Detection Of Diabetic Peripheral Neuropathy Research Articles

Early Detection of Diabetic Peripheral Neuropathy in Diabetic Patients: A Cross-Sectional Study.

Diabetic Peripheral Neuropathy (DPN) is a chronic complication in Type 2 Diabetes Mellitus (T2DM) patients and is characterized by paresthesia, pain, and hypoesthesia of the extremities. The Diabetic Neuropathy Symptom-Score (DNS) is a quick, inexpensive, and easy-to-perform tool to detect DPN in clinical practice. Biochemical markers like Nitric Oxide (NO) and Vascular Endothelial Growth Factor (VEGF) play a role in the early detection of DPN. This study aims to investigate the relationship between risk factors and these biomarkers. So, it is expected to improve the prevention and treatment of diabetic neuropathy more effectively. A cross-sectional method was used for this study. The sample size was 85 patients with T2DM who visited several primary healthcare in Medan, selected by consecutive sampling method based on eligibility criteria. Data collected included DNS, assessment of NO, VEGF, Glycated Hemoglobin (HbA1C), plasma blood glucose (PBG), and lipid profile. The collected data were analyzed using an independent T-test. The results showed that most T2DM patients, namely 73 people (85.9%), experienced DPN. From the bivariate analysis results, the risk factors associated with the prevalence of DPN in T2DM patients were found to be increased levels of total cholesterol, HbA1c, NO, and VEGF (p < 0.05). Meanwhile, blood pressure, fasting BGL, HDL-C, LDL-C, and triglycerides were not related to the occurrence of DPN in this study (p> 0.05). DNS can be used as a quick and easy initial screening tool implemented in clinical practice for screening DPN. Diabetic patients with DPN tend to have lower NO and increased VEGF; besides, NO levels are also associated with the progression of DPN. Furthermore, education, blood sugar control, and physical exercise, especially leg exercises, can prevent progressive DPN.

IDF23-0361 Comparison of bedside testing methods for detection of diabetic peripheral neuropathy in newly diagnosed type 2 DM

IDF23-0361 Comparison of bedside testing methods for detection of diabetic peripheral neuropathy in newly diagnosed type 2 DM

Semmes Weinstein monofilament test for detection of diabetic peripheral neuropathy: sensitivity and specificity

BackgroundPeripheral neuropathy predisposes to diabetic foot and this predilection is worsened by poorly controlled sugars. Diabetic foot increases the mortality and morbidity associated with diabetes. Thus, it is crucial to screen for diabetic polyneuropathy. Early detection of diabetic polyneuropathy improves foot care and decreases morbidity. This study aimed to assess the sensitivity of Semmes Weinstein monofilament test in the diagnosis of Diabetic Peripheral Neuropathy. Forty-three Type 2 diabetes mellitus patients availing IP/OP services of a Medical College Hospital were included for the study. Patients underwent Semmes Weinstein monofilament test, following which they were subjected to nerve conduction study of both lower limbs.ResultsForty six and half percentage of patients had diabetic peripheral neuropathy, taking NCS as gold standard.Of these 80% of the cases were also detected by the monofilament test.The specificity of the monofilament test was 100%. Positive predictive value was 100% and negative predictive value was 85.19% and the overall accuracy of the test was 90.7%.ConclusionsIn this study, we found that sensitivity and specificity of the SWM test are fairly high; thus, it can be used as a valid screening tool for DPN in resource limited settings, such as India.

The Value of Muscle Thickness of Lower Limbs in Detection of Diabetic Peripheral Neuropathy

&#x0D; Background: Neuropathy stands out as the highest-prevalence diabetes-related complication, impacting no less than 50% of individuals with diabetes throughout their lifespan. As The most common reason for disability due to walking difficulties, foot ulcerations, and limb loss, DPN is worthy of study, and early diagnosis of DPN signs is required.&#x0D; Objectives: This study aims to aid in the identification of diabetic peripheral neuropathy (DPN) by determining the muscle thickness of the lower extremities in patients with DPN.&#x0D; Patients and Methods: The study included 24 subjects with diabetic peripheral neuropathy (DPN) and 25 individuals as a control group, subdivided into 8 diabetic patients without DPN and 17 healthy individuals. Both control and DPN subjects underwent bilateral peroneal and tibial motor nerve conduction studies (NCS) and high-resolution muscle ultrasounds to measure muscle thickness. Abductor hallucis muscle (AH), extensor digitorum brevis muscle (EDB), extensor hallucis longus muscle (EHL), tibialis anterior muscle (TA), and rectus femoris muscle (RF) were evaluated on both sides using ultrasound.&#x0D; Results: Comparing the tested muscles to the control group, the study revealed a statistically significant decrease in the thickness of many of the muscles being tested when compared to the control group.&#x0D; Conclusions: These findings point to the possibility that quantitative muscle ultrasound could be beneficial in identifying muscle changes associated with DPN. It is necessary to conduct additional studies to verify the results in larger samples of diabetic patients.&#x0D; Keywords: Neuromuscular Ultrasound, Muscle Thickness, Diabetic Peripheral Neuropathy

Early detection of diabetic peripheral neuropathy using EMLA-induced skin wrinkling

Background &amp; Objective: Screening for early diabetic peripheral neuropathy (DN) is essential for foot ulcer prevention. The Semmes–Weinstein monofilament (SWMF) is commonly used to detect DN in Thailand. However, SWMF interpretation requires patient participation, which is susceptible to risk of error in patients with impaired cognitive function or uncooperative patients. In contrast, stimulated skin wrinkling (SSW) can be interpreted by trained investigators, which is more appropriate. This study aimed to investigate the utility of SSW using a eutectic mixture of local anesthetic (SSW-EMLA) for early DN diagnosis. Methods: This cross-sectional study, recruited 102 patients with diabetes (DM group), 33 with diabetes with foot ulcer (DN control group), and 30 without diabetes (non-DN control group) from the Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Thailand, from February 3, 2021 to November 30, 2021. SSW was conducted by applying EMLA on the tips of the 2nd, 3rd, and 4th fingers of both hands. SWMF, sensory perception of pain (SPP), vibration perception threshold (VPT), joint position sense (JPS), and deep tendon reflexes (DTR) were also evaluated on the same day. Results: The Interrater agreement of two investigators for SSW-EMLA was high with intraclass correlation coefficients of 0.87 (0.824–0.904) for the right hand and 0.874 (0.830–0.907) for the left hand. The kappa coefficients of agreement of SSW-EMLA for SPP, SWMF, VPT, JPS, and DTR testing were 0.411, 0.478, 0.714, 0.444, and 0.681, respectively. The sensitivity and specificity of SSW-EMLA testing for DN detection were 83.3%, was 85.7%, respectively. Conclusion: The SSW-EMLA test can be considered as an alternative method for DN detection, due to its noninvasiveness, inexpensiveness (50THB), being a simple procedure, high sensitivity and specificity, and acceptable rater variation.

Diagnostic Accuracy of Perception Threshold Tracking in the Detection of Small Fiber Damage in Type 1 Diabetes.

An objective assessment of small nerve fibers is key to the early detection of diabetic peripheral neuropathy (DPN). This study investigates the diagnostic accuracy of a novel perception threshold tracking technique in detecting small nerve fiber damage. Participants with type 1 diabetes (T1DM) without DPN (n = 20), with DPN (n = 20), with painful DPN (n = 20) and 20 healthy controls (HCs) underwent perception threshold tracking on the foot and corneal confocal microscopy. Diagnostic accuracy of perception threshold tracking compared to corneal confocal microscopy was analyzed using logistic regression. The rheobase, corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), and corneal nerve fiber length (CNFL) (all P < .001) differed between groups. The diagnostic accuracy of perception threshold tracking (rheobase) was excellent for identifying small nerve fiber damage, especially for CNFL with a sensitivity of 94%, specificity 94%, positive predictive value 97%, and negative predictive value 89%. There was a significant correlation between rheobase with CNFD, CNBD, CNFL, and Michigan Neuropathy Screening Instrument (all P < .001). Perception threshold tracking had a very high diagnostic agreement with corneal confocal microscopy for detecting small nerve fiber loss and may have clinical utility for assessing small nerve fiber damage and hence early DPN. NCT04078516.

Interest of Sudoscan in the detection of diabetic peripheral neuropathy

Introduction: Disturbance of pain sensation is considered one of the major initial risk factors for diabetic foot ulcers. Sweat dysfunction leading to abnormal skin conditions, including dryness and fissures, may increase the risk of foot ulcer. The objective of this study was to evaluate the Sudoscan, a new rapid, non-invasive, quantitative method for early detection of diabetic peripheral neuropathy by measuring sweat electrical conduction (SEC). Patients and methods: We conducted this study on 85 type 2 diabetic patients. The data of the study were collected through a questionnaire, clinical examination (DN4, monofilament) and sudoscan for SEC. Results: We recruited 85 patients, the average age of the subjects was 58.32 ± 10.89 years. 77.6% were women and 22.4% were men. A significant proportion (67%) of our study population had a duration of diabetes of less than 10 years, Among 85 patients 40% had a positive DN4 and only 17.2% of the participants had a positive monofilamant test. 52.9% of the patients had a moderate dysfunction of the electrical conduction of sweat (SEC) and only 29.4% had a severe dysfunction, and 17.6% of the patients had a normal conduction we did not objectify a significant correlation between the sudoscan and the other tests notably the DN4 and the monofilament. Conclusion: The Sudoscan is a reproducible technique, with a high specificity, it is a simple test for the detection of neuropathy diabetic peripheral allowing an early prevention of foot lesions.

Interest of Sudoscan in the detection of diabetic peripheral neuropathy

Interest of Sudoscan in the detection of diabetic peripheral neuropathy

Development of a prototype toe sensor for detection of diabetic peripheral small fiber neuropathy.

Diabetic peripheral neuropathy (DPN) affects a large proportion of people with diabetes, and early detection is essential to prevent further progression. Widespread clinical testing relies on simplicity and cost-effectiveness of examination. Early signs of DPN may be detected by assessing the sudomotor nerves, and sudomotor activity can be measured by bioimpedance. We present a prototype toe probe for DPN detection including sensors for measuring skin AC conductance, skin temperature and humidity. The prototype was tested on five participants with DPN and five healthy age-matched controls in a pilot study. Sudomotor sensor responses to a simple deep breathing test were very weak or absent in the DPN group, with all controls having larger responses than the DPN group. Evaporation was lower for the DPN group, and skin temperature was higher on average. For the same foot, the results for sudomotor responses were in agreement with sensory neurography amplitudes from the sural nerve whereas the monofilament test gave normal results for two of the DPN participants. If sufficient detection accuracy is confirmed in larger studies, the method may provide a simple and cost-effective tool to support clinical examination. Clinical Relevance- We present the early realization and testing of a simple device to support early detection of diabetic peripheral neuropathy.

Accuracy and Cost-effectiveness of the Diabetic Foot Screen Proforma in Detection of Diabetic Peripheral Neuropathy in Myanmar.

ObjectiveProper foot assessment is important for early detection and treatment of diabetic peripheral neuropathy (DPN), the main cause of diabetic foot ulcers (DFUs). This study aimed to determine the accuracy and cost-effectiveness of the locally developed Diabetic Foot Screen (DFS) proforma in detecting DPN among diabetic patients at 10 selected clinics in Yangon, Myanmar.MethodologyThe study included 625 type 2 diabetics from 10 primary care clinics who participated in the diagnostic accuracy and cost-effectiveness analysis. They were assessed with DFS proforma and biothesiometry by two examiners independently. The cost-effectiveness analysis was conducted based on available data in the local primary care setting.ResultsThe overall accuracy of the DFS proforma assessment was 74.76% (95% CI: 70.46%- 79.06%). The optimal cut-off DFS score was ≥1.5 (sensitivity 62%; specificity 76%) in detecting DPN. Compared to biothesiometry, the cost-effectiveness of DFS proforma assessment in DPN detection was 41.79 USD per DPN case detected.ConclusionThis study supported the use of DFS proforma for DPN detection in primary care clinics. It also provided new information on the estimated costs per patient with DPN detected in Myanmar.

Early Detection of Diabetic Peripheral Neuropathy by fMRI: An Evidence-Based Review.

With the significant rise in the prevalence of diabetes worldwide, diabetic peripheral neuropathy (DPN) remains the most common complication among type 1 and 2 diabetics. The adverse sequelae of DPN, which include neuropathic pain, diabetic foot ulcers and lower-limb amputations, significantly impact quality of life and are major contributors to the biopsychosocial and economic burden of diabetes at the individual, societal and health system levels. Because DPN is often diagnosed in the late stages of disease progression by electromyography (EMG), and neuropathic pain as a result of DPN is difficult to treat, the need for earlier detection is crucial to better ascertain and manage the condition. Among the various modalities available to aid in the early detection of DPN, functional magnetic resonance imaging (fMRI) has emerged as a practical tool in DPN imaging due to its noninvasive radiation-free nature and its ability to relate real-time functional changes reflecting the local oxygen consumption of regions of the CNS due to external stimuli. This review aims to summarize the current body of knowledge regarding the utility of fMRI in detecting DPN by observing central nervous system (CNS) activity changes among individuals with DPN when compared to controls. The evidence to date points toward a tendency for increased activity in various central neuroanatomical structures that can be detected by fMRI and positively correlates with diabetic neuropathic pain.

Neuron-specific biomarkers predict hypo- and hyperalgesia in individuals with diabetic peripheral neuropathy

Aims/hypothesisThe individual risk of progression of diabetic peripheral neuropathy is difficult to predict for each individual. Mutations in proteins that are responsible for the process of myelination are known to cause neurodegeneration and display alteration in experimental models of diabetic neuropathy. In a prospective observational human pilot study, we investigated myelin-specific circulating mRNA targets, which have been identified in vitro, for their capacity in the diagnosis and prediction of diabetic neuropathy. The most promising candidate was tested against the recently established biomarker of neural damage, neurofilament light chain protein.MethodsSchwann cells were cultured under high-glucose conditions and mRNAs of various myelin-specific genes were screened intra- and extracellularly. Ninety-two participants with type 2 diabetes and 30 control participants were enrolled and evaluated for peripheral neuropathy using neuropathy deficit scores, neuropathy symptom scores and nerve conduction studies as well as quantitative sensory testing at baseline and after 12/24 months of a follow-up period. Magnetic resonance neurography of the sciatic nerve was performed in 37 individuals. Neurofilament light chain protein and four myelin-specific mRNA transcripts derived from in vitro screenings were measured in the serum of all participants. The results were tested for associations with specific neuropathic deficits, fractional anisotropy and the progression of neuropathic deficits at baseline and after 12 and 24 months.ResultsIn neuronal Schwann cells and human nerve sections, myelin protein zero was identified as the strongest candidate for a biomarker study. Circulating mRNA of myelin protein zero was decreased significantly in participants with diabetic neuropathy (p < 0.001), whereas neurofilament light chain protein showed increased levels in participants with diabetic neuropathy (p < 0.05). Both variables were linked to altered electrophysiology, fractional anisotropy and quantitative sensory testing. In a receiver-operating characteristic curve analysis myelin protein zero improved the diagnostic performance significantly in combination with a standard model (diabetes duration, age, BMI, HbA1c) from an AUC of 0.681 to 0.836 for the detection of diabetic peripheral neuropathy. A follow-up study revealed that increased neurofilament light chain was associated with the development of a hyperalgesic phenotype (p < 0.05), whereas decreased myelin protein zero predicted hypoalgesia (p < 0.001) and progressive loss of nerve function 24 months in advance (HR of 6.519).Conclusions/interpretationThis study introduces a dynamic and non-invasive assessment strategy for the underlying pathogenesis of diabetic peripheral neuropathy. The diagnosis of axonal degeneration, associated with hyperalgesia, and demyelination, linked to hypoalgesia, could benefit from the usage of neurofilament light chain protein and circulating mRNA of myelin protein zero as potential biomarkers.Graphical abstract

TENS can be used as a new tool in diagnosing vibration sense for early detection of diabetic peripheral neuropathy

Introduction: When diabetes mellitus is diagnosed, peripheral neuropathy is present in about 20 % of cases. Using electric current for nerve activation to relieve pain known as transcutaneous electrical nerve stimulation. TENS (Transcutaneous electrical nerve stimulation) is a process in which electrical impulses proceed through intact skin targeting nerves beneath, so it is considered as a peripheral stimulation technique. Materials and Methods: 100 patients in 2 parallel groups. Result: The results show a statistically significant difference between diabetic patients and control by using TENS in which there is significant decrease in vibration sense in diabetic patients in comparison to control. Conclusion: DPN (Dermatosis papulosa nigra) is very common in diabetic patients but it may take a long time to be diagnosed. This may lead to life threatening complications, like amputation. So it is critical to find new ways of diagnosing DPN early. TENS may be considered as a new way of evaluating DPN.

Nerve conduction studies (NCS) and electromyography (EMG) O-NE001. Correlation of nerve conduction velocity with body fat mass and oxidative stress markers in type 2 diabetic neuropathy patients

Introduction . Diabetic peripheral neuropathy (DPN) is the most common but least recognised and understood long term complication of type 2 diabetic patients (T2DM). There is a close association between obesity and type 2 diabetes as well as its complications. Nerve conduction study is an important non-invasive diagnostic modality used in the detection of diabetic peripheral neuropathy. Obesity is associated with increased oxidative stress and lipid peroxidation is thought to play a crucial role in the development of diabetic neuropathy. The aim of this study is to see the correlation of nerve conduction velocity parameters viz nerve conduction velocity and nerve conduction amplitude with the total body fat mass and oxidative stress markers. Methods . The study included 90 type 2 diabetes patients with clinically suggestible symptoms of diabetic peripheral neuropathy (DPN). 50 type 2 diabetic subjects without peripheral neuropathy served as control. Total body fat mass was measured using bioelectric impedance analysis. Oxidative stress markers viz total antioxidant capacity and malondialdehyde were measured using elisa kit. Nerve conduction study both motor and sensory was carried out in relevant nerves. Results . Serum levels of total antioxidant capacity and super oxide dismutase were significantly decreased in type 2 diabetic with neuropathy as compared to the ones without neuropathy. Serum levels of malondialdehyde, on the other hand, was significantly elevated. Motor nerve conduction velocity (MNCV) of ulnar and common peroneal nerve and sensory nerve conduction velocity of ulnar and sural showed a significantly decreased conduction velocity as compared to control. The total body fat mass showed a significant negative correlation with the motor conduction velocity of median, posterior tibial and sensory conduction velocity of median and sural nerve. Conclusion . The nerve conduction velocity test and total body fat mass evaluation is a cost- effective tool for earlier detection of neuropathy in type 2 diabetes patient.

Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres.

Diabetic peripheral neuropathy (DPN) is the most common complication of both type 1 and 2 diabetes. As a result, neuropathic pain, diabetic foot ulcers and lower-limb amputations impact drastically on quality of life, contributing to the individual, societal, financial and healthcare burden of diabetes. DPN is diagnosed at a late, often pre-ulcerative stage due to a lack of early systematic screening and the endorsement of monofilament testing which identifies advanced neuropathy only. Compared to the success of the diabetic eye and kidney screening programmes there is clearly an unmet need for an objective reliable biomarker for the detection of early DPN. This article critically appraises research and clinical methods for the diagnosis or screening of early DPN. In brief, functional measures are subjective and are difficult to implement due to technical complexity. Moreover, skin biopsy is invasive, expensive and lacks diagnostic laboratory capacity. Indeed, point-of-care nerve conduction tests are convenient and easy to implement however questions are raised regarding their suitability for use in screening due to the lack of small nerve fibre evaluation. Corneal confocal microscopy (CCM) is a rapid, non-invasive, and reproducible technique to quantify small nerve fibre damage and repair which can be conducted alongside retinopathy screening. CCM identifies early sub-clinical DPN, predicts the development and allows staging of DPN severity. Automated quantification of CCM with AI has enabled enhanced unbiased quantification of small nerve fibres and potentially early diagnosis of DPN. Improved screening tools will prevent and reduce the burden of foot ulceration and amputations with the primary aim of reducing the prevalence of this common microvascular complication.

Standard Clinical Screening Tests, Sural Radial Amplitude Ratio and F Wave Latency Compared to Conventional Nerve Conduction Studies in the Assessment of Sensorimotor Polyneuropathy in Patients with Type 2 Diabetes Mellitus.

Background and Aims:The measuring tools used for assessment of neuropathy include various questionnaires, monofilament testing, Biothesiometry and the gold standard test, nerve conduction studies (NCS). This study aims to evaluate the diagnostic accuracies of Michigan Neuropathy Screening Instrument (MNSI), Biothesiometry, Semmes Weinstein Monofilament (SWMF), Sural Radial Amplitude Ratio (SRAR) and minimal F wave latency as compared to conventional NCS and arrive at a simple diagnostic algorithm for early detection of Diabetic Peripheral Neuropathy (DPN).Methods:In a cross-sectional observational study on 48 Type 2 diabetes mellitus patients, MNSI, Biothesiometry, SWMF and NCS including F waves and SRAR were done and diagnostic accuracies (sensitivity, specificity, positive and negative predictive values) calculated taking NCS as gold standard.Results:MNSI, Biothesiometry, SWMF, SRAR and minimal F wave latency had a sensitivity of 64.3%, 78.6%, 14.3%, 100% and 78.6% and specificity of 67.7%, 52.9%, 94.1%, 23.53% and 76.47% respectively, with reference to NCS. Based on combined sensitivities and specificities, we arrived at a simple algorithm for early diagnosis of DPN, which showed that DPN could either be diagnosed or ruled out in 75% of the patients by a combination of the Biothesiometry, SRAR and left lower limb minimal F wave latency results.Conclusions:In the setting of an outpatient, multidisciplinary diabetic clinic, simple tests such as questionnaires, monofilament testing and biosthesiometer could be performed with greater ease while considering NCS as the gold standard. This algorithm, combining Biothesiometry, SRAR and left lower limb minimal F wave latency would be less time consuming and help in early diagnosis of DPN.

A Comparison of Neuropathy Quality of Life Tools: Norfolk QOL-DN, PN-QOL-97, and NeuroQOL-28

Aims To explore the effectiveness of the Norfolk QOL-DN (QOL-DN), PN-QOL-97, and NeuroQOL-28 as tools for early detection of diabetic peripheral neuropathy in overweight, obese, and inactive (OOI), prediabetes (PD), and type 2 diabetes (T2D) individuals. Methods Thirty-four adults were divided by A1C [(10 OOI, 13 PD, and 11 T2D] and the sural nerves were tested bilaterally via NC-Stat DPN Check, conducting a sural nerve conduction study (NCS). Participants were individually timed, filling out questionnaires (QOL-DN, NeuroQOL-28, and PN-QOL-97) at a self-selected pace. Data were analyzed and compared to NCS findings to determine the best instrument for early neuropathy detection, usability in screening settings, and application for individuals with OOI, PD, and T2D. Results Abnormal NCS results were obtained from 27 individuals, of which 25 were bilateral and symmetrical. Confirmed DSPN criteria were met for 24, and 1 case met criteria for subclinical neuropathy. Normal NCS findings, reported symptoms, and reduced bilateral sensation were found in 7 cases. The QOL-DN and NeuroQOL-28 significantly predict neuropathy criteria in OOI, PD, and T2D subjects. Analyses revealed the QOL-DN as the quickest for completion (M=5.17; SD=1.83), followed by the NeuroQOL-28 (M=5.58; SD=3.56), and the PN-QOL-97 (M=13.23; SD=3.606). Conclusions The QOL-DN and NeuroQOL-28 are valid early screening measures for DPN detection. Time completion studies revealed that the QOL-DN and NeuroQOL-28 may be used as excellent short screening measures, completed in approximately 6 minutes or less, with reasonable scoring for both. The NeuroQOL-28 is a better fit for immediate feedback, time constraints, or limited staff. Future investigations should evaluate these tools for detection in DPN-prone individuals and in subclinical populations screenings.

Prevalence and Determinants of Diabetic Peripheral Neuropathy/Foot Syndrome in the Rural Population of North India

Introduction: Diabetic peripheral neuropathy (DPN), a common and troublesome complication of diabetes mellitus (DM), leads to a higher risk of diabetic foot ulcers and lower limb amputation. This study aimed to assess the prevalence of DPN among patients of type 2 DM from rural North India and associated risk factors for the condition. Materials and Methods: A facility-based cross-sectional study was carried out among type 2 diabetic patients attending the Non-Communicable Diseases (NCD) clinic of a secondary care hospital in rural North India. A questionnaire that included sociodemographic details, clinical and laboratory parameters, and the Michigan Neuropathy Screening Instrument (MNSI) for detecting peripheral neuropathy was administered to 100 consecutive eligible patients. Statistical Package for Social Sciences (SPSS) version 25.0 was used for entering and analyzing data. Bivariate analysis was performed to determine the factors significantly associated with the presence of DPN. Results: The prevalence of DPN was found to be 42.0%. Male gender, advancing age (≥60 years), longer duration of diabetes (&gt;10 years), smoking, physical inactivity, obesity, uncontrolled blood pressure, poor glycemic control and altered lipid profile were found to be significantly associated with the presence of DPN. Conclusions: The prevalence of DPN among type 2 diabetes patients from rural northern India is alarmingly high. There is a need for essential screening of all diabetic patients by their primary care provider for early detection of DPN, particularly in rural India.

FAKTOR RESIKO NEUROPATI PERIFER DIABETIK PADA PASIEN DIABETES MELITUS TIPE 2 : TINJAUAN LITERATUR

Type 2 diabetes mellitus is one of the chronic diseases that has increased globally and is a cause of various organ dysfunction such as diabetic peripheral neuropathy. Early detection of diabetic peripheral neuropathy and identification of risk factors can reduce the morbidity of diabetic peripheral neuropathy. This literature review was written to present the risk factors of diabetic peripheral neuropathy in type 2 diabetes mellitus patients. Literature search was conducted to obtain appropriate articles through the electronic database Medline, Cinahl, Proquest, and Clinical Key with keywords: prevalence of diabetic peripheral neuropathy, risk factors and type 2 diabetes mellitus. The results obtained 16 articles according to the topic and through a review, it is known that risk factors of diabetic peripheral neuropathy in type 2 diabetes mellitus patients are old age, male sex, duration of diabetes mellitus, poor glycemic control, retinopathy, nephropathy, and risk factors of cardiovascular diseases such as: obesity, overweight, hypertension,and dyslipidemia.

Shear wave elastography evaluation of the median and tibial nerve in diabetic peripheral neuropathy.

To evaluate the value of shear wave elastography (SWE) in the detection of diabetic peripheral neuropathy (DPN) of the median and tibial nerves. The study included 40 DPN patients, 40 diabetic mellitus (DM) patients without DPN, and 40 healthy subjects. High-resolution ultrasonography (US) and SWE were performed on the median nerve (MN) and tibial nerve (TN), and cross-sectional area (CSA) and nerve stiffness were measured. ROC analysis was also performed. The patients with DPN demonstrated higher stiffness of the median and tibial nerve compared with that of healthy volunteers and DM patients (P<0.001). Bilateral analysis showed that there was no significant difference in nerve stiffness between the left and right median nerves and tibial nerves in DPN patients (P>0.05). The stiffness of median nerve and tibial nerve in each one side also had no significant difference in patients with DPN (P>0.05). The CSA of the tibial nerve in the DPN group was significantly larger than that in the other groups (P<0.001), while there was no significant difference of median nerve CSA among the three groups (P>0.05). The area under curve (AUC) of SWE (MN: 0.899, TN: 0.927) to diagnose DPN was significantly greater than that of CSA (TN: 0.798). The optimal cut-off value in SWE of the tibial nerve and median nerve for diagnosis of DPN was 4.11 and 4.06 m/s, respectively, with a good sensitivity and specificity. Median and tibial nerve stiffness was significantly higher in patients with DPN. These findings suggest that SWE-based stiffness measurement of the nerve was a better method than CSA, and it can be used as another effective assistant method in the diagnosis of DPN.