Diagnosis Of Diabetic Neuropathy Research Articles

POLA PENGGUNAAN DAN ANALISIS EFEKTIVITAS BIAYA OBAT ANTINYERI PADA PASIEN DIABETIK NEUROPATI DI RUMAH SAKIT ISLAM SULTAN AGUNG SEMARANG

Diabetic neuropathy is gathering symptom clinic which influence system nerves, well single or combination and could happen in a manner suddenly, no detected, with symptom clinic and no specific signs but dangerous. Incidence diabetic neuropathy happen between 60% to 70% on type I and type II DM patients. Methods of data collection carried out prospectively. Data were obtained from outpatient data with a diagnosis of diabetic neuropathy who met the inclusion criteria and received analgetics from September to December 2020. Then a cost-effectiveness analysis was performed by calculating the ACER (Average Cost-Effectiveness Ratio) and ICER (Incremental Cost-Effectiveness Ratio) values. The results showed that the most commonly used analgetics was gabapentin at 65.96%, either alone or in combination with an effectiveness percentage of 83.87%. The use of analgetics with the lowest cost is a single Paracetamol of IDR 73,770. The lowest ACER values were shown in the use of the single analgetics Paracetamol and the combination of Amitriptyline-Paracetamol, namely 737.70 and 805.30.

FM latency, FM ratio, F-wave latency versus F-wave index in the diagnosis of diabetic neuropathy

BackgroundDiabetes is one of the most common causes for peripheral neuropathy which warrants early diagnosis and treatment. The conventional nerve conduction studies appear to be normal if few of the nerve roots are escaping the lesion. In view of identifying a better clinical testing method, a late response index comprising most of the parameter of F wave was constructed and compared with the diagnosing ability of other parameters.MethodsThis hospital-based cross-sectional study was conducted among male diabetics aged 30 to 50 years in a tertiary care hospital. Maintaining an ambient temperature of 28 °C and following a supramaximal stimulation of the median nerve of both upper limbs, using a digitalized nerve conduction/electromyography/EP machine, the F-wave tracing was obtained.ResultsThe F-wave index detected a greater number of subjects with diabetic peripheral neuropathy when compared to F-wave mean latency, F M latency and F–M ratio.ConclusionF-wave index can be used as a surrogate electrophysiological study to detect peripheral neuropathy at an early stage and aids in better prognosis.

Serum Myelin Oligodendrocyte Glycoprotein and Myelin Protein Zero as Diagnostic Biomarkers in Diabetic Neuropathy

Background: Diabetic neuropathy can affect any peripheral nerve, including sensory neurons, motor neurons, and the autonomic nervous system. Therefore, diabetic neuropathy has the potential to affect essentially any organ and can affect parts of the nervous system like the optic nerve, spinal cord, and brain. In addition, chronic hyperglycemia affects Schwann cells, and more severe patterns of diabetic neuropathy in humans involve demyelization. Schwann cell destruction might cause a number of changes in the axon. study aims to evaluate serum myelin protein level as a predicting marker in the diagnosis of diabetic neuropathy and to prevent early neuropathy complications of type 2 diabetes. Subjects and methods: To achieve the purpose of the objective, this study involved 120 individuals divided into three groups. The first group included 40 healthy individuals; the second group included 40 type 2 diabetic patients with a diabetes duration of more than 5 years; and the last group included 40 type 2 diabetic patients with a diabetes duration of less than or equal to 5 years. The enzyme-linked immunesorbent assay (ELISA) system is used to detect serum MOG and MPZ. Results: both groups of type 2 diabetes patients had significant (p≤ 0.05) increases in serum myelin protein zero P0 (MPZ) and myelin oligodendrocyte glycoprotein (MOG). Conclusion: According to the results, myelin protein can be used to diagnose patients with diabetic neuropathy at an early stage. But it did not rise to the level of a biomarker due to a lack of sensitivity

Study of clinical patterns of diabetic neuropathy in patients of type 2 diabetes mellitus in a tertiary care hospital

Introduction:Diabetic neuropathy manifests with sensory, motor, and autonomic functions. The symptoms ofneuropathy are highly unpleasant, affecting the quality of life. The diagnosis of diabetic neuropathy is often delayed,so there remains a substantial need for its early diagnosis for timely management. Objective:The aim of this study was to describe patterns of diabetic neuropathy, study nerve conduction study(NCS) findings in diabetic patients with symptoms of neuropathy, and find the relationship between clinical patternsof neuropathy and worsening glycemic control. Methods:This is a hospital-based cross-sectional study of 104 known cases of diabetes mellitus patients withsymptoms of neuropathy visiting Sree Gokulam Medical College and undergoing NCS as a part of the investigation.The Fisher’s exact test was used accordingly. Results:The mean age of the study population was 63.1±6.1 years. The mean body mass index was27.1±3.2 kg/m2. Overall, 97.1% patients had HbA1c above 7%. Approximately 54.8% of patients presented withtingling sensation, 42.3% with burning sensation, 31.7% complained of pain, 16.3% presented with numbness,51% patients had abnormal NCS findings in sural and peroneal nerves, 54.8% in superficial peroneal nerve,46.2% in tibial nerve, and 31.7% patients had abnormal NCS findings in median nerve. Based on the patterns ofneuropathy, 68.2% had sensory motor polyneuropathy, 5.8% had carpal tunnel syndrome, 20.2% had small fiberneuropathy (normal NCS), 2.9% had tibial mononeuropathy, and 2.9% had ulnar mononeuropathy. No associationwas found between the clinical patterns of neuropathy and glycemic control (HbA1c). Conclusion:The most common pattern of neuropathy was sensory motor polyneuropathy. The common nervesinvolved were sural, peroneal, and superficial peroneal nerve, and the most common presenting complaintwas tingling sensation, followed by burning sensation. There was no relationship between clinical patterns ofneuropathy and worsening glycemic control.

The role of neurohumoral factors in the persistence of aseptic bone inflammation in patients with diabetic neuroosteoarthropathy

BACKGROUND: Diabetic neuroosteoarthropathy (DNOAP, Charcot foot) is a relatively rare complication of diabetes mellitus (DM), which can lead not only to impaired support function of the lower limb in such patients, but also to high amputation. DNOAP is characterized by persistent aseptic inflammation of the bone structures of the foot, which creates significant ­difficulties in planning therapeutic measures. In the medical literature, there are data demonstrating the role of individual ­cytokines and neurohumoral factors in the prolongation of the inflammatory process in diabetes, however, there are currently very few studies that determine reliable markers of aseptic inflammation in DNOAP.AIM: To study the effect of neurohumoral factors and advanced glycation end products on the activity of aseptic inflammation in the bone structures of the foot in patients with type 2 diabetes mellitus (DM2) and diabetic neuroosteoarthropathy.MATERIALS AND METHODS. The study included 88 patients with type 2 diabetes (45 men, 43 women). Group 1 consisted of patients with DM2 and inactive DNOAP (n= 43), group 2 (n= 45) consisted of patients with DM2 and distal diabetic neuropathy without osteoarticular pathology. The diagnosis of diabetic neuropathy was based on the analysis of the clinical picture and indicators of peripheral sensitivity. Diagnosis of DNOAP and determination of its stage was based on clinical data, the results of infrared thermometry and radiology tests of the foot bones. General clinical assessment was used, radiology tests (X-ray, MRI), evaluation of CRP, calprotectin, copeptin, glutathione peroxidase 1 (GP1).RESULTS. According to the results of examination and palpation of the feet, as well as the analysis of the temperature gradient of the skin of the affected and contralateral limb (infrared thermometry), DNOAP was detected and the stage of this complication was determined. The diagnosis of the chronic stage of DNOAP was confirmed by the results of MRI and the clinical picture (no difference in skin temperature on the symmetrical areas of the feet). According to the results of laboratory analysis, a statistically significant difference in copeptin values was revealed — in group 1 — 0.232 µg/ml [0.147; 0.342], in group 2 — 0.115 µg/ml [0.065; 0.203] (p>0.05) and CRP — in group 1 — 7.113 mg/l [2.453; 16.505], in group 2 — 2.187 mg/l [1.131; 5.567] (p>0.05), leukocyte levels in the groups did not differ significantly: group 1 — 7.86 [6.40; 9.00]*10^9, group 2 — 7.00 [6.00; 8.15] (p>0.05). There was a trend towards an increase in the level of calprotectin and glutathione peroxidase-1 in the DNOAP group, however, the differences were not significant. calprotectin — in group 1 — 1.948 [1.229; 2.969], in group 2 — 1.692 [1.16; 2.514] μg/ml and glutathione peroxidase-1 in group 1 — 24.72 [20.1; 31.82], in group 2 — 22.98 [18.94; 31.2] ng/ml.CONCLUSION. In the study, statistically significant differences were obtained in the levels of copeptin and C-reactive protein: in patients with DNOAP, their values were significantly higher, which indicates the persistence of the aseptic inflammatory process in the bone tissue of patients even in the chronic stage of DNOAP. These data may help in deciding whether to use one or another method of unloading the affected joints, which will affect the clinical prognosis. The study of neurohumoral markers of arthropathy in the blood serum of patients with DM2 is carried out for the first time, and therefore it is difficult to compare with the results of other authors. It can be assumed that copeptin and CRP are significant markers of persistent inflammation of the osteoarticular structures of the foot in DNOAP.

Cardiovascular risk of gabapentin and pregabalin in patients with diabetic neuropathy

BackgroundGabapentin and pregabalin are commonly prescribed medications to treat pain in patients with diabetic neuropathy. Gabapentin and pregabalin can cause fluid retention, which is hypothesized to be associated with cardiovascular diseases. However, whether long-term use of gabapentin and pregabalin is associated with adverse cardiovascular diseases remains unknown. This study aims to examine the association between gabapentin use, pregabalin use and several adverse cardiovascular events.MethodsThis retrospective cohort study used propensity score matching within patient electronic health records (EHRs) from a multicenter database with 106 million patients from 69 health care organizations in the US. The study population comprised 210,064 patients who had a diagnosis of diabetic neuropathy and were prescribed diabetic neuropathy medications in their EHRs. The exposure cohort comprised patients who were prescribed gabapentin or pregabalin to treat diabetic neuropathy. The comparison cohort comprised patients who were not prescribed either gabapentin or pregabalin but were prescribed other drugs to treat diabetic neuropathy. The outcomes of interest were myocardial infarcts, strokes, heart failure, peripheral vascular disease, and venous thromboembolic events. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for 3-month and 5-year risk for adverse cardiovascular events between the propensity score-matched cohorts.ResultsBoth gabapentin and pregabalin were associated with increased risk of 5-year adverse cardiovascular events compared with the comparison group. In patients prescribed gabapentin, the highest risk was observed for deep venous thrombosis (HR: 1.58, 95% CI 1.37–1.82), followed by pulmonary embolism (HR: 1.5, 95% CI 1.27–1.76), peripheral vascular disease (HR: 1.37, 95% CI 1.27–1.47), stroke (HR: 1.31, 95% CI 1.2–1.43), myocardial infarction (HR: 1.25, 95% CI 1.14–1.38) and heart failure (HR: 1.14, 95% CI 1.07–1.21). In patients prescribed pregabalin, the highest risk was observed for deep venous thrombosis (HR: 1.57, 95% CI 1.31–1.88), followed by peripheral vascular disease (HR: 1.35, 95% CI 1.22–1.49), myocardial infarction (HR: 1.29, 95% CI 1.13–1.47), pulmonary embolism (HR: 1.28, 95% CI 1.04–1.59), stroke (HR: 1.26, 95% CI 1.12–1.42), and heart failure (HR: 1.2, 95% CI 1.11–1.3). There were significant associations between short-term (3 month) gabapentin use and heart failure, myocardial infarction, peripheral vascular disease, deep venous thrombosis, and pulmonary embolism. Short-term (3 month) pregabalin use was associated with deep venous thrombosis, peripheral vascular disease.ConclusionIn patients with diabetic neuropathy who were prescribed gabapentin and pregabalin, there is an increased risk for heart failure, myocardial infarction, peripheral vascular disease, stroke, deep venous thrombosis, and pulmonary embolism with long-term use. Our findings suggest that increased risk for adverse cardiovascular events, along with other side effects, the efficacy of pain control and the degree of tolerance of the patient, should be considered when prescribing gabapentin and pregabalin long-term in patients with diabetic neuropathy.

Value of neutrophil/lymphocyte ratio in the diagnosis of diabetic neuropathy

Value of neutrophil/lymphocyte ratio in the diagnosis of diabetic neuropathy

Inflammatory Biomarkers Levels in T2DM Emirati Patients with Diabetic Neuropathy.

IntroductionPrevious studies have suggested the involvement of chronic low‐grade inflammation in the pathogenesis of diabetic neuropathy (DNP). However, none of these studies have examined the levels of monocyte chemoattractant protein-1 (MCP-1) in type 2 diabetes mellitus (T2DM) patients with confirmed diagnosis of neuropathy. Therefore, the present study aims to investigate the levels of MCP-1 along with IL-6, IL-8 and TGF-β in patients with T2DM and confirmed neuropathy and identify correlations, if any, between MCP-1 and other parameters.MethodsA single center cross-sectional clinical study was conducted at University Hospital Sharjah (UHS) and University of Sharjah. One hundred and two patients with T2DM were recruited from diabetes clinics at UHS and were stratified into different groups based on diagnosis of DNP and other parameters. Several analyses were conducted to evaluate and compare the levels of MCP-1, IL-6, IL-8, and TGF-β across these groups of patients and identify correlations, if any, between MCP-1 and other variables.ResultsA significant increase was found in the levels of MCP-1 in T2DM patients with DNP compared to the patients without DNP (p=0.002, p-adj=0.007). Further analysis has shown that levels of IL-8 (p=0.008) and TGF-β (p=0.06) were increased and decreased, respectively, in patients with DNP compared to patients without DNP. Moreover, strong correlations were found between MCP-1, IL-8 and TGF-β levels.ConclusionThe key finding of the present study is the significant elevation in levels of MCP-1 in T2DM patients with DNP compared to the patients without DNP and IL-8 and TGF-β were strong predictors of MCP-1 increased levels.

The relationship Between Osteocalcin and Bone Alkaline Phosphatase in Patients with Diabetic Neuropathy.

The current study aimed to determine bone formation markers ( osteocalcin and bone alkaline phosphatase) as biomarkers for diagnosis the patients with diabetic neuropathy (DN) and to find the relationship between these markers and dyslipidemia in Iraqi patients with diabetic neuropathy, and if these patients are more prone to the risk of atherosclerosis disease.Subjects & Methods: in this study, serum samples were obtained from 25 healthy individuals as a control group (G1), 25 diabetic patients with dyslipidemia as a group (G2), and 25 diabetic patients without dyslipidemia as a group (G3). Age range (45-65) years for all subjects.Patients were attended in the National Diabetes Center / AL-Mustansiriya University/Baghdad. Serum was frozen until used for the analysis of FBG, Ocn , BALP, TG, Ch, HDL-ch, LDL-ch, and VLDL-ch. HbA1C is determined in whole blood.Results: the results showed a highly a significant increase in FBG,HbA1C, Ocn and BALP in G2 and G3 when compare with G1, and a significant difference in lipids levels between two patients groups and control. There is a significant negative correlation between serum Ocn and BALP. Serum Ocn and ALP level concentrations were independently and highly positively correlated with TG,VLDL-ch, and AIP ratio. Conclusions: Ocn and BALP were further increased in DN with complications and poor glycemic control. The AIP ratio was highly significant elevated in DN patients with and without dyslipidemia comparing with control ,therefore, these patients are more prone to the risk of atherosclerosis disease. Much remains to be further investigated to confirm such a relationship between Ocn and BALP, in addition, to clarify their role in DN. Changes in bone biomarkers can reflect these underlying changes ahead of time, enabling clinicians to respond fast and effectively, which allows bone biomarkers to be used as markers for DN diagnosis.

209-OR: Physical Activity and Nerve Structure and Function in Patients with Long-Standing Type 1 Diabetes

Physical activity (PA) is recommended for patients with diabetes to improve glycemic control. In prediabetes and T2D there is a causal relationship between PA and peripheral nerve health; however, the effect of PA on nerve structure and function in longstanding T1D is unclear. We aimed to determine the relationship between PA and small nerve fiber morphology, large nerve fiber function and cardiac autonomic function in this population. Data from 75 participants was collected as part of the Canadian Study of Longevity in T1D. Participants completed a physical exam, medical history and neuropathy assessment including nerve conduction studies (NCS), corneal confocal microscopy measurement of corneal nerve fiber length (CNFL) and assessment of heart rate variability. Participants also reported their daily PA from the preceding 12-months. There were 41(55%) female participants, mean ± SD age was 66 ± 8 years, median duration of diabetes was 54 [52,58] years, BMI was 26.6 ± 3.8, HbA1c of 7.3 ± 0.8. 65(89%) participants met the criteria for diagnosis of diabetic neuropathy. The weekly mean PA time was 156 ± 132 min and 35(47%) reported ≧150 minutes/week. PA time was associated with a greater cooling detection threshold (r=0.24; p=0.043), higher peroneal and sural amplitude (r=0.36; p=0.0017, rs=0.26; p=0.024) and conduction velocity (rs=0.28; p=0.015, r=0.23; p=0.050). Vibration perception threshold at the toe was inversely associated with PA (r=-0.31; p=0.025), whereas there was no association at the finger. There was no association between PA time and heart rate variability (r=-0.040; p=0.74) or CNFL (r=0.23; p=0.055). Linear regression for NCS, adjusting for age and A1c, showed that for each 30 min of PA there was an 0.09 mv higher peroneal amplitude (p=0.032) and 0.048 ms lower peroneal F-wave latency (p=0.022). In individuals with longstanding T1D, PA is associated with substantially better large nerve fiber function in the lower limbs and some better measures of small nerve fiber function. Disclosure E. J. H. Lewis: Board Member; Self; Nutarniq Corp, Board Member; Spouse/Partner; Nutarniq Corp, Research Support; Self; Canadian Institutes of Health Research. B. A. Perkins: Advisory Panel; Self; Abbott Diabetes, Boehringer Ingelheim International GmbH, Insulet Corporation, Novo Nordisk Canada Inc., Other Relationship; Self; Abbott Diabetes, Medtronic, Novo Nordisk Canada Inc. L. Lovblom: None. S. O. Lanctot: None. D. Scarr: None. N. Cardinez: None. A. Weisman: None. M. H. Brent: Advisory Panel; Self; Novartis Pharmaceuticals Canada Inc., Roche Canada, Research Support; Self; Bayer AG, Novartis Pharmaceuticals Canada Inc. V. Bril: Advisory Panel; Self; Akcea Therapeutics, Alnylam Pharmaceuticals, Inc., CSL Behring, Sanofi Genzyme, Consultant; Self; Janssen Research & Development, LLC, Research Support; Self; Takeda Canada. D. Cherney: Other Relationship; Self; AbbVie Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Scientific Affairs, LLC., Lilly Diabetes, Merck & Co., Inc., Mitsubishi-Tanabe, Maze Inc, Prometic, Novo Nordisk, Sanofi. Funding JDRF (17-2013-312)

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.

Risk factors associated with peripheral neuropathy among diabetic individuals: a case control study

Background: Diabetic neuropathy is one among the most common complication in diabetes mellitus. Diabetic peripheral neuropathy hinders the quality of life causing morbidity and mortality. The purpose of this study was to find the risk factors associated with diabetic neuropathy.Methods: This case control study involved 100 diabetic patients attending the Dohnavur fellowship hospital, Dohnavur from October 2019 to March 2020. Sociodemographic profile and diabetic characteristics of the study group were obtained and analysed. Diagnosis of Diabetic Neuropathy was done by using the diagnostic method proposed by American Diabetic Association.Results: Of the total study population with mean age 59.43 years, 63% had family history of diabetes. Almost 70% had poor diabetic control. Statistically significant relationships were found between neuropathy and duration of diabetes, glycaemic control, history of hypertension, monofilament test and pinprick sensation.Conclusions: In this study, glycemic control, dyslipidemia and hypertension were modifiable risk factors for diabetic neuropathy. Early interventional programs to sensitize diabetics on these factors could improve the quality of life of Diabetic patients.

Subjective versus objective assessment of painful diabetic peripheral neuropathy

Introduction Diabetic peripheral neuropathy (DPN) is one of the commonest chronic complications of diabetes mellitus. It is documented that 26.4% of the cases with type 2 diabetes mellitus have painful DPN, whereas approximately half of the DPN cases may not have symptoms. Although neurophysiologic studies represent an objective and sensitive tool in the diagnosis of diabetic neuropathy, they remain limited owing to many factors; thus, there is a need to develop simpler tools that can fit into this gap, hence the development of different neuropathy scores. Aim To evaluate different tools and methods either subjective or objective in diagnosis of painful DPN in type 2 diabetic patients. Patients and methods We included 200 cases with type 2 diabetes mellitus recruited from the diabetes and diabetic neuropathy clinics in Mansoura Specialized Medical Hospital fulfilling the inclusion and exclusion criteria. They were divided into two groups: group 1 included 150 diabetic cases with painful peripheral diabetic neuropathy, and group 2 included 50 diabetic cases without neuropathy. Results Glycated hemoglobin was significantly elevated in the peripheral neuropathy group compared with the other group (8.24 vs. 7.27%; P Conclusion Higher grades of the scores performed in this study were associated with a severe form of neuropathy. Both duration of diabetes and glycated hemoglobin levels had a significant positive correlation with these scores. Regarding neutrophil/lymphocytic ratio in our study, it did not show a significant difference between the two groups.

PSY2 - Pregabalin use on Diabetic Neuropathy Patients and the Risk of Heart Failure

Pregabalin is widely used in neuropathic pain patients (including diabetic neuropathy) as a first-line agent. However, there are concerns regarding its cardiovascular safety, especially the risk of heart failure (HF). Moreover, diabetes is a risk factor for HF. Therefore, it is critical to assess whether pregabalin increases the risk of HF in diabetic neuropathy patients. We conducted a retrospective cohort study in a commercially insured population using IMS LifeLink PharMetrics Plus™ data. Patients with a diagnosis of diabetic neuropathy and receiving any one of the first-line medications – pregabalin, duloxetine, gabapentin or amitriptyline – between June 01 2006 and April 30 2015 were included in the study. Patients were required to be enrolled 6 months prior to the therapy initiation (index date). Primary comparison was between users of pregabalin and users of duloxetine. The outcome was defined as emergency department visit or inpatient hospitalization for HF within 90 days of index date. All covariates were gathered 6 months prior to index date and included in a cox proportion-hazards regression model. The final sample consisted of 2950 patients for the primary comparison. We found no difference in the risk of HF with pregabalin compared to duloxetine (hazard ratio of 1.319, 95% CI 0.445-3.912). Secondary analyses yielded similar results that pregabalin has no higher risk of HF compared to either amitriptyline or gabapentin (hazard ratio of 0.532, 95% CI 0.219-1.294; hazard ratio of 0.599, 95% CI 0.336-1.069, respectively) Our results showed no increase of HF risk in diabetic neuropathy patients who used pregabalin.

The role of ultrasound in the diagnosis and evaluation of diabetic neuropathy in nerve roots of the foot

Background Neuropathies are characterized by a progressive loss of nerve fiber function. Diabetic peripheral neuropathy is the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes. The diagnosis of diabetic neuropathy is based primarily on characteristic symptoms and is confirmed with nerve conduction studies (NCS), which are time-consuming, slightly invasive, and occasionally not well tolerated for repeated evaluations. In contrast, ultrasonographic (US) examinations can be performed to assess peripheral nerves with less discomfort and have already been used for the evaluation of several disorders of the peripheral nervous system such as carpal tunnel syndrome. Patients and methods A total of 50 patients were included in the study, with 40 patients with type 2 diabetes and 10 controls. All cases underwent clinical history, local clinical examination, NCS, and real-time high-resolution US. Ultrasound examination The patients were examined in supine position, and the foot was bolstered with a pillow to expose the anterior and medial portion of the lower leg and foot. The transducer was placed immediately above the medial malleolus to locate the tibial nerve in the transverse (short axis) and the longitudinal (long axis) views. The 5.0–12.0-MHz multifrequency linear array probe was used for tibial nerve scanning. The instrument used was Philips HD3 ultrasound scanner. Result There was a statistically significant difference between case and controls regarding US cross-sectional area done for right and left tibial nerves, with high mean among cases (0.18±0.02 and 0.17±0.02, respectively). There was a statistically significant difference between US and NCS. There was no statistically significant difference between the two groups regarding the other measurements. Conclusion High-resolution US can be used as adjuvant tool for the NCS for diabetic patients suspected to have neuropathy.

Less is More in Diabetic Neuropathy Diagnosis: Comparison of Quantitative Sudomotor Axon Reflex and Skin Biopsy.

To compare the frequency of abnormalities in epidermal nerve fiber density (ENFD) and quantitative sudomotor axon reflex (QSART) in patients with diabetic distal symmetric polyneuropathy (DSPN). Nerve conduction studies, ENFD, and QSART data were obtained pre- and postexercise, in patients enrolled in a prospective diabetic neuropathy study. McNemar's test was applied to compare the yield of ENFD and QSART. Eighteen patients (58 ± 4 years) were enrolled, with 36 data collection points. In diabetic DSPN and diabetic large fiber DSPN (DSPN-L), abnormal ENFD (77% and 100% respectively) is more frequent than abnormal QSART (39% and 35%, respectively) (P value = 0.001 in diabetic DSPN and P value = 0.0002 in diabetic DSPN-L), whereas in diabetic small fiber DSPN (DSPN-S), both tests have similar yields (47%). ENFD has a high diagnostic yield in diabetic DSPN and DSPN-L. Including QSART data adds little to the sensitivity of EFND in DSPN-S.

Feasibility of foot deformations corrective operations performing in patients with diabetes

Objective: To improve methods of early diagnosis of diabetic neuropathy and suggest options for surgical prophylaxis possible purulent and necrotic complications in patients with diabetic foot syndrome. Materials and Methods. The study involved 64 patients with complicated diabetic foot syndrome (DFS). The average age of patients - 61,9 ± 3,8 years, duration of diabetes - 11,47 ± 3,2 years. The patients had neuropathic and mixed forms of DFS, fingers or arched foot deformations with the presence of pressor venous trophic ulcers in the forefoot. Patients were randomized into two groups: the main group - 34 and comparison group - 30 patients. There were representative characteristics for all groups: age, sex, comorbidity and did not differ significantly (P> 0,05). There were no statistically significant difference between the groups of these data (χ2 = 0,05; P = 0,8195). Results. After 6 months of complex treatment the ulcers were healed in more than half of patients in both groups - 19 (63,3%) of patients in the comparison group and 25 (73,5%) of the main group. In 8 (26,7%) patients in the comparison and 7 (20,6%) of the main group positive dynamics was observed, but over a longer period of treatment . After 12 months, the number of patients whose ulcers were completely healed differed significantly by the main group (P = 0,0007; χ2 = 11,41). Also in the main group was only 1 (3,0%) patient with ulcer that was not healed, in contrast to the comparison group - 7 (23,3%) patients (P = 0,0373; χ2 = 4,34). Conclusions. Operations aimed at correction of fingers and feet deformations in combination with standard therapy and unloading of the lower limb, allow improving the results of patients with complicated DFS treatment by reducing the number of relapses.

Prevalence and incidence of peripheral polyneuroapathy and correlation among different clinical factors in people with type 1 diabetes

Background: The control and early diagnosis of diabetic neuropathy (DNP) reduce the risk of diabetes foot ulceration and lower-extremity amputation. The aim of this study is to assess correlation among different clinical factors and prevalence of DNP as the result of type-1 diabetes mellitus (DM). Patients and methods: A total of 385 outpatients (52,8% female vs. 41,2% male) with diabetes type 1 were identified from our retrospective monocentric database. Last clinic visit was recorded from 01.09.2013 to 30.9.2015. Mean datas were as following: age 50,65 years, duration of diabetes 22,8 years, BMI 27,3 kg/m2, HbA1c DCCT adjusted 7,2%/55,78 mmol/mol, blood pressure 136/79 mmHg. Polyneuropathy was diagnosed using the neuropathy symptom score and the neuroapthy disability score by Young and Boulton and examination of foot status. Results: Overall prevalence of DPN in type-1 DM patients was 34,2% (male predominant 59,32%). Duration of diabetes, severe of HbA1c, reduction of GFR, non-severe hypoglycemia, diastolic hypertension were associated with prevalence of DNP (P < 0.001). The incidence of DNP was scarcely high in the first five years after the diagnosis of diabetes. The incidence rises from the 5th year on and affects every second patient with type-1 DM after 30 years. The risk factors as systolic arterial hypertension (p = 0.308), BMI (p = 0,5) and albuminuria (p = 1,93) were not significantly correlated with DNP. Conclusions: The prevalence of DPN is high in patients with type-1 diabetes. Presence of certain risk factors, duration of diabetes should be predictive for the prevalence of DNP.

Measurement of current perception thresholds using the Neurometer(®) - applicability in diabetic neuropathy.

The incidence of diabetes mellitus is continuously growing worldwide, while the specific chronic complications that it induces have a negative impact on life expectancy andquality, entailing extremely high costs of healthcare services. Diabetic peripheral neuropathy is one of the most common chronic complications of diabetes, affecting almost half of diabetic people during life.This review aims at summarizing the evidence on the advantages and the usefulness of current perception threshold measurement for peripheral diabetic neuropathy assessment. Among the different methods used for the screening and diagnosis of diabetic neuropathy, measurement of current perception threshold using the Neurometer® has the ability to assess three sub-types of nerve fiber by producing transcutaneous electrical stimuli at frequencies of 2000, 250 and 5 Hz.Current evidence shows that this method provides a useful, noninvasive evaluation technique of patients with peripheral nervous system disorders, being able to detect neuropathy in the earliest and asymptomatic stages.

Changes of the gait parameters and sensory-motor deficit associated with peripheral diabetic neuropathy

Peripheral nervous system impairment with sensory and motor loss, as observed in diabetic neuropathy, might induce severe effects on balance control and gait in this population. Objective: To evaluation the performance of the gait and the sensory-motors changes, due of the peripheral diabetic neuropathy (PDN). Method: Participated twenty four individuals with PDN and twenty eight healthy individuals without glycemic alterations indicative of diabetes. Participants were subjected to confirm the clinical diagnosis of diabetic neuropathy through the tactile sensitivity of the soles of the feet with monofilament test. Subsequently, ankle angular variation in static condition and during the gait was investigated through kinematics. The ankle muscle strength was investigated using a digital dynamometer. Results: Diabetic neuropathy group showed greater duration in double support and full support periods of gait than control group with impairment in balance control. Diabetic neuropathy group showed reduces muscle strength of plantiflexors and dorsiflexors. Conclusion: The losses sensory-motors deriving from PDN may imply in impairment in gait performance, with consequent loss of balance.