Diabetic Neuropathy Examination Research Articles

Ayurveda Management in Diabetic Neuropathy vis-à-vis Prameha Upadrava–A Case Study

Background- Diabetes mellitus (DM) in India has a higher prevalence (4.3%) than in the west (1-2%) and its complication rate is also high. Diabetic neuropathy symptoms include pain, numbness, reduced sensation of touch or oversensitivity, uncomfortable tingling and burning, skin ulcer and reduced reflexes. Diabetic neuropathies are seen in approximately 50% of individuals with long standing type 1 and type 2 DM and it often goes undiagnosed. This article presents a case study of patient with signs and symptoms of neuropathy who came with the complaint of lower back pain, bilateral lower limb pain, pricking sensation and burning sensation. Diabetic Neuropathy Examination score (DNE) along with other neuropathy screening parameters was more than 60% indicating functional loss. The Nerve conduction study also revealed demyelinating polyneuropathy.
 Observations and Results: The patient was treated with ayurvedic oral medication, Abhyanga (~application of medicated oils), swedana (~fomentation), and basti (~medicated enema). After ayurvedic treatment the patient showed good remission in pain, burning sensation and DNE along with all neuropathy screening were less than 20%. Patient got marked relief in all the symptoms.

Determinants and Stratification of Microvascular Complications of Type 2 Diabetes Mellitus.

Background Diabetes mellitus (DM) is a prevalent metabolic disorder characterized by high blood sugar levels. It is classified into type 1 (T1DM) and type 2 (T2DM), which have different mechanisms and complications. The global prevalence of diabetes, particularly T2DM, has increased significantly in recent decades, leading to a need for standardized data collection of macrovascular and microvascular complications to track disease progression and guide treatment options. This study aims to assess and correlate the prevalence and severity of microvascular complications in patients with T2DM. Methodology This observational, cross-sectional study was conducted at Poonam Multispeciality Hospital in Ahmedabad, India. A total of 4,123 diabetic patients admitted to the hospital were included. Information on sociodemographics and medical history was collected using standardized forms. Fundus photography and fluorescein angiography were performed to assess diabetic retinopathy, and estimated glomerular filtration rate and albumin-to-creatinine ratio were measured to evaluate renal function. Neurological examinations were conducted to score diabetic neuropathy. Chi-square tests were used to determine associations between medical history with diabetic retinopathy and nephropathy, and t-tests were used to compare diabetic neuropathy scores. Kendall's Tau correlation was used to determine correlations between diabetic retinopathy and nephropathy. P-values <0.05 were considered statistically significant. Results The overall prevalence of diabetic retinopathy, nephropathy, and neuropathy was 37.5%. Of the patients included, 47.9% had diabetic nephropathy and 28.9% had diabetic neuropathy. A significant association was observed between the severity of diabetic retinopathy and age, body mass index, duration of diabetes, and hemoglobin A1c (HbA1C) levels. Similarly, significant associations were found between these factors and the severity of diabetic nephropathy. Unpaired t-tests revealed significant differences in diabetic neuropathy examination scores based on the duration of diabetes and Hba1C levels. Moreover, correlation analysis indicated a low, positive correlation between diabetic retinopathy and diabetic nephropathy. Conclusions This study provides insights into the prevalence, severity, and associations of microvascular complications in patients with T2DM, contributing to the understanding and management of these conditions. Additionally, the research revealed a direct association between diabetic retinopathy and different stages of chronic kidney disease determined by the Kidney Disease Improving Global Outcome guidelines.

A Combination Effect of Sensory Motor Training and Proprioceptive Neuromuscular Facilitation in a Case of Peripheral Polyneuropathy Manifested by Foot Drop in Type II Diabetes Mellitus – A Case Study

Peripheral neuropathy is one of the common complications in patients with diabetes Mellitus (DM) which leads to disrupting the peripheral nervous system resulting in reduce sensory inputs and motor outputs. Patients with foot drop (FD) will have weakness in dorsiflexor muscles of ankle and toe and sensory loss due to disruption of small myelinated and unmyelinated nerve fibers. Sensory motor training (SMT) will facilitate sensory inputs, correcting muscle imbalance, and ensuring correct program at the level of central nervous system whereas Proprioceptive Neuromuscular facilitation techniques (PNF) not only helps facilitating the weaker group of muscles also improve strength . Hence the purpose of the study to combine the effect on use of SMT along with PNF in a case of peripheral polyneuropathy manifested by foot drop in patient with type II DM. The case report study of 72 year old male patient diagnosed with diabetic polyneuropathy manifested by foot drop in type II diabetes mellitus on medication. Intervention of patient received Sensory motor training and Proprioceptive Neuromuscular Facilitation in foot drop for 5 days a week for 4 weeks and outcome measures used were Stanmore Assessment Questionnaire (SAQ) , Diabetic Neuropathy Examination (DNE) score for diabetic neuropathy which were taken on day one and after 4 weeks of intervention and results shown improved on both the outcome measures which concluded that on combination of SMT and PNF techniques have shown efficacy on improving ankle range of motion and strength , sensory discrimination , thereby implementing these combination techniques, will reduce functional dependence and improve quality of life.

Association of C-peptide level with peripheral neuropathy in type 2 diabetes: An observational cross-sectional preliminary study

Backround and aimsPeripheral neuropathy is the most common microvascular complication of diabetes mellitus. In subjects with type 1 diabetes (T1D) relationship of C-peptide levels and neuropathy has been observed in several studies, however, there are very few studies in type 2 diabetes (T2D) subjects. In this study we aim to assess the association of C-peptide levels with peripheral neuropathy in Indian subjects with T2D. MethodOne hundred patients of T2D were included in this study. Clinical and laboratory parameter was assessed for all participants. The C-peptide level was measured by fluorometric enzyme immunoassay method. Assessment of diabetic peripheral neuropathy was based on diabetic neuropathy symptom score and the diabetic neuropathy examination scores. ResultsTotal 100 patients completed the study. Mean age of subjects was 60.03 years and male: female ratio was 1.17. Peripheral neuropathy was detected in 47% of subjects evaluated. Subjects were further divided in to neuropathy group and no-neuropathy group for analysis. Age in neuropathy group was significantly higher than no-neuropathy group [65.62 ± 10.5 vs 55.08 ± 9.41 yrs (p-value <0.0001)] and similarly duration of T2D was significantly higher in neuropathy group [10.11 ± 6.13 vs 4.16 ± 3.7 yrs (p-value <0.0001)]. Importantly mean fasting C-peptide (2.27 ± 0.98 vs 3.12 ± 0.84 ng/ml) and mean post meal C-peptide (4.27 ± 1.34 vs 5.33 ± 0.89 ng/ml) were significantly lower in neuropathy group compared to no-neuropathy group. An association of HbA1c level and neuropathy was statistically not significant (p = 0.793). ConclusionSerum C-peptide concentrations are associated with peripheral neuropathy in T2DM patients, independent of the degree of glycemic control.

Serum neuron-specific enolase as a biomarker in diagnosing diabetic peripheral neuropathy: A cross-sectional study

Background: Diabetic peripheral neuropathy remains asymptomatic until the late stages. Hence, a need exists for a reliable and sensitive biomarker for the early diagnosis of diabetic peripheral neuropathy. Aims and Objectives: This study aimed to evaluate serum neuron-specific enolase (NSE) reliability as a biomarker in diagnosing diabetic peripheral neuropathy. Materials and Methods: In the department of biochemistry and internal medicine, a cross-sectional study was conducted at Government Villupuram Medical College from May 2018 to January 2020. One hundred diabetes patients with peripheral neuropathy were compared with 100 patients without peripheral neuropathy. A diabetic neuropathy symptom (DNS) questionnaire and diabetic neuropathy examination (DNE) score were used for diagnosis. In addition, vibration position sense and NSE values were compared between the two groups. For statistical analysis, R studio and coGuide were used. Results: Comparisons between groups were based on age, sex, and other baseline parameters. Statistically, significance was observed between the two groups in outcome parameters such as VPB (right), VPB (left), and DNS (P&lt;0.05). There was a weak positive correlation between NSE and DNS (rs value: 0.514, P&lt;0.001). On the other hand, there was a strong positive correlation between NSE and DNE (rs value: 0.937, P&lt;0.001). The NSE of 6.50 and above had a sensitivity of 53% (95%CI 42.76–63.06%) and specificity of 57% (95% CI 46.71–66.86%). Conclusion: NSE acts as a biomarker for diabetic peripheral neuropathy. Therefore, NSE can be used for the early diagnosis of diabetic peripheral neuropathy, thereby preventing a severe form of the disease.

State of the science in diabetic foot: subjective screening vs. objective diabetic neuropathy examination in primary care

Among the conditioning factors of Diabetic Foot (DF), neuropathy is considered the main factor, arteriopathy the aggravating factor, and foot deformities the triggering factor. The preventive interventions for DF and its complications are distributed by levels of care. At the higher level, hospital care focuses on reducing DF amputations. At the lower level, Primary Care (PC) and Podiatry, focused on preventing DF. PC is considered the ideal place to identify the conditioning factors of DF. In this area, prevention follows the recommendations of the International Working Group on Diabetic Foot (IWGDF) by screening neuropathy focused on the sensitive or insensitive foot. The American Diabetes Association (ADA) a recommends person-centered assessment of neuropathy by clinical examination of symptoms and signs testing sensory, motor, and autonomic neuropathy. This controversy lead us to investigate which methodology (screening or clinical examination) could be more accurate in identifying the conditioning factors of DF in a group of people recruited in the TERMOPIEDI study. Neuropathy was assessed following the definition of diabetic neuropathy, the Young MJ diagnostic criteria, and the Toronto Council diagnostic category. These results allowed us to know the applicability of this procedure in PC within nursing competencies, detecting a greater number of patients with neuropathy compared to the screening method. People with neuropathy presented higher plantar temperature, concluding that neuropathy interferes with foot thermoregulation.

Effect of foot-ankle flexibility and resistance exercise in the secondary prevention of plantar foot diabetic ulcer

The study aimed to evaluate the effects of foot-ankle flexibility and resistance exercises on the recurrence rate of plantar foot diabetic ulcers, HbA1c levels, diabetic neuropathy examination (DNE) scores, ankle brachial index (ABI), and walking speed within 12 and 24weeks. We conducted a double-blind randomized clinical trial. Fifty patients with recently healed plantar foot diabetic ulcers were randomized to an intervention group that performed foot-ankle flexibility and resistance exercise three times a week in their home (n=25) or a control group (n=25). Both groups were given foot care education. Outcomes were assessed at plantar foot diabetic ulcer recurrence or at 12 and 24weeks whichever came first. Outcome measures included plantar foot diabetic ulcer recurrence, changes of HbA1c levels, DNE scores, ankle brachial index ABI, and walking speed. There were significant difference between groups in ulcer recurrence at either 12weeks (intervention 8%, control 68%, RR 0.288; 95% CI 0.156-0.534, P=0.000) within 12weeks. or 24weeks (intervention 16%, control 72%, RR 0.222; 95% CI 0.088-0.564, P=0.000).). There were significant differences in the DNE score delta (P=0.000) and walking speed delta (P=0.000), but there were no significant differences in the HbA1c delta and ABI delta between groups at either 12 or 24weeks. Foot-ankle flexibility and resistance exercises can reduce the recurrence of plantar foot diabetic ulcer incidence and improve diabetic neuropathy and walking speed. Clinical trial number: NCT04624516.

Development and Comparative Efficacy of Lagos Neuropathy Protocol for Improving Recovery of Symptom and Functional Independence Performance in Individuals with Diabetic Peripheral Sensorimotor Polyneuropathy.

Diabetic peripheral sensorimotor polyneuropathy (DPSP) has been treated with sketchy outcomes and available approaches are not applicable for self-administration. This study developed protocol for managing symptoms of DPSP and assessed its comparative efficacy. Study developed Lagos Neuropathy Protocol (LNP) through existing concept in DPSP and tested its safety, clinical applicability, and ease of self-administration. Its efficacy was compared with Buerger-Allen Exercise (BAE) by involving 31(11males) with DPSP, randomized into LNP and BAE and treated for 10-week. Toronto Clinical Scoring System was used to diagnose DPSP while Diabetic Neuropathy Examination was used to diagnose distal polyneuropathy. Sensory/pressure perception was assessed using 10 g-monofilament while Short Physical Performance Battery, Bergs Balance Scale and Visual Analogue Scale was used to assess functional performance, strength and balance, and pain respectively. LNP has three domains: sensory/pressure/proprioception, strength/balance, and pain/swelling. Most (80%) of the participants rated the LNP as excellently safe while the rest (20%) rated as very good in safety. All the participants rated LNP excellent in terms of self-administration and suitability for clinical use without adverse effect. The mean age of the participants for the comparative phase was 66.20±9.48years while their length of diagnoses of diabetes was 15.80±13.35years. About a third (32.5%) had DPSP. Both LNP and BAE had significant improvement (p<0.05) in sensory/pressure perception, pain, strength and balance, and functional performance but LNP had better significant improvement. LNP is safe, good for self-administration, clinically applicable and efficacious in improving sensory/pressure perception, balance, pain and functional performances in individuals with DPSP.

Association of Vitamin D Level and Nerve Conduction Study Parameters with Cognitive Function in Diabetic Neuropathy Patients

BACKGROUND: Type 2 diabetes mellitus (T2DM) and its major long-term complication, diabetic polyneuropathy (DPN), continue to be a major global health problem and are important contributors of significant disability worldwide. Vitamin D plays a significant role in their pathogenesis as well as in the development of dementia in non-diabetic patients. Nevertheless, the role of Vitamin D in the development of cognitive impairment in DPN patients has not yet been extensively studied. AIM: We aimed to investigate the association between Vitamin D level and cognitive function in DPN patients and to evaluate several potential contributor factors to cognition, including demographic factors, glycemic control, and nerve conduction study (NCS) parameters. METHODS: Thirty-one DPN patients were included in this cross-sectional study. Patients were recruited from the outpatient endocrinology and neurology clinic of Haji Adam Malik General Hospital Medan Indonesia. We used the diabetic neuropathy examination (DNE) scale, diabetic neuropathy symptom (DNS) scale, and NCS to determine the presence and severity of the neuropathy. We measured the levels of Vitamin D, random blood sugar, and glycated hemoglobin (HbA1c). Cognitive function was assessed using the Indonesian version of Montreal Cognitive Assessment (MoCA-INA), trail making test A and B (TMT A and TMT B), and verbal fluency test. RESULTS: Most of the patients were female (80.6%), with a mean age of 55.71 ± 8.34 years. The proportion of patients with abnormal cognitive function was higher than cognitively unimpaired patients. The mean of MoCA-INA score and level of Vitamin D was lower than normal, 23.32 ± 3.00 and 24.91 ± 13.59 ng/ml, respectively. Using the Pearson correlation test, we did not find any significant association of Vitamin D level, NCS parameters, and other clinical characteristics with global cognitive function. Age and level of education were significantly associated with MoCA-INA score. Blood sugar level was significantly higher in patients with normal TMT-A and TMT-B tests compared to patients with abnormal results. CONCLUSION: Vitamin D and NCS parameters are not associated with cognitive function. Of the demographic and clinical characteristics, a significant association exists between age, level of education, and blood sugar level and cognition. This might suggest the complexity underlying cognitive impairment in T2DM patients.

Correlates of diabetic polyneuropathy of the elderly in Sub-Saharan Africa.

BackgroundDiabetic polyneuropathy is associated with significant physical disability among older adults. However, their frequency and correlates are not well known in the older adults in Sub-Saharan-Africa. The objectives were to evaluate the hospital-based prevalence of diabetic polyneuropathy and identify its correlates in older adults.MethodsOver a period of 5 months, a cross-sectional survey was carried out at Douala Laquintinie Hospital (DLH), a main reference hospital in Douala, the economic capital of Cameroon. Participants in our study group comprised all patients with type 2 diabetes, whatever the reason for their reporting to the hospital. Diabetic Polyneuropathy was defined according to a Diabetic Neuropathy Examination score > 3/16.ResultsA total of 159 older adults with diabetes were examined during this recruitment period, among whom 106 (66.7%) were women. The mean age was 68.3 ± 6.5 years. Diabetes median duration was 108 months. For all patients assessed using the Diabetic Neuropathy Examination score, polyneuropathy was reported in 31.4%; among them, polyneuropathy proved symptomatic in 78% of them. Correlates of polyneuropathy were glycated hemoglobin (p = 0.049), HIV infection (p = 0.031) and albuminuria (p< 0.001), even after adjustment for age, gender and duration of diabetes.ConclusionA third of older adults with diabetes who visited our hospital were diagnosed with prevalent diabetes-related polyneuropathy. It shows that early detection is required through routine screening and regular follow-up examinations in order to reduce the risk of disability and improve the quality of life in elderly diabetics.

The Association between Pesticide Exposure and Neurological Signs and Symptoms in Farmers in Magelang District, Central Java, Indonesia

BACKGROUND: Excessive use of pesticides is known to cause neurotoxicity. Chronic effects of pesticide poisoning include neuropathy and tremors.&#x0D; AIM: This study aimed to determine the association between pesticide exposure and the occurrence of neurological signs and symptoms, especially neuropathy and tremor, in farmers.&#x0D; METHODS: This was a cross-sectional study. The study location was Seloprojo Village, Ngablak District, Magelang Regency, Central Java Province. Farmers as subjects were recruited to determine neuropathy using Diabetic Neuropathy Symptom (DNS) and Diabetic Neuropathy Examination (DNE) scoring. Tremor events were measured with Tremor Rating Scale (TRS). Cholinesterase levels were examined using venous blood samples to determine the level of pesticide poisoning.&#x0D; RESULTS: Of the 120 farmers studied, 68.3% experienced pesticide poisoning with cholinesterase levels below normal values. Weakness of the upper limb was found in 10 subjects (8.33%), while weakness of the lower limbs was found in 6 subjects (5%). There were 59.2% farmers who met the neuropathy criteria from the DNS score and those who met the neuropathic criteria from the DNE score were 6.7%. Tremor symptoms were found in 71.7% of the farmers. There was no significant association between cholinesterase levels and DNS score (p = 0.737), but there were significantly lower levels of cholinesterase (p = 0.046) in the neuropathy group measured with DNE score. There was no significant association between cholinesterase levels and TRS (p = 0.204).&#x0D; CONCLUSION: Cholinesterase levels were significantly associated with neuropathy incidence measured with DNE criteria but statistically not related to tremors in farmers exposed to pesticides.

Efficacy of homoeopathic treatment for diabetic distal symmetric polyneuropathy: A multicentric randomised double-blind placebo-controlled clinical trial.

BackgroundIn course of diabetes, some 20–90% of individuals eventually develop diabetic neuropathy. Looking at the disease burden research studies in Homoeopathy were conducted and have shown positive results. These studies were not robust enough to prove the efficacy of individualized homoeopathy. ObjectiveTo assess efficacy of individualized homoeopathic medicines in management of DDSP. MethodsA multi-centric double-blind, placebo controlled, randomised clinical trial was conducted by the Central Council for Research in Homoeopathy at six centres with a sample size of 84. Based on earlier observational studies and repertorial anamnesis of DDSP symptoms 15 homoeopathic medicines were shortlisted and validated scales were used for evaluating the outcomes post-intervention. Primary outcome measure was change in Neuropathy Total Symptom Score-6 (NTSS-6) from baseline to 12 months. Secondary outcomes included changes in peripheral nerve conduction study (NCS), World Health Organization Quality of Life BREF (WHOQOL-BREF) and Diabetic Neuropathy Examination (DNE) Score at 12 months. ResultsData of 68 enrolled cases was considered for data analysis. Statistically significant difference (p<0.014) was found in NTSS-6 post intervention in the Verum group. Positive trend was noted for Verum group as per the graph plotted for DNE score and assessment done for NCS. No significant difference was found between the groups for WHOQOL-Bref. Out of 15 pre-identified homoeopathic medicines 11 medicines were prescribed in potencies in ascending order from 6C to 1M. ConclusionFurther studies must be taken up with larger sample size and defined parameters for NCS to assess the effectiveness of homoeopathy.

A study of diffusion tensor imaging of median nerve in diabetic peripheral neuropathy

ObjectiveTo evaluate the role of diffusion tensor imaging (DTI) in the evaluation of diabetic peripheral neuropathy (DPN) compared to clinical scores and nerve conduction studies (NCS).Patients and methodsWe included 30 patients with diabetes mellitus complaining of neuropathy symptoms and 15 healthy volunteers. All subjects underwent evaluation using 1.5-T DTI of median nerves and NCS. Patients underwent clinical evaluation using the Neuropathy Deficit Score (NDS), Neuropathy Impairment Score in the Lower Limbs (NIS-LL), and Diabetic Neuropathy Examination (DNE) score.ResultsWe found statistically significant differences between healthy volunteers and patients in fractional anisotropy (FA) of the distal segment (P = 0.016) and whole median nerve (P = 0.024), apparent diffusion coefficient (ADC) of proximal (P = 0.027) and distal (P < 0.001) segments, and whole median nerve (P = 0.019). Distal segment FA was significantly correlated with NDS (P = 0.003), DNEs (P = 0.003), sensory amplitude (P = 0.048), and motor CV (P = 0.020). Distal segment ADC was significantly correlated with NDS (P = 0.007), NIS-LL (P = 0.003), DNEs (P = 0.01), and sensory amplitude (P = 0.032). The best cut-off value of distal segment for FA was 0.45 (87% sensitivity, 80% specificity) and of distal segment ADC was 1.217 (80% sensitivity and specificity).ConclusionsOur results suggest that 1.5-T DTI examination of the median nerve can provide useful non-invasive information in patients with DPN.Trial registrationClinicalTrials.gov, NCT03934970. Registered on May 1, 2019

Safety and Efficacy of Pregabalin Treatment and Quality of Life in Patients Treated with Pregabalin in Painful Diabetic Peripheral Neuropathy

The treatment modalities for painful diabetic peripheral neuropathy (PDPN) include antidepressants, anticonvulsants, capsaicin, membrane stabilizers and analgesics. Recent guidelines recommend pregabalin as a first line treatment for PDPN. But controversy exists about its efficacy and safety. The main objective of the study is to determine the safety, efficacy of pregabalin treatment for PDPN. An interventional cohort study was carried out in a tertiary care teaching hospital. Subjects who satisfy the inclusion criteria were included in the study after obtaining written informed consent. A total of 52 subjects were enrolled in the study. PDPN was confirmed by means of (1) Diabetic neuropathy symptom (DNS) score of more than one point, (2) Diabetic neuropathy examination score (DNE) of more than three points, (3) Neuropathic disability score (NDS) of more than 6 points and (4) Pain of more than 50% assessed by Visual Analog Scale (VAS). The subjects received pregabalin 75mg once daily for one week followed by 75 mg twice daily for further 3 weeks based on patient’s tolerability. Pain intensity was measured by using Short-Form McGill pain questionnaire. Safety of therapy was assessed from the incidence of adverse events including physical as well as laboratory evaluations. All study subjects’s enrolled received pregabalin. Study showed that pregabalin treatment significantly reduced pain in diabetic peripheral neuropathy with mean pain score 11.52 ± 9.30 (P value 0.00). The most common adverse effects of pregabalin were dizziness, peripheral edema, and somnolence. The study concluded that pregabalin significantly reduces pain and improve quality of life in PDPN.There was a dose-related increase in efficacy of pregabalin treatment. Moreover, there was a dose-related increase in incidence of most adverse events which are generally mild to moderate. Disclosure C. Radhakrishnan: None. A. Ut: None. S. K: None. N. Manikath: None. R.R. Cr: None.

Pengaruh Senam Kaki Terhadap Penurunan Resiko Neuropati Perifer Dengan Skor Diabetic Neuropathy Examination Pada Pasien Diabetes Melitus Tipe 2 Di Puskesmas Sibela Kota Surakarta

Abstract : Foot Gymnastics, Diabetic Neuropathy Examination Score. Peripheral neuropathy is one of chronic complications frequently found in diabetes mellitus case. The risks of the diabetic patient with peripheral neuropathy face included repeated infection, refractory ulcer and finger and foot amputation. This condition requires an easy and cheaper primary treatment, foot gymnastic. This research aimed to find out the effect of foot gymnastic on the decreased peripheral neuropathy with diabetic neuropathy examination score in patients with type 2 diabetes mellitus in Puskesmas (Public Health Center) Sibela in Surakarta City. The Research Methods could be used design using quasy experiment design with one group method pre test – post test. The samples are 30 participant of foot gymnastics at Puskesmas Sibela in February until April 2015. This research use paired t test in order to know risk decrease of peripheral neuropathy by diabetic neuropathy examination score. The results could from 30 respondents is obtained a mean diabetic examination neuropathy score before foot gymnastics was 7,67 with a standard deviation of 2,63 and after foot gymnastics was 5,37 with a standard deviation of 2,632. From the paired t test analysis was obtained p = 0,001 (p&lt;0,05). Conclusion existence of influence foot gymnastic againts a decreased risk of peripheral neuropathy based on diabetic neuropathy examination scores. Suggestion for the next research measurement diabetic neuropathy examination scores for 3 to 6 months to obtain optimal result.

Prevalence and Risk Factors for Peripheral Neuropathy among Type 2 Diabetes Mellitus Patients at a Tertiary Care Hospital in Coastal Karnataka.

Context and Objective:In view of the growing burden of type 2 diabetes mellitus (T2DM) globally and associated microvascular and macrovascular complications, the study was done to assess the prevalence and risk factors for diabetic neuropathy among T2DM patients attending a tertiary care hospital.Subjects and Methods:T2DM patients’ ≥30 years of both gender, presenting to the Medicine Department at a tertiary care hospital were included in the study. Diabetic Neuropathy Symptom (DNS) questionnaire to assess symptoms and Diabetic Neuropathy Examination (DNE) scoring to assess clinical signs were used.Results:A total of 273 patients were included. The mean age was 57.8 ± 11.5 years. The male to female distribution was 75% (202) and 25% (71), respectively. According to DNS instrument, 41.4% patients scored positive for the presence of neuropathy while only 24.5% had neuropathy according to DNE score. The proportion of males affected by neuropathy was more than females. 43.1% males had a positive DNS score while only 27.2% of them had a positive DNE score. Duration of the disease was positively correlated with neuropathy. Neuropathy was more prevalent among people who had higher systolic and diastolic blood pressure as per DNS and DNE instruments.Conclusions:The present study identified a higher proportion of males to be affected by neuropathy. Hence, more detailed evaluation must be accorded to elderly male diabetic patients with longer duration of the disease. Lifestyle modifications and watchful screening need to be incorporated as part of routine patient health education during follow-up clinic visits.

Serum Vitamin B12 Levels in Type 2 Diabetes Patients on Metformin Compared to those Never on Metformin: A Cross-sectional Study.

Context:There are limited data about the effect of metformin use on serum Vitamin B12 levels in type 2 diabetes patients from India.Aims:We studied serum Vitamin B12 levels in patients with type 2 diabetes mellitus who were receiving metformin and compared them to those never treated with metformin.Subjects and Methods:A total of 183 patients (“metformin” group 121, “no metformin” group 63) of type 2 diabetes from the endocrinology clinic of a tertiary care center in North India were studied. Serum Vitamin B12 levels were measured in all patients. Diabetic neuropathy symptom score (DNS) and diabetic neuropathy examination score (DNE) were used to assess peripheral neuropathy while hemoglobin and mean corpuscular volume (MCV) were used to assess anemia.Results:The serum Vitamin B12 levels were 267.7 ± 194.4 pmol/l in metformin group and 275.1 ± 197.2 pmol/l in the no metformin group (P = 0.78). When adjusted for duration of diabetes, metformin use was associated with a 87.7 ± 37.7 pmol/l (95% confidence interval [CI], −162.1–−3.3, P = 0.02) lower serum Vitamin B12 levels. No significant increase in the prevalence of neuropathy (DNS and DNE scores), anemia, or MCV was found in the Vitamin B12 deficient patients (levels <150 pmol/l) as compared to patients with normal Vitamin B12. However, serum Vitamin B12 levels for the entire cohort were higher by 12.2 ± 3.0 pmol/l (95% CI 6.4–18.0, P < 0.001) for every 1 year increase in the duration of diabetes.Conclusions:Metformin use was associated with a lower serum Vitamin B12 levels when adjusted for duration of diabetes. Increasing duration of diabetes was associated with higher serum Vitamin B12 levels.

Examination and analysis of diabetic optic neuropathy after cataract surgery

Objective To analyse the characteristics of diabetic optic neuropathy (DON) in cataract patients with diabetes by using fluorescein fundus angiography (FFA), optical coherence tomography (OCT), visual evoked potential (VEP) and perimetry examination. Methods A total of 235 eyes of 125 cataract patients with diabetes were included in the study. These patients received cataract surgery and performed with FFA, OCT, VEP and perimetry examination postoperatively. The examination results and clinical characteristics of diabetic retinopathy (DR) and DON were analyzed. Results Seventy eyes (29.8%) were diagnosed with DR, 75 eyes(31.9%) were diagnosed with DON. FFA in DON patients showed macular edema, optic disc edema, filling defect and optic disc neovascularization. OCT mainly showed macular edema, thickening or atrophy. VEP mainly showed prolonged P100 wave latency or decreased wave amplitude. Perimetry examination showed various kinds of insults. Conclusion DR and DON show a high occurrence rate in diabetes mellitus patient with cataract. FFA plays a key role in the early diagnosis of DR and DON. Retinal ganglion cells are damaged in patients with early DR. Key words: Optic neuropathy, diabetic; Examination, postoperative, cataract; Fundus fluorescein angiography; Optical coherence tomography; Visual evoked potential

Effect of Proprioceptive Neuromuscular Facilitation (PNF) in Improving Sensorimotor Function in Patients with Diabetic Neuropathy Affecting Lower Limbs

Background: Diabetic Mellitus is a group of metabolic disease characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action or both. Distal Sensorimotor Polyneuropathy is the most common complication of diabetes which mainly affects the lower limbs. Most of the studies aimed at individually increasing muscle strength or sensation but not on overall performance enhancements of the diabetic lower limbs. The evidence supporting the effectiveness of PNF in diabetic neuropathic patients is scarce.Methods: 30 patients, with age between 50 to 70 years, diagnosed with Diabetic Sensorimotor Polyneuropathy (DSP) were selected from the department of Medicine and department of Neurosurgery Guru Gobind Singh Medical College and Hospital. Patients were evaluated at the beginning and at the end of the intervention using Diabetic Neuropathy Examination scores. Patients received 3 sets of exercises one hour/day with 3 days/week for 3 months. Each set of exercises consists of 5 repetitions of PNF patterns (alternate day) and techniques.Results: D1 & D2 patterns of PNF are effective in improving both motor and sensory functions of diabetic patients with neuropathic symptoms. Improvement in muscle strength, reflex and sensations occurred to a greater extent after the treatment of three months in these subjects. This study shows that PNF patterns were effective at enhancing sensorimotor problems of lower limbs.Conclusion: This study concluded that PNF is found to be effective in improving sensorimotor functions of diabetic neuropathic patients affecting lower limbs.

Correlation between clinical neuropathy scores and nerve conduction studies in patients with diabetic peripheral neuropathy

Background Diabetic peripheral neuropathy (DPN) represents one of the most common complications of diabetes mellitus. Objective The aim of this study was to assess the correlation between clinical neuropathy scores and nerve conduction studies (NCS). Patients and methods This study included 30 (12 men and 18 women) Egyptian patients with type 2 diabetes mellitus complaining of symptoms suggestive of DPN. All patients underwent a clinical evaluation using three clinical scores: the Neuropathy Disability Score (NDS), the Neuropathy Impairment Score in the Lower Limbs (NIS-LLs), and the Diabetic Neuropathy Examination (DNE) score. Neurophysiological studies using NCS as well as measurement of glycated hemoglobin (HbA1C) were carried out. Results HbA1C was significantly correlated with NDS, NIS-LL, and DNE. The NDS was statistically correlated to median nerve sensory amplitude, sensory conduction velocity; ulnar nerve sensory amplitude, sensory conduction, motor amplitude, motor conduction velocity; and peroneal nerve sensory amplitude, sensory conduction velocity, motor amplitude, and motor conduction velocity. NIS-LL was significantly correlated with median nerve sensory amplitude, sensory conduction velocity; motor amplitude, motor conduction velocity; ulnar nerve sensory amplitude, sensory conduction velocity, motor conduction velocity; and peroneal nerve sensory amplitude, sensory conduction velocity, motor amplitude, and motor conduction velocity. DNE was significantly correlated with median nerve sensory amplitude, sensory conduction velocity, motor amplitude, motor conduction velocity; ulnar nerve sensory amplitude, sensory conduction velocity, motor amplitude, motor conduction velocity; and peroneal nerve sensory amplitude, sensory conduction velocity, motor amplitude, and motor conduction velocity. Conclusion Clinical neuropathy scores represent a simple tool for evaluation and follow-up of patients with DPN in comparison with NCS, and we recommend the use of these scores in clinical practice on a routine basis.