Diabetic Distal Polyneuropathy Research Articles

Features of diagnostics and treatments of the patient with type 2 diabetes mellitus and chronic ischtmia with threating lower limb loss

The article presents the result of our own observation of the patient with a poor control of type 2 diabetes mellitus (DM) for a long period, complicated by obliterating atherosclerosis of the arteries of the lower extremities, Menckeberg’s sclerosis and chronic ischemia threatening loss of the lower extremity (CLLI). A feature of the clinical manifestation are complications associated with potentially regional (angiosomal) ischemia of the foot, as well as variant anatomy, represented by hypoplasia of the vascular lower leg in the patient. The clinical consequences of vascular calcification due to long-term decompensation of carbohydrate metabolism and the development of diabetic distal polyneuropathy (DDP) led to falsely high values of the cuff test in the patient. Disadvantages of non-invasive methods for diagnosing limb ischemia and advantages of the complex application of tests for diseases of the arteries of the lower extremities are discussed. Using WIFI classification according to the degree of ulceration, the degree of ischemia, and the degree of infection on the foot (Wound, Ischemia and Foot Infection), the tactics of managing the patient are presented. The important role of ultrasonic duplex scanning (USDS) in the visualization of the arteries of the legs and feet in patients with DM is substantiated. The importance of a multidisciplinary approach in the management of a comorbid patient with type 2 diabetes and CLTI is emphasized.

Influence of a comprehensive method of rehabilitation includes transcranial magnetic stimulation and balance therapy on the severity of neurological disorders, gate function and balance in patients with diabetic neuropathy

Objective. To evaluate the effectiveness of a new method of rehabilitation of patients with diabetic polyneuropathy using balance therapy and transcranial magnetic stimulation against the background of a basic rehabilitation program to reduce neurological symptoms and improve the function of movement and balance. Material and methods. The study sample consisted of 34 patients with type 2 diabetes mellitus and with a severe degree of diabetic neuropathy, distal sensorimotor form, from which 2 groups were formed by randomization: the main group (n=17) and the control group (n=17). Patients of the main group received a new rehabilitation method, including rhythmic transcranial magnetic stimulation, No. 10, balance therapy on a simulator with biofeedback, No. 10, whirlpool baths for the lower extremities, No. 10, physical therapy, No. 10, and massage of the lower extremities, No. 10. The rehabilitation method for the control group included magnetic therapy for the lower extremities, No. 10, whirlpool baths for the lower extremities, No. 10, physical therapy, No. 10, and massage of the lower extremities, No. 10. Results. There were revealed a decrease in NSS scale values by 33.3% (from 6.0 [4.0; 7.0] to 4.0 [3.0; 6.0] points, p=0.029) and DN4 questionnaire scores – by 36.4% (from 5.5 [3.0; 7.0] to 3.5 [2.5.0; 5.0] points, p=0.034, p=0.045 in comparison with control), increase in walking speed by 10.7% (from 75.0 [59.0; 88.0] to 83.0 [68.0; 103.0] steps per minute, p = 0.047), decrease in time performing the “Up and go test” from 12.0 [7.0; 15.0] to 10.0 [5.0; 11.0] sec (p=0.039) and an increase in the time of maintaining balance in the “One leg standing test” with eyes closed on the right leg from 2.0 [1.0; 3.5] to 3.5 [1.5; 6.0] sec (p=0.041, p=0.022 compared with control) in patients of the main group, after completion of rehabilitation,. In the control group, there were no reliably significant changes in any of the studied indicators (p>0.05). Conclusion. A new rehabilitation complex, including transcranial magnetic stimulation and balance therapy with biofeedback against the background of standard therapy, helps to significantly reduce the severity of symptoms of distal diabetic polyneuropathy, increase walking speed and improve static balance.

Comorbid disorders and risk factors for neiropathic pain in distal diabetic polyneuropathy

Comorbid disorders and risk factors for neiropathic pain in distal diabetic polyneuropathy

Effects of Foot Dry Cupping in Diabetic Distal Polyneuropathy: A Pilot Controlled Clinical Trial

Background: Distal polyneuropathy is a common complication of diabetes mellitus with a considerable negative impact on the quality of life. This study aimed to evaluate the effect of dry cupping on distal polyneuropathy in diabetic patients. Methods: This controlled clinical trial was performed on 34 patients with diabetic polyneuropathy (DPN) for eight weeks. The non-invasive dry, fixed cupping therapy was performed on the sole of the right foot in the patients three times a week for 10 minutes, and the left foot of the same patient was considered as a control. The severity of diabetic neuropathy was measured using the modified Toronto Clinical Neuropathy Score (mTCNS), and the symptom and sensory test scores were determined. Results: Twenty patients (40 feet) completed the study. There was a significant difference between the control foot and the treated foot in terms of the mTCNS after four and eight weeks (P values=0.004 and 0.001, respectively), in terms of the sensory test scores after four and eight weeks (P values=0.007 and 0.005, respectively), and in terms of the symptom scores after eight weeks (P value=0.002). Conclusion: For the first time, this study demonstrated that cupping therapy might be effective as a complementary treatment in alleviating the symptoms of DPN, although understanding the underlying mechanism requires further investigation.

Diabetic distal polyneuropathy: prevention, treatment and rehabilitation (review)

Relevance. Due to lifestyle changes, the prevalence of diabetes mellitus is increasing worldwide. Diabetes can affect the nervous system in various forms in the form of cognitive disorders, mono- or polyneuropathies ending in trophic disorders and "diabetic foot"; and distal symmetrical sensory-motor polyneuropathy. In the modern literature there is a significant amount of research in the field of methods of prevention, treatment and rehabilitation of patients with diabetes mellitus, accompanied by damage to the nervous system, but there is no generalized information on a comprehensive analysis of currently available techniques.The purpose of study. To study the available and most modern methods of rehabilitation of patients with diabetic damage to the nervous system with subsequent systematization of information.Materials and methods. The most relevant domestic and foreign literature sources containing information on the types of diabetic lesions of the nervous system, pathogenesis and rehabilitation of patients with these pathologies were analyzed.Results. An analysis of modern literature has shown a great variability in the prevention, treatment and rehabilitation of patients with distal diabetic polyneuropathy. Drug therapy is effective, however, with long-term use, it can be accompanied by complications from the body systems. Physiotherapeutic therapy is not inferior in variety, affecting the nervous, vascular and epithelial tissue by various methods – electric current, magnetic field, laser beams or photochromo-radiation, you can get the desired analgesic effect. The need for lifestyle is also an important part of patient therapy: maintenance of normoglycemia, smoking cessation and special physical activity.Conclusion. Treatment and rehabilitation of patients with diabetic distal painful polyneuropathy is a big problem for a neurologist-clinician. In modern sources, there is a significant variety of methods for correcting this condition, both medication and physiotherapy. Drugs as the first line of correction of somatosensory disorders are a necessary point in the treatment plan, but it is necessary to remember the side effects of any prescribed drug, the slow onset of the desired analgesic effect. This is necessary for the competent preparation of the patient for a difficult and lengthy rehabilitation process. Among the most effective drugs are gabapentin and prebagalin, drugs of the anticonvulsant group and thioctic acid. A possible bypass of side effects from drug therapy is the appointment of physical therapy, adjusting drug treatment. A significant effect, based on the presented studies, is observed when using magnetotherapy in combination with infrared radiation, transcutaneous electrical nerve stimulation and impulse current with vacuum exposure.

"Electrotherapy for the Treatment of Diabetic Distal Polyneuropathy"

Mustafa Kh Al-Zamil* Author Affiliations Professor of physiotherapy department of RUDN, Peoples’ Friendship University of Russia, Physiotherapy, Moscow/Russian Federation, Russia Received: January 17, 2022 | Published: January 27, 2022 Corresponding author: Mustafa Kh Al-Zamil, Professor of physiotherapy department of RUDN, Peoples’ Friendship University of Russia, Physiotherapy, Moscow/Russian Federation, Russia DOI: 10.26717/BJSTR.2022.41.006598

Long-term results of mesodiencephalic modulation therapy in patients with diabetic distal polyneuropathy

Long-term results of mesodiencephalic modulation therapy in patients with diabetic distal polyneuropathy

Involvement of Cutaneous Sensory Corpuscles in Non-Painful and Painful Diabetic Neuropathy.

Distal diabetic sensorimotor polyneuropathy (DDSP) is the most prevalent form of diabetic neuropathy, and some of the patients develop gradual pain. Specialized sensory structures present in the skin encode different modalities of somatosensitivity such as temperature, touch, and pain. The cutaneous sensory structures responsible for the qualities of mechanosensitivity (fine touch, vibration) are collectively known as cutaneous mechanoreceptors (Meissner corpuscles, Pacinian corpuscles, and Merkel cell–axonal complexes), which results are altered during diabetes. Here, we used immunohistochemistry to analyze the density, localization within the dermis, arrangement of corpuscular components (axons and Schwann-like cells), and expression of putative mechanoproteins (PIEZO2, ASIC2, and TRPV4) in cutaneous mechanoreceptors of subjects suffering clinically diagnosed non-painful and painful distal diabetic sensorimotor polyneuropathy. The number of Meissner corpuscles, Pacinian corpuscles, and Merkel cells was found to be severely decreased in the non-painful presentation of the disease, and almost disappeared in the painful presentation. Furthermore, there was a marked reduction in the expression of axonal and Schwann-like cell markers (with are characteristics of corpuscular denervation) as well as of all investigated mechanoproteins in the non-painful distal diabetic sensorimotor polyneuropathy, and these were absent in the painful form. Taken together, these alterations might explain, at least partly, the impairment of mechanosensitivity system associated with distal diabetic sensorimotor polyneuropathy. Furthermore, our results support that an increasing severity of DDSP may increase the risk of developing painful neuropathic symptoms. However, why the absence of cutaneous mechanoreceptors is associated with pain remains to be elucidated.

The dynamics of allodynia in the treatment of patients with diabetic polyneuropathy using transcutaneous electroneurostimulation

BACKGROUND: Allodynia, hyperalgesia, and positive sensory symptoms are the main symptoms of neuropathic pain. Studying these symptoms and their dynamics in the treatment of neuropathic pain broadens our understanding of neuropathic pain and how it can be treated.
 AIMS: To study the effect of different TENS modalities on allodynia in patients with severe neuropathic pain syndrome developed against the background of diabetic distal polyneuropathy of the lower extremities.
 MATERIAL AND METHODS: 75 patients with allodynia on the background of distal polyneuropathy of the lower extremities (DPLE) were treated with pharmacotherapy (n=26), high-frequency TENS (n=25), and low-frequency TENS (n=24).
 RESULTS: Immediately after treatment, we observed a more pronounced decrease in allodynia after the application of high-frequency TENS (by 72.2%) and low-frequency TENS (by 61.1%). Moreover, in the control group, the regression of allodynia averaged 28.6%. At the 2nd month of the long-term period, the severity of allodynia continued to decrease more rapidly against the background of high-frequency TENS (26.7%) than after low-frequency TENS (19%) and remained without significant dynamics against the background of pharmacotherapy.
 CONCLUSION: The use of TENS 1.3 times enhances the therapeutic effect of pharmacotherapy in treatment of neuropathic pain in patients with diabetic DPLE. High-frequency TENS is more effective than low-frequency TENS in the treatment of allodynia by 18.2% immediately after treatment and by 40% at the end of the 2nd long-term period. By the 6th month of the long-term period, the results of treatment in both groups did not differ significantly.

Does sensorimotor training influence neuromuscular responses, balance, and quality of life in diabetics without a history of diabetic distal polyneuropathy?

ObjectiveTo evaluate the effect of supervised and home sensorimotor training on static postural balance (SPB), quality of life (QL), and neuromuscular responses of Type 2 Diabetics (DM-2). DesignRandomized controlled blind study with DM-2 patients, between 45 and 64 years old, of both sexes, divided into 3 groups: Control Group - CG (n = 27), Home Training Group - HTG (n = 27), and Supervised Training Group - STG (n = 26). The subjects were evaluated before and at the end of 3 months of treatment, with a four-week follow-up. The intervention was held twice a week, for 45 min, divided into three phases: warm-up, sensorimotor training, and cool-down. The primary outcome was SPB, using the force platform. Secondary outcome: questionnaires and clinical measures related to diabetic foot and knee flexor-extensors using isokinetic dynamometry. ResultsIn the baseline, the characteristics were similar between groups and between times. Tactile and vibratory sensitivity demonstrated the absence of symptoms of peripheral neuropathy in diabetic patients. In the intra-group comparison, there was a significant increase in the classification without symptoms of diabetic distal polyneuropathy in the HTG and STG groups (p < 0.05) and there were no significant effects on other clinical outcomes and QL and SPB, muscle strength, and sense of knee joint position. ConclusionThe intervention showed no improvement in SPB, QL, and other clinical outcomes of DM-2 patients. Thus, no differences were found between the groups, considering that the patients did not present clinical characteristics of diabetic distal polyneuropathy.

Functional electrical stimulation in the treatment of patients with type 2 diabetes mellitus complicated by diabetic angiopathy and polyneuropathy

Diabetic distal polyneuropathy (DPN) is the main cause of disability in patients with type 2 diabetes mellitus (DM2). The purpose of the research with 72 patients was to study the effect of functional electrical stimulation (FES) on reducing the degree of functional motor disorders in patients with DM2, angiopathy and DPN. Method. The patients were divided into 3 randomized groups (2 main groups, 1 control group). In addition to basic therapy, the patients of the main groups were treated with FES of the lower extremities with a frequency of 10–30 Hz in group 1 and 80–100 Hz in group 2. Results: the dynamics of quantitative assessment of the overall score on the NSS scale after treatment was significantly higher in the main groups compared to group 3 (Mann-Whitney test p 1–3 = 0,001, p 2–3 = 0,006). There was no significant difference in the overall score of the NSS between groups 1 and 2. The most pronounced positive changes in neurofunctional disorders after treatment on the NDS scale were achieved in group 1: the overall score decreased by 52% after the treatment and was significantly lower than in other groups (p 1–2 = 0,014, p 1–3 = 0,002, Mann-Whitney test). According to the treadmill test, tolerance to physical activity increased in all patients after the treatment. Significant positive dynamics of the stabilometric index of the ratio of energy consumption with closed and open eyes while standing on a balancing pillow was observed only in main group 1 (decreased by 41%, p=0,000, Wilcoxon test). Conclusions. The use of FES of the lower extremities as part of complex therapy in patients with DM2 complicated by angiopathy and DPN is safe and allowed reducing the degree of functional disorders and neuropathic complaints to a greater extent in the study group using FES with a frequency of 10–30 Hz.

The effect of proprioceptive training on postural control in people with diabetes: A randomized clinical trial comparing delivery at home, under supervision, or no training

Objective: Analyze postural control in the bipedal position as well as during gait and functional tests in patients with type 2 diabetes mellitus after supervised and unsupervised proprioceptive training. Design: A three-group randomized controlled trial. Setting: Physiotherapeutic Resources Lab, Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo Subjects: Eighty patients with type 2 diabetes allocated to three groups: control, home training, and supervised training. Interventions: The supervised and home training groups performed two weekly sessions of proprioceptive exercises for 12 weeks. The control group was not submitted to any of treatment. Main measures: Bipedal balance, gait, and performance on functional tests were evaluated before and after 12 weeks using the Balance Evaluation Systems Test (BESTest) and the force plate. Results: No significant improvements were found regarding postural control, gait, or performance on the functional tests, as evidenced by the inter-group comparisons of the total BESTest score [control: 90.7 (81.5–92.6); home training: 85.2 (77.8–90.3); supervised training: 88.4 (82.6–91.4), P > 0.05] as well as the tests performed on the force plate (P > 0.05). The clinical effect size of the proposed intervention was less than 0.2, demonstrating no effect for the main outcome variable evaluated by the “Sensory Orientation” item of the BESTest and by the mCTSIB (pressure plate). Conclusions: The proposed proprioceptive training did not lead to improvements in postural control in patients with type 2 diabetes with no clinical signs of diabetic distal polyneuropathy when analyzed using the BESTest clinical evaluation and a force plate. Trial registration: NCT01861392 (clinicaltrials.gov).

Axonal swellings are related to type 2 diabetes, but not to distal diabetic sensorimotor polyneuropathy

Aims/hypothesisDistal diabetic sensorimotor polyneuropathy (DSP) is a common complication of diabetes with many patients showing a reduction of intraepidermal nerve fibre density (IENFD) from skin biopsy, a validated and sensitive diagnostic tool for the assessment of DSP. Axonal swelling ratio is a morphological quantification altered in DSP. It is, however, unclear if axonal swellings are related to diabetes or DSP. The aim of this study was to investigate how axonal swellings in cutaneous nerve fibres are related to type 2 diabetes mellitus, DSP and neuropathic pain in a well-defined cohort of patients diagnosed with type 2 diabetes.MethodsA total of 249 participants, from the Pain in Neuropathy Study (UK) and the International Diabetic Neuropathy Consortium (Denmark), underwent a structured neurological examination, nerve conduction studies, quantitative sensory testing and skin biopsy. The study included four groups: healthy control study participants without diabetes (n = 45); participants with type 2 diabetes without DSP (DSP−; n = 31); and participants with evidence of DSP (DSP+; n = 173); the last were further separated into painless DSP+ (n = 74) and painful DSP+ (n = 99). Axonal swellings were defined as enlargements on epidermal-penetrating fibres exceeding 1.5 μm in diameter. Axonal swelling ratio is calculated by dividing the number of axonal swellings by the number of intraepidermal nerve fibres.ResultsMedian (IQR) IENFD (fibres/mm) was: 6.7 (5.2–9.2) for healthy control participants; 6.2 (4.4–7.3) for DSP−; 1.3 (0.5–2.2) for painless DSP+; and 0.84 (0.4–1.6) for painful DSP+. Swelling ratios were calculated for all participants and those with IENFD > 1.0 fibre/mm. When only those participants with IENFD > 1.0 fibre/mm were included, the axonal swelling ratio was higher in participants with type 2 diabetes when compared with healthy control participants (p < 0.001); however, there was no difference between DSP− and painless DSP+ participants, or between painless DSP+ and painful DSP+ participants. The axonal swelling ratio correlated weakly with HbA1c (r = 0.16, p = 0.04), but did not correlate with the Toronto Clinical Scoring System (surrogate measure of DSP severity), BMI or type 2 diabetes duration.Conclusions/interpretationIn individuals with type 2 diabetes where IENFD is >1.0 fibre/mm, axonal swelling ratio is related to type 2 diabetes but is not related to DSP or painful DSP. Axonal swellings may be an early marker of sensory nerve injury in type 2 diabetes.Graphical abstract

ULTRASOUND GUIDED TIBIAL NERVE BLOCK IN MANAGEMENT OF PAINFUL DIABETIC NEUROPATHY

Background: Diabetic neuropathy (DN) refers to signs and symptoms of neuropathy in patients with diabetes in whom other causes of neuropathy have been excluded. Distal symmetrical neuropathy is the most common form accounting for 75 % of DN. Objective: To determine the pain relief efficacy of three successive ultrasound guided tibial nerve block at the ankle with bupivacaine and betamethasone, as a primary outcome in the management of chronic painful diabetic neuropathy of the foot resistant to medical management, compared to ultrasound guided placebo tibial nerve block. Serum glucose levels for assessment of diabetes control and patients satisfaction were measured as a secondary outcome. Patients and Methods: After obtaining the Ethics Committee’s approval of Anesthesia Department of Al-Zahra’a University Hospital, and the patients’ written informed consent, 40 Patients (aged 18-60y) with chronic painful distal diabetic polyneuropathy were prospectively enrolled in this double blind and random study. The patients were classified randomly into two equal groups: Group (I): Control group: patients who received ultrasound guided tibial nerve injection by sterile cold normal saline (28 C), and Group (II): Steroid group: Patients received ultrasound guided tibial nerve injection by betamethasone (7mg amp) which was diluted in 7ml saline, then 1mg was diluted in 0.25% bupivacaine. Each limb was injected in both groups by three successive injections each other week in alteration with other limb, then followed up monthly for 3 months. Results: Three successive ultrasound guided tibial nerve block at ankle level with 1mg betamethasone in 0.25% bupivacaine decreased LANSS score and analgesic requirements with more patient satisfaction in distal painful diabetic neuropathy resistant to medical treatment. Conclusion: The therapeutic benefits provided by ultrasound guided tibial nerve block with bupivacaine and betamethasone more effective than placepo block. Pain and other symptoms decrease abruptly after the first tibial nerve block and disappear after the third tibial nerve block.

TORONTO CLINICAL NEUROPATHY SCORE AND MODIFIED TORONTO CLINICAL NEUROPATHY SCORE DIAGNOSTIC TESTS IN DISTAL DIABETIC SENSORIMOTOR POLYNEUROPATHY PATIENTS

Background: Distal diabetic sensorimotor polyneuropathy is a common complication occurred in diabetes mellituspatients. Even though the number of diabetes mellitus patients has been increasing, the prevalence is still far from its actual numbers due to diagnostic and method criteria. Objectives:We aimed to determine Toronto Clinical Neuropathy (TCN) and modified Toronto clinical neuropathy (mTCN) scores in distal diabetic sensorimotor polyneuropathy patients. Methods: Cross-sectional study was carried out from October 29th, 2014-June 1st, 2015 in 77 diabetes mellitus patients who visited Outpatient Clinic. Polyneuropathy diagnosis was based on TCN and mTCN scores, with gold standard of peroneal and/or sural nerve conduction velocity examination. Results: Area under curvevalue of TCN score was 84.5% (95% CI: 74.7%-94.3%). TCN diagnostic score above 4 had sensitivity, specificity, and accuracy of 96%, 40%, 82%, respectively. On the other hand, TCN diagnostic score above 8 had sensitivity, specificity, accuracy of 72%, 80%, 74%, respectively. The AUC value of mTCN score was 81.9% (95% CI: 71.8%-92.1%). mTCN diagnostic score above 8 had sensitivity, specificity, accuracy of 63%, 75%, 66%, respectively. Conclusion: TNC score above 4 could be used as a screening test, while score above 8 could be used as a diagnostic test for distal DSP.

Advances in neurometabolic therapy

Actovegin is a calf blood extract that contains more than 200 biologically active compounds. Experiments have shown that Actovegin reduces the neurotoxic effect of amyloid, neutralizes reactive oxygen species, and normalizes the endothelial function of small vessels. The drug has not been shown to stimulate tumor growth in the neuroblastoma model. Clinical experience with Actovegin suggests that the drug has an undoubted efficacy in treating moderate vascular cognitive impairment and chronic distal symmetric diabetic polyneuropathy and that it is used as additional therapy for primary degenerative and vascular dementia. The clinical efficacy of Actovegin in chronic obliterating diseases of the lowerlimb arteries is being actively studied now.

Electroneuromyography for early diagnosis of diabetic distal polyneuropathy

BACKGROUND: Diabetic distal polyneuropathy (DDPN) is a predictor of diabetic foot syndrome development, ulcer formation and lower limb amputation. An early DDPN diagnosis is therefore relevant.&#x0D; AIM: To investigate the effectiveness and suitability of electroneuromyography (ENMG) for early DDPN diagnosis.&#x0D; MATERIALS AND METHODS: This study was performed in the Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya. L. Tsivyan. A total of 80 participants were examined, including 30 DM2 patients, 30 patents without carbohydrate metabolism disorders, and 20 healthy volunteers aged 2030 years. None of the participants showed clinical signs of distal polyneuropathy (DPN). All participants underwent evaluation of neuropathy symptoms by the Neuropathy Symptom Score scale, neurological assessment using on the scale of Neuropathic Dysfunctional Score and stimulating ENMG.&#x0D; RESULTS: ENMG revealed the presence of neuropathy in 86.7% of DM2 patients. Moreover, among DM2 patients, 12 (40%) presented sensory DDPN, 13 (43.3%) presented sensorimotor neuropathy and 1 (3.3%) presented motor DDPN. The medial and lateral plantar nerves were the most commonly affected (p = 0.018 and p = 0.002, respectively). Among the 30 control individuals, 9 (30%) showed signs of DPN in combination with radiculopathy. ENMG - indicators of DDPN: latency and amplitude and speed for 3 sensory (n. Plantaris lateralis, n. Plantaris medialis, n. Suralis) and 2 motor nerves (n. Peroneus, n. Tibialis) were significantly worse in individuals with DM2 than in the control group, both for those with and without radiculopathy. Among participants with DM2, those sensorimotor DDPN tended to have a longer diabetes duration (p = 0.503), higher levels of HbA1c (p = 0.077) and higher BMI (p = 0.050) than those with sensory neuropathy, although the differences were not significant.&#x0D; CONCLUSION: This study confirms the effectiveness and suitability of ENMG for the early diagnosis of DDPN. Moreover, the optimal ENMG indices necessary for this diagnosis were identified.

Effect of pentoxifylline on diabetic distal polyneuropathy in type 2 diabetic patients: A randomized trial.

Background:Diabetes is one of the most common causes of peripheral neuropathy. There are no known cures for diabetic neuropathy. Pentoxifylline could theoretically be a beneficial treatment for diabetic sensory neuropathy, but there is not enough evidence to prove its effect. The aim of this study was to investigate the effect of pentoxifylline on distal diabetic neuropathy.Materials and Methods:In this randomized double-blinded placebo-controlled trial, 60 patients with diabetic peripheral neuropathy were randomized into two groups. The intervention group received Vitamin B1 (100 mg twice daily) and pentoxifylline (400 mg twice daily) and control group received Vitamin B1 (100 mg twice daily) and placebo (twice daily) for 2 months. Before and after the intervention, the symptoms of distal polyneuropathy were recorded by the Michigan Neuropathy Screening Instrument. ANCOVA, Paired t-test, unpaired t-test, Chi-square, and Fisher's exact test were used to compare changes in symptoms and sign of distal polyneuropathy.Results:The mean age of patients was 57.1 ± 8.02 years. There was no significant difference between the two groups in regard to the baseline variables. Blood pressure, body mass index, and blood glucose did not change significantly during the study. In the pentoxifylline group, the symptoms of peripheral neuropathy were significantly improved, in comparison with placebo group (P = 0.042).Conclusion:This study showed pentoxifylline could be effective in reducing the symptoms of distal diabetic neuropathy.

Dynamics of sensory and motor deficiency against the background of transcutaneous electroneuro stimulation in the therapy of patients with diabetic distal polyneuropathy

Dynamics of sensory and motor deficiency against the background of transcutaneous electroneuro stimulation in the therapy of patients with diabetic distal polyneuropathy

NEURO-SPECIFIC BLOOD PROTEINS IN THE DIAGNOSIS OF PRECLINICAL FORMS OF DIABETIC DISTAL POLYNEUROPATHY

Objective: to assess the information value of laboratory markers of nervous tissues to diagnose preclinical variants of distal diabetic polyneuropathy. Material and methods. We examined patients (n = 181) who were divided into 2 groups: the main group (n = 81) with the verified diagnosis of diabetes mellitus (DM) and the comparison group (n=100) without any endocrine pathology. The results having obtained in the main group were compared depending on the preclinical form of distal diabetic polyneuropathy detected on the basis of the electroneuromyography data: sensory form (group 1, n = 49) and sensor-motor form (group 2, n = 32). The levels of neuro-specific proteins: neuron-specific enolase (NSE), protein S 100 were determined in the blood of the patients. Results. It has been found that the NSE level in the patients of the main group was mainly within 0.17 and 2 ng/ml and, more rarely, within 2.07 and 6.93 ng/ml. The range of normal NSE values in the patients of the comparison group was mainly within 8.01 and 12.0 ng/ml. The ranges of S 100 protein values did not differ in patients with DM or without DM. The threshold value of NCE = 1.04 ng/ml has been found, which makes it possible to perform a differential diagnosis of the preclinical forms of distal diabetic polyneuropathy (groups 1 and 2) with sensitivity and specificity of 85.7%; (± 95% CI: 72.8-94.1) and 78.1% (± 95% CI: 60.0-90.7), respectively. Conclusion The level of NSE is a sensitive marker of distal diabetic polyneuropathy which allows to detect the development of distal diabetic polyneuropathy during the preclinical stage, as well as to perform a differential diagnosis of sensory and sensor-motor preclinical forms.