Early Diagnosis Of Diabetic Neuropathy Research Articles

Early diagnosis of diabetic neuropathy and prophylaxis of diabetic foot

Introduction: the diabetic foot is one of the most serious complications of diabetes mellitus. About 50% of non-traumatic amputations occur in these patients. In addition, it is an important public health problem and constitutes a chronic and complex metabolic disorder that is characterized by impaired metabolism of glucose and other complications in essential organs for the maintenance of life. Objective: to evaluate the sensitivity and specificity of diabetic neuropathy using the Michigan self-assessment and physical examination in type 1 and type 2 diabetics. Methods: this is a cross-sectional study. The “Michigan Neuropathy Screening Instruments” classification was used to assess the degree of peripheral neuropathy, in which participants answered the questionnaire and were evaluated for the presence of foot lesions. All participants were stratified by the risk of developing foot ulcers according to the IWGDF protocol. Results: the sample had 200 participants. Regarding the IWGDF classification, 23 patients were classified as moderate risk (11.50%) and 61 as high risk for developing foot ulcers (30.50%). Using a cutoff of 2.5 on the physical examination score to diagnose neuropathy, a sensitivity of 97.62% and a specificity of 47.41% were obtained. Using a score greater than or equal to 6 in the self-assessment for the diagnosis of neuropathy, a sensitivity of 50.00% and a specificity of 94.83% were found. Conclusion: the association of the Michigan physical examination (high sensitivity) with self-assessment (high specificity) increases the accuracy for the diagnosis of diabetic neuropathy.

Electrodermal activity and heart rate variability for detection of peripheral abnormalities in type 2 diabetes: A review.

Modern medicine exhibits an upward trend towards non-invasive methods for early detection of disease and long-term monitoring of patients' health. Diabetes mellitus and its complications are a promising area for implementation of new medical diagnostic devices. One of the most serious complications of diabetes is diabetic foot ulcer. The main causes responsible for diabetic foot ulcer are ischemia caused by peripheral artery disease and diabetic neuropathy caused by polyol pathway-induced oxidative stress. Autonomic neuropathy impairs function of sweat glands, which can be measured by electrodermal activity. On the other hand, autonomic neuropathy leads to changes in heart rate variability, which is used to assess autonomic regulation of the sinoatrial node. Both methods are enough sensitive to detect pathological changes caused by autonomic neuropathy and are promising screening methods for early diagnosis of diabetic neuropathy, which could prevent the onset of diabetic ulcer.

Determination of Visfatin Level in Patients with Diabetes and Peripheral Neuropathy as Early Predicted Factor

Peripheral neuropathy represents one of the common diabetic complications in patients with diabetes mellitus type 2 (DMT2). Peripheral neuropathy affects the feet, legs, hands, and arms. It was found that one-third to one-half of diabetics have peripheral neuropathy. The current study aimed to evaluate the level of visfatin in diabetic patient groups with or without peripheral neuropathy in comparison with healthy subjects to knowledge whether visfatin can be applied as a predictor factor for this type of disease complication. The study included 120 males and females ranging in age from 40 to 97 years old. (40 patients with type 2 diabetes, 40 patients with diabetic peripheral neuropathy, and 40 healthy people served as the control group.) All of the diabetes patients had a verified diagnosis (type 2). During the period from October 2021 to December 2021, the patients were assessed at the National Diabetes Center, Al-Mustansiriya University in Baghdad. Visfatin levels were tested using the ELISA technique, and HbA1c was assessed using Cobas C111. In patients, HbA1C levels are significantly higher (p≤0.05) than in controls. Males and females with DPN and DM have greater Visfatin mean values than the control group. Visfatin levels are strong indications for early diagnosis of diabetic neuropathy in both males and females, according to the current study.

MICRO-CONTROLLED THERMAL STIMULATOR FOR DETECTING FINE FIBER CHANGES IN PATIENTS WITH DIABETES MELLITUS: A DIAGNOSTIC ACCURACY STUDY

AimTo evaluate sensitivity and specificity of the micro-controlled thermal stimulator (MTS) for detecting pathological changes in fine fiber of neuropathy patients with DM. MethodsA diagnostic accuracy study including 84 patients, aged 15–75 years was conducted. A patient’s foot was subjected to dermatological, musculoskeletal, vascular, and neurological evaluations. The latter was performed through the perception of a sharp touch with a toothpick (pinprick), thermal sensitivity (cold and hot temperature sensations measured using Diapason Handle and MTS, respectively), vibratory sensitivity (128 Hz Diapason Handle), 10 g Semmes-Weinstein monofilament, and a reflex test. Statistical analyses were performed using Stata® software version 13.0. The sensitivity, specificity, positive and negative predictive values, likelihood ratios, AUC, Kappa index, and accuracy of the diagnostic instruments were evaluated. ResultsOf the 84 volunteers, 66.7% were female, with an average age of 54 years. We observed that 17% of the total patients were positive for pain sensations in the foot, 13% for cold-temperature sensations, and 21% for hot-temperature sensations. The MTS (hot temperature) obtained 97.6% sensitivity and 90% specificity, agreeing on 87.5% (Kappa index) with the Diapason Handle (cold temperature) (AUC > 0.937; p < 0.05). ConclusionMTS is an accurate, sensitive, and specific instrument for the evaluation of diabetic neuropathy as compared with the tuning fork as the standard method and, consequently, it could be of help for the early diagnosis of diabetic neuropathy.

糖尿病神経障害：早期診断のための新しい検査法・治療について

糖尿病神経障害：早期診断のための新しい検査法・治療について

Advantages of early diagnosis of diabetic neuropathy in the prevention of diabetic foot ulcers

AimsTo evaluate the utility of the sudomotor function test (SFT) as a clinical tool in the Risk Stratification System of diabetic patients and to demonstrate the earlier detection of the risk of developing diabetic foot ulcers (DFU) compared to the standard clinical tests. MethodsProspective follow-up study on 263 patients enrolled consecutively over 3.5 years. Diabetic patients without active DFU were classified according to the International Working Group Risk Stratification System (RSS) and categorized according to the results of the Semmes-Wenstein Monofilament (SWM) and biothesiometer measurements or the SFT. The main outcome evaluated was the development of DFU. ResultsMedian follow-up was 42 [38–44] months. Sixty patients (22.8%) developed DFU after a median of 6.2 [3–17] months. Ten patients that were included in the no-risk group (group 0) based on the SWM and biothesiometer results developed DFU. Thus the sensitivity of this approach was 83.33% and the specificity was 50.47%. Based on the SFT results, all patients that developed DFU were included in the correct risk group. This approach had 100% sensitivity and 31.53% specificity. Regarding the diagnostic accuracy of the two Methods, the respective AUC values were 0.776 (95% CI 0.702–0.849) and 0.816 (95% CI 0.757–0.874). ConclusionsSFT improved RSS in diabetic patients in a specialized diabetic foot unit. SFT categorized patients correctly according to the risk of developing DFU.

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.

A fully automatic nerve segmentation and morphometric parameter quantification system for early diagnosis of diabetic neuropathy in corneal images

Diabetic Peripheral Neuropathy (DPN) is one of the most common types of diabetes that can affect the cornea. An accurate analysis of the nerve structures can assist the early diagnosis of this disease. This paper proposes a robust, fast and fully automatic nerve segmentation and morphometric parameter quantification system for corneal confocal microscope images. The segmentation part consists of three main steps. First, a preprocessing step is applied to enhance the visibility of the nerves and remove noise using anisotropic diffusion filtering, specifically a Coherence filter followed by Gaussian filtering. Second, morphological operations are applied to remove unwanted objects in the input image such as epithelial cells and small nerve segments. Finally, an edge detection step is applied to detect all the nerves in the input image. In this step, an efficient algorithm for connecting discontinuous nerves is proposed. In the morphometric parameters quantification part, a number of features are extracted, including thickness, tortuosity and length of nerve, which may be used for the early diagnosis of diabetic polyneuropathy and when planning Laser-Assisted in situ Keratomileusis (LASIK) or Photorefractive keratectomy (PRK). The performance of the proposed segmentation system is evaluated against manually traced ground-truth images based on a database consisting of 498 corneal sub-basal nerve images (238 are normal and 260 are abnormal). In addition, the robustness and efficiency of the proposed system in extracting morphometric features with clinical utility was evaluated in 919 images taken from healthy subjects and diabetic patients with and without neuropathy. We demonstrate rapid (13 seconds/image), robust and effective automated corneal nerve quantification. The proposed system will be deployed as a useful clinical tool to support the expertise of ophthalmologists and save the clinician time in a busy clinical setting.

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.

In vivo nonlinear imaging of corneal structures with special focus on BALB/c and streptozotocin-diabetic Thy1-YFP mice

Two-photon microscopy (TPM) allows high contrast imaging at a subcellular resolution scale. In this work, the microscopy technique was applied to visualize corneal structures in two mouse models (BALB/c and B6.Cg-Tg(Thy1-YFP)16Jrs/J) in vivo. In particular, the transgenic Thy1-YFP mice expressing the yellow fluorescent protein (YFP) in all motor and sensory neurons had been used for investigating the nerve fiber density in healthy and streptozotocin-diabetic mice. This model is clinically relevant since patients suffering from diabetes mellitus have a high risk to develop small fiber neuropathy. Nonlinear laser scanning microscopy displayed a reduction of nerve fiber density in streptozotocin-diabetic versus healthy mice and confirmed data obtained by confocal laser scanning microscopy (CLSM). In recent years, corneal CLSM was proved to be an appropriate non-invasive tool for an early diagnosis of diabetic neuropathy. Nevertheless, validation of the CLSM method for the clinical routine is currently a matter of investigation and requires confirmation by further studies and complementary techniques. Thus, the present study provides further evidence of corneal confocal microscopy as a promising technique for non-invasive detection of diabetic neuropathy. Information derived from these experiments may become clinically relevant and help to develop new drugs for treatment of diabetic neuropathy.

An early diagnostic tool for diabetic peripheral neuropathy in rats.

The skin’s rewarming rate of diabetic patients is used as a diagnostic tool for early diagnosis of diabetic neuropathy. At present, the relationship between microvascular changes in the skin and diabetic neuropathy is unclear in streptozotocin (STZ) diabetic rats. The aim of this study was to investigate whether the skin rewarming rate in diabetic rats is related to microvascular changes and whether this is accompanied by changes observed in classical diagnostic methods for diabetic peripheral neuropathy. Computer-assisted infrared thermography was used to assess the rewarming rate after cold exposure on the plantar skin of STZ diabetic rats’ hind paws. Peripheral neuropathy was determined by the density of intra-epidermal nerve fibers (IENFs), mechanical sensitivity, and electrophysiological recordings. Data were obtained in diabetic rats at four, six, and eight weeks after the induction of diabetes and in controls. Four weeks after the induction of diabetes, a delayed rewarming rate, decreased skin blood flow and decreased density of IENFs were observed. However, the mechanical hyposensitivity and decreased motor nerve conduction velocity (MNCV) developed 6 and 8 weeks after the induction of diabetes. Our study shows that the skin rewarming rate is related to microvascular changes in diabetic rats. Moreover, the skin rewarming rate is a non-invasive method that provides more information for an earlier diagnosis of peripheral neuropathy than the classical monofilament test and MNCV in STZ induced diabetic rats.

Early Diagnosis of Diabetic Neuropathy and Prevention of Its Progression

Early Diagnosis of Diabetic Neuropathy and Prevention of Its Progression

Electrophysiological changes in sensorimotor nerves in diabetes mellitus &amp; usefulness of nerve conduction studies for early diagnosis of diabetic neuropathy

Background: Diabetes Mellitus(DM) a metabolic disorder is the most common cause of peripheral neuropathy. Nerve conduction studies(NCS) are commonly employed to detect the neuropathy. The present study was undertaken to find out the utility of NCS as an early indicator of neuropathy in diabetic patients. Materials & methods: Study was carried out in 50 diagnosed DM patients attending OPD in Medicine, Civil Hospital, Ahmedabad. Diabetic subjects were selected having FBS >110 mg/dL with duration of DM > 5 years. Their HbA1c levels were measured for glycaemic control. Diabetic patients with good glycaemic control were grouped in group A & that with poor glycaemic control in group B. 25 age matched non-diabetic & healthy subjects were selected for control group C. NCS was performed at Institute of Spine, Civil Hospital Campus, Ahmedabad. Nerve conduction parameters like compound muscle action potential(CMAP), sensory nerve action potential(SNAP), nerve conduction velocity(NCV) & distal latency(DL) were studied. Results: In our study there is increase in DL of peroneal, sural; median & ulnar sensory nerves in group B subjects. NCV of sensorimotor nerves is significantly decreased in group B subjects. SNAP of all nerves is reduced in group A & B. CMAP is reduced significantly in all nerves in group B. Conclusion: As DM progress further, it increases risk of neuronal involvement which can be accelerated by poor glycaemic control. Our result indicates demyelinating type of neuropathy with some changes of axonopathy. Therefore NCS is done for early detection of neuropathy in DM patients.

NEW METHODS OF DIAGNOSIS DIABETIC NEUROPATHY

Diabetic neuropathy is the most common complications of diabetes and is a leading cause of disability of patients. According to epidemiological studies, depending on the methods of examination frequency of diabetic neuropathy among the patients ranged from 5 to 100%. The disease significantly reduces the quality of life of patients and is one of the major risk factors for foot ulcers, burns, frostbite, gangrene and diabetic foot syndrome. The main objective of this publication – to make a review of the literature in recent years to a wider circle of local doctors with the most modern methods of early diagnosis of diabetic neuropathy.

Plantar thermography is useful in the early diagnosis of diabetic neuropathy

OBJECTIVES:This study evaluated plantar thermography sensitivity and specificity in diagnosing diabetic polyneuropathy using cardiac tests (heart rate variability) as a reference standard because autonomic small fibers are affected first by this disease.METHODS:Seventy-nine individuals between the ages of 19 and 79 years old (28 males) were evaluated and divided into three groups: control (n = 37), pre-diabetics (n = 13) and type 2 diabetics (n = 29). The plantar images were recorded at baseline and then minutes after a provocative maneuver (Cold Stress Test) using an infrared camera that is appropriate for clinical use. Two thermographic variables were studied: the thermal recovery index and the interdigital anisothermal technique. Heart rate variability was measured in a seven-test battery that included three spectral indexes (in the frequency domain) and four Ewing tests (the Valsalva maneuver, the orthostatic test, a deep breathing test, and the orthostatic hypotension test). Other classically recommended tests were applied, including electromyography (EMG), Michigan inventory, and a clinical interview that included a neurological physical examination.RESULTS:Among the diabetic patients, the interdigital anisothermal technique alone performed better than the thermal recovery index alone, with a better sensitivity (81.3%) and specificity (46.2%). For the pre-diabetic patients, the three tests performed equally well. None of the control subjects displayed abnormal interdigital anisothermal readouts or thermal recovery indices, which precluded the sensitivity estimation in this sample of subjects. However, the specificity (70.6%) was higher in this group.CONCLUSION:In this study, plantar thermography, which predominately considers the small and autonomic fibers that are commonly associated with a sub-clinical condition, proved useful in diagnosing diabetic neuropathy early. The interdigital anisothermal test, when used alone, performed best.

Early Diagnosis of Diabetic Neuropathy in Almadinah Almunawwarah

Abstract Objectives Diabetes mellitus (DM) is a major public health problem worldwide. The aim is to assess the early detection of impaired nerve function and the risk factors associated with the development of diabetic neuropathy. Methods It is a prospective descriptive study of age-matched 263 diabetic Saudi patients from the outpatient clinic of the Diabetic Centre in King Fahd Hospital in Almadinah Almunawwarah in Kingdom of Saudi Arabia during 2008-2009. Written informed consent was obtained from each subject after the protocol was approved by the local ethics committee. All subjects were diagnosed as diabetics using WHO criteria. We obtained detailed demographic data as age, sex, special habits, height, weight and body mass index, arterial blood pressure, type and duration of diabetes, glycosated haemoglobin (HbA1C), lipid profile, management, family history of hypertension, diabetes. Assessment of neuropathy by using the Diabetic neuropathy index and diabetic neuropathy score. Asymptomatic patients who scored less than two in clinical examination were referred to be assessed by complete neurological examination, and nerve conduction studies. Data were calculated and compared by using SPSS version 13.0. Results The type I were 39 (14.8%) and type II were 244 (85.2%) diabetic patients and the mean duration of diabetes mellitus in all diabetic patients was 13.89 ± 8.7 years. The symptomatic diabetic neuropathy patients were 165 (62.7%)s out of 263 diabetic patients and the asymptomatic were 98 (37.3%). The risk factors for neuropathy were old age, poor blood sugar control, long duration of diabetes, hyperlepidemia, Body Mass Index (BMI). There were no statistical significant differences in relation to types of diabetes mellitus. There was positive correlation which shown by the linear regression charts between the grades of nerve conduction defects in asymptomatic diabetic neuropathy patients and duration of diabetes, age, BMI and HbA1C. Conclusion The early detection of by sub-clinical nerve conduction of diabetic patients is of a major clinical interest that could lead to more intensive supervision of diabetic patients. Further studies should be performed in order to confirm these findings.

Early Diagnosis of Diabetic Neuropathy in Almadinah Almunawwarah “Arabic Abstracts”

Early Diagnosis of Diabetic Neuropathy in Almadinah Almunawwarah “Arabic Abstracts”

Neurophysiological Tools for Small Fiber Assessment in Painful Diabetic Neuropathy (Comment Letter)

We would like to congratulate Veves et al. for their excellent review that stressed the importance of painful diabetic neuropathy diagnosis [1]. However, apart from neuropathic pain scales and skin biopsy, we believe that neurophysiological tools are also useful in the diagnostic work-up of diabetic patients with neuropathic pain complaints due to small fiber involvement. Small fiber function can be noninvasively assessed by quantitative sensory testing for thermal sensation [2], in which warm and heat pain thresholds reflect the function of C- and Ad-fibers, respectively. This method has been proposed in the assessment of patients with diabetic neuropathy [3], but is limited by the subjectiveness of the individual’s responses [4]. In the last few years, more objective techniques have been developed for small fiber assessment. Lasergenerated radiant heat pulses selectively activate Ad and C nociceptors [5] and have been used for the early diagnosis of diabetic neuropathy [6,7]. Unfortunately, because of the imminent risk for skin lesions—especially in diabetic subjects—its use is not recommended in routinary basis. More recently, contact heat-evoked potentials have been introduced for small fiber evaluation without the risk of cutaneous lesions [8]. The system delivers rapidly raising heat stimuli through a thermode placed in the skin, able to evoke cerebral potentials reliably [9,10], and has been used for the study of many small fiber syndromes [9–11] with a good correlation with the density of C fibers in the superficial skin [10].

EFFECT OF HYPERGLYCEMIA ON ELECTRODERMAL ACTIVITY IN DIABETIC RATS

This study investigated the relationship between hyperglycemia and electrodermal activity (EDA) parameters in streptozotocin (STZ) induced diabetic rats. The article evaluates the course of development of neurophysiological alterations in the peripheral nervous system in diabetic rats through EDA. Rats were made diabetic using a moderate dose of STZ (DI) and high dose (DII). The placebo group (P) was injected with physiological saline. EDA was recorded 1 h before the injection (beginning, 0, day), 1st day (one day after the injection) and 10th day. Skin conductance level (SCL) was lower in DII than P on the 1st and the 10th days. The SCL and SC fluctuation rate (SCFr) of DI were significantly lower on the 10th day compared to their first record. SC response rate (SCRr) was lower on the 10th day compared to the 1st day, in the DI. In the DI, SCL, SC fluctuation rate (SCFr) and SC response rate (SCRr) were lower on the 10th day compared to the 1st day. The DII was statistically higher in electrodermal non-responsiveness compared to other groups on the 1st day. The results obtained show that hyperglycemia affects the peripheral nervous system, and EDA parameters are affected by blood glucose level. It is suggested that EDA is a simple and non-invasive electrophysiological method in early diagnosis of diabetic neuropathy.

Heart rate variability.

Heart rate variability is a recognized tool for the estimation of cardiac autonomic modulations. Recently, several studies have advanced the field of heart rate variability in three areas: 1) in technical modes of electrocardiogram processing and heart rate variability assessment, 2) in physiologic understanding and interpretation, and 3) in clinical and practical use. The most recent technical studies concentrate on the analysis of nonlinear aspects of heart period variations and on coherence between electrocardiogram variability and other physiologic factors such as respiration. Principal physiologic investigations studied the components of heart rate variability attributable to the individual limbs of the autonomic nervous system. It is becoming recognized that behavior and responses to the environment, including the psychosocial environment, play an important role in long-term heart rate variability. Established clinical applications of heart rate variability are presently restricted to the assessment of risk after myocardial infarction and to the early diagnosis of diabetic neuropathy. Nevertheless, recent studies indicate that heart rate variability might soon become a similarly powerful tool for risk prediction and monitoring of disease progression in congestive heart failure and for monitoring or reinnervation after heart transplantation.