Symptoms Of Diabetic Neuropathy Research Articles

The systematic review on Madhumeha w.r.t. Diabetic Neuropathy and its management: A review article

The world's fastest-growing major illness is diabetes mellitus. It's a metabolic illness that could lead to an insufficiency or malfunction in the production of insulin. Many of the Samhitas contain detailed descriptions of Madhumeha. Diabetic neuropathy is most common complication of Diabetes, approximately 50% of patients with diabetes eventually develop neuropathy. Symptoms of diabetic neuropathy not directly mentioned in Ayurveda but symptoms like Suptata, Chumchumayan, Karpada Daha, seen in Prameha either in Prameha prodomal stage, exhibition stage or in complication stage. As Samprapti of diabetic neuropathy not clearly mentioned in Samhitas so, after reviewing different Samhitas, a Samprapti has been suggested with possible management of Diabetic neuropathy in Ayurveda i.e., Shodhan and Samana Chikitsa and mode of action of Shodhan Chikitsa.

Effect of Sensory Re-Education with Aerobic Training on Sensation and Balance among Diabetic Peripheral Neuropathy Patients: A Pilot Study

Background: People with diabetes have 10 to 30 times higher risk of lower limb amputation than people without thedisease. 85% of non-traumatic amputations in diabetic patients begin with a foot ulcer. Therefore, early interventionis necessary to control the symptoms of diabetic peripheral neuropathy and improve balance. Resistance andaerobic training reduce diabetic symptoms by lowering HbA1C levels. In order to restore functional sensibility,improve adaptive functioning, and improve balance, sensory re-education and aerobics are combined. Therefore,the aim of this study is to find out the effect of Sensory re-education and aerobics on sensation and balance amongdiabetic peripheral neuropathy patients.Purpose: The Purpose of the study is to determine the effects of sensory re-education with aerobic training onsensory perception and balance in Diabetic peripheral neuropathy patients.Material and Method: This study included diabetic individuals of both genders between the ages of 45-60, lowPAR-Q risk scores and Toronto clinical neuropathy scores (TCNS) between 6 and 11. A total of 20 participantswere randomly selected and received sensory re-education with aerobics for six weeks.Results: Individuals with diabetic peripheral neuropathy experienced statistically significant improvement inTCNS from 9.3±1.25 to 4.5± 1.3, in BBS 48.5 ± 2.70 to 41.7±1.41, in TUG 8.12±1.28 to 6.95 ±1.30, with a P value of <0.01.Conclusion: Sensory re-education with aerobic training for 6 weeks of duration reported improvement in sensoryperception and balance among people with diabetic peripheral neuropathy patients.

Ankle reflex and neurological symptom score: a primary level screening method for diabetic peripheral neuropathy.

Herein, we aimed to develop an easily available and efficient screening method for diabetic peripheral neuropathy (DPN) suitable for primary care settings, emphasizing simplicity, speed, and accuracy. Nerve conduction studies were conducted on 214 patients with diabetes, encompassing the outcomes of five distinct assessments: diabetic neuropathy symptom (DNS), vibration perception threshold (VPT), and nerve screening. The diagnostic accuracy of the VPT and nerve screening was evaluated by comparing them with that of the nerve conduction study. To assess diagnostic efficacy, various combinations were examined, including DNS combined with VPT, pain, temperature, touch, and ankle reflex. The diagnostic performance of DNS was superior to that of the five neurological screening items and VPT, with sensitivity, specificity, and accuracy of 0.68, 0.81, and 0.73, respectively. Among the two combined methods, "DNS + ankle reflex" was identified as having the highest diagnostic value, with an area under the curve, a sensitivity, a specificity, and an accuracy of 0.81, 0.89, 0.70, and 0.80, respectively. Furthermore, a combination of "DNS + ankle reflex + touch + pain + VPT" achieved the best performance among the five combinations, with an area under the curve, sensitivity, specificity, and accuracy of 0.85, 0.93, 0.68, and 0.81, respectively. The combination of DNS, ankle reflex, touch, pain, and VPT methods showed the highest diagnostic value for DPN. However, considering factors including accuracy, time, and economic cost, we recommend using a simpler combination of DNS and ankle reflex for large-scale screening of patients with DPN.

Enhancing Sensory Disparities: A Case Report on Structured Exercise Protocol in Diabetic Peripheral Neuropathy Management

Diabetes encompasses a spectrum of metabolic disorders marked by elevated blood sugar levels due to issues with insulin secretion, its effectiveness, or both. Despite numerous investigations into managing symptoms of Diabetic Peripheral Neuropathy (DPN), a structured protocol has yet to be established. The present study aimed to shed light on the impact of a structured exercise protocol on symptom management and the enhancement of superficial and deep sensations. Specifically, the study explores the effectiveness of a Structured Exercise Program in addressing symptoms of DPN, with a focus on improving both superficial and deep sensations to enhance overall quality of life. The case report involved a participant diagnosed with DPN. Following a comprehensive clinical assessment and diagnostic tests, specific predetermined criteria were established to confirm the alleviation of symptoms. Physiotherapy interventions were employed to address various symptoms, with superficial and deep vibratory sensation serving as indicators of progress. Over the 30-day monitoring period, the patient showed improvements in light touch and pressure sensations during everyday activities. The treatment strategies effectively addressed the specific challenges associated with enhancing the patient’s quality of life and functional abilities. In conclusion, this case study highlights the complexities of managing DPN and the effectiveness of combining physiotherapy interventions. The enhancements in sensory functions and daily activities underscore the potential of exercise therapy in improving the quality of life for individuals with DPN.

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.

Reliability of a novel point of care device for monitoring diabetic peripheral neuropathy

We aimed to assess DPNCheck’s reliability for repeated sural nerve conduction (NC) parameters. This post hoc analysis used data from the randomized controlled ACUDPN trial assessing NC of the N. Suralis every eight weeks over a 6-month period in 62 patients receiving acupuncture against diabetic peripheral neuropathy (DPN) symptoms. The reliability of DPNCheck for nerve conduction velocity and amplitude was assessed using intraclass correlation coefficients (ICC) and was calculated using data from single time points and repeated measures design. The results of the NC measurements were correlated with the Total Neuropathy Score clinical (TNSc). Overall, for both nerve velocity and amplitude, the reliability at each measurement time point can be described as moderate to good and the reliability using repeated measures design can be described as moderate. Nerve velocity and amplitude showed weak correlation with TNSc. DPNCheck’s reliability results question its suitability for monitoring DPN’s progression. Given the limitation of our analysis, a long-term, pre-specified, fully crossed study should be carried out among patients with DPN to fully determine the suitability of the device for DPN progression monitoring. This was the first analysis assessing the reliability of the DPNCheck for DPN progression monitoring using data from multiple collection time points.

The relationship between pesticide exposure and neuropathy in farmers in Wuluhan district

Farmers rely heavily on pesticides to protect crops from pests. Pesticides exposure will inhibit the acetylcholinesterase enzyme and will cause cholinergic symptoms which manifest as neuropathy. The research was conducted in March-April 2023 in Wuluhan District, Jember Regency. Pesticide exposure was evaluated through interviews using a pesticide exposure questionnaire, while neuropathy was evaluated through interviews and physical examination using the Diabetic Neuropathy Symptom Score-Indonesian version (DNS-Ina) and Diabetic Neuropathy Examination-Indonesian version (DNE-Ina) questionnaires. Univariate data analysis and bivariate analysis using the Chi-Square test. The results of this study showed that most of the study subjects had worked 10 years, the frequency of using pesticides ≤2 times per week, the duration of using pesticides ≤3 hours per day, the use of PPE is lacking. Bivariate analysis showed that neuropathy occurred in the farmer group, and there was a significant relationship between length of service and neuropathy, as well as the completeness of PPE use and neuropathy. However, there was no relationship between the frequency of pesticide use and neuropathy and the duration of pesticide use and neuropathy. The conclusion of this study is that the variable length of service and the completeness of the use of PPE have a relationship with the symptoms of neuropathy in farmers. While the variables of frequency and duration of use of pesticides are not related to neuropathy in farmers.

Association of Sensory Nerve Action Potential Amplitude and Velocity With Type 2 Diabetic Peripheral Neuropathy.

There is ongoing controversy regarding the predominant type of nerve injury in diabetic peripheral neuropathy, whether it is demyelination or axonal degeneration. This study aimed to investigate the association between nerve conduction study parameters, specifically nerve conduction velocity and the amplitude of the action potential, with diabetic peripheral neuropathy and determine their potential as early indicators of the condition. A cross-sectional study was conducted involving diagnosed type 2 diabetes mellitus patients, who were divided into two groups: Group I (n = 111) with symptomatic diabetic peripheral neuropathy and Group II (n = 109) without clinically detectable peripheral neuropathy. Age and sex-matched healthy controls (n = 100) were also included. Nerve conduction velocity measurements were performed on both upper and lower limbs, with motor nerve conduction study focusing on the dominant side using the median and posterior tibial nervesand sensory nerve conduction study using the median and sural nerves. The nerve conduction studies revealed significantly lower sensory nerve action potential amplitudes and compound muscle action potential amplitudes in the median, posterior tibial, and sural nerves of the diabetic groups compared to the control subjects. Furthermore, these changes were more prominent in patients with peripheral neuropathy. Among the 220 diabetic patients analyzed, 135 (61.36%) exhibited nerve conduction abnormalities. The highest rate of abnormality was observed in the sural nerve, followed by the posterior tibial and median nerves. The most common abnormality detected in diabetic patients was a decrease in sensory nerve action potential, followed by a decrease in sensory nerve conduction velocity. The study findings suggest an association between reduced sensory nerve action potential amplitude and diabetic peripheral neuropathy. These results highlight the potential of sensory nerve action potential and velocity as a sensitive indicator of peripheral neuropathy in diabetic patients.

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.

Effectiveness of Functional Strength Training Exercises Versus Neurodynamic Exercises on Balance and Gait of Patients with Diabetic Peripheral Neuropathy

Background: Diabetic neuropathy is one of the long-term complications of Diabetes Mellitus. Diabetic neuropathy symptoms include pain and numbness in the legs, feet and hands, causing decreased sensation, proprioception, reflexes, and strength in the lower extremities which affects balance and gait. Various interventions which are used by the physical therapist to minimize balance dysfunction and improve Gait in people with Diabetic Polyneuropathy. Approximately 50 percent of patients with diabetes will eventually develop neuropathy which leads to impairment in Balance and Gait. The Functional Strength Training improves the intermuscular and intramuscular synchronization through the neural control, thereby increases the muscle power by functional activities. Neurodynamic is the communication between different parts of the nervous system and mobilize the peripheral nervous system, it is a physical approach to the treatment of pain. This influences pain physiology via mechanical treatment of neural and the non-neural structures of the nervous system. Both Functional Strength Training and Neurodynamic exercises have influence on improving balance, gait and reduces the risk of fall. The aim of this study is to compare the effects of Functional strength training Versus Neurodynamic exercises on Balance and Gait of patients with Diabetic Peripheral Neuropathy. Methodology: 30 patients aged 40-80 years presenting with more than 7 years who were clinically diagnosed with Diabetic Peripheral Neuropathy were selected and assigned into two groups. Experimental group A received Functional Strength Training Exercises and Group B received Neurodynamic Exercises for 40 minutes, 5 days per week for a period of 4 weeks. Balance and Gait were assessed in terms of Berg Balance Scale and Functional Gait Assessment. Paired and unpaired ‘t-tests’ were used to determine significant differences in data among groups and between the groups. Results: A significant improvement in the values of Berg Balance Scale and Functional Gait Assessment was observed in Functional Strength Training Exercises as well as in Neurodynamic Exercises. Functional Strength Training Exercises showed statistically significant improvement in terms of BBS and FGA than the Neurodynamic Exercises. Conclusion: Both Functional Strength Training Exercises and Neurodynamic Exercises were found to improve the Balance and Gait in patients with Diabetic Peripheral Neuropathy. However, the Functional Strength Training showed more significantly improvement in Balance and Gait subsequently reducing fall and fall risk injury.

Evaluating the effect of acupuncture on symptoms of diabetic peripheral neuropathy (DPN) among individuals with diabetic neuropathy: A single-blind, randomized trial study.

This study aimed to investigate the impact of acupuncture on Diabetic peripheral neuropathy (DPN) symptoms among individuals with diabetic neuropathy. In a single-blind, randomized trial conducted between 2019 and 2020, 60 patients diagnosed with diabetic neuropathy were enrolled. These participants were randomly assigned to either the intervention or control group. The intervention group received real acupuncture alongside routine treatment once a week for seven sessions, each lasting 20min. Meanwhile, the control group received sham acupuncture as an adjunct to their routine treatment, following the same schedule. To evaluate treatment efficacy, the study assessed primary outcomes, such as pain intensity measured using the Visual Analogue Scale (VAS). Secondary outcomes included evaluating fatigue severity and diabetic peripheral neuropathy (DPN) side effects, measured using the multidimensional fatigue inventory (MFI-20) and a standard questionnaire after each session. No statistically significant differences in pain and fatigue scores were observed between the two groups throughout all visits, even after adjusting for baseline characteristics, age, sex, type of diabetes, discopathy, and carpal tunnel syndrome parameters (P > 0.05). The findings did not provide strong evidence supporting a significant effect of real acupuncture compared to sham acupuncture on pain and fatigue values (P = 0.267 and 0.634, respectively). However, the 95% confidence interval for pain scores (-0.35, 1.28) was inconclusive, encompassing effect sizes favoring sham acupuncture. Findings suggest that using acupuncture as an adjunctive therapy alongside routine treatment may not lead to a significant reduction in the symptoms of peripheral neuropathy and fatigue severity among individuals with diabetic neuropathy. The online version contains supplementary material available at 10.1007/s40200-023-01314-1.

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

Background & 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<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.

Diabetes-Induced Amplification of Nociceptive DRG Neuron Output by Upregulation of Somatic T-Type Ca2+ Channels.

The development of pain symptoms in peripheral diabetic neuropathy (PDN) is associated with the upregulation of T-type Ca2+ channels (T-channels) in the soma of nociceptive DRG neurons. Moreover, a block of these channels in DRG neurons effectively reversed mechanical and thermal hyperalgesia in animal diabetic models, indicating that T-channel functioning in these neurons is causally linked to PDN. However, no particular mechanisms relating the upregulation of T-channels in the soma of nociceptive DRG neurons to the pathological pain processing in PDN have been suggested. Here we have electrophysiologically identified voltage-gated currents expressed in nociceptive DRG neurons and developed a computation model of the neurons, including peripheral and central axons. Simulations showed substantially stronger sensitivity of neuronal excitability to diabetes-induced T-channel upregulation at the normal body temperature compared to the ambient one. We also found that upregulation of somatic T-channels, observed in these neurons under diabetic conditions, amplifies a single action potential invading the soma from the periphery into a burst of multiple action potentials further propagated to the end of the central axon. We have concluded that the somatic T-channel-dependent amplification of the peripheral nociceptive input to the spinal cord demonstrated in this work may underlie abnormal nociception at different stages of diabetes development.

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.

Pathology of carbohydrate metabolism in primary hyperparathyroidism: epidemiological and clinical characteristics

Primary hyperparathyroidism (PHPT) is characterized by disorders of not only mineral metabolism, but also other kinds of the human metabolism. Due to the increased frequency of cardiovascular risk factors among patients with PHPT, the study of the carbohydrate metabolism pathology in this cohort of patients will allow developing optimal approaches to their timely diagnosis and treatment.Aim. To determine the frequency and describe the clinical features of carbohydrate metabolism disorders in patients with PHPT.Material and methods. A single-center retrospective study of adults with PHPT was carried out with an assessment of the main parameters of mineral and carbohydrate metabolism before surgical treatment of the disease. The exclusion criteria were the absence of PHPT remission or a recurrence of the disease after parathyroidectomy; pregnancy, lactation. The frequency of various disorders of carbohydrate metabolism in PHPT, the comparative characteristics of mineral parameters in patients with and without them, as well as the severity of type 2 diabetes mellitus in PHPT were determined. In addition, potential relationships between the parameters of various types of metabolism have been studied.Results. The study was based on a clinical information of 367 patients with PHPT, most of whom had a symptomatic form of the disease. The overall incidence of prediabetic disorders was 4,9% (95% CI: 3-8). Type 2 diabetes mellitus was previously diagnosed in 45 patients (12%, 95% CI: 9-16), there were no cases of first diagnosed diabetes mellitus. Individuals with impaired carbohydrate metabolism had a statistically significantly higher body mass index and lower values of osteocalcin (27,2 [24,2; 30,4] kg/m2 vs 32,7 [28,1; 39,4 kg/m2 and 48,1 [34; 76,3] ng/mL vs 33,1 [20,8; 51,8] ng/mL, respectively, for all parameters p&lt;0,001). Among patients with type 2 diabetes mellitus, 36 people (80%) took hypoglycemic therapy, 14 of which received metformin monotherapy and 8 received two-component therapy, including metformin. 5 people were on insulin therapy. Diabetic nephropathy was diagnosed in 36,4% of patients, 15,4% had signs of diabetic retinopathy, symptoms of diabetic distal neuropathy were observed in 61,9% of patients with PHPT. Fasting glucose and glycated hemoglobin were negatively correlated with bone metabolism, and also expectedly depended on the glomerular filtration rate.Conclusion. Among patients with PHPT, type 2 diabetes mellitus is more common than in the general population. The likely reason of this may be insulin resistance, that can be caused by the effects of bone metabolites, primarily osteocalcin. In most cases, metformin makes it possible to achieve compensation for diabetes mellitus in PHPT.

The role of protein kinases in diabetic neuropathic pain: an update review.

Diabetic neuropathic pain (DNP) is a debilitating symptom of diabetic neuropathy which seriously impairs patient's quality of life. Currently, there is no specific therapy for DNP except for duloxetine and gabapentin that show limited utility in alleviating DNP. The present review aims to discuss the central role of protein kinases in the pathogenesis of DNP and their therapeutic modulation. Scopus, PubMed, and Google scholar were searched up to January 2022 to find relevant studies with English language in which the roles of proteins kinases in DNP were examined. DNP is associated with hyperactivity in pain sensory neurons and therapies aim to specifically suppress redundant discharges in these neurons without affecting the activity of other sensory and motor neurons. Transient receptor potential vanilloid 1 (TRPV1) and purinergic 2 × 7 receptors (P2 × 7R) are two receptor channels, highly expressed in pain sensory neurons and their blockade produces remarkable analgesic effects in DNP. The activities of receptor channels are mainly regulated by the protein kinases whose modulation provides remarkable analgesic effects in DNP models. Capsaicin, TRPV1 modulator, is the only agent successfully examined in clinical trials with promising effects in patients with DNP. Current data suggest that blocking calcium calmodulin dependent protein kinase II (CaMKII) is superior to other approaches, considering its pivotal role in regulating the pain neuron potentials. By this means, DNP alleviation is achievable without affecting the activity of other sensory or motor neurons.

Topical capsaicin for the management of painful diabetic neuropathy: a narrative systematic review.

Aim: To investigate the potential benefit of topical capsaicin formulations. Materials& methods: A narrative systematic review was employed. Results: About8% Capsaicin patches were found to significantly reduce symptoms of diabetic peripheral neuropathy. Capsaicin was found to improve sleep quality (p=0.02). Capsaicin patch exposure for 60minshowed significant reduction in symptoms (-32.8%). Capsaicin cream significantly reduced pain at weeks 2 and 6 (p=0.003 andp=0.03, respectively), but not at week 8 in comparative studies. 0.025% Capsaicin gel had an insignificant reduction in pain compared with placebo (p=0.53), however 0.075% was found to be significant (p=0.038). Capsaicin cream did not have superior improvement of pain as compared with clonidine gel (p=0.931). The most common adverse events included application site discomfort, erythemaand burning. Conclusion: Topical capsaicin treatments are a potentially beneficial peripherally acting medication. Further research is needed to determine the best means of ameliorating the side effects of treatments.

Use of plasma rich in growth factors for symptoms of diabetic neuropathy.

Painful peripheral polyneuropathy is a common complication of diabetes mellitus (DM) and is a significant source of chronic disability and remains a challenging condition with no available disease-modifying treatment. In the present case report, we describe the treatment of a patient featuring painful diabetic neuropathy with perineural injections of autologous plasma rich in growth factors (PRGF). At one-year post-procedure, the patient exhibited improved scores on the neuropathic pain scale and improvement in the activity level. Plasma rich in growth factors (PRGF) is an autologous product that can be prepared and administered in a physician's office. PRGF can be infiltrated as a liquid, creating a three-dimensional gel scaffold in the body. PRGF releases growth factors involved in nerve healing. PRGF may be established as a potent alternative treatment of painful diabetic polyneuropathy.

Multi-omics analysis revealed the role of CYP1A2 in the induction of mechanical allodynia in type 1 diabetes.

Background: Mechanical allodynia (MA) is one of the leading clinical symptoms of painful diabetic peripheral neuropathy (PDPN), which is a primary reason for non-traumatic amputations, foot ulceration, and gait abnormalities in patients with diabetes. However, the pathogenic mechanisms of MA have not yet been fully elucidated, and there is no effective treatment. This study aims to study the potential pathogenetic mechanisms of MA and to provide targets for the therapy of MA. Methods: A single intraperitoneal injection of streptozotocin induced type 1 diabetes in rat models. Subsequently, rats were divided into the control group, the diabetic group without MA, and the diabetic group with MA based on weekly behavioral assays. The differentially expressed lipids in the sciatic nerve of each group were detected using untargeted lipidomics, and the differentially expressed genes in the sciatic nerve of each group were detected by transcriptomics. The pathogenesis of MA was predicted using integrated analysis and validated by immunofluorescence staining and transmission electron microscopy. Results: Untargeted lipidomics revealed the accumulation of a more severe lipid in MA rats. Transcriptomics results suggested that differentially expressed genes in MA rats were primarily related to lipid droplets and myelin sheath. Integrated analysis results indicated that the downregulation of Cytochrome P450 1A2 (CYP1A2) expression was closely linked to lipid metabolism disorders. Immunofluorescence staining demonstrated that down-regulation of CYP1A2 expression occurred in MA rats. Transmission electron microscopy results showed that more severe lipid droplet accumulation and myelin sheath degeneration occurred in MA rats. Conclusion: Our findings imply that the downregulation of CYP1A2 expression leads to disorders of lipid metabolism and further leads to lipid droplet accumulation and myelin sheath degeneration, which might ultimately lead to the development of MA. Therefore, our study contributes to promoting the understanding of the molecular mechanisms of MA and providing potential targets for the clinical treatment of MA.

Prevalence of Karapada daha-suptata in Madhumeha with reference to diabetic peripheral neuropathy in type 2 diabetes mellitus patients.

Background: Diabetes mellitus is a major health issue in today's world. Main threat is not the disease itself but its complications like nephropathy, retinopathy and neuropathy etc. Diabetic peripheral neurropathy is the leading cause of foot ulcers, their complications like limb amputation and cost associated with it. Madhumeha which has been described as 'Maharogas' i.e. difficult to treat disease has many similarities with Diabetes mellitus can be understood and studied as same disease. Ayurveda has mentioned the causes, pathophysiology and symptoms of Diabetic Peripheral Neuropathy as 'karapada daha -suptata' in purvarupa lakshanas and upadrava lakshanas but inscattered form. It needs depth study to understand the concept of Karapada daha- suptata (DPN).&#x0D; Objective: To study prevalence of Karapada daha-suptata (Diabetic peripheral neuropathy) and the relation of Karapada daha- suptata (DPN) with age, gender, duration of disease Madhumeha, blood sugar level, alcohol and smoking habit etc in Madhumeha patients.&#x0D; Method :A cross sectional study was carried out in Tribhuvan University Ayurveda Teaching Hospital,. Madhumeha patients (Type 2 diabetes mellitus) patients were recruited for the study. MNSI (Michigan Neuropathy Screening Instrument) was used to diagnose Karapada daha- suptata (Diabetic peripheral neuropathy).&#x0D; Result: Among 100 patients 31% patient had Karapada daha- suptata (DPN). Our study showed that the prevalence of Karapada daha-suptata(DPN) increased with increasing age of the study population. Similarly prevalence of Karapada daha -suptata in patients with disease duration of Madhumeha (DM2) for more than 5 years was 61.29% where as patients having Diabetes for less than 5 year was 38.71%. Prevalence of Karapada daha-suptata (DPN) was very high (43.13%) among uncontrolled fasting blood sugar level (&gt;126mg/dl) and (47.5%) among uncontrolled post prandial blood sugar level (&gt;200mg/dl). In this study mean Fasting blood sugar level was 177.0323 mg/dl in the patients with Karapada daha-suptata(DPN) and mean post prandial blood sugar level in patients with diabetic peripheral neuropathy was 239.1613mg/dl.&#x0D; Conclusion: Our study showed Karapada daha-suptata/DPN is highly prevalent and increasing as the duration of disease Madhumeha increses but its not uncommon in newly disagnosed disease too. This study showed significant relation of Karapada daha suptata with disease duration of Madhumeha, level of blood sugar, and increasing age of the patients.Study showed no significant differences in the prevalence of Kara pada daha- suptata in male and female patients and with the smoking habit of the patients.