Diabetic Polyneuropathy Patients Research Articles

Vitamin b12 deficit mimics diabetic polyneuropathy in patients taking metformin

Vitamin b12 deficit mimics diabetic polyneuropathy in patients taking metformin

The effect of foot somatosensory loss in postural control during Functional reach test in patients with diabetic polyneuropathy: A controlled study

BackgroundIn patients with diabetic polyneuropathy (DPN), differences in postural control due to losing the lower limb somatosensory information were reported. However, it is still unclear by which mechanisms the dynamic postural instability is caused. ObjectivesThis study aimed to investigate postural control differences and neuromuscular adaptations resulting from foot somatosensory loss due to DPN. MethodsIn this controlled cross-sectional study, fourteen DPN patients and fourteen healthy controls performed the Functional Reach Test (FRT) as a dynamic task. The postural control metrics were simultaneously measured using force plate, motion capture system, and surface electromyography (sEMG). The main metrics including reach length (FR), FR to height ratio (FR/H), displacement of CoM and CoP, moment arm (MA), and arch height ratio. Also, kinematic (range of motion of ankle, knee, and hip joints), and sEMG metrics (latencies and root mean square amplitudes of ankle and hallux muscles) were measured. To compare variables between groups, the independent sample T-test for (normally distributed) and the Mann-Whitney U test (non-normally distributed) were used. ResultsThe subjects' reach length (FR), FR to height ratio, absolute MA, and displacement of CoM were significantly shorter than controls, while displacement of CoP was not significant. Arch height ratio was found significantly lower in DPN patients. We observed that CoM was lagging CoP in patients (MA = + 0.89) while leading in controls (MA = -1.60). Although, the muscles of patients showed significantly earlier activation, root mean square sEMG amplitudes were found similar. Also, DPN patients showed significantly less hip flexion, knee extension, and ankle plantar flexion. ConclusionsThis study presented that decreasing range of motion at lower limbs’ joints and deterioration in foot function caused poor performance at motor execution during FRT in DPN patients.

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

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

Effects of vitamin D3 (cholecalciferol) supplementation on diabetic polyneuropathy in patients diagnosed with diabetes mellitus

Abstract Introduction: Peripheral sensorimotor polyneuropathy is present in nearly half of the patients diagnosed with diabetes mellitus. Over the past 10 years, animal and human studies have suggested that vitamin D3 treatment may have a role in preventing or reducing neuropathic complaints and symptoms. Material and method: Our clinical, prospective, interventional, placebo-controlled study investigated the therapeutic effect of 2.000 IU oral cholecalciferol administered for three months on diabetic polyneuropathy. Patients treated with vitamin D and B, thioctic acid, and other analgesics were excluded. Using the single-blind technique, they were randomly assigned into vitamin D-treated and placebo-treated groups. In addition to recording anamnestic data, the study included - a Toronto Clinical Neuropathy Scoring System and Michigan Neuropathy Screening Instrument based - questionnaire to assess subjective symptoms and a physical examination including sensory tests (fine touch-, temperature awareness, pain-, vibration perception). Vitamin D levels were measured. After three months of therapy, the examination was repeated. Results: Most of the patients were found to have vitamin D deficiency (36% of the total population) or insufficiency (43%). In the cholecalciferol-treated group, but not in the control group, subjective symptoms decreased in intensity and/or frequency, and a significant improvement in the overall complaint scale was observed (p = 0.006), but no change regarding the sensory tests (p > 0.05). Conclusions: Our results show that oral administration of cholecalciferol for three months significantly reduced subjective symptoms and neuropathic pain as assessed by our questionnaire, however, there was no significant change in the results of the sensory tests. Vitamin D deficiency/insufficiency was common in diabetic patients (79% in our population), therefore screening is recommended.

Diyabetik Polinöropati ve Karpal Tünel Sendromu İlişkisi: Glisemik Kontrol ve Mikrovasküler Komplikasyonların Rolü

Introduction: Carpal tunnel syndrome (CTS) is more common in diabetes mellitus (DM), especially in individuals with diabetic polyneuropathy (DPN). This study aimed to retrospectively investigate the effects of elevated glycosylated hemoglobin (HbA1c) levels, duration of diabetes, and other microvascular complications of DM on the frequency and severity of CTS in patients with DPN. 
 Material and methods: 124 DPN patients were included in the study. In these patients, fasting blood glucose (FBG) and HbA1c levels, duration of DM, antidiabetic drugs used, comorbidities, and other complications of diabetes were questioned. According to the results of the electrophysiological examination, the patients were divided into 2 groups: those with only DPN and those with DPN + CTS. 
 Results: When diabetes complications were investigated, diabetic nephropathy was found only in those with DPN + CTS (p=0.045). Electrophysiologically, in sensory fibers in all patients, In 43 patients (34.7%), involvement of motor fibers was accompanied. A positive correlation was found between the severity of CTS and duration of diabetes, FBG and HbA1c levels, and subcutaneous insulin use (p=0.018, p=0.014, p=0.003, p=0.029, respectively).
 Conclusion: Good glycemic control can reduce the risk of developing CTS with microvascular complications of diabetes. Therefore, it is important for patients to protect their hand function and prevent the development of CTS by being informed about the complications of diabetes.

Assessing Corneal Confocal Microscopy and Other Small Fiber Measures in Diabetic Polyneuropathy.

Damage to small nerve fibers is common in diabetic polyneuropathy (DPN), and the diagnosis of DPN relies on subjective symptoms and signs in a combination with objective confirmatory tests, typically electrophysiology or intraepidermal nerve fiber density (IENFD) from skin biopsy. Corneal confocal microscopy (CCM) has been introduced as a tool to detect DPN. However, it is unclear if CCM can reliably be used to diagnose DPN and how the technique compares with other commonly used measures of small fiber damage, such as IENFD, cold detection threshold (CDT), and warm detection threshold (WDT). Therefore, we assessed and compared the use of CCM, IENFD, CDT, and WDT in the diagnosis of DPN in patients with type 2 diabetes. In this cohort study, the participants underwent detailed neurologic examination, electrophysiology, quantification of IENFD, CCM, and quantitative sensory testing. Definition of DPN was made in accordance with the Toronto criteria for diabetic neuropathy (without relying on IENFD and thermal thresholds). A total of 214 patients with at least probable DPN, 63 patients without DPN, and 97 controls without diabetes were included. Patients with DPN had lower CCM measures (corneal nerve fiber length [CNFL], nerve fiber density, and branch density), IENFD, CDT, and WDT compared with patients without DPN (p ≤ 0.001, <0.001, 0.002, p < 0.001, p = 0.003, and <0.005, respectively), whereas there was no difference between controls and patients with diabetes without DPN. All 3 CCM measures showed a very low diagnostic sensitivity with CNFL showing the highest (14.4% [95% CI 9.8-18.4]) and a specificity of 95.7% (88.0-99.1). In comparison, the sensitivity of abnormal CDT and/or WDT was 30.5% (24.4-37.0) with a specificity of 84.9% (74.6-92.2). The sensitivity of abnormal IENFD was highest among all measures with a value of 51.1% (43.7-58.5) and a specificity of 90% (79.5-96.2). CCM measures did not correlate with IENFD, CDT/WDT, or neuropathy severity in the group of patients with DPN. CCM measures showed the lowest sensitivity compared with other small fiber measures in the diagnosis of DPN. This indicates that CCM is not a sensitive method to detect DPN in recently diagnosed type 2 diabetes. This study provides Class III evidence that CCM measures aid in the detection of DPN in recently diagnosed type 2 diabetics but with a low sensitivity when compared with other small fiber measures.

Comparison of Sural Nerve Amplitude and Sural/Radial Amplitude Ratio in Electrodiagnosis of patients with neuropathy in Type 2 diabetes

Diabetic neuropathy is the most common and bothersome diabetes mellitus complication, leading to considerable morbidity and mortality. The results of these studies and the importance of early detection and prevention of polyneuropathy in diabetic patients motivated the authors to carry out the present study. In this cross-sectional study all consecutive patients with type 2 diabetes mellitus were referred to the Endocrinology Clinic at Golestan Hospital in Ahvaz, Iran. The Nihon Kochden gadget was utilized on all patients, who were all examined by an individual. Average sensory amplitude was defined as greater than 6 V for the sural nerve and greater than 15 V for the radial nerve. In the present investigation, a sural/radial nerve amplitude ratio greater than or equal to 21 percent was considered normal. In total, 80 subjects were included in the analysis, there is a non-significant direct correlation between the sural nerve and sural/radial nerve amplitude ratio, to diagnose patients with and without neuropathy (p=0.625). Moreover, there is a non-significant direct correlation between the sural nerve and sural/radial nerve amplitude ratio with the body mass index of patients with diabetes, and this correlation is negligible (p&gt;0.05). The findings demonstrated that sural/radial nerve amplitude ratio was a promising method for detecting neuropathy in patients with type 2 diabetes. Also, sural nerve and sural/radial nerve amplitude ratio had a significant inversion relationship with age and duration of diabetes for detecting diabetic neuropathy in type 2 diabetes patients

Comparison of Sural Nerve Amplitude and Sural/Radial Amplitude Ratio in Electrodiagnosis of patients with neuropathy in Type 2 diabetes

Diabetic neuropathy is the most common and bothersome diabetes mellitus complication, leading to considerable morbidity and mortality. The results of these studies and the importance of early detection and prevention of polyneuropathy in diabetic patients motivated the authors to carry out the present study. In this cross-sectional study all consecutive patients with type 2 diabetes mellitus were referred to the Endocrinology Clinic at Golestan Hospital in Ahvaz, Iran. The Nihon Kochden gadget was utilized on all patients, who were all examined by an individual. Average sensory amplitude was defined as greater than 6 V for the sural nerve and greater than 15 V for the radial nerve. In the present investigation, a sural/radial nerve amplitude ratio greater than or equal to 21 percent was considered normal. In total, 80 subjects were included in the analysis, there is a non-significant direct correlation between the sural nerve and sural/radial nerve amplitude ratio, to diagnose patients with and without neuropathy (p=0.625). Moreover, there is a non-significant direct correlation between the sural nerve and sural/radial nerve amplitude ratio with the body mass index of patients with diabetes, and this correlation is negligible (p&gt;0.05). The findings demonstrated that sural/radial nerve amplitude ratio was a promising method for detecting neuropathy in patients with type 2 diabetes. Also, sural nerve and sural/radial nerve amplitude ratio had a significant inversion relationship with age and duration of diabetes for detecting diabetic neuropathy in type 2 diabetes patients.

EFFECT OF NON-ALCOHOLIC FATTY LIVER DISEASE ON THE COURSE OF DIABETIC POLYNEUROPATHY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.

The aim: To study the peculiarities of diabetic polyneuropathy in patients with type 2 diabetes mellitus and concomitant NAFLD. Materials and methods: We examined 75 patients with type 2 diabetes mellitus, including 31 (41.3%) women and 44 (58.7%) men. The main group included 35 patients with NAFLD (46.7%), and the control group included 40 patients without NAFLD (53.3%). The severity of polyneuropathy was assessed using the Toronto clinical neuropathy score. The presence of neuropathic pain syndrome in patients allowed us to divide patients into groups with painful or painless forms of diabetic polyneuropathy. The electroneuromyographic examination was used to study nerve conduction parameters, namely peroneal motor nerve conduction velocity (PMNCV), sensory nerve action potential (SNAP), and sensory nerve conduction velocity (SNCV). Results: The proportion of patients who did not have diabetic polyneuropathy in the NAFLD group was 12.5%, and in the group without NAFLD - 87.2%. The frequency of diabetic polyneuropathy was higher in the main group, namely: mild, moderate, and severe polyneuropathy was 80%, 56% and 59.3%, respectively, compared to the control group - 20%, 44%, 40.7% (p=0.02). The painful form of DPN was more common in patients of the main group than in the control group, respectively 69.8% and 30.2% (p=0.01). The degree of liver fibrosis did not affect the course of DPN. The study of nerve conduction by PMNCV, SNAP, and SNCV parameters showed that PMNCV was higher in the NAFLD group, and SNAP and SNCV - in the control group, but without statistical significance (p>0.05). Conclusions: In patients with type 2 diabetes mellitus, the presence of NAFLD affects the severity of diabetic polyneuropathy and increases the risk of painful DPN. The degree of liver fibrosis did not show an effect on the development of diabetic polyneuropathy. ENMG parameters did not demonstrate a statistically significant difference in the study groups.

Electroencephalography functional connectivity-A biomarker for painful polyneuropathy.

Advanced analysis of electroencephalography (EEG) data has become an essential tool in brain research. Based solely on resting state EEG signals, a data-driven, predictive and explanatory approach is presented to discriminate painful from non-painful diabetic polyneuropathy (DPN) patients. Three minutes long, 64 electrode resting-state recordings were obtained from 180 DPN patients. The analysis consisted of a mixture of traditional, explanatory and machine learning analyses. First, the 10 functional bivariate connections best differentiating between painful and non-painful patients in each EEG band were identified and the relevant receiver operating characteristic was calculated. Later, those connections were correlated with selected clinical parameters. Predictive analysis indicated that theta and beta bands contain most of the information required for discrimination between painful and non-painful polyneuropathy patients, with area under the receiver operating characteristic curve values of 0.93 for theta and 0.89 for beta bands. Assessing statistical differences between the average magnitude of functional connectivity values and clinical pain parameters revealed that painful DPN patients had significantly higher cortical functional connectivity than non-painful ones (p= 0.008 for theta and p= 0.001 for alpha bands). Moreover, intra-band analysis of individual significant functional connections revealed a positive correlation with average reported pain in the previous 3months in all frequency bands. Resting state EEG functional connectivity can serve as a highly accurate biomarker for the presence or absence of pain in DPN patients. This highlights the importance of the brain, in addition to the peripheral lesions, in generating the clinical pain picture. This tool can probably be extended to other pain syndromes.

82-OR: Phase Angle of Bioelectrical Impedance Analysis Correlates with Multiple Parameters of Diabetic Polyneuropathy in Patients with Type 2 Diabetes

Background and Aims: Sensorimotor polyneuropathy (DPN) is the most common diabetic complication and a major contributor to increased morbidity and mortality in diabetic patients. With diagnostic methods still being limited, we aimed to correlate the phase angle (PhA) , a marker derived from bioelectrical impedance analysis, with determinants of DPN. In particular we used magnetic resonance neurography (MRN) together with state-of-the-art clinical and electrophysiological measurements of DPN. Materials and Methods: In this cross-sectional observational study we included 1healthy subjects and 2patients with type 2 diabetes (T2D) , amongst which 63 had DPN. The PhA was calculated using a multi-frequency bioelectrical impedance analyzer. Nerve conduction studies, quantitative sensory testing (QST) and diffusion weighted 3 Tesla MRN to determine the fractional anisotropy (FA) were performed. Results: In the group comparison lower PhA values were found in T2D patients with DPN in contrast to T2D patients without DPN (5.71+/-0.vs. 6.07+/-0.08, p=0.007) and healthy controls (5.71+/-0.vs. 6.18+/-0.08, p&amp;lt;0.001) . Confounder-adjusted analysis among T2D patients showed positive correlations of the PhA with the FA of MRN (r=0.41, p=0.006) , with conduction velocities and action potentials of the peroneal (r=0.27, p&amp;lt;0.001; r=0.29, p&amp;lt;0.001) and tibial nerve (r=0.22, p=0.005; r=0.30, p&amp;lt;0.001) and with Z-scores of QST (thermal detection r=0.31, p&amp;lt;0.001; thermal pain r=0.20, p=0.010; mechanical pain r=0.19, p=0.015; mechanical detection r=0.19, p=0.013) . Conclusion: The close association of the PhA with the FA, a marker of structural nerve integrity of MRN, might reflect the similar physics of current or diffusion respectively being impaired by altered nerve composition. Due to correlations of the PhA with classical diagnostics of DPN it could become a novel, easily accessible and powerful marker for a quick assessment of DPN. Disclosure L.Schimpfle: None. C.Mooshage: None. D.Tsilingiris: None. Z.Kender: None. F.T.Kurz: None. J.M.E.Jende: None. J.M.Szendroedi: Consultant; Boehringer Ingelheim International GmbH. M.Bendszus: None. S.Kopf: Board Member; Novo Nordisk, Speaker's Bureau; AstraZeneca, Recordati S.p.A. Funding The German Research Council (DFG, SFB 1158)

Effect of Antigravity Treadmill Training on Gait and Balance in Patients with Diabetic Polyneuropathy: A Randomized Controlled Trial

Background: Diabetic polyneuropathy (DPN) is the most prevalent consequence of diabetes mellitus, and it has a significant impact on the patient's health. This study aims to evaluate effects of antigravity treadmill training on gait and balance in patients with DPN. Methods: The study included 45 males with type 2 diabetes who were randomly assigned to one of two groups: the experimental group (n=23) or the control group (n=22). For a period of 12 weeks, the experimental group received antigravity treadmill training (75% weight bearing, 30 min per session, three times per week) combined with traditional physical therapy. During the same time period, the control group received only traditional physical therapy. The Biodex Balance System was used to assess postural stability indices, while the GAITRite Walkway System was used to assess spatiotemporal gait parameters. All measurements were obtained before and at the end of the study after 12 weeks of treatment. Results: The mean values of all measured variables improved significantly in both groups (P<0.05), with the experimental group showing significantly greater improvements than the control group. The post-treatment gait parameters ( i.e., step length, step time, double support time, velocity, and cadence) were 61.3 cm, 0.49 sec, 0.25 sec, 83.09 cm/sec, and 99.78 steps/min as well as 56.14 cm, 0.55 sec, 0.29 sec, 75.73 cm/sec, and 88.14 steps/min for the experimental and control group, respectively. The post-treatment overall stability index was 0.32 and 0.70 for the experimental and control group, respectively. Conclusions: Antigravity treadmill training in combination with traditional physical therapy appears to be superior to traditional physical therapy alone in terms of gait and balance training. As a result, the antigravity treadmill has been found to be an effective device for the rehabilitation of DPN patients.

Predictive factors for distal and symmetric polyneuropathy in diabetic patients

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Motor Strategies Used to Restore Balance in People With and Without Impaired Sensory Organization Suffering From Diabetic Polyneuropathy

Background and Objectives Reduced ability to control balance is one of the disorders affecting the quality of life and daily activities of people with diabetic polyneuropathy (DPN), which can lead to dangerous consequences such as falling. By identifying the causes of balance disorders, we can better understand this condition to provide effective and evidence-based treatments for these patients. This study aims to investigate and compare the use of motor strategies in people with and without impaired sensory organization suffering from DPN. Subjects and Methods In this cross-sectional study, 40 people with DPN participated. Their demographic information were recorded and then underwent balance performance test using the sensory organization test. Based on the results, they were divided into two groups: Control group without impaired sensory organization (n=18) and Patient group with impaired sensory organization (n=22). Results The prevalence of inappropriate use of motor strategies to restore balance in DPN patients with impaired sensory organization was higher than in the control group. The adopted inappropriate strategy was mostly in using ankle strategy, where the somatosensory and visual perturbations were higher. Conclusion Patients with DPN use ankle strategy, instead of hip strategy, to restore balance. This non-use of hip strategy is more common in patients with impaired sensory organization.

Radiculopathy in diabetic polyneuropathy patients: difficulties in the diagnosis and therapy

Neuropathic pain (NP) is not uncommon in clinical practice. NP can occur when various neural structures are damaged, such as peripheral nerves, spinal roots, spinal cord, and brain structures. Depending on the level of damage, NP is divided into central and peripheral. At the same time, peripheral NP is more common. When diagnosing NP, the results of a physical examination of the patient are the most valuable. In order to study the state of the peripheral neuromotor apparatus, patients undergo stimulation electromyography with an analysis of the conduction along motor fibers and sensory fibers caused by the skin sympathetic potential, and EMG using needle electrodes is often used to verify the level and stage of the pathological process. Difficulties in making a diagnosis arise when a patient has a combination of several types of neuropathic pain and comorbid pathology. For the treatment of NP, antidepressants, anticonvulsants, opioid analgesics, drugs for local anesthesia, botulinum toxin type A are used. Alpha-lipoic (thioctic) acid preparations are used in the treatment of diabetic polyneuropathy. The presence of several nosologies in a patient, each of which has individual manifestations of NP, determines the tactics of treating a particular patient, which is considered on the example of two clinical cases.

Effect of Vitamin D on Aldose Reductase in Indonesian Diabetic Polyneuropathy Patients a Randomized Clinical Trial

Aldose Reductase (AR) is an important factor in the pathogenesis of several Diabetes Mellitus (DM) complications, including diabetic neuropathy (DN). Vitamin D has a direct effect on the pathogenesis of DN. Aldose reductase inhibition is an important element in the prevention of DM complications. The objective of this paper was to assess the effect of vitamin D on AR in Indonesian diabetic polyneuropathy (DPN) patients. This cohort study was undertaken at Haji Adam Malik General Hospital Medan, North Sumatera, Indonesia. In a double-blind, placebo-controlled, clinical trial, eligible patients were randomized to receive vitamin D 50,000 IU/week or placebo for 10 weeks. The primary end-point was mean changes of nerve conduction velocity (NCV) from baseline and after 10 weeks of supplementation. There was no significant correlation between mean changes of vitamin D and AR levels. There was significant correlation with negative direction and weak strength between mean changes of AR level and NCV of motor Tibial nerve (p&lt;0.05; r=-0.337). There was significant correlation with positive direction and moderate strength between mean changes of vitamin D level and NCV of motor Median and Peroneal nerves, and motor and sensory Ulnar nerves (p&lt;0.001; r=0.438 – 0.527). In conclusion, vitamin D supplementation had no effect on AR level in Indonesian DPN patients. Higher AR level was correlated with decreased NCV of motor Tibial nerve. Vitamin D supplementation improved NCV in DPN.

Relationship between subclinical hypothyroidism and distal-symmetric diabetic polyneuropathy in type 2 diabetes mellitus referred to Kosar Hospital in Semnan and related indicators in 2019-2020.

Introduction:Diabetes is one of the most common metabolic diseases and one of its important complications is diabetic neuropathy. Due to the relationship between diabetes and thyroid disorders, the present study was performed to determine the association between subclinical hypothyroidism and end-stage diabetic polyneuropathy in patients with type 2 diabetes.Materials and Methods:In this descriptive, analytical study, 154 patients with type 2 diabetes referred to Kosar Hospital in Semnan were evaluated. After recording their demographic information, samples were received for biochemical testing. The patients’ neuropathy was then evaluated based on the United Kingdom screening test (UKST). The results were recorded in the data collection form and then analyzed using SPSS Statistics 22 software.Results:In this study, 154 patients were studied, including 49 with subclinical hypothyroidism and 105 with euthyroid. The results of the present study showed that the mean age of patients in the subclinical hypothyroid group was 60.08 years and in the euthyroid group was 60.77 years. Mean ± standard deviation (SD) of the patients’ age, blood pressure, duration of diabetes, body mass index, fasting blood sugar (FBS) and Glucose, and 2-hour post prandial (2HPP) were not statistically significant between the two groups. The frequency of neuropathy severity based on clinical signs during examination and symptoms mentioned by the patients in the two groups was statistically significant (P = 0.005 and P = 0.001, respectively). The severity of neuropathy was not significantly associated with thyroid-stimulating hormone (TSH) levels (P > 0.05).Conclusion:From the results of the present study, it can be concluded that the severity of neuropathy based on the clinical signs during examination and the symptoms mentioned by the patient in diabetic patients is related to subclinical hypothyroidism. Further studies are recommended.

Which combined nerve conduction study scores are best suited for polyneuropathy in diabetic patients?

Nerve conduction studies (NCS) are widely used in diagnosing diabetic polyneuropathy. Combining the Z scores of several measures (Z-compounds) may improve diagnostics by grading abnormality. We aimed to determine which combination of nerves and measures is best suited for studies of diabetic polyneuropathy. Sixty-eight patients with type 1 diabetes and 35 controls were included in this study. NCS measurements were taken from commonly investigated nerves in one arm and both legs. Different Z-compounds were calculated and compared with reference material to assess abnormality. A sensitivity proxy, the accuracy index (AI), and Cohen's d were calculated. Z-compounds with the highest AI consisted of the tibial and peroneal motor, and the sural, superficial peroneal, and tibial medial plantar sensory nerves in one or two legs. All Z-compounds were able to discriminate between diabetic subjects and nondiabetic controls (mean Cohen's d= 1.42 [range, 1.03-1.63]). The association between AI and number of measures was best explained logarithmically (R2 = 0.401), with diminishing returns above approximately 14 or 15 measures. F-wave inclusion may increase the AI of the Z compounds. Although often clinically useful among the non-elderly, the additional inclusion of medial plantar NCS into Z-compounds in general did not improve AI. Performing unilateral NCS in several motor and sensory lower extremity nerves is suited for the evaluation of polyneuropathy in diabetic patients. The use of Z-compounds may improve diagnostic accuracy in diabetic polyneuropathy and may be particularly useful for follow-up research studies as single summary measures of NCS abnormality development over time.

Risk factors for depression and anxiety in painful and painless diabetic polyneuropathy: A multicentre observational cross-sectional study.

BackgroundDespite the high prevalence of depression and anxiety in chronic pain conditions, current knowledge concerning emotional distress among painful diabetic polyneuropathy (pDSPN) and other diabetes mellitus (DM) sufferers is limited.MethodsThis observational multicentre cohort study employed the Hospital Anxiety and Depression Scale, the Beck Depression Inventory II and the State‐Trait Anxiety Inventory to assess symptoms of depression and anxiety in several groups with diabetes, as well as in a control group. The study cohort included 347 pDSPN patients aged 63.4 years (median), 55.9% males; 311 pain‐free diabetic polyneuropathy (nDSPN) patients aged 63.7 years, 57.9% males; 50 diabetes mellitus (DM) patients without polyneuropathy aged 61.5 years, 44.0% males; and 71 healthy controls (HC) aged 63.0 years, 42.3% males. The roles played in emotional distress were explored in terms of the biological, the clinical (diabetes‐, neuropathy‐ and pain‐related), the socio‐economic and the cognitive factors (catastrophizing).ResultsThe study disclosed a significantly higher prevalence of the symptoms of depression and anxiety not only in pDSPN (46.7% and 60.7%, respectively), but also in patients with nDSPN (24.4% and 44.4%) and DM without polyneuropathy (22.0% and 30.0%) compared with HCs (7.0% and 14.1%, p < 0.001). Multiple regression analysis demonstrated the severity of pain and neuropathy, catastrophic thinking, type 2 DM, lower age and female sex as independent contributors to depression and anxiety.ConclusionsIn addition to the severity of neuropathic pain and its cognitive processing, the severity of diabetic polyneuropathy and demographic factors are key independent contributors to emotional distress in diabetic individuals.SignificanceIn large cohorts of well‐defined painless and painful diabetic polyneuropathy patients and diabetic subjects without polyneuropathy, we found a high prevalence of the symptoms of depression and anxiety, mainly in painful individuals. We have confirmed neuropathic pain, its severity and cognitive processing (pain catastrophizing) as dominant risk factors for depression and anxiety. Furthermore, some demographic factors (lower age, female sex), type 2 diabetes mellitus and severity of diabetic polyneuropathy were newly identified as important contributors to emotional distress independent of pain.

Zinc deficiency correlates with severity of diabetic polyneuropathy.

ObjectivesThere are controversies about the role of zinc in the development of both types 1 and 2 diabetes. The aim of this study was to assess serum zinc level in diabetic patients with and without peripheral neuropathy in comparison to healthy controls and to explore the possible relationship between serum zinc level and severity of peripheral neuropathy.MethodsThis case control study was conducted on 120 subjects: 40 patients fulfilled the criteria for diagnosis of probable diabetic polyneuropathy (DPN), 40 diabetic patients without polyneuropathy (N‐DPN) and 40 healthy controls. DPN patients were submitted to clinical assessment of diabetic neuropathy using neuropathy symptom and change (NSC) scale, Michigan Neuropathy Screening Instrument Physical Assessment (MNSI) scale and electrophysiological assessment using nerve conduction study. Zinc serum level was measured in all subjects included in this study using direct colorimetric test method.ResultsDiabetic patients with and without neuropathy were found to have significantly lower mean values of serum zinc than healthy controls (p = .025, .03 respectively). There is a statistically significant negative correlation between zinc serum level and hemoglobin A1C (HA1C) (p ˂ .001), NSC score (p = .001) and MNSI score (p = .003) in DPN group. There were also statistically significant correlations between zinc serum level and nerve conduction study values.ConclusionZinc deficiency significantly correlates with the severity of DPN and glycemic control.