Diabetic Neuropathy Symptom Score Research Articles

Ayurvedic Treatment Modalities of Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy is the damage of the nerves due to the uncontrolled diabetes. It can affect any of the neurons can affect any of the neurons. Diabetic distal symmetric sensory and sensorimotor polyneuropathy is the most prevalent type of diabetic neuropathy. The symptoms appear as sensory loss, first in the toes and progressively moving up the legs, fingers, and arms over time. Tingling sensation, Burning sensation, Deep aching pain are other related symptoms. A patient age 54 years with diabetes for past 15 years, hypertension, dyslipidemia, complains of burning sensation of both feet (right>left), numbness, pricking pain, unsteadiness while walking, brownish red discolouration of both lower limbs. The symptoms were gradual in onset. Nerve Conduction Study showed axonal type of motor and sensory affecting peroneal nerve neuropathy. He admitted in Vaidyaratnam Ayurveda College Hospital, done Vibrotherm Neuropathy Analyzer and revealed small and large fibre neuropathy with severe loss of sensations. The main intention of the study is to improve the quality of life of the patient by reducing the symptoms that is disturbing his day today routine. Patient given with anti diabetic Ayurvedic formulations internally. Externally Rookshana, Vatahara, Brimhana treatments were done. After the treatment, Michigan neuropathy screening instrument, diabetic Neuropathy symptom score, Toronto clinical scoring system score were reduced. Neuropathy Analyzer showed mild to moderate loss of sensation. By adopting Prameha hara chikitsa coupled with Vata vyadhihara chikitsa, complications of diabetes can be managed. It is important to focus on diet and regimen since diabetes is a lifestyle disorder and, in ayurveda it is considered as an Anushangi Vyadhi.

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

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

Prevalence and Predictors of Diabetic Peripheral Neuropathy in Newly Diagnosed Type 2 Diabetes Mellitus Patients.

The present study aimed to determine the prevalence and predictors of DPN in newly diagnosed T2DM patients. Diabetic Peripheral Neuropathy (DPN) is the most common and debilitating complication of Type 2 Diabetes Mellitus (T2DM). Newly diagnosed T2DM patients visiting the outpatient department were recruited. Detailed demographic parameters, histories, physical examinations, and biochemical investigations were carried out. Patients were screened for DPN using the Diabetic Neuropathy Symptom (DNS) score, the revised Disability Neuropathy Score (NDS), Vibration Perception Threshold (VPT) using a biosthesiometer, and the 10g SW Monofilament Test (MFT). A total of 350 newly diagnosed T2DM patients (mean age 46.4±13.6 years) were included. The prevalence of DPN was found to be 34% using the combined DNS and NDS scores. VPT was moderately impaired in 18.3% and severely impaired in 12% patients, while MFT revealed a loss of protective sensation in 35.4% patients. After logistic regression analysis, DPN was significantly associated with increasing age (OR 1.08, 95%CI 1.06-1.11), increasing HbA1C levels (OR 1.23, 95%CI 1.05-1.42), increasing TSH levels (OR 1.23, 95%CI 1.05-1.44), presence of hypertension (OR 2.78, 95%CI 1.51-5.11), and reduced BMI (OR 0.9, 95%CI 0.84- 0.99). The sensitivity and specificity of detecting DPN by combining VPT and MFT were 91.6% and 84.2%, respectively. The prevalence of DPN was high even in newly diagnosed T2DM and associated significantly with increasing age, HbA1C levels, TSH levels, hypertension, and reduced BMI. Earlier screening for DPN, along with aggressive control of glycemia, blood pressure, and hypothyroidism, may be beneficial.

Analysis of determinant diabetic neuropathy symptom score factors in diabetes mellitus patients

Background: Diabetes peripheral neuropathy (DPN) is a set of signs and symptoms of peripheral nervous system dysfunction in diabetes mellitus patients. Abdominal obesity is one of the main risk factors for DPN. Diabetic neuropathy symptom (DNS) is a reliable instrument with consistent results for the diagnosis of neuropathy. Objective: This study aimed to determine the correlation of abdominal obesity with scores. Methods: This research was a quantitative study with a cross-sectional approach. The sample of this study was 92 type 2 diabetes mellitus (T2DM) patients aged range 30-60 years who participated in the chronic disease management program (Prolanis) and the integrated healthcare center (Posbindu) for people in the area of three public health centers (Puskesmas) in Pekalongan Regency which purposively selected. Instruments used to measure DPN were DNS sheets, and abdominal obesity was measured by waist circumference using a midline. The bivariate analysis was performed using the Pearson correlation and linear regression tests. Results: There was a correlation between abdominal obesity and DNS scores with a p value of 0.043 with a correlation coefficient of 0.212. The DNS score was influenced by age, gender, duration of diabetes, and body mass index by 13.4%. Conclusion: There was a correlation between abdominal obesity and DNS scores. It indicated that the higher the value of abdominal obesity was, the higher DNS scores increased.

The association of vitamin D level with diabetic peripheral neuropathy: A comparative cross- sectional study

Background &amp; Objective: Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (DM). Vitamin D deficiency has been shown to be prevalent among patients with type 2 DM, particularly in those with DPN. This study aimed to look at the association of serum vitamin D level with peripheral neuropathy in patients with type 2 DM. Methods: This was a comparative cross- sectional study conducted in a tertiary hospital in Malaysia. Fifty diabetic patients with DPN and fifty diabetic patients without DPN were recruited. Serum vitamin D level was determined by measuring 25-hydroxyvitamin D [25(OH)D] level. The patients were clinically assessed and screened with Diabetic Neuropathy Symptoms score. Nerve conduction study was performed for patients with DPN. Results: The serum 25(OH)D level was significantly lower in patients with DPN (11.81 [9.09-18.06] vs 18.63 [11.25-22.63] ng/ml; p=0.006). Multiple logistic regression analysis showed that DPN was significantly associated with higher BMI, longer duration of DM, insulin usage and serum 25(OH)D level. The usage of fibrates had negative association with DPN. Subgroup analysis of the DPN group showed that patients with painful DPN had significant lower serum 25(OH)D level (p&lt;0.001) and the clinical severity of DPN negatively correlated with serum 25(OH)D level (p=0.015). Conclusion: Vitamin D deficiency is associated with DPN in patients with type 2 DM. In addition, patients with painful DPN tend to have significantly lower serum 25(OH)D level.

Relationships of blood pressure and control with microvascular dysfunction in type 2 diabetes

BackgroundIn type 2 diabetes mellitus (T2D), cardiovascular risk factors including glycemic control differentially affect various microcirculatory beds. To date, studies comparing the impact of blood pressure (BP) on various microvascular beds in T2D are limited. We assessed the associations of BP and its control with neural, renal, and retinal microvascular dysfunction. MethodsThis was a cross-sectional study among 403 adults with T2D. Microvascular dysfunction was based on nephropathy (albumin-creatinine ratio ≥ 30 mg/g), neuropathy (vibration perception threshold ≥ 25 V and/or Diabetic Neuropathy Symptom score > 1), and retinopathy (based on retinal photography). Logistic regression was used to examine the associations of hypertension, systolic BP, and diastolic BP with microvascular dysfunction with adjustments for age, sex, diabetes duration, smoking pack years, HbA1c concentration, total cholesterol concentration, and BMI. ResultsThe mean age (± SD), proportion of females, and proportion of hypertensives were 56.35 (± 9.91) years, 75.7%, and 49.1%, respectively. In a fully adjusted model, hypertension was significantly associated with neuropathy [odds ratio 3.44, 95% confidence interval 1.96–6.04, P < 0.001] and nephropathy [2.05 (1.09–3.85), 0.026] but not for retinopathy [0.98 (0.42–2.31), 0.970]. Increasing Z-score systolic BP was significantly associated with nephropathy [1.43 (1.05–1.97), 0.025] but not for neuropathy [1.28 (0.98–1.67), 0.075] or retinopathy [1.27 (0.84–1.91), 0.261]. Increasing Z-score diastolic BP was significantly associated with nephropathy [1.81 (1.32 – 2.49), < 0.001] but not retinopathy [1.38 (0.92–2.05), 0.120] or neuropathy [0.86 (0.67–1.10), 0.230]. ConclusionOur study shows varying strengths of associations of hypertension, systolic BP, and diastolic BP with microvascular dysfunction in different microcirculatory beds. Hypertension prevention and/or control may be valuable in the prevention/treatment of microvascular disease, especially nephropathy, and neuropathy.

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.

Association between P300 parameters and cognitive function in people with diabetic neuropathy.

The purpose of this study was to investigate the association between event-related potential (ERP) P300 with cognitive function in people with diabetic peripheral neuropathy (DPN). We performed a cross-sectional analysis of 19 type 2 diabetes mellitus (T2DM) patients, aged 18 and older with DPN. The participants were assessed for neuropathy, cognitive function, & dual-task performance. DPN was examined via the administration of diabetic neuropathy symptom score (DNSS) and vibration perception threshold (VPT). Cognitive dysfunction was evaluated using Mini-mental state examination (MMSE), trail making test-B (TMT-B), and ERP P300 wave latency & amplitude. For assessing dual-task performance, the dual-task cost (DTC) was calculated using the timed-up and go (TUG) test and TUG with dual task (TUG-DT). P300 latency was linearly related to TMT-B (R = 0.31, p = 0.01) and DTC (R = 0.22, p = 0.04). A similar trend was observed in TMT-B (R = 0.13, p = 0.04) & DTC (R =0 .67, p = 0.001) with respect to P300 amplitude. MMSE did not relate with P300 latency (R = 0.14, p = 0.58) & amplitude (R = 0.63, p = .44). P300 latency and amplitude are associated with cognitive function and DTC of individuals with DPN.

Implementation of corneal confocal microscopy for screening and early detection of diabetic neuropathy in primary care alongside retinopathy screening: Results from a feasibility study.

ObjectiveScreening for diabetic peripheral neuropathy (DPN) is essential for early detection and timely intervention. Quantitative assessment of small nerve fiber damage is key to the early diagnosis and assessment of its progression. Corneal confocal microscopy (CCM) is a non-invasive, in-vivo diagnostic technique that provides an accurate surrogate biomarker for small-fiber neuropathy. In this novel study for the first time, we introduced CCM to primary care as a screening tool for DPN alongside retinopathy screening to assess the level of neuropathy in this novel cohort.Research design and methods450 consecutive subjects with type 1 or type 2 diabetes attending for annual eye screening in primary care optometry settings underwent assessment with CCM to establish the prevalence of sub-clinical diabetic peripheral neuropathy. Subjects underwent assessment for neurological and ocular symptoms of diabetes and a history of diabetic foot disease, neuropathy and diabetic retinopathy (DR).ResultsCCM examination was completed successfully in 427 (94.9%) subjects, 22% of whom had neuropathy according to Diabetic Neuropathy Symptom (DNS) score. The prevalence of sub-clinical neuropathy as defined by abnormal corneal nerve fiber length (CNFL) was 12.9%. In the subjects with a short duration of type 2 diabetes, 9.2% had abnormal CNFL. CCM showed significant abnormalities in corneal nerve parameters in this cohort of subjects with reduction of corneal nerve fiber density (CNFD, p<0.001), CNFL (p<0.001) and corneal nerve branch density (CNBD, p<0.001) compared to healthy subjects. In subjects who had no evidence of DR (67% of all subjects), 12.0% had abnormal CNFL.ConclusionsCCM may be a sensitive biomarker for early detection and screening of DPN in primary care alongside retinopathy screening.

The relation between serum uric acid levels and diabetic peripheral neuropathy in type 2 diabetes in Guilan, north of Iran

BackgroundDiabetic peripheral neuropathy (DPN) is one of the most common chronic microvascular complications in type 2 diabetes mellitus (T2DM). Hence, the present study aimed to investigate the association between Serum Uric Acid (SUA) levels and diabetic peripheral polyneuropathy in patients with type 2 diabetes.MethodsWe performed this case–control study during 2019–2020 on individuals with diabetes referring to the Razi clinic of Rasht, in the north of Iran. Polyneuropathy in patients was assessed based on the Neuropathy Disability Score (NDS), Diabetic neuropathy symptom score (DNS) scoring system, and electromyography (EMG)/nerve conduction velocity (NCV). The inclusion criterion for the control group was normal EMG/NCV. Then, the patients were assessed for SUA level and also laboratory results.ResultsIn total, 230 patients with type 2 diabetes were examined. The mean SUA level in the DPN group was significantly higher compared to the control group (6.72 ± 1.75 vs. 4.57 ± 1.49 mg/dL). With increasing the SUA, the odds of developing neuropathy increased by 2.2 times (OR = 2.2). The risk factors for diabetic polyneuropathy included gender (male) (OR = 0.347), SBP (OR = 1.1), retinopathy (OR = 3.29), and microalbuminuria (OR = 4.44). The chance of developing polyneuropathy in patients with retinopathy was 3.3 times higher than in the control group, it was 4.4 times in microalbuminuria patients.ConclusionElevated SUA level increased the chance of developing peripheral polyneuropathy in a person with type 2 diabetes. SUA levels higher than 5.25 mg / dL expose a person with type 2 diabetes to developing peripheral polyneuropathy.

Comparison of efficacy and safety of gabapentin and duloxetine in painful diabetic peripheral neuropathy: A systematic review and meta-analysis of randomised controlled trials.

In patients with diabetes mellitus, painful diabetic peripheral neuropathy (PDPN) is a frequent complication and can cause poor quality of life. We compared the efficacy and safety of duloxetine with those of gabapentin in patients with PDPN through a systematic review and meta-analysis of randomised controlled trials. PubMed, Embase and the Cochrane Library were searched for eligible studies published from database inception to January 2021. Visual Analogue Scale (VAS), sleep interference score, Clinical Global Impression of Change (CGIC), Patient Global Impression of Change (PGIC), Diabetic Neuropathy Symptom (DNS) score, Diabetic Neuropathic Examination (DNE) score, Neuropathic Disability Score (NDS) and side effects were used to compare duloxetine and gabapentin in patients with PDPN. Three eligible randomised controlled trials involving 290 patients were included. No significant differences were observed between patients receiving duloxetine and gabapentin with respect to VAS (mean change difference = -1.23, 95% CI, -6.09 to 3.62; P = .62), sleep interference score (mean change difference = 0.42, 95% CI, -0.15 to 1.00; P = .15), CGIC (mean difference = 0.04, 95% CI, -0.11 to 0.20; P = .60), PGIC (mean difference= 0.24, 95% CI, -0.13 to 0.60; P = .21), DNS (mean change difference = 0.14, 95% CI, -0.35 to 0.63; P = .58), DNE (mean change difference = 0.26, 95% CI, -0.35 to 0.86; P = .41) and NDS (mean change difference = 0.30, 95% CI, -0.02 to 0.63; P = .07). No significant differences were observed in the efficacy of duloxetine and gabapentin when treating patients with PDPN.

Point Prevalence of Peripheral Neuropathy in Children and Adolescents with Type 1 Diabetes Mellitus.

To assess the point prevalence of peripheral neuropathy (PN) in children with type 1 diabetes mellitus (T1DM) and to determine their predictors. In this cross-sectional study, children aged 8-18 y with T1DM on insulin therapy for > 2 y and free from acute complications were enrolled. All participants were evaluated for symptoms of PN with diabetic neuropathy symptom (DNS) score and underwent a detailed neurological examination. Assessment of nerve dysfunction was done using nerve conduction studies (NCS). The disease-related factors that increase the risk of PN were determined. Fifty children (52% boys) were enrolled with mean age of 12.2 ± 2.8 y and duration of diabetes 5.1 ± 2.1 y. No subject had clinical evidence or DNS score suggestive of PN. Twenty-eight (56%) children demonstrated subclinical neuropathy on NCS. Proportion of children with pure motor, pure sensory, and mixed motor-sensory neuropathy was 40%, 2%, and 14%, respectively. The peroneal nerve was the most common motor nerve affected. Poor glycemic control (HbA1c > 9%) and longer duration of diabetes (> 5 y) were significantly associated with the risk of PN (p value < 0.05). A large proportion of children with T1DM have subclinical PN. Poor glycemic control and longer duration of diabetes are risk factors for nerve dysfunction. Neurophysiological studies should be performed in these children to facilitate early detection.

Study of Epalrestat in Diabetic Distal Symmetric Polyneuropathy and correlation of its therapeutic efficacy with erythrocyte sorbitol levels : A step towards Precision Medicine

Aims : Diabetic Distal Symmetric Polyneuropathy (DSPN), despite being the most common and a disabling diabetic complication, remains difficult to treat. It has led to rekindle our interest in Epalrestat which has the potential to alter the natural history of the disease. The present study was designed to evaluate the efficacy of Epalrestat in DSPN and to corelate its therapeutic efficacy with baseline erythrocyte sorbitol levels. Methods : 100 patients with duration of diabetes more than five years and Diabetic Neuropathy Symptom Score (DNSS) ≥ 1 were included. They were divided into two groups of 50 patients each : Group 1 (received Tablet Epalrestat 150 mg once a day), Group 2 (received placebo). Baseline Diabetic Neuropathy Symptom Score (score out of 4), Numeric Pain Intensity Scale (score out of 10), Monofilament score (score out of 10), Vibration Perception Threshold (VPT) by Sensitometer and erthyrocyte sorbitol levels (by ELISA) were recorded. Same parameters were repeated at three months follow up visit. Results : Epalrestat was overall more effective than placebo in improving the symptoms as well as in improving the quantitative sensory nerve function measured by sensitometer The improvement in all the parameters positively correlated with baseline erythrocyte sorbitol levels. Conclusions : Epalrestat offers a ray of hope in the treatment of DSPN patients who have high baseline erythrocyte sorbitol levels and thus can be a useful tool in predicting the response to drug.

The relationship between the severity of peripheral diabetic neuropathy and sleep quality in type 2 diabetic mellitus patients

ObjectiveThis study aims to determine the relationship between the severity of peripheral diabetic neuropathy and sleep quality in patients with type 2 diabetes. MethodsThis study is an observational analytic cross-sectional design. Data collected consisted of age, gender, HbA1c level, duration of DM, Diabetic Neuropathy Symptom (DNS) score, the severity of diabetic neuropathy, and sleep quality. Diabetic Neuropathy Symptom (DNS) score is a diabetic neuropathy screening consisting of scores from 1 to 4, and a score of ≥1 is considered significant. The severity of diabetic neuropathy was measured using an England score consisting of mild, moderate, and severe. While sleep quality is measured by the Pittsburgh Sleep Quality Index (PSQI), which consists of 7 components, namely subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleeping drugs and dysfunction of daily activities. Each component has a value of 0–3. The score of the seven components added to the value between 0 and 21. The number of samples that meet the research criteria is 18 samples. Sampling by consecutive sampling method for three months at the neurologic clinic of Wahidin Sudirohusodo Hospital Makassar. The data obtained were recorded and grouped according to the purpose and type of data, then the statistical method was chosen following the significance limit p<0.05, namely by using the Spearman correlation test. ResultThe majority of respondents had moderate diabetic neuropathy, 11 patients, and seven patients with severe neuropathy. The lowest PSQI score is three, and the highest is 17, with the global average PSQI score obtained 8.72±4.22. The results showed that there was a significant relationship between the severity of peripheral diabetic neuropathy with sleep quality (global PSQI score) with a value of p=0.001. The relationship between the two variables is unidirectional and has a strong correlation with the positive coefficient correlation, r=0.724. ConclusionThere is a significant relationship between the severity of peripheral diabetic neuropathy and sleep quality (global PSQI score). The more severe the degree of peripheral diabetic neuropathy, the worse the quality of sleep.

Peripheral Polyneuropathy and Cognitive Impairment in Type II Diabetes Mellitus.

BackgroundNeuropathy is one of most common complications in diabetic patients. Diagnosis of diabetic neuropathy is essential for decreasing the rate of the disability and death. Neuron-specific enolase (NSE) is released from damaged neuronal cells and enters the blood circulation through an injured blood brain barrier. Therefore, serum NSE can reflect the damage of neurons and brain tissue.ObjectiveTo evaluate peripheral polyneuropathy and cognitive function in Type 2 Diabetes Mellitus (T2DM) and correlate them with NSE level as a possible biomarker of diabetic neuropathy.Subjects and MethodsForty five T2DM patients with polyneuropathy were randomly recruited in this study compared to 45 healthy age and sex matched subjects as a control. Patients group were divided into two subgroups, 24 diabetic patients with painful peripheral neuropathy and 21 with painless peripheral neuropathy. All were subjected to clinical assessment by diabetic neuropathy symptom score, Dyck neuropathy grading, Mini-Mental State Examination (MMSE), assessment of HbA1c, NSE biomarker and neurophysiological assessment (nerve conduction study (NCS), event related potential (P300wave) and somatosensory evoked potential (SSEP) of the right median nerve).ResultsThere were significant decrease in cognitive functions in diabetic patients compared to controls and a significant increase in NSE in diabetic patients. There were no significant difference between patients with painless and painful diabetic neuropathy as regard MMSE, HbA1c and NSE. There were significant correlation of P300 in diabetic patients with HbA1c and NSE.ConclusionNeurophysiological assessment of diabetic patients by NCS, SSEP and P300 have well evaluation of cognitive functions, painless, and painful diabetic polyneuropathy. NSE is a beneficial biomarker in diabetic patients to pick up neurological complications.

Analgesic effect of duloxetine compared to nortryptiline in patients with painful neuropathy: A randomized, double-blind, placebo-controlled trial.

Background:Diabetic neuropathic pain (DNP) is a common complication of diabetes and has a profound effect on patients’ quality of life. Therefore. The purpose of the present study was to compare the analgesic effects of duloxetine and nortryptiline in the management of patients with diabetic neuropathy.Methods:This was a randomized, double-blind, parallel-group, placebo-controlled trial in subjects with a proven diagnosis of DM and suffered from neuropathic pain. Patients were recruited in this study from 20 February 2016 (first patient, first visit) to 22 June 2017 (last patient, last visit), including 5 weeks follow-up. A diagnosis of DNP was based on history, clinical examination, Nerve conduction velocity and Diabetic neuropathy symptom score (more than one point).Results:Both drugs reduced pain when compared with placebo. A significant VAS reduction from 6.4 at baseline to 3.75 at endpoint was observed in the duloxetine group. However, there was no significant difference in the efficacy between nortriptyline and duloxetine based on patient's visual analogue scale (VAS) (p>0.05). No clinically significant changes or serious adverse events were found among treatment groups including changes in vital signs, laboratory assessments, physical examination or electrocardiograms. The decrease in the mean pain intensity was significantly greater in the duloxetine and nortriptyline group compared to the placebo group both in the primary analysis and in the by-visit analysis (p<0.003).Conclusion:The present study demonstrates the safety and effectiveness of both duloxetine and nortriptyline in the management of DNP.

Effectiveness of Exposure in Vivo for Patients with Painful Diabetic Neuropathy: a Pilot Study of Effects on Physical Activity and Quality of Life.

ObjectiveTo evaluate the effects of personalized exposure in vivo on level of physical activity and quality of life in patients with painful diabetic neuropathy.DesignRandomized, single-case, ABC design.SubjectsTwelve patients with painful diabetic neuropathy, age > 18 years, diabetes mellitus type II, Clinical Neurological Examination score > 5, Diabetic Neuropathy Symptom Score ≥ 1 and Douleur Neuropathique 4 Questions score ≥ 3.MethodsThe treatment consists of an Intensive screening, followed by an 8-week exposure in vivo intervention specifically adapted to the needs/risks of patients with painful diabetic neuropathy, and 6-months follow-up. Outcome measures included daily and non-daily measures of physical activity, quality of life, metabolic parameters, disability, depression, general and painful diabetic neuropathy-related anxiety, pain intensity and pain catastrophizing.ResultsDue to high drop-out rates (n = 6 during screening, n = 2 during treatment, n = 1 after treatment), only 3 participants completed the study. Slight, but non-significant, changes in physical activity and disability were observed. In quality of life, no changes were observed.ConclusionAnalysis of the reasons for the high drop-out rate indicate that exposure in vivo may have added value in patients with painful diabetic neuropathy only for those patients: (i) whose daily life functioning is impaired mainly by the painful diabetic neuropathy; (ii) in whom painful diabetic neuropathy-related fears are exaggerated and irrational; (iii) in whom specific activities evoke the painful diabetic neuropathy-related fears; (iv) whose spouse and healthcare providers are involved in the treatment; and (v) who are willing to change their daily behaviour. Further research is needed into this subject.LAY ABSTRACTPainful diabetic neuropathy places a high burden on patients’ physical and emotional wellbeing. Patients with painful diabetic neuropathy may have several fears related to diabetes and pain (e.g. fear of pain, fear of falling), which can limit their physically activity in daily life. This study investigated the effects of a personalized rehabilitation treatment, exposure in vivo, which aimed to help people with painful diabetic neuropathy to overcome their fears, so that they could become more active in daily life and improve their quality of life. Slight improvements in physical activity and disability were seen. There were no changes in quality of life. The results of this study should be interpreted with caution, as there was a large number of drop-outs.

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.

Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan

ObjectiveTo assess the prevalence of vitamin B12 deficiency in people with type 2 diabetes mellitus (T2DM) on metformin and without metformin.MethodologyBetween May 2018 and January 2019, this prospective multicenter observational...

The impact on large fibre function and small fibre function in patients with type 2 diabetes on benfotiamine therapy

Diabetes mellitus (DM) is the leading cause of neuropathy worldwide. Based on the data from several studies, sensorimotor polyneuropathy (diffuse and symmetric neuropathy) will develop within 10 years of the onset of DM in 40 % to 50 % of patients with type 1 and type 2 DM. In patients with type 2 DM, target blood glucose levels are associated with a reduced incidence of neuropathy. Objective — to study the correlation between the stage of diabetic peripheral polyneuropathy in type 2 diabetic patients, and the effects and efficacy of benfotiamine as transketolase activator. Materials and methods. In this study, 190 patients with type 2 DM were screened for DPN. DPN was confirmed in 105 patients displaying both clinical manifestations of neuropathy with a positive Diabetic Neuropathy Symptom (DNS) score and increased vibration perception threshold (VPT) on a biotensiometer. Based on the above stated criteria patients were divided into 4 groups: 1 — with positive DNS score, positive 10 g monofilament test score, VPT between 16—25 volts; 2 — with positive DNS score, positive 10 g monofilament test score, VPT between 26—35 volts; 3 — with positive DNS score, positive 10 g monofilament test score and VPT between 35—40 volts; 4 — control group with positive DNS score, negative 10 g monofilament test score and normal VPT value (n = 25 (23 %); 20 females and 5 males). The first 3 groups received benfotiamine 300 mg daily for 6 weeks, the control group was benfothiamine naïve. All the groups continued their antidiabetic medication. Results and discussion. The diabetic neuropathy score and vibration perception threshold was assessed in 105 patients (84 females and 21 males) with type 2 DM, before starting of benfotiamine 300 mg daily and after 6 weeks of therapy. Results of DNS: differences between group 3 and both group 1 and 2 were significant, but not between group 1 and 2. Patients in group 1 (n = 24), in females (n = 18) the DNS varied from 1—2, and in males (n = 6) the DNS varied from 1—3. After the 6 weeks,DNS score decreased in both females and males i.e. 1—1.25 and 1—2.5 correspondingly. Conclusions. The role of benfotiamine in clinical practice has been demonstrated in many clinical trials with variable trial design, patient groups and history of diabetes. In our study we found that patients with mild neuropathy and vibration perception threshold of 16—25 volts showed a reduction in VPT of up to 16 %, and the patients with moderate neuropathy and reduced vibration perception threshold of 26—35 volts were the ones who benefitted the most from benfotiamine therapy. Benfotiamine activates transketolase and thus helps in the reduction of AGEs formation and associated sugar induced metabolic stress.