Diabetic Neuropathy Study Research Articles

Nerve conduction velocity studies in diabetic peripheral neuropathy involving sural nerve—A meta-analysis

ABSTRACT Introduction: Diabetes mellitus (DM) poses a significant health burden globally, impacting millions due to its metabolic disruptions. Among its complications, diabetic peripheral neuropathy (DPN) is a prevalent concern, affecting sensory and motor nerves. While various diagnostic methods exist, discrepancies persist in prevalence estimates of DPN among diabetic populations. Objective: This meta-analysis aimed to assess the prevalence of DPN in individuals with DM, focusing on sural nerve conduction velocity (NCV) measurements. Additionally, the study explored how different evaluation techniques influenced prevalence estimates. Methods: A systematic literature search was conducted following PRISMA guidelines across multiple databases. Studies reporting sural nerve NCV measurements in diabetic patients were included. Data extraction, quality assessment, and statistical analyses were performed to synthesize findings. Results: Twenty-six studies met the inclusion criteria, providing insights into sural nerve NCV among diabetic individuals. Pooled analysis revealed a mean sural nerve NCV of 42.12 m/s (95% CI: 39.87-44.36), indicative of reduced conduction velocity in diabetic populations. Furthermore, sural nerve amplitude was significantly lower in diabetic individuals, with a pooled mean of 4.68 μV (95% CI: 3.11-6.25). Conclusion: Individuals with type 2 DM exhibit impaired sural nerve function, as evidenced by reduced NCV and amplitude measurements. Timely NCV assessment, alongside glycemic monitoring, is crucial for identifying and managing DPN to prevent further complications. Interventions addressing glycemic control, dietary regulation, and lifestyle modifications are recommended to mitigate the progression of neuropathy in diabetic populations.

Prevalence and characteristics of diabetic symmetric sensorimotor polyneuropathy in Japanese patients with type 2 diabetes: The Japan Diabetes Complication and its Prevention Prospective study (JDCP study 10).

This study aimed to investigate the prevalence and characteristics of diabetic symmetric sensorimotor polyneuropathy (DSPN) in patients with type 2 diabetes registered in the Japan Diabetes Complication and its Prevention Prospective study. In the study, 6,338 patients with diabetes who had been treated by diabetes specialists were registered in 2007-2009. Of these, patients with type 2 diabetes who could be evaluated for DSPN were analyzed using the t-test, χ2 -test and logistic regression analyses. DSPN was diagnosed using the Simple Diagnostic Criteria for Diabetic Polyneuropathy proposed by the Diabetic Neuropathy Study Group in Japan. Of the total participants, 5,451 patients (mean age 61.4 years, duration of diabetes 10.8 years) were analyzed. Based on the criteria, 35.8% of patients were diagnosed with DSPN. The prevalence of sensory symptoms was 25.8%. The following factors increased the risk for DSPN: age (odds ratio[OR] 1.57, 95% confidence interval [CI] 1.42-1.73), duration of diabetes (OR 1.32, 95% CI 1.21-1.43), body mass index (OR 1.19, 95% CI 1.09-1.30), systolic blood pressure (OR 1.06, 95% CI 1.01-1.10), hemoglobin A1c (OR 1.15, 95% CI 1.09-1.22), biguanides (OR 1.22, 95% CI 1.06-1.39) and insulin therapy (OR 1.59, 95% CI 1.36-1.84). The following factors decreased the risk for DSPN: total cholesterol (OR 0.98, 95% CI 0.96-1.00) and exercise therapy (OR 0.85, 95% CI 0.73-0.98). The baseline survey clarified the prevalence and characteristics of DSPN in Japanese patients with type 2 diabetes. The survey also showed the risk factors of DSPN.

Study of Risk Factors Diabetic Peripheral Neuropathy at One Single Center in Indonesia

Background: Diabetes Mellitus (DM) is a disease that can lead to diabetic peripheral neuropathy (DPN). DPN is caused by various risk factors such as age, body mass index (BMI), glycated hemoglobin variability including mean HbA1c (M-HbA1c), hypertension status, triglyceride levels, total cholesterol levels, low-density lipoprotein (LDL) levels, and high-density lipoprotein (HDL) levels. This study aims to investigate the factors influencing DPN.Methods: A retrospective cross-sectional study of diabetic patients with and without DPN was undertaken at Jakarta referral hospitals from January 2021 to December 2022. Age, BMI, mean HbA1c variability, hypertension status, triglycerides, total cholesterol, LDL, and HDL values were compared between DPN and non-DPN groups. Chi-square analysis and logistic regression were performed to identify factors influencing DPN.Results: There were 62 patients diagnosed with DPN and 51 patients without DPN. Chi-square analysis showed a correlation between the variability of M-HbA1c (p = 0.003), triglycerides (p = 0.002), total cholesterol (p = 0.001), and LDL (p = 0.016) and the incidence of DPN in patients. Variability of M-HbA1c (p = 0.032, PR: 0.340, 0.127 – 0.914 95% CI), (p = 0.008, OR : 0.430, 0.205 – 0.793 95% CI), and HDL levels (p = 0.024, OR : 0.325, 0.122 – 0.865 95% CI) was revealed by logistic regression analysis.Conclusion: DPN correlates with a high degree of variability in M-HbA1c, triglyceride levels, total cholesterol, and LDL. Consequently, diabetics must monitor their respective health conditions in order to prevent DPN. AbstrakLatar belakang: Diabetes Mellitus (DM) merupakan penyakit yang dapat menyebabkan neuropati diabetik perifer (NDP). Neuropati diabetik perifer disebabkan oleh berbagai faktor risiko seperti usia, indeks massa tubuh (IMT), variabilitas HbA1c salah satunya rata-rata HbA1c (M-HbA1c), status hipertensi, kadar trigliserida, kadar kolesterol total, kadar low-density lipoprotein (LDL), dan kadar high-density lipoprotein (HDL). Penelitian ini untuk mengetahui faktor-faktor yang memengaruhi NDP.Metode: Penelitian potong-lintang retrospektif dengan melibatkan pasien DM dengan komplikasi neuropati diabetik perifer dan tidak di rumah sakit rujukan nasional di Jakarta, Indonesia pada Januari 2021 - Desember 2022. Perbandingan antara grup NDP dan tidak berdasarkan umur, IMT, Variabilitas rata-rata HbA1c, status hipertensi, trigliserida, kolesterol total, LDL, dan HDL. Analisis chi-square dan regresi logistik dilakukan untuk mengidentifikasi faktor-faktor mempengaruhi NDP.Hasil: 62 pasien datang dengan diagnosis NDP dan 51 pasien tanpa NDP. Analisis chi-square menyatakan terdapat hubungan signifikan antara variabilitas rata-rata HbA1c (p = 0,003), trigliserida (p = 0,002), kolesterol total (p = 0,001), dan LDL (p = 0,016) dengan kejadian NDP pasien. Analisis regresi logistik menunjukkan variabilitas rata-rata M-HbA1c (p = 0,032, OR: 0,340, 0,127 – 0,914 95% CI), kadar trigliserida (p = 0,008, OR : 0,430, 0,205 – 0,793 95% CI), dan kadar HDL (p = 0,024, OR : 0,325, 0,122 – 0,865 95% CI).Kesimpulan: Variabilitas M-HbA1c, kadar trigliserida, kolesterol total, LDL yang tinggi berkorelasi dengan NDP. dengan demikian, para penderita DM ini perlu selalu memantau kondisi kesehatan masing-masing agar tidak menimbulkan NDP.

Efficient Evaluation of Prediction Rules in Semi-Supervised Settings under Stratified Sampling.

In many contemporary applications, large amounts of unlabeled data are readily available while labeled examples are limited. There has been substantial interest in semi-supervised learning (SSL) which aims to leverage unlabeled data to improve estimation or prediction. However, current SSL literature focuses primarily on settings where labeled data is selected uniformly at random from the population of interest. Stratified sampling, while posing additional analytical challenges, is highly applicable to many real world problems. Moreover, no SSL methods currently exist for estimating the prediction performance of a fitted model when the labeled data is not selected uniformly at random. In this paper, we propose a two-step SSL procedure for evaluating a prediction rule derived from a working binary regression model based on the Brier score and overall misclassification rate under stratified sampling. In step I, we impute the missing labels via weighted regression with nonlinear basis functions to account for stratified sampling and to improve efficiency. In step II, we augment the initial imputations to ensure the consistency of the resulting estimators regardless of the specification of the prediction model or the imputation model. The final estimator is then obtained with the augmented imputations. We provide asymptotic theory and numerical studies illustrating that our proposals outperform their supervised counterparts in terms of efficiency gain. Our methods are motivated by electronic health record (EHR) research and validated with a real data analysis of an EHR-based study of diabetic neuropathy.

Study of Diabetic Peripheral Neuropathy in Adults of Telangana

Background: Diabetic peripheral neuropathy (DPN) predisposes to foot ulceration and gangrene. It has been reported thatprevalence of DPN is lower in Indians relative to Caucasians. Studies among recent onset patients with type 2 diabetesmellitus (Type2-M) are very few. We studied the prevalence and risk factors of DPN in patients with newly diagnosedType2DM.Methods: We prospectively studied 80 consecutive patients over age 30 with a duration of diabetes ≤1 year. Every patientunderwent a clinical and biochemical evaluation and was screened for DPN using TCSS scale (Toronto clinical scoringsystem) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale.Results: The cases had a mean age of 60.28 years and duration of symptoms of DM is <1year prior to presentation. Theoverall prevalence of DPN was 12.5%. The prevalence of DPN showed an increasing trend with FBS (trend chi-square=3.517, P = 0.0304). A logistic regression analysis showed that DPN was independently associated with Fasting Blood Sugar(P = 0.0304), Body mass index (P= 0.0389), HbA1c (P = 0.0451), family history (P= 0.0426) and physical activity (P= 0.0219)but not with age, sex and education.Conclusions: Our study showed high prevalence of PN in recently diagnosed patients with Type2DM, which wasindependently associated with age and duration of symptoms of diabetes prior to the diagnosis. FBS, HbA1c, BMI, werefound to be risk factors for prevalence of Diabetic Neuropathy.

Painful Diabetic Peripheral Neuropathy Study of Chinese Outpatients (PDNSCOPE): A Multicentre Cross-Sectional Registry Study of Clinical Characteristics and Treatment in Mainland China.

IntroductionThis aim of this study was to delineate current clinical scenarios of painful diabetic peripheral neuropathy (PDN) and associated anxiety and depression among patients in Mainland China, and to report current therapy and clinical practices.MethodsA total of 1547 participants were enrolled in the study between 14 June 2018 and 11 November 2019. Recruitment was conducted using a multilevel sampling method. Participants’ demographics, medical histories, glucose parameters, Douleur Neuropathique 4 Questionnaire (DN4) scores, visual analogue scale (VAS) pain scores, Patient Health Questionnaire 9 (PHQ-9) scores, Generalised Anxiety Disorder 7 (GAD-7) scores and therapies were recorded.ResultsThe male-to-female ratio was 1.09:1 (807:740), and the mean age at onset was 61.28 ± 11.23 years. The mean DN4 score (± standard deviation) was 4.91 ± 1.88. The frequencies of DN4 sub-item phenotypes were: numbness, 81%; tingling, 68.71%; pins and needles, 62.90%; burning, 53.59%; hypoaesthesia to touch, 50.16%; electronic shocks, 43.31%; hypoaesthesia to pinprick, 37.94%; brushing, 37.82%; painful cold, 29.61%; and itching, 25.86%. Age, diabetic duration, depression history, PHQ-9 score and GAD-7 score were identified as risk factors for VAS pain score. Peripheral artery disease (PAD) was a protective factor for VAS pain score. For all participants currently diagnosed with PDN and for those previously diagnosed PDN, fasting blood glucose (FBG) was a risk factor for VAS; there was no association between FBG and VAS pain score for PDN diagnosed within 3 months prior to recruitment. Utilisation rate of opium therapies among enrolled participants was 0.71% , contradiction of first-line guideline recommendation for pain relief accounted for 9.43% (33/350) and contradiction of second-line guideline recommendation for opium dosage form was 0.57% (2/350).ConclusionModerate to severe neuropathic pain in PDN was identified in 73.11% of participants. Age, diabetic duration, depression history, PHQ-9 score, GAD-7 score and FBG were risk factors for VAS pain scores. PAD was protective factor. The majority of pain relief therapies prescribed were in accordance with guidelines.Trial registrationClinicalTrials.gov identifier, NCT03520608, retrospectively registered, 2018-05-11.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-021-00281-w.

Correlation between Quantitative Ultrasonography on Small Muscles of the Foot in Diabetic Peripheral Neuropathy and Electrodiagnostic Study

Abstract Background: DPN is worthy of study as it's a leading cause for disability due to foot ulceration and amputation, gait disturbance, and fall-related injury. That makes the early diagnosis of DPN invaluable. Aim of Study: To assess the correlation between quantita-tive muscle ultrasonography (US) findings and electrodiag-nostic study results in patients with diabetic peripheral neu-ropathy (DPN). The clinical importance of quantitative muscle US in DPN was also evaluated. Patients and Methods: Twenty-five patients with DPN and 25 healthy volunteers were recruited. All control and DPN subjects underwent a bilateral peroneal and tibial motor nerve conduction study (NCS) and quantitative muscle US. Ultrasound images of the abductor haullicis (AH) muscle and the extensor digitorum brevis (EDB) muscle were obtained to measure thickness, muscle cross-sectional area (CSA) and echo intensity (EI). Differences in muscle thickness, CSA, and EI between the control and DPN patients' groups were analyzed. Relationships between electrodiagnostic study results and quantitative US parameters were evaluated. Results: A close relations observed between US findings (EI, CSA and muscle thickness) and NCS neuro-physiological findings indicating that we can use both examinations to detect muscle atrophy, and that US can expect changes in neurophys-iologic parameters in diabetics (muscle thickness and CSA were decreased, and EI was increased). The findings in the peroneal nerve were more significant than those in tibial nerve. Comparison between cases and controls regarding quantitative muscle US revealed a statistically insignificant difference in most the parameters, but some parameters showed statistically significant difference. However, there was a clinical importance of the US examination despite the insig-nificant statistics. Conclusion: These findings suggest that quantitative muscle ultrasound may be useful for detecting muscle changes in DPN. Further studies are needed to confirm the findings in larger groups of diabetic patients and to evaluate peripheral muscles by using quantitative muscle US in other types of neuropathy and neuromuscular diseases.

A Secondary Analysis from a Randomized Trial on the Effect of Plasma Tetrahydrocannabinol Levels on Pain Reduction in Painful Diabetic Peripheral Neuropathy

This report examines the association between tetrahydrocannabinol (THC) plasma levels and pain response in a secondary analysis of data from a recent diabetic neuropathy study that demonstrated a dose-dependent reduction in spontaneous and elicited pain at specific time points. A randomized, double-blinded, placebo-controlled crossover study was conducted in sixteen patients with painful diabetic peripheral neuropathy. Subjects participated in four sessions, separated by 2 weeks, during each of which they were exposed to one of four conditions: placebo, or 1%, 4%, or 7% THC dose of cannabis. Baseline assessments of spontaneous and evoked pain were performed. Subjects were then administered aerosolized cannabis or placebo and pain intensity and cognitive testing at specific time points for 4 hours. A blood sample was drawn from the left antecubital vein for plasma assay of total THC at 0, 15, 30, 45, 60, 150, and 240 minutes. Associations were made between pain intensity, cognitive impairment and THC plasma levels in this secondary analysis. Results suggested a U-shaped relation whereby pain ratings are greatest at extreme (low and high) levels of THC. The therapeutic window appeared to fall between 16 ng/mL and 31 ng/mL THC plasma level. There was a significant linear effect of THC on only one out of the three cognitive tests. These findings stress the importance of measuring cannabinoid plasma levels when performing future research.Perspective: This analysis correlating plasma THC levels and pain reduction in diabetic neuropathy suggest a therapeutic window. Low and high THC levels had a negative association (no reduction) and THC levels within the window had a positive association (reduction). There was a minor negative linear effect of THC on cognitive function.

Effects of mirogabalin on tingling or pins & needles in a phase 3 study of diabetic peripheral neuropathy

Effects of mirogabalin on tingling or pins & needles in a phase 3 study of diabetic peripheral neuropathy

Correlation between risk factors for diabetic peripheral neuropathy and nerve conduction study parameters in children with type 1 diabetes mellitus attending Sudan childhood diabetes centre

Diabetic peripheral neuropathy (DPN) is the commonest microvascular complication of diabetes mellitus. Risk factors related to the development of DPN are mainly duration of diabetes, degree of glycaemic control, height of the patient and age at onset of diabetes mellitus. This study aimed to correlate between the risk factors for diabetic peripheral neuropathy (DPN) and lower limbs nerve conduction study (NCS) parameters in children with type 1 diabetes mellitus attending Sudan Childhood Diabetes Centre. This cross-sectional study recruited 50 patients with type 1diabetes, with mean disease duration of 4.9 ± 3.8 years attending Sudan Childhood Diabetes Centre. NCS parameters (latency, amplitude, and conduction velocity) of sural, common peroneal and posterior tibial nerves were measured bilaterally. Using Pearson correlation statistics, the study revealed significant negative correlation between the patient age and the motor velocities of tibial and common peroneal nerves. Furthermore, it proved significant negative correlation between the patient height and velocities of sural, tibial and common peroneal nerves. It also showed significant negative correlation between the age at onset of the disease and the motor velocities of the right tibial and right common peroneal nerves. Moreover, there was significant negative correlation between HbA1c and the motor velocities of both right and left tibial nerves. Duration of the disease did not show any correlation with NCS parameters. The study proved that most of the risk factors for diabetic peripheral neuropathy decrease significantly the conduction velocity especially of the motor lower limbs nerves in type 1 diabetic children.

Voltage-gated sodium channel and painful diabetic neuropathy

Sodium channel provides a new idea for the study of painful diabetic neuropathy. Based on the research status of sodium channel and painful diabetic neuropathy at home and abroad, five sodium channels with high correlation with diabetic painful neuropathy were selected, and the characteristics of these sodium channels were summarized.The expression status of sodium channel in diabetic painful neuropathy model was summarized, and the role of sodium channel in the pathogenesis of diabetic painful neuropathy was summarized. The relationship between sodium channel and diabetic painful neuropathy was analyzed, as well as the difficulties facing the current research, in order to provide references for the research and application of sodium channel in the treatment of diabetic painful neuropathy. Key words: Sodium channels; Diabetic neuropathies; Review

Factors associated with diabetic polyneuropathy-related sensory symptoms and signs in patients with polyneuropathy: A cross-sectional Japanese study (JDDM 52)using a non-linear model.

Aims/IntroductionTo assess the prevalence of diabetic polyneuropathy (DPN)‐related sensory symptoms/signs and associated factors in patients with polyneuropathy, considering non‐linear effects for numerical variables.Materials and MethodsA cross‐sectional survey of patients with type 2 diabetes mellitus from 17 primary care clinics across Japan was carried out. DPN and DPN‐related sensory symptoms/signs were diagnosed according to the Diabetic Neuropathy Study Group in Japan criteria.ResultsOf the 9,914 patients with type 2 diabetes mellitus in this study, 2,745 had DPN and 1,689 had DPN‐related sensory symptoms/signs (61.5% of patients with DPN). There were significant correlations between DPN‐related sensory symptoms/signs and smoking status (odds ratio 2.04 for current and 1.64 for former; P < 0.001 and P = 0.002, respectively), sex (odds ratio 0.56 for male/female; P < 0.001) and alcohol consumption (odds ratio 2.02 for former/never; P = 0.004). Based on the non‐linear logistic regression model, significant correlations were observed between the presence of DPN‐related sensory symptoms/signs and higher systolic blood pressure (SBP), longer diabetes duration, and decreasing age. The logarithm of odds for SBP increased until reaching approximately 130 mmHg, then it plateaued.ConclusionsSome modifiable factors assessed in the large survey database might be associated with DPN‐related sensory symptoms/signs, namely smoking, alcohol consumption and SBP. Maintaining SBP <130 mmHg was associated with lower odds of DPN‐related sensory symptoms/signs in patients with DPN.

Intraepidermal Nerve Fiber Analysis in Human Patients and Animal Models of Peripheral Neuropathy: A Comparative Review.

Analysis of intraepidermal nerve fibers (IENFs) in skin biopsy samples has become a standard clinical tool for diagnosing peripheral neuropathies in human patients. Compared to sural nerve biopsy, skin biopsy is safer, less invasive, and can be performed repeatedly to facilitate longitudinal assessment. Intraepidermal nerve fiber analysis is also more sensitive than conventional nerve histology or electrophysiological tests for detecting damage to small-diameter sensory nerve fibers. The techniques used for IENF analysis in humans have been adapted for large and small animal models and successfully used in studies of diabetic neuropathy, chemotherapy-induced peripheral neuropathy, HIV-associated sensory neuropathy, among others. Although IENF analysis has yet to become a routine end point in nonclinical safety testing, it has the potential to serve as a highly relevant indicator of sensory nerve fiber status in neurotoxicity studies, as well as development of neuroprotective and neuroregenerative therapies. Recently, there is also interest in the evaluation of IENF via skin biopsy as a biomarker of small fiber neuropathy in the regulatory setting. This article provides an overview of the anatomic and pathophysiologic principles behind IENF analysis, its use as a diagnostic tool in humans, and applications in animal models with focus on comparative methodology and considerations for study design.

1620-P: Trends in Cannabis Use among Patients with Diabetes—The National Survey on Drug Use and Health, 2005-2017

Cannabis legalization for medical and recreational uses has increased, driven by the more permissive attitudes towards cannabis. Potential beneficial effects of cannabinoids have been reported in studies of diabetic retinopathy and neuropathy. Higher prevalence of diabetic ketoacidosis, however, was reported in type 1 diabetes patients who use cannabis. Whether cannabis use has changed over time among patients with diabetes is unknown. Here, we estimate the prevalence of cannabis use among participants with diabetes in the National Survey on Drug Use and Health (NSDUH, 2005-2017), a large nationally representative sample of the United States non-institutionalized population aged 12 years and older. Audio computer-assisted self-interview system (ACASI) assessed cannabis use in the participant residence. During the ACASI, participants were asked whether a doctor or health care professional had ever told them that they had diabetes. The number of NSDUH participants with diabetes ranged from 1537 (weighted % = 6.7) in 2005 to 2919 (9.3%) in 2017. The prevalence of past 30-day cannabis use among diabetes patients was 1.7% (95% CI = 1.1, 2.6) in 2005, increasing to 4.8% (95% CI = 3.8, 6.0) in 2017. Similarly, past 12-month use has increased from 2005 to 2017. This increasing trend is observed across age, sex, ethnic self-identification and education subgroups, and in states with or without medical cannabis laws. In summary, cannabis use has increased ∼180% in NSDUH participants with diabetes from 2005 to 2017. Physicians should educate patients on cannabis use, including its effects on appetite and gastric emptying, and its effect on perception and treatment adherence, which can be crucial in insulin-dependent diabetes. Additional research is also needed to understand the effect of cannabis on glucose metabolism and diabetes complications. Disclosure O. Alshaarawy: None. Funding National Center of Complementary and Integrative Health (R00AT009156); Michigan State University

2237-PUB: Validation of the Simple Diagnostic Criteria in Japan

Introduction: The simple diagnostic criteria (SDC) proposed by Diabetic Neuropathy Study Group in Japan has been widely accepted in our country. However, the diagnostic ability has not yet been fully validated. In the present study, we examined the usefulness of SDC in diagnosis of diabetic polyneuropathy (DPN). Methods: We evaluated admitted 114 diabetic subjects who were diagnosed as DPN employing three independent decision rules consisting SDC: physical signs and symptoms (PHY), nerve conduction study (NCS), or coefficient of variation of RR interval (CVR-R) on electrocardiogram (CVRR). #1. PHY rule: satisfied any two or more of following three items: the presence of symptoms considered to be due to DPN, the decrease or disappearance of bilateral Achilles tendon reflexes, and decreased vibration in the bilateral medial malleoli. #2. NCS rule: one or more nerve conduction abnormalities in two or more nerves out of 12 peripheral nerves. #3. CVRR rule: less than 2% of CVR-R. The diagnostic accuracy was evaluated using the NCS rule as the reference standard. Result: 1. Ninety-six subjects (84.2%) diagnosed as DPN. The proportions of DPN were 37.7% for PHY, 74.6% for NCS, and 43.9% for CVRR. 2. The diagnostic accuracy of PHY and/or CVRR. Discussion: Diagnosis by NCS showed the highest prevalence. The sensitivity of PHY was improved by a combination with CVRR. DPN can be identified effectively utilizing SDC. Disclosure T. Himeno: None. Y. Shibata: None. H. Shimoda: None. M. Kondo: None. S. Tsunekawa: None. Y. Kato: Speaker's Bureau; Self; Merck &amp; Co., Inc. J. Nakamura: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Japan Tobacco Inc., Kissei Pharmaceutical Co., Ltd., Merck Sharp &amp; Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Kowa Pharmaceu. Co. Ltd., Merck Sharp &amp; Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. H. Kamiya: Speaker's Bureau; Self; Astellas Pharma Inc., Eli Lilly Japan K.K., MSD K.K., Novartis Pharma K.K., Novo Nordisk Oharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi K.K.

Painful Diabetic Peripheral Neuropathy Study of Chinese OutPatiEnts (PDN-SCOPE): protocol for a multicentre cross-sectional registry study of clinical characteristics and treatment in China

IntroductionPainful diabetic peripheral neuropathy (PDN) is a growing public health problem in China. Despite recent progress in treatment, there has been no nationwide study evaluating current medical practices and compliance...

Study of Diabetic Neuropathy among Telangana Population

90 known diabetic patients (48 females 42 males) aged between 30–68 years old of Telangana region were studied. The regional classification of diabetic neuropathy was, distal symmetrical peripheral neuropthy were 32(35.5%) proximal neuropathy were 18(20%) cranial and truncal neuropathy were 12(13.3%). Mononeuropathy multiplex were 28(31.1%), the clinical manifestation were cardio vascular were 25(27.7%), included HTN-11(12.2%), tachycardia 9(10%) orthostatic hypotension 5(5.5%), Gastrointestinal were 27(30%) included oesophageal 6(6.6%), Gastroparesis 8(8.8%), Constipation 6(6.6%), diarrhea 7(7.7%). Genitourinary 23(25.5%) included Erectile dysfunction 7(7.7%), Neurognic bladder 10(11.1%), Cystopathy 6.(66%). Miscellaneous were 15 (16.6%) included sweating disturbance 6(6.6%), heat intolerance 5(5.5%), hypoglycemia 4(4.4%), Biochemical study included duration of D.M 1 to 4 year were 10(11.1%), 5 to 10 years were 32 (35.5%) more than 10 years were 48(53.3%), FBG-in 44(48.8%), patients had 197 to 210(mg/dl), 46(51.1%) patients had 211 to 232(mg/dl) HbA1c value in 42 (46.6%) patients had 8.89 to 9.10 (mg/d1) 48(53.3%)patients had 9.20 to 10.5(mg/dl). Total cholesterol in 41(45.5%) patients had 177 to 181 mg/dl, 49(54.4%) had 182 to 184 mg/dl. LDL levels in 38 (42.2%) patients 102 to 107 mg/dl. 52(57.7%) patients 108 to 111 mg/dl. Triglyceride level in 39(43.3%), was 149 to 152, 51(56.6%) patients had 153 to 158 mg/dl. Systolic BP in 46(51.1%) patients had 132 to 137 (mmHg) 44(48.8%) patients had 138 to 141(mmHg). Diastolic BP in 43 (mmHg) (47.7%) patient had 83.8 to 85.2 (mmHg) 47(52.2%) patients had 86 to 90 (mm/Hg). This study will b quite useful to endocrinologist, physician to correlate the regional DN and its clinical manifestation, bio-chemical study to rule out the severity of disease and treat the patients efficiently.

Schwann Cells as Crucial Players in Diabetic Neuropathy.

Schwann cells maintain peripheral nerve structure and function by ensheathment of unmyelinated axons, myelination of myelinated axons, and secretion of neurotrophic factors, and these cells also play a crucial role in the pathogenic mechanisms of diabetic neuropathy. A decrease in unmyelinated and small myelinated axons appeared earlier than a decrease in large myelinated fibers in diabetic neuropathy. Electron microscopic studies of human diabetic neuropathy demonstrated edematous cell cytoplasm, aggregates of glycogen particles, and hyperplasia of the surrounding basal lamina in Schwann cells. Diabetic conditions also induces metabolic disorders, such as polyol pathway hyperactivity, activation of protein kinase C, and increased advanced glycosylation end products in Schwann cells, followed by the depletion of neurotrophic factor production.Cell transplantation using progenitor or stem cells is expected to cure diabetic neuropathy. Many studies demonstrated that the paracrine effect of abundant secreted factors from transplanted stem cells was crucial for the success of cell transplantation in diabetic neuropathy. Transplantation of progenitor or stem cells in diabetic animal models ameliorated impaired nerve conduction velocity, nerve blood flow, sensory disorders, and intraepidermal nerve fiber density, with an increase of myelin thickness. The supernatant from cultured dental pulp stem cells increased the proliferation and production of myelin-related protein in Schwann cells, suggesting that Schwann cells is the main target of cell transplantation for diabetic neuropathy.

Correlative study of diabetic retinopathy and peripheral neuropathy in Vijayawada population

Correlative study of diabetic retinopathy and peripheral neuropathy in Vijayawada population

The Prevalence and Characteristics of Diabetic Polyneuropathy in Japanese Type 2 Diabetic Patient

This study aims to investigate the prevalence and characteristics of diabetic polyneuropathy (DPN) in type 2 diabetic patients registered in the Japan Diabetes Complication and its Prevention Prospective (JDCP) study. In the JDCP study, 6,338 diabetic patients who had been treated by diabetes specialists were registered in 2007-9. Of these, 5,451 patients with type 2 diabetes (61.4 years-old, duration of diabetes 10. 8 years, BMI 24.5 and HbA1c 7.42%) who could be evaluated for DPN were analyzed by using t-test, chi-square test and logistic regression analysis. The diagnosis of DPN was performed by using simple diagnostic criterion for diabetic polyneuropathy proposed by Diabetic Neuropathy Study Group in Japan. This criterion should meet two or more of the following three items: 1) sensory symptoms (SS) considered to be due to DPN, 2) bilaterally decreased or absent Achilles tendon reflex (ATR) and 3) decreased vibratory perception threshold (VPT) in bilateral medical malleoli. The prevalence of positive SS, bilaterally decreased/absent ATR and symmetric decrease in VPT were 25.8%, 40.9% and 48.1%, respectively. Based on simple diagnostic criterion, DPN was observed in 35.8% of the total. The decrease/absence of bilateral ATR showed high sensitivity (87.2%) and specificity (84.8%) in the diagnosis of DPN. In the group with DPN, we investigated the odds ratio (OR) of covariates for neuropathy and found that the age (OR 1.58, p&amp;lt;0.001), the duration of diabetes (OR 1.32, p&amp;lt;0.001), BMI (OR 1.20, p&amp;lt;0.001), T-cho (OR 0.98, p&amp;lt;0.05), insulin therapy (OR 1.62, p&amp;lt;0.001), systolic blood pressure (OR 1.06, p&amp;lt;0.01), HbA1c (OR 1.17, p&amp;lt;0.001), oral administration of biguanide (OR 1.19, p&amp;lt;0.01) and exercise therapy (OR 0.83, p&amp;lt;0.05) showed significant. Baseline survey of the JDCP study, the prevalence of DPN in type 2 diabetic patients was similar to that reported previously, suggesting the possibility that the evaluation of bilateral ATR is useful for the diagnosis of DPN. Disclosure H. Kamiya: Other Relationship; Self; MSD K.K., Ono Pharmaceutical Co., Ltd., Sanofi K.K., AstraZeneca, Astellas Pharma KK, Eli Lilly and Company, Novartis Pharma K.K., Dainippon Sumitomo Pharma Co., Ltd, Boehringer Ingelheim Pharmaceuticals, Inc., Takeda Pharmaceutical Co., Ltd, Ono Pharmaceutical Co., Ltd.. A. Watarai: None. M. Baba: None. R. Nishimura: Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Astellas Pharma US, Inc., Eli Lilly and Company, Abbott, Medtronic, MSD K.K., Novo Nordisk A/S, Sanofi, Takeda Development Center Asia, Pte. Ltd., Kissei Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd.. N. Tajima: None. J. Nakamura: Other Relationship; Self; Astellas Pharma US, Inc., AstraZeneca, Ono Pharmaceutical Co., Ltd., MSD K.K., Kyowa Hakko Kirin Co., Ltd., Kowa Pharmaceuticals America, Inc., Sanofi K.K., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Mitsubishi Tanabe Pharma Corporation, Eli Lilly and Company, Novartis Pharma K.K., Pfizer Inc..