epidemiology of Diabetes Phenotypes and Association with Cardiovascular Risk in the National Health and Nutrition Examination Survey (NHANES)

Introduction: A recent study among Scandinavian adults identified novel unique diabetes phenotypes using data on traditional diabetes characteristics. Our objective was to assess whether unique diabetes phenotypes are present in a multi-ethnic US sample and, if so, are differentially associated with cardiovascular disease (CVD) risk factors. Methods: We included 4300 NHANES participants (age ≥20 years) from exams 2003-04 to 2013-14 identified as having diabetes by any of the following: self-report of previous diabetes diagnosis, self-report of diabetes medication use, fasting glucose ≥126 mg/dL (≥8 hours fasting), random glucose ≥200 mg/dl, and glycated hemoglobin (HbA1c) ≥6.5%. We used an iterative data-driven method ( k- means clustering) to partition the sex-stratified sample into unique groups based on data for each of the following: self-reported age of diabetes diagnosis, body mass index (BMI), waist circumference, HbA1c, and years of insulin use. We estimated the association between diabetes subgroup with traditional CVD risk factors, accounting for demographics and NHANES sampling methods. Results: We identified four unique subgroups of diabetes phenotypes related to age (AR), insulin use (IU), severe obesity (SOR), and severe hyperglycemia (SHG). Of the 4300 diabetes cases, 51.3% were AR, 5.9% were IU, 30.3% were SOR, and 12.5% were SHG (Table). We observed differences in subgroup prevalence by race/ethnicity. Compared to the AR phenotype, all groups had higher HbA1c and BMI, the IU and SOR groups had greater blood pressure and cholesterol medication use, and the IU group had worse profiles for renal, eye, and neuropathy complications. Conclusion: Our findings corroborate that diabetes is a heterogeneous disease with unique subgroups and, a novel aspect of our work, differentially distributed across race/ethnicity. Our findings challenge whether diabetes prevention and treatment strategies should be reconsidered to phenotype-specific in order to reduce diabetes incidence, morbidity, and mortality.

Vitamin D Deficiency in Patients with Diabetic Peripheral Neuropathy

Objective: To determine the frequency of vitamin D deficiency in patients presenting with diabetic peripheral neuropathyPatients and Methods: This cross sectional study was carried out in Department of Medicine and Neurology Indus Medical College, Tando Muhammad khan. from March 2017 to August 2017. Total 74 cases of Diabetes Mellitus presenting with peripheral diabetic neuropathy were selected for the study. Evolution of degree of Neuropathy was based on TCSS score as: {no neuropathy: ≤5, severe: ≥12, moderate: 9-11 and mild: 6-8}. Vitamin D level was categorized as (deficiency (0-20 ng/ml), insufficiency (21-30 ng/ml) sufficiency (&gt;30 ng/ml), excess (&gt;50 ng/ml) and toxicity (&gt;100 ng/ml). All the data was entered in SPSS.Results: Total 74 patients with diabetic neuropathy were studied. Vast majority of patients 36(48.6%) were found in age group 51-60 years, Majority were males 45(60.8%). Most of the cases 35(47.3%) were with 1-3 years duration of neuropathy. Majority of patients 42(56.8%) were found with Mild peripheral neuropathy. Vitamin-D deficiency was present in 2(43.2%) cases and insufficiency was observed in 27(36.5%) cases. No significant association was found between vitamin D deficiency and severity of neuropathy.Conclusion: Vitamin D deficiency was found (43.2%) in patients of diabetic peripheral neuropathy. Vitamin screening and intake of supplement is necessary, will help to decrease the complication of peripheral neuropathy in Diabetic cases. Key words: Diabetes, Peripheral neuropathy, Vitamin D

How and why SGLT2 inhibitors should be explored as potential treatment option in diabetic retinopathy: clinical concept and methodology.

Patients suffering from type 2 diabetes are at an increased risk of developing classical microvascular complications such as retinopathy, neuropathy, and nephropathy, which represent a significant health burden. Tight control of blood glucose, blood pressure, and serum cholesterol reduce the risk of microvascular complications but effective pharmacologically targeted treatment options for the treatment and prevention of diabetic microangiopathy are still lacking. Pharmacological inhibition of sodium glucose cotransporter 2 (SGLT2) might have the potential to directly protect against microvascular complications and could represent a potential treatment option. Randomized controlled clinical proof of concept trials are needed to investigate a potential central role of SGLT2 inhibitors in the prevention of diabetic microangiopathy and its classical clinical complications of retinopathy, neuropathy, and nephropathy.

ASSOCIATION OF SERUM HOMOCYSTEINE IN DIABETIC NEUROPATHY

Aims and Objectives: The main aim of the study was to find out the association of serum homocysteine (HCY) in diabetic neuropathy patients. Methods: All the patients who were diagnosed with Type II diabetes mellitus will be included. Their serum levels of fasting blood sugar, postprandial blood sugar, glycated hemoglobin, and associated blood parameters will be assessed. Diabetic neuropathy will be confirmed using nerve conduction testing, electromyography, and quantitative sensory testing with clinically correlated. The serum HCY levels will be measured and correlated with other blood parameters. Results: Of 1000 patients, 46 were Type I diabetic and 954 were Type II. The prevalence of neuropathy in diabetic patients was 156. Mean serum HCY without diabetic neuropathy was 6.8+2.9 and serum HCY with diabetic neuropathy was 21.6+0.29 and p value was found to be 0.0017. The correlation between serum HCY and diabetic neuropathy was found to be 14.5 with p=0.001. Conclusion: There has been a significant increase of HCY in diabetic patients. It can be clearly seen that elevated serum HCY level has led to some of the complications of diabetic neuropathy.

Albumin-Creatinine Ratio is More Diagnostic Sensitive than Cystatin-C in Assessment of Diabetic Peripheral Neuropathy

Background: Diabetic Peripheral neuropathy is one of the most common cardiovascular complications among diabetes mellitus patients and occurs in more than half of the population of diabetic patients world-wide. It is a common cause of foot ulcer, gangrene and amputation among diabetics. Thus, its prevention or early treatment can improve the quality of life of diabetic patients. In a bid to reduce it, various biochemical markers have been evaluated to enable early treatment and amelioration of diabetic neuropathy among diabetes mellitus patients. Aim: Evaluation of the diagnostic relevance of Cystatin-C versus Albumin-creatinine ratio in assessment of Peripheral neuropathy in diabetic type 2 subjects. Method: 102 type 2 DM subjects (66 females and 36 males) and 100 control subjects of same age range (40 – 80 years) were recruited for this study which includes 51 subjects with peripheral neuropathy and 51 subjects without peripheral neuropathy. Serum Cystatin-C, Microalbuminuria, Urine creatinine and HBA1c were analysed with standard methods. Results: Cystatin-C, Microalbuminuria, Albumin-creatinine ratio and Glycated haemoglobin were significantly elevated (P&lt;0.05) in diabetic subjects compared to the control. Cystatin-C (ng/ml), microalbuminuria (mg/l), albumin creatinine ratio (mg/mmol) and HBA1c (%) is [105.52 ± 45.11; 90.07±20.29; 10.48 ± 4.82; 6.9±1.7] respectively. Microalbuminuria, albumin creatinine ratio showed significant increase (P&lt;0.05) in subjects with peripheral neuropathy compared to those subjects without [92.11± 22.82; 35.70±16.35; 2.61±1.1; 6.38±1.79]. The ROC curve shows that Albumin-creatinine ratio showed significant (P&lt;0.05) sensitivity to peripheral neuropathy [AUC=0.714] while Cystatin-C showed no significant (P&lt;0.05) sensitivity to peripheral neuropathy complication [AUC=0.553]. Conclusion: Cystatin-C was found to be deranged in diabetics. However, Albumin-creatinine ratio showed more diagnostic sensitivity for peripheral neuropathy than Cystatin-C.

Sleep disturbances in diabetic peripheral neuropathy patients: a clinical and polysomnographic study

BackgroundDisordered sleep breathing is a common complication of diabetic peripheral neuropathy (DPN) manifested by excessive daytime sleepiness, morning headache, morning dizziness, cognitive decline, and mood changes.MethodsThis study was performed on 30 non-obese type 2 diabetic patients; 20 with clinically evident DPN and 10 without. Ten age-, sex-, and body mass index-matched healthy control subjects were also included. Patients and control were subjected to history taking, neurological examination, glycated hemoglobin, and clinical assessment of the sensori-motor manifestations by the neuropathy symptom score and neuropathy disability score. The autonomic nervous system was evaluated clinically by the systolic blood pressure response to standing and heart rate response to each of standing, Valsalva, and deep breath. Finally, sleep was assessed by one-night polysomnogram (PSG) followed by multiple sleep latency test in the next day.ResultsThe study showed significant increase in sleep apnea syndromes in diabetic peripheral neuropathy patients compared to diabetic neuropathy free patients and healthy control (p < 0.0001). The sleep apnea was mainly obstructive and to a little extent mixed (obstructive/central) sleep apnea. The severity of sleep PSG abnormalities was positively correlated with the severities of sensory, motor, and autonomic manifestations.ConclusionsNon-obese type 2 diabetic patients complicated by peripheral neuropathy especially those having dysautonomia are at increased risk of developing sleep disordered breathing resulting in their excessive daytime sleepiness, decreased productivity, and poor glycemic control.

Serum Angiopoietin-2 levels as a marker in type 2 diabetes mellitus complications

Angiopoietin-2 (Ang-2) has been reported to be involved in the development of type 2 diabetes (T2D) and accelerates micro and macro vascular complication. The current study aimed to investigate serum Ang-2 levels in Saudi patients with type 2 diabetes and its complications. In this observational cross-sectional study, serum was collected from 329 T2D subjects aged 34–79 years. All subjects were evaluated for fasting blood glucose (FBG), HbA1c, lipid profile, and kidney profile. Serum concentration of Ang-2 was assayed by ELISA-based method. Mean serum Ang-2 level was significantly higher in female T2D subjects (2881 ± 1550 pg/ml) compared with male T2D subjects (2450 ± 1477 pg/ml). The mean serum Ang-2 levels in female T2D subjects significantly increased with increase in their age and BMI, while mean serum Ang-2 levels did not significantly increase among the male with their age and BMI. A significantly higher level of Ang-2 was found in patients with diabetic complications like neuropathy (3293 ± 1728 pg/ml), retinopathy (2986 ± 1645 pg/ml), and vascular complications (3152 ± 1571 pg/ml). The study has established comprehensive Ang-2 levels in various subsets of adults with diabetes. While interpreting Ang-2 levels, the differences in age and sex need to be taken into account. Diabetic patients with higher Ang-2 levels should be monitored closely and level of serum Ang-2 should be served as a marker to identify patients at high risk of diabetic complications.

Diagnosis and impact of neuropathic pain in leprosy patients in Nepal after completion of multidrug therapy

ObjectivesNeuropathic pain (NP) can occur as a chronic complication of leprosy neuropathy. NP epidemiology and its impact on patients have not been well documented. This study investigates NP prevalence and impact in the years after patients are declared “released from treatment” (RFT) following multidrug therapy (MDT) completion.MethodsIn this cross-sectional study, 85 RFT patients were recruited within leprosy referral services in Nepal. The Douleur Neuropathique 4 Questionnaire (DN4) was used to screen for NP. Pain severity, impacts on patients’ daily activities and mental health were measured by using the Brief Pain Inventory (BPI), Screening of Activity Limitation and Safety Awareness (SALSA), and General Health Questionnaire-12 (GHQ-12) respectively.Results96% surveyed had been treated for multibacillary leprosy. 44 (52%) complained of pain of which 30 (68%) were diagnosed with NP. NP was not associated with age, gender, or presence of skin lesions or nerve symptoms at leprosy diagnosis. 70% of patients with NP had either history of or ongoing reactions and 47% had grade 2 disability. Nerve tenderness (p = 0.023) and current reactions (p = 0.018) were significant risk factors for NP. Patients with NP suffered significantly higher intensity pain (p = 0.023) and daily life interference (p = 0.003) and were more likely to have moderate to extreme daily activity limitations (p = 0.005). 13 (43%) exhibited psychological distress, and medications only reduced moderate degree (50–60%) of pain.ConclusionsIn our study, 35% of RFT patients had ongoing NP. Risk factors include nerve tenderness and reaction. They suffer from more daily life interference and psychological distress. Leprosy patient care should include recognition and management of NP.

Insulin Resistance, Cardiovascular Autonomic Neuropathy, and Left Ventricular Hypertrophy in Patients with Congenital Generalized Lipodystrophy

Congenital generalized lipodystrophy (CGL) subjects have a high prevalence of cardiovascular autonomic neuropathy (CAN) and cardiac complications, including left ventricular hypertrophy (LVH). This study aimed to analyze insulin resistance (IR), CAN severity and LVH association. A cross sectional study with 10 CGL patients and 20 healthy controls. We evaluated clinical and laboratory data, echocardiogram parameters, 3 spectral analysis components - high frequency (HF), low frequency (LF), and very low frequency (VLF) - of heart rate variability (HRV), sympathetic-vagal balance, time domains of HRV, corrected QT interval (cQT), and 4 cardiovascular reflexes tests (postural hypotension test, orthostatic, respiratory, and valsalva coefficients - 2 abnormal tests: clinic CAN, 1 abnormal test: incipient CAN, and postural hypotension: advanced CAN). In CGL group 50% had CAN (40% clinic and 10% incipient) and 40% LVH. There was inverse correlation between LVMI and HF (p=0,007), IVS and HF (p=0,013), and positive correlation between IVS and HOMA-IR (p=0,042), and BP drop (p=0,010). These suggest that IR may be involved in the severity of CAN and cardiac autonomic dysfunction in the pathophysiology of cardiovascular complications in these disease. Disclosure V.O. Fernandes: None. C.M.M. Ponte: None. M.C. Gurgel: None. A.D.R. Montenegro: None. L.A.A. Batista: None. C.B.R. Liberato: None. C.B. D'Alva: None. R.M. Montenegro: None.