Diagnosis Of Diabetic Polyneuropathy Research Articles

Diagnosis of diabetic polyneuropathy in type 2 diabetes mellitus: focus on changes in peripheral nerves according to ultrasonic research method

Diagnosis of diabetic polyneuropathy in type 2 diabetes mellitus: focus on changes in peripheral nerves according to ultrasonic research method

Simplified electrophysiological approach combining a point-of-care nerve conduction device and an electrocardiogram produces an accurate diagnosis of diabetic polyneuropathy.

This study aimed to investigate the diagnostic potential of two simplified tests, a point-of-care nerve conduction device (DPNCheck™) and a coefficient of variation of R-R intervals (CVR-R), as an alternative to traditional nerve conduction studies for the diagnosis of diabetic polyneuropathy (DPN) in patients with diabetes. Inpatients with type 1 or type 2 diabetes (n = 167) were enrolled. The study population consisted of 101 men, with a mean age of 60.8 ± 14.8 years. DPN severity was assessed using traditional nerve conduction studies, and differentiated based on Baba's classification (BC). To examine the explanatory potential of variables in DPNCheck™ and CVR-R regarding the severity of DPN according to BC, a multiple regression analysis was carried out, followed by a receiver operating characteristic analysis. Based on BC, 61 participants (36.5% of the total) were categorized as having DPN severity of stage 2 or more. The multiple regression analysis yielded a predictive formula with high predictive power for DPN diagnosis (estimated severity of DPN in BC = 2.258 - 0.026 × nerve conduction velocity [m/s] - 0.594 × ln[sensory nerve action potential amplitude (μV)] + 0.528In[age(years)] - 0.178 × ln[CVR-R], r = 0.657). The area under the curve in receiver operating characteristic analysis was 0.880. Using the optimal cutoff value for DPN with severer than stage 2, the predictive formula showed good diagnostic efficacy: sensitivity of 83.6%, specificity of 79.2%, positive predictive value of 51.7% and negative predictive value of 76.1%. These findings suggest that DPN diagnosis using DPNCheck™ and CVR-R could improve diagnostic efficiency and accessibility for DPN assessment in patients with diabetes.

Phase Angle of Bioelectrical Impedance Analysis as an Indicator for Diabetic Polyneuropathy in Type 2 Diabetes Mellitus.

Due to the heterogenous clinical symptoms and deficits, the diagnosis of diabetic polyneuropathy (DPN) is still difficult in clinical routines, leading to increased morbidity and mortality. We studied the correlation of phase angle (PhA) of bioelectrical impedance analysis (BIA) with clinical, laboratory, and physical markers of DPN to evaluate PhA as a possible diagnostic method for DPN. In this cross-sectional observational study as part of the Heidelberg Study on Diabetes and Complications, we examined 104 healthy individuals and 205 patients with type 2 diabetes mellitus (T2D), among which 63 had DPN. The PhA was calculated from multifrequency BIA. Nerve conduction studies, quantitative sensory testing (QST) and diffusion-weighted magnetic resonance neurography to determine fractional anisotropy (FA) reflecting peripheral nerve integrity were performed. T2D patients with DPN had lower PhA values (5.71 ± 0.10) compared to T2D patients without DPN (6.07 ± 0.08, P = .007, + 6.1%) and healthy controls (6.18 ± 0.08, P < .001, + 7.9%). Confounder-adjusted analyses showed correlations of the PhA with conduction velocities and amplitudes of the peroneal (β=.28; β=.31, P < .001) and tibial nerves (β=.28; β=.32, P < .001), Z-scores of QST (thermal detection β=.30, P < .05) and the FA (β=.60, P < .001). Receiver-operating characteristic analysis showed similar performance of PhA in comparison to the mentioned diagnostic methods. The study shows that PhA is, in comparison to other test systems used, at least an equally good and much easier to handle investigator-independent marker for detection of DPN.

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.

The significance of neutrophil/lympocyte ratio and platelet/lymphocyte ratio in predicting diabetic polyneuropathy and neuropathic pain severity as inflammatory factors.

<p>Neuropathic pain may appear as one of the first symptoms that take the patient to the physician in type 2 diabetes, which can be asymptomatic for years. Although it is accepted that diabetes is a trigger for vascular inflammation, it has been suggested that inflammation itself may trigger diabetes. In our study, we aimed to investigate the relationship between diabetic polyneuropathy and neuropathic pain and inflammatory markers.</p>. <p>The study included 44 healthy controls, 46 diabetic patients with normal electroneuromyography (ENMG) and 44 diabetic patients with polyneuropathy detected in ENMG. Sedimentation, C-reactive protein (CRP), Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLO) and mean platelet volume (MPV) values were recorded in the sera of the patients. The Douleur Neuropathic 4 (DNP4) Questions was used to evaluate the presence of neuropathic pain in the patients, and the Visual Analogue Scale (VAS) was used to evaluate the severity of pain.</p>. <p>NLR, CRP, sedimentation levels were statistically significantly higher in the DMP+ and DMP&ndash; patient groups compared to the control group. PLO and MPV levels were significantly higher in the DMP+ patient group compared to both the DMP&ndash; patient group and the control group.&nbsp;<br>The means of VAS and DN4 scores were statistically significantly higher in the DMP+ patient group than in the DMP&ndash; patient group. In the DMP&ndash; patient group, the NLR levels of those with neuropathic pain according to the DN4 scale were statistically significantly higher than those without neuropathic pain.</p>. <p>Diabetic neuropathy is one of the common complications of diabetes, affecting about half of patients. Our study shows that NLR, PLO, MPV values can be used as parameters to help us make an easy and fast diagnosis in diabetic polyneuropathy. However, their reliability in the diagnosis of diabetic polyneuropathy should be evaluated with studies to be conducted with larger patient and control groups.</p>.

Screening and diagnosis of diabetic polyneuropathy in clinical practice: A survey among German physicians (PROTECT Study Survey)

AimsWe sought to obtain detailed information on the procedures and appraisal of screening for and diagnosing diabetic sensorimotor polyneuropathy (DSPN) in clinical practice. MethodsThis cross-sectional survey included 574 physicians from 13 federal states across Germany who responded to a tripartite questionnaire. ResultsThe vast majority of the respondents reported to screen for DSPN at least once a year (87 %), while 65 % reported to examine the feet of DSPN patients at least twice a year. However, only 28 % and 20 % of the respondents used questionnaires and scores to assess the severity of neuropathic symptoms and signs, respectively. The rates of participants reporting that they do not use a standardized testing procedure were 58 % for pressure sensation, 62 % for pain sensation, and 54 % for thermal sensation. The rates of respondents reporting that they do not deploy a standardized assessment were 41 % for vibration sensation, 73 % for pressure sensation, 77 % for pain sensation, and 66 % for thermal sensation. Half of the physicians oriented themselves towards clinical guidelines when diagnosing DSPN. ConclusionsDespite relatively high screening rates, the willingness to implement both standardized testing procedures and assessment and to follow guidelines is low among physicians when screening for and clinically diagnosing DSPN.

Value of tibial and peroneal minimum F-wave latency ROC curves in diabetic polyneuropathy diagnosis

Introduction: F wave is one of the most sensitive electrodiagnostic parameters to verify the diabetic neuropathy even in absent or mild clinical symptoms. Methods: In our prospective study, we determined the best cut-off point measures of tibial and peroneal Minimal F-Waves Latency (MFL), in 100 diabetic patients using Receiver Operating Characteristic (ROC) curves. We calculated the diagnostic measures with and without the correction for height to reveal the effect of correction on sensitivity and specificity.

Whole plantar nerve conduction study: An useful tool in diagnosis of diabetic polyneuropathy

Whole plantar nerve (WPN) allows the registration of a summation sensory action nerve potentials (SNAPs), simultaneously recording from both lateral and medial plantar nerves. Thus, WPN may be useful in length-dependent polyneuropathy, as well as diabetic peripheral neuropathy. We aimed to assess the reliability of whole plantar nerve (WPN) conduction study in diabetic subjects.

Differential diagnosis of polyneuropathies in diabetes mellitus

Diabetic polyneuropathy (DPN) is heterogeneous in its clinical course and clinical manifestations. Depending on the primary lesion of large or small nerve fibers, different onset, course and clinical manifestations of polyneuropathy are possible. In patients with diabetes, the incidence of associated lesions of the peripheral nervous system is high. When verifying the diagnosis of DPN, it is necessary to carry out a differential diagnosis with a number of diseases: paraneoplastic neuropathies, metabolic neuropathies, neuropathies in vasculitis, toxic neuropathies, autoimmune neuropathies, inflammatory neuropathies and hereditary neuropathies. Diabetes is not the only cause of polyneuropathy. Up to 50% of all cases of polyneuropathies in diabetes have additional causes. Diagnosis of diabetic polyneuropathy - diagnosis of exclusion. The development of polyneuropathy in patients with a duration of type 1 diabetes less than 5 years, the absence of nephropathy and / or retinopathy, asymmetry in symptoms and signs, the predominance of motor symptoms, beginning with upper limb lesions, rapid progression should justify the doctor for differential diagnostic search. You should also take into account the characteristics of the patient (old age, vegetarianism and alcohol use), medical and toxic effects (taking metformin&gt; 3 years and&gt; 2 g / day; cytostatics, chemotherapy, heavy metals), family history of neuropathy. Therapeutic tactics should be individualized and take into account the polyneuropathy polyetiology. The purpose of this review is to discuss the most common reasons peripheral neuropathy in diabetes mellitus. The differential diagnosis of the diabetic polyneuropathy is the focus of this article.

P-NE003. Frequency of carpal tunnel syndrome in patients having diabetes mellitus with neuropathy in a tertiary care hospital

Introduction. Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. Carpal tunnel syndrome (CTS) and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy. Methods. This study was a hospital based descriptive cross sectional study done in BIRDEM general hospital between July, 2015 and June, 2016, for a period of twelve months. The initial clinical diagnosis of DPN was made and was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Results. A total of 354 cases were finally analyzed with 153 (43.2%) patients being symptomatic and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. Majority (38.4%) of patients belonged to the age group of 51-60 years. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). Study subjects with CTS had significantly higher BMI, higher fasting blood sugar and higher HbA1c in comparison to patients without CTS. The mean compound motor action potential was not significantly different between patients with and without CTS. Conclusion. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions should be made carefully after nerve conduction study and proper diagnosis.

A Cross-Sectional Web Survey of Satisfaction with Treatment for Pain in Participants with Suspected Diabetic Peripheral Neuropathic Pain in Both Feet.

IntroductionDiabetic peripheral neuropathic pain (DPNP), a symptom of diabetic polyneuropathy (DPN), is underdiagnosed in people with diabetes. To date, no studies have determined the relationship between diagnosis of DPN and satisfaction with treatment for pain. Additionally, the factors that influence satisfaction with treatment for pain remain unknown. This questionnaire study was conducted to understand satisfaction with treatment for pain among participants with diabetes who experienced bilateral pain or numbness in their feet.MethodsThis cross-sectional, observational, web-based questionnaire study for participants with diabetes and suspected DPNP was conducted in Japan. Potential respondents were registered in the INTAGE Disease Panel or the Rakuten Insight Disease Panel. The primary endpoint was the number and percentage of participants who were satisfied with their DPNP treatment. Secondary endpoints included participant opinions regarding treatment-related efficacy, side effects, and economic burden, and factors affecting satisfaction with treatment.ResultsThe questionnaire was accessed by 7565 potential participants; 777 met the eligibility criteria (final analysis set). Satisfaction with treatment for bilateral foot pain was low (satisfied, 27.9%; neither satisfied nor unsatisfied, 42.2%; unsatisfied, 23.4%; very unsatisfied, 6.4%). Participants were somewhat more satisfied with treatment side effects than with treatment efficacy and economic burden. Satisfaction with treatment mainly differed by improvement in actions in daily life, improvement in quality of life, and communication with doctors. The diagnostic testing rate for DPN was low, and diagnosis was more common in participants who complained of symptoms of pain and numbness (any visit) versus those who did not.ConclusionParticipants with diabetes who experience bilateral foot pain or numbness reported a low level of satisfaction with treatment for pain.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01810-x.

Зміни морфометричних параметрів макули як неінвазивний біомаркер ступеня тяжкості діабетичної полінейропатії

Diabetic polyneuropathy (DPN) is one of the most common complications of diabetes mellitus (DM), affecting up to a quarter of all patients with DM, and in asymptomatic form it is present in all patients. A number of changes in the retina, optic nerve, corneal nerve fibers, and visual function may correlate with DPN, so their evaluation may provide additional information on the detection and determination of its severity. The aim. To determine the peculiarities of changes in morphometric parameters of the central zone of the retina depending on the severity of DPN. Materials and methods. In total, 575 patients with type II DM were examined (1150 eyes). In 365 (63.5 %) DM patients, the diagnosis of DPN was excluded (stage N0). DPN was diagnosed in 210 (36.5 %) DM patients. Asymptomatic DPN was observed in 101 (17.5 %) DM patients: N1A stage – in 47 (8.1 %) patients, N1B stage – in 54 (9.4 %) patients; symptomatic DPN – in 89 (15.5 %) DM patients: N2A stage – in 46 (8.0 %) patients, N2B stage – in 43 (7.5 %) patients; stage of severe complications (N3 stage) – in 20 (3.5 %) DM patients. The control group consisted of 50 healthy individuals (100 eyes). In addition to standard ophthalmic examination methods, optical coherent tomography of the retina and optic nerve was performed. Results. Patients with type 2 DM had morphometric features of macular lesions depending on the severity of DPN: the index of focal loss volume (FLV) of retinal ganglion cells was 8.4 times higher in asymptomatic stage A DPN, 8.7 times higher in asymptomatic stage B DPN, 14.1 times higher in symptomatic stage A DPN, 14.3 times higher in symptomatic stage B DPN, 15.3 times higher at the stage of severe DPN complications (p &lt;0.05), and the thickness of the retina in the foveolar zone in patients with asymptomatic stage A DPN was 9.1 % lower, with asymptomatic stage B DPN it was 8.9 % lower, and at the stage of severe complications of DPN it was 12.7 % lower than the respective indices in healthy age-matched individuals. Conclusions. The obtained data indicate the relationship between morphometric parameters of the macula and the severity of DPN. The identified morphometric features of the macula in type 2 DM can serve as a non-invasive ophthalmic biomarker of the severity of DPN.

Role of pathogenetic therapy for diabetic polyneuropathy

In our country, alpha-lipoic acid is widely used as a pathogenetic therapy for diabetic polyneuropathy (DPN).Objective: to compare the efficiency and safety of using oral and injectable α-lipoic acid for DPN.Patients and methods. The investigation enrolled 47 patients with a verified diagnosis of DPN, who were divided into two groups. Group 1 included 23 patients (10 men and 13 women; mean age, 62.9±7.5 years), Group 2 consisted of 24 patients (9 men and 15 women, mean age, 65.5±7.9 years). All the patients used Berlithione: Group 1 received its intravenous doses of 600 mg for 14 days, then oral ones of 600 mg for other 16 days; Group 2 took oral doses of 600 mg for 30 days. The therapy results were assessed using the digital rating scale (DRS), the Douleur Neuropathique 4 (DN4) neuropathic pain rating scale, and the neurological soft signs (NSS), and electroneuromyography (ENMG) data.Results and discussion. Berlithione was found to have a good tolerability. No adverse reactions were detected in any case; and there was no need to discontinue this drug. On day 21 of therapy, there were statistically significant differences in the indicators of pain intensity on DRS in Group 1 patients (p&lt;0.05), some of them (n=8) had positive clinical changes as a reduction in the severity of hypesthesia. Both groups showed a tendency to improve ENMG parameters as a certain increase in excitation propagation velocity and M-response amplitude; however, these changes did not reach a statistical significance level. At the same time, in 6 out of the 8 patients in Group 1 with positive clinical changes, the described ENMG changes correlated with a reduction in the severity of hypesthesia. There were no significant changes on the NSS scale after 3 weeks of therapy. On day 30 of treatment, both groups were recorded to have statistically significant changes in pain intensity measures versus the baseline values, but no significant inter-group differences.Conclusion. Thus, Berlithione demonstrated its efficacy in both patient groups, but its positive effect occurred 1 week earlier in the step therapy group. It is noted that it is expedient to use this drug long (&gt;1 month) for DPN.

Diagnosis of diabetic polyneuropathy in primary care

<h3>ЦЕЛЬ РАБОТЫ</h3> Анализ и описание существующих методов первичной диагностики диабетической полиневропатии (ДПН), включая шкалы и опросники. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Проведен поиск и анализ рекомендаций по диагностике ДПН, методик оценки периферической чувствительности, шкал и опросников, применяемых для диагностики ДПН. Поиск публикаций осуществлялся в базах данных eLibrary, PubMed, Web of Science, Springer, Google Scholar, ClinicalKey. Глубина поиска — 20 лет; также включались публикации, имеющие исторический интерес. <h3>РЕЗУЛЬТАТЫ</h3> Всего в настоящий обзор включено 79 публикаций. В большинстве публикаций с целью первичной диагностики ДПН предлагается проводить сбор жалоб и анамнеза больного, оценку температурной и/или болевой чувствительности (оценку функции тонких нервных волокон), оценку вибрационной и тактильной чувствительности (оценку функции толстых нервных волокон). Для первичной диагностики ДПН возможно использование валидизированных диагностических опросников, таких как Мичиганский инструмент скрининга невропатии (Michigan Neuropathy Screening Instrument — MNSI), Невропатический дисфункциональный счет (модифицированный вариант) (Neuropathy Disability Score modified — NDSm). Для оценки выраженности болевой симптоматики рекомендованы Шкала симптомов невропатии (Neuropathy Symptom Score — NSS) и визуально-аналоговая шкала боли (ВАШ), для подтверждения невропатического характера боли — опросник DN4. Большинству пациентов с помощью методов первичной диагностики удается поставить диагноз, расширенная диагностика используется в случаях, требующих дифференциальной диагностики, и может включать электронейромиографию (ЭНМГ), конфокальную микроскопию тонких нервов роговицы, интраэпидермальную панч-биопсию, количественное сенсорное тестирование. <h3>ЗАКЛЮЧЕНИЕ</h3> Использование предложенных алгоритмов позволит объективизировать диагноз и улучшить своевременность и качество оказываемой медицинской помощи пациентам с ДПН.

Small and large fiber sensory polyneuropathy in type 2 diabetes: Influence of diagnostic criteria on neuropathy subtypes.

Diabetic polyneuropathy (DPN) can be classified based on fiber diameter into three subtypes: small fiber neuropathy (SFN), large fiber neuropathy (LFN), and mixed fiber neuropathy (MFN). We examined the effect of different diagnostic models on the frequency of polyneuropathy subtypes in type 2 diabetes patients with DPN. This study was based on patients from the Danish Center for Strategic Research in Type 2 Diabetes cohort. We defined DPN as probable or definite DPN according to the Toronto Consensus Criteria. DPN was then subtyped according to four distinct diagnostic models. A total of 277 diabetes patients (214 with DPN and 63 with no DPN) were included in the study. We found a considerable variation in polyneuropathy subtypes by applying different diagnostic models independent of the degree of certainty of DPN diagnosis. For probable and definite DPN, the frequency of subtypes across diagnostic models varied from: 1.4% to 13.1% for SFN, 9.3% to 21.5% for LFN, 51.4% to 83.2% for MFN, and 0.5% to 14.5% for non-classifiable neuropathy (NCN). For the definite DPN group, the frequency of subtypes varied from: 1.6% to 13.5% for SFN, 5.6% to 20.6% for LFN, 61.9% to 89.7% for MFN, and 0.0% to 6.3% for NCN. The frequency of polyneuropathy subtypes depends on the type and number of criteria applied in a diagnostic model. Future consensus criteria should clearly define sensory functions to be tested, methods of testing, and how findings should be interpreted for both clinical practice and research purpose.

Исследование нервных волокон роговицы в ранней диагностике диабетической полинейропатии

Исследование нервных волокон роговицы в ранней диагностике диабетической полинейропатии

Diagnosis and prevalence of diabetic polyneuropathy: a cross-sectional study of Danish patients with type 2 diabetes.

Diabetic polyneuropathy (DPN) is a common complication of diabetes. Using the Toronto criteria for diabetic polyneuropathy and the grading system for neuropathic pain, the performance of neuropathy scales and questionnaires were assessed by comparing them to a clinical gold standard diagnosis of DPN and painful DPN in a cohort of patients with recently diagnosed type 2 diabetes. A questionnaire on neuropathy and pain was sent to a cohort of 5514 Danish type 2 diabetes patients. A sample of 389 patients underwent a detailed clinical examination and completed neuropathy questionnaires and scales. Of the 389 patients with a median diabetes duration of 5.9years, 126 had definite DPN (including 53 with painful DPN), 88 had probable DPN and 53 had possible DPN. There were 49 patients with other causes of polyneuropathy, neuropathy symptoms or pain, 10 with subclinical DPN and 63 without DPN. The sensitivity of the Michigan Neuropathy Screening Instrument questionnaire to detect DPN was 25.7% and the specificity 84.6%. The sensitivity of the Toronto Clinical Neuropathy Scoring System, including questionnaire and clinical examination, was 62.9% and the specificity was 74.6%. Diabetic polyneuropathy affects approximately one in five Danish patients with recently diagnosed type 2 diabetes but neuropathic pain is not as common as previously reported. Neuropathy scales with clinical examination perform better compared with questionnaires alone, but better scales are needed for future epidemiological studies.

Диагностика диабетической полинейропатии на основе исследования нервных волокон роговицы

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Diagnosis and treatment of the early stages of diabetic polyneuropathy

Diabetic polyneuropathy (DPN) is the most common and earliest complication of diabetes mellitus and it may occur much earlier in patients with type-2 diabetes than in patients with type-1. Distal polyneuropathy can develop not only in diabetes mellitus, but also at the stage of prediabetes and even in patients with metabolic syndrome without impaired glycemic state. Hyperglycemia viewed as a major, but not the sole factor, responsible for development and progression DPN. The control of blood glucose as an obligatory step of therapy to delay or reverse DPN is no longer an arguable issue. Damage of peripheral nervous system in prediabetes and in the initial stages of diabetes mainly affects small nerve fibers, which also leads to disorders of the autonomic nervous system. Cardiac autonomic neuropathy diagnosed in 5-7.7% of patients at the time of diagnosis of type 1 and type 2 diabetes mellitus. For the early diagnosis of DPN, both routine assessment of peripheral sensation can be used, as well as specialized methods (sympathetic skin reactions, skin biopsy, confocal corneal microscopy, quantitative sensory tests) and validated questionnaires (Utah Early Neuropathy Scale) focused on assessing the function of small nerve fibers. Non-electrophysiological studies also were tested for early diagnosis of DPN: peripheral nerve sonoelastography, optical coherence tomography, MRI neurography, spiral positron emission CT (SPECT) with 123I-MIBG. DPN diagnosis in the pre-clinical stage very important, because treatment with diet and lifestyle intervention may be successful. The correlation between the severity of oxidative stress and the activity of antioxidant defense is considered as a potential mechanism for early nerves damage with hyperglycemia and as a possible target for therapeutic intervention. In this work, we will review prevalence, diagnostic approaches and potential treatment options for early diabetic polyneuropathy.

Detection of early motor involvement in diabetic polyneuropathy using a novel MUNE method – MScanFit MUNE

ObjectiveDetection of motor involvement in diabetic polyneuropathy (DPN) by nerve conduction studies (NCS) does not occur until there is substantial loss of motor units, because collateral reinnervation maintains compound muscle action potential (CMAP) amplitude. Motor unit number estimation (MUNE) methods may therefore be more sensitive. This study was undertaken to test whether the novel method, MScanFit MUNE (MScan) can detect motor involvement in DPN despite normal NCS. MethodsFifty-two type-2 diabetic patients and 38 healthy controls were included. The median nerve was examined in all participants using standard NCS and a detailed CMAP scan, used for MScan. Additional lower extremity NCS in patients were used for DPN diagnosis. ResultsOf 52 diabetic patients, 21 had NCS-defined DPN while lower extremity NCS were normal in 31 patients. MScan motor unit number and size showed higher sensitivity and incidence of abnormality than motor NCS parameters, and a similar sensitivity to sensory NCS. ConclusionsMScan is able to detect motor axonal damage at times when collateral reinnervation limits NCS changes. SignificanceMScan is a sensitive method to detect motor involvement in DPN, which our data suggests is present as early as sensory.