Higher Prevalence Of Neuropathy Research Articles

Sex-Based Differences in Clinical Profile and Complications among Individuals with Type 2 Diabetes Seen at a Private Tertiary Diabetes Care Centre in India.

This study aimed to compare the clinical and biochemical profiles as well as the complications in males and females with type 2 diabetes (T2DM) presenting to a private tertiary diabetes care centre in India. This is a retrospective study, conducted between 1 January 2017 and 31 December 2019, and included 72,980 individuals with T2DM, aged ≥ 18 years (age and sex-matched-males-36,490; females-36,490). Anthropometric measurements, blood pressure, fasting plasma glucose (FPG), post-prandial plasma glucose (PPPG), glycated haemoglobin (HbA1c), lipids, urea, and creatinine were measured. Retinopathy was screened using retinal photography, neuropathy using biothesiometry, nephropathy measuring urinary albumin excretion, peripheral vascular disease (PVD) using Doppler, and coronary artery disease (CAD) based on the history of myocardial infarction and/or drug treatment for CAD and/or electrocardiographic changes. Obesity (73.6% vs. 59.0%) rates were significantly higher in females compared to males. FPG, PPPG, and HbA1c were higher among younger age groups among both sexes, with males having higher values compared to females. However, after the age of 44 years, control of diabetes was worse among females. In addition, only 18.8% of the females achieved glycemic control (HbA1c < 7%) compared to 19.9% in males (p < 0.001). Males had higher prevalence of neuropathy (42.9% vs. 36.9%), retinopathy (36.0% vs. 26.3%), and nephropathy (25.0% vs. 23.3%) compared to females. Males had 1.8- and 1.6-times higher risk of developing CAD and retinopathy compared to females. Hypothyroidism (12.5% vs. 3.5%) and cancers (1.3% vs. 0.6%) were significantly higher in females compared to males. In this large sample of T2DM seen at a chain of private tertiary diabetes centres, females had higher prevalence of metabolic risk factors and poorer diabetes control compared to males, emphasizing the need for better control of diabetes in females. However, males had higher prevalence of neuropathy, retinopathy, nephropathy, and CAD compared to females.

Frequency and Correlation of Hypogonadism in Men with Type 2 Diabetes

Aim: The present study aimed to determine the frequency and association of hypogonadism in men with type 2 diabetes mellitus. Material and Methods: This cross-sectional study was conducted on 242 type 2 DM male patients in the Department of General Medicine, Bahria International Hospital, Lahore from 16th January 2022 to 15th July 2022. The Androgen deficiency in aging male (ADAM) questionnaire was used for screening hypogonadal symptoms in the study group. The presence of low serum testosterone below 3 ng/mL and positive ADAM score was referred to as hypogonadism. T2DM patients with and without hypogonadism had their clinical and biochemical variables compared. Total testosterone, BMI, free testosterone, waist circumference, and sex hormone–binding globulin were measured. SPSS version 26 was used for data analysis. Results: Of the total 242 T2DM male patients, the prevalence of hypogonadism was 24.8% (n=60). The most prevalent symptoms in T2DM patients were hypogonadal symptoms. The overall mean age was 45.8± 9.63 years with range (25-70 years). Mean BMI value was 24.8 ± 3.64 kg/m2. The incidence of overweight and obese patients were 17.8% and 49.3% respectively. The prevalence of erectile dysfunction, reduced libido, and work performance deterioration in hypogonadism were 94.8%, 68.2%, and 56.3% respectively. T2DM patients without hypogonadism had lower a) incidence of diabetic neuropathy (18.6% vs. 43.8%; p=0.021), b) T2DM duration (5.3± 3.82 vs. 9.2± 4.9 years; P=0.002), c) occurrence of diabetic retinopathy (26.9% vs. 57.8%; P=0.006), and d) HbA1c (8.9± 1.53% vs. 9.9 ± 2.54%: P=0.005), and insulin therapy (21.5% vs. 45.8%: P=0.031) compared to those with hypogonadism. Conclusion: The present study found that prevalence of hypogonadism was 24.8% in type 2 diabetes mellitus. Patients with hypogonadism had higher HbA1c, higher prevalence of neuropathy and retinopathy, longer diabetic duration, and predominantly used insulin therapy than those T2DM patients without hypogonadism. Keywords: Hypogonadism, Type 2 diabetes mellitus, Androgen deficiency in aging male (ADAM).

Current and Emerging Pharmacotherapeutic Interventions for the Treatment of Peripheral Nerve Disorders.

Peripheral nerve disorders are caused by a range of different aetiologies. The range of causes include metabolic conditions such as diabetes, obesity and chronic kidney disease. Diabetic neuropathy may be associated with severe weakness and the loss of sensation, leading to gangrene and amputation in advanced cases. Recent studies have indicated a high prevalence of neuropathy in patients with chronic kidney disease, also known as uraemic neuropathy. Immune-mediated neuropathies including Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy may cause significant physical disability. As survival rates continue to improve in cancer, the prevalence of treatment complications, such as chemotherapy-induced peripheral neuropathy, has also increased in treated patients and survivors. Notably, peripheral neuropathy associated with these conditions may be chronic and long-lasting, drastically affecting the quality of life of affected individuals, and leading to a large socioeconomic burden. This review article explores some of the major emerging clinical and experimental therapeutic agents that have been investigated for the treatment of peripheral neuropathy due to metabolic, toxic and immune aetiologies.

Neuropathy in Parkinson's disease: Risk determinants and impact on quality of life

Neuropathy has been described in significantly higher proportion of PD patients than in control subjects. This study ascertains the prevelance of neuropathy and its determinants in PD patients, in particular relation with nutritional status, along with impact of neuropathy on Quality of life.Methods:This was a hospital based observational cross-sectional study of PD patients attending the Neurology OPD of a tertiary care hospital. The prevalence and type of neuropathy was determined using the validated MNSI scale. The nutritional status was assessed using MNA score and PDQ-39 was used for assessing quality of life. Patients with and without neuropathy were compared to ascertain risk factors for neuropathy.Results:Twenty-four out of 93 PD patients (26%) had neuropathy and 12 (50%) out of them had painful neuropathy. Older patents and those who had longer duration of disease had higher prevalence of neuropathy. In addition there was significant correlation with malnutrition and neuropathy. 79% of patients with neuropathy had abnormal nutritional status. On comparison of patients with painful neuropathy as compared to those without pain, Vitamin B 12 levels were found to be low only in the former group.Conclusions:Our study shows that there is significant prevalence of neuropathy in PD patents that affects the quality of life of PD patients. Neuropathy in PD is disease dependent and is precipitated by malnutrition. Hence, neuropathy must be timely diagnosed and effective nutritional management may help to improve the patient's quality of life.

Mental disorders in type 2 diabetes

To assess the prevalence of mental disorders in patients with type 2 diabetes mellitus (DM2) and their relationship with laboratory findings, somatic comorbidities and psychosocial consequences. In the frames of the INTERPRET-DD multicenter 200 T2DM patients from primary care (47 men and 153 women) from the Russian sample were studied. The psychometric assessment included MINI-6, HAMD-17, PHQ-9, PAID, WHO-5. One hundred and seventeen patients (58.5%) have mental disorders. Current mental disorders were diagnosed in 93 (46.5%) of patients. Depression (depressive episode, recurrent depressive disorder, bipolar affective disorder type II) was identified in 34 (17.0%), dysthymia in 26 (13.0%), and anxiety spectrum disorders in 39 (19.5%). In about half of the cases, anxiety disorders were combined with depression. The most severe problems were observed in the patients with depression and dysthymia. Patients with social phobia had significantly higher levels of glycated hemoglobin compared to patients without mental disorders. The significant decrease of systolic arterial pressure and body mass index was observed in patients with agoraphobia compared to patients without mental disorders. In addition, there was an increased prevalence of chronic ischemic heart disease in recurrent depression, dysthymia and generalized anxiety disorder, higher prevalence of neuropathy in depressive episode and recurrent depression and nephropathy in panic disorder. Depressive and anxiety disorders, as well as severe psychosocial problems, are consistently associated with T2DM. At the same time, concomitant somatic disorders and complications of DM2 are not just by chance comorbid to various forms of mental disorders, which allows for a new look at the problem of comorbidity/multimorbidity in T2DM.

Prevalence of neuropathy in patients with type 2 diabetes in Iran : Asystematic review and meta-analysis.

Diabetic neuropathy is one of the most common complications of diabetes, which leads to amputation and significant disability in patients. Studies conducted in this field show different prevalences and inconsistencies in the country. This study attempts to determine the overall prevalence of neuropathy in patients with type2diabetes in Iran with ameta-analysis. The present study was conducted using a meta-analysis method from January 2000 to December 2018. The papers related to the study subject were obtained from searching Scopus, ScienceDirect, Magiran, Barakat Knowledge Network, SID, Medline (PubMed), and Google Scholar databases. The heterogeneity of studies was examined using I2index and the data were analyzed using the software Comprehensive Meta-Analysis (version3, Biostat, Englewood, NJ, USA). The results of the systematic review showed regional differences in the prevalence of neuropathy in Iran. According to the meta-analysis and review of 10studies and 2992individuals between the ages of 5years and 86years, the overall prevalence of neuropathy in type2 diabetes patients in Iran was 56.5% (95% confidence interval, CI 42.8-69.3%). The highest prevalence of neuropathy in type2 diabetic patients was found in Mashhad with 87.2% (95% CI 77.9-92.3%) in 2012 and the lowest prevalence of neuropathy in type2 diabetic patients was found in Ahvaz with 22.7% (95% CI 18.5-27.6%) in 2014. With the increase in years of research, the prevalence of neuropathy in type2diabetes in Iran was reduced, with statistically significant differences (P < 0.05). Considering the high prevalence of neuropathy in patients with type2diabetes in the country, it is essential that health policy makers take effective measures to reduce this disease in diabetes patients.

Central Obesity is Associated With Neuropathy in the Severely Obese

ObjectiveTo determine the prevalence of neuropathy stratified by glycemic status and the association between extensive anthropometric measurements and neuropathy. Patients and MethodsWe performed a cross-sectional, observational study in obese individuals, before surgery, with body mass index (BMI) greater than 35 kg/m2. Lean controls were recruited from a research website. Neuropathy was defined by the Toronto consensus definition of probable neuropathy. We compared nine anthropometric measurements between obese participants with and without neuropathy. We used multivariable logistic regression to explore associations between these measures, and other metabolic risk factors, and neuropathy. ResultsWe recruited 138 obese individuals and 46 lean controls. The mean age (SD) was 45.1 (11.3) years in the obese population (76.1% female, n=105) and 43.8 (12.1) years in the lean controls (82.2% female, n=37). The prevalence of neuropathy was 2.2% (n=1) in lean controls, 12.1% (n=4) in obese participants with normoglycemia, 7.1% (n=4) in obese participants with pre-diabetes, and 40.8% (n=20) in obese participants with diabetes (p≤.01). Waist circumference was the only anthropometric measure that was larger in those with neuropathy (139.3 cm vs 129.1 cm, p=.01). Hip-thigh (71.1 cm vs 76.6 cm, p<.01) and mid-thigh (62.2 cm vs 66.3 cm, p=.03) circumferences were smaller in those with neuropathy. The body mass index was comparable between patients who were obese with and without neuropathy (p=.86). Waist circumference (odds ratio [OR], 1.39; 95% CI, 1.10 to 1.75), systolic blood pressure (OR, 2.89; 95% CI, 1.49 to 5.61), and triglycerides (OR, 1.31; 95% CI, 1.00 to 1.70) were significantly associated with neuropathy. ConclusionNormoglycemic obese patients have a high prevalence of neuropathy indicating that obesity alone may be sufficient to cause neuropathy. Waist circumference, but not general obesity, is significantly associated with neuropathy.

Hypertension and Micro-Vascular Complications Among Type 2 Dm Adult Patients in Mukalla, Yemen

The Background and Purpose: to assess the prevalence of hypertension and micro-vascular complications among type 2 diabetic patients registered in primary health care center in Mukalla city at eastern Yemen. Methods: A Cross-sectional study was conducted in a randomly selected eligible patients from the diabetic registry of the AL Noor Charity Center (ACC), Mukalla city in Yemen. Results: Prevalence of hypertension in the T2DM patients were 46.7% (56/120). Retinopathy is the most micro-vascular complications among the adults having T2DM (73/120, 60.8%) while nephropathy is the least prevalence (13/120, 10.8%), prevalence of neuropathy was 49.2% (59/120). a high prevalence of retinopathy in males (66%) than females (55.7%) and a high prevalence of neuropathy in male adults (52.2%) than females (46%).No statistical significant difference were exit related to gender for any studied complications. Similar findings were observed regarding age related variations. Conclusion: A high prevalence of hypertension, retinopathy and neuropathy were reported among T2DM patients in Mukalla. Adopting effective and safe treatment strategies are highly recommended to prevent premature death and complications due to DM.

Clinical Outcomes of Foot Infections in Patients Without Diabetes

The aim of this study was to report clinical outcomes of moderate and severe foot infections in patients without diabetes. Medical records of 88 nondiabetic patients with foot infections treated at a safety net hospital were retrospectively reviewed. Patients were grouped by the presence of soft-tissue infection (STI) or osteomyelitis (OM). The diagnosis of OM was determined by positive bone culture or histopathology. STIs were defined by negative bone biopsy or negative imaging with magnetic resonance imaging or computed tomography/dual-modality radiolabeled white blood cell single-photon emission computed tomography. Patient outcomes were recorded ≤1 year after admission. Eighty-eight nondiabetic patients admitted to our institution for moderate or severe foot infections were included, 45 OM and 43 STI. No differences were noted in patient characteristics except that OM patients had a higher prevalence of neuropathy (66.7% versus 39.5%, p = .02). OM patients required surgery more often (97.8% versus 67.4%, p < .01), a greater number of surgeries (2.0 ± 1.2 versus 1.4 ± 1.3, p = .02), and more amputations (75.6% versus 11.6%, p < .01) than STI patients. OM patients had a higher proportion of wounds that healed (82.2% versus 62.8%, p = .04). There were no significant differences in reinfection (35.6% versus 25.6%, p = .36), foot-related readmission to hospital (35.6% versus 23.3%, p = .25), or total duration of antibiotics (13.9 ± 10.2 versus 13.5 ± 12.9, p = .87) between OM and STI patients. In conclusion, OM patients required more surgeries and amputations than patients with STIs; however, they had similar rates of reinfection and readmission within a year after the index hospitalization.

Incidences of Severe Hypoglycemia and Diabetic Ketoacidosis and Prevalence of Microvascular Complications Stratified by Age and Glycemic Control in U.S. Adult Patients With Type 1 Diabetes: A Real-World Study.

To assess the burden of disease for adults with type 1 diabetes in a U.S. electronic health record database by evaluating acute and microvascular complications stratified by age and glycemic control. This is a retrospective observational study of adults with type 1 diabetes (1 July 2014-30 June 2016) classified using a validated algorithm, with disease duration ≥24 months and, during a 12-month baseline period, not pregnant and having one or more insulin prescriptions and one or more HbA1c measurements. Demographic characteristics, acute complications (severe hypoglycemia [SH], diabetic ketoacidosis [DKA]), and microvascular complications (neuropathy, nephropathy, retinopathy) were stratified by age (18-25, 26-49, 50-64, ≥65 years) and glycemic control (HbA1c <7%, 7% to <9%, ≥9%). Of 31,430 patients, ∼20% had HbA1c <7%. Older patients had lower HbA1c values than younger patients (P < 0.001). Patients with poor glycemic control had the highest annual incidence of SH (4.2%, 4.0%, and 8.3%) and DKA (1.3%, 2.8%, and 15.8%) for HbA1c <7%, 7% to <9%, and ≥9% cohorts, respectively (both P < 0.001), and a higher prevalence of neuropathy and nephropathy (both P < 0.001). For adults with type 1 diabetes, glycemic control appears worse than previously estimated. Rates of all complications increased with increasing HbA1c. Compared with HbA1c <7%, HbA1c ≥9% was associated with twofold and 12-fold higher incidences of SH and DKA, respectively. Younger adults had more pronounced higher risks of SH and DKA associated with poor glycemic control than older adults.

Higher prevalence of neuropathy in patients with diabetic nephropathy

Higher prevalence of neuropathy in patients with diabetic nephropathy

Gender differences and patterns of cardiovascular risk factors in Type 1 and Type 2 diabetes: a population-based analysis from a Scottish region.

To explore the gender differences, along with the relationships between BMI, glycaemic control, cardiovascular risk factors and the prevalence of diabetes complications, in a representative population-based group of people with Type 1 and Type 2 diabetes. Data were obtained from general practices in Ayrshire and Arran, Scotland for 15 351 patients. In the cohort with Type 1 diabetes, after adjustment for age, men had a significantly lower BMI (P = 0.007) and significantly lower total cholesterol (P = 0.005), HDL-cholesterol (P = 2.5*10(-17)) and HbA1c levels (P = 0.003) than women. By contrast, men had higher blood pressure, both systolic (P = 0.034) and diastolic (P = 0.0003), and higher non-fasting triglyceride levels (P = 0.001). Men with Type 1 diabetes had a higher prevalence of neuropathy (P = 0.021). Among people with Type 2 diabetes, men had a significantly lower BMI (P = 4.26*10(-37)), and significantly lower total cholesterol (P = 2.96*10(-62)) and HDL-cholesterol levels (P = 8.25*10(-141)) but higher non-fasting triglyceride levels (P = 0.0002). In Type 2 diabetes, men had a higher prevalence of ischaemic heart disease (P = 1.66*10(-25)), stroke (P = 0.002) and peripheral vascular disease (P = 1.68*10(-12)), while women were older (P = 4.83*10(-23)), heavier and had a higher prevalence of hypertension (P = 5.32*10(-12)). More people with Type 2 diabetes were on lipid-lowering treatment (84.7 vs 52.4%; P = 5.51*10(-8)) than were those with Type 1 diabetes. The prevalence of retinopathy was higher among non-smokers thank smokers in people with both Type 1 and Type 2 diabetes (Type 1, P = 0.016; Type 2, P = 0.001). The study shows gender differences between Type 1 and 2 diabetes that are of clinical significance and require further investigation. Follow-up of the patients included in the present study should give us much greater understanding of the importance of gender in the development of metabolic abnormalities and diabetes complications.

Levodopa, vitamins, ageing and the neuropathy of Parkinson’s disease

Higher prevalence of neuropathy has been described in patients with Parkinson's disease (PD) in comparison with age and gender-matched controls. The cause of neuropathy may be levodopa-induced impairment of vitamin B12 metabolism, suggesting levodopa-naïve subjects should be unaffected. There may, however, be other yet unidentified determinants of neuropathy in PD. We screened 33 consecutive levodopa-naïve PD patients for neuropathy. Demographics, vitamin B12 and folate levels were studied. Findings were analyzed in the light of our previous available data on levodopa-treated PD patients. Four of 33 (12.1%) levodopa-naïve PD patients were diagnosed with neuropathy. This compared to 13/36 (36.1%) previously evaluated levodopa-treated patients (p=0.027) and 3/37 controls (p=0.7). Analysis of our whole PD cohort consisting of a total of 70 subjects, including levodopa-naïve and levodopa-treated patients, revealed that neuropathy correlated with use of levodopa (p=0.041), cumulative levodopa exposure (p=0.046), age at time of study (p=0.005) and serum folate levels <10μg/L (p=0.003). There was no association of neuropathy with PD duration. Multivariate regression analysis showed that neuropathy was only independently associated with age (p=0.016) and serum folate levels <10μg/L (p=0.012). We conclude that this study confirms the roles of levodopa usage and cumulative levodopa exposure in the neuropathy of PD. However, the effects of levodopa only appear contributory and are surpassed by age and lower folate levels. In view of the independent implication of lower folate levels, the need for preventative/protective supplementation including folate in addition to vitamin B12, probably irrespective of levodopa use, may deserve consideration in patients with PD.

Peripheral neuropathy and quality of life of adults living with HIV/AIDS in the Rulindo district of Rwanda

Although the life expectancy of people living with HIV/AIDS (PLWH) has increased in the past years, they could experience secondary illness such as peripheral neuropathy (PN). Therefore, they need to adapt to chronic disablement which could affect their quality of life (QoL). The research that informed this article aimed at determining the prevalence of PN among adults living with HIV/AIDS and attending the outpatients’ clinic at Rutongo Hospital in the Rulindo district of Rwanda. Another aim was to determine these patients’ QoL. A cross-sectional descriptive quantitative research design was used. A time-constrained method was used to sample 185 adults living with HIV/AIDS and attending the outpatients’ clinic at Rutongo Hospital. The subjective PN screen and the World Health Organization Quality of Life Scale Brief Version were used to collect the data. Data were analysed using the Statistical Package for the Social Sciences. Student's t-test and one-way analysis of variance were performed to determine if significant differences existed between QoL scores in participants with and without PN symptoms. The results indicated that 40.5% of respondents experienced PN. QoL in participants with PN showed significantly lower scores in the physical (p = 0.013) and psychological (p = 0.020) domains when compared with those who did not have PN. These results indicate a high prevalence of neuropathy among PLWH attending the outpatients’ clinic at Rutongo Hospital. In addition, patients with neuropathy had lower QoL scores in the physical and psychological domains than those without neuropathy symptoms. The management of PLWH should therefore include interventions to optimise QoL as well as screening for neuropathy symptoms so that sufferers can liaise with their medical providers to find medical and supportive therapies that could assist them.

Progression of leprosy neuropathy: a case series study

A need still exists to determine the clinical and neurophysiological characteristics of leprosy neuropathy at distinct times of the disease by different methods that measure the various nerve fiber functions. A prospective clinical study was performed with 10 paucibacillary (PB) and 12 multibacillary (MB) patients evaluated at diagnosis and one year after cessation of multidrug therapy (MDT). Peripheral nerve function was assessed clinically and by means of the sympathetic skin response, skin vasomotor reflex, and nerve conduction study (NCS). At diagnosis, 73% of the total 22 patients had nerve function impairment (NFI). Autonomic function (χ2= 5.5, P= 0.019) and NCS (χ2= 7.765, P= 0.01) were significantly more altered in MB than PB patients. At final evaluation, NFI of the MB patients had worsened, especially among the six who had leprosy reaction. As the NFI of PB patients showed improvement, a significant difference between the two groups (χ2= 12.320, P= 0.001) was observed. A high prevalence of neuropathy was observed in newly diagnosed patients. Associating different tests with a thorough clinical neurological evaluation increases detection rates.

IgM Amyloidosis: Clinical Features in Therapeutic Outcomes

It is not widely recognized that patients with amyloidosis may be associated with an IgM monoclonal protein. We reviewed the characteristics of 22 IgM amyloidosis patients seen at Mayo Clinic from 1989 through 2010 and uniformly treated with stem cell transplantation. IgM patients are older, have a higher prevalence of neuropathy, a lower incidence of cardiac involvement (lower troponin T and NT-proBNP), and a much lower level of the involved immunoglobulin free light chain.

A Novel Robotic Monofilament Test for Diabetic Neuropathy

The use of the Semmes-Weinstein (SW) monofilament test is recommended as a screening method for diabetic neuropathy. It offers an important chance to prevent further complications of diabetic foot. We aimed to develop a prototype Robotic Monofilament Inspector that can be used as a standard machine for screening of diabetic neuropathy. Development was divided into three parts: computer software, control box, and Robotic Monofilament Inspector. The examiner conducted the SW test (by hand and by robotic inspector), vibration perception threshold, and Toronto Clinical Scoring System without knowledge of patient information. The unpaired t test or Wilcoxon rank-sum test was used to determine the differences between independent groups in terms of continuous outcomes, while the χ(2) test was used to determine categorical outcomes. Agreement between the various diabetic neuropathy tests was measured using the kappa statistic. The SW test and vibration perception threshold were more valid tests for neuropathy than the Toronto test. The robotic test was in excellent agreement with the two former tests and appeared to be valid (kappa statistic, 0.35-0.81). Another indirect evidence for the validity of the robotic test was the finding that diabetic patients with foot ulcers had a higher prevalence of neuropathy (77%vs. 38%). This might indicate that the robotic test was more valid than the manual test. The Robotic Monofilament Inspector could be used as a simple screening machine. This prototype may be developed further for routine clinical use.

Peripheral neuropathy in monoclonal gammopathy of undetermined significance: prevalence and immunopathogenetic studies.

In an unselected series of patients with monoclonal gammopathy of undetermined significance (MGUS) we found neuropathy in 2 of 34 patients with IgG (6%), 2 of 14 with IgA (14%), and 8 of 26 with IgM MGUS (31%). The neuropathy was subclinical in 6 patients (1 IgG, 1 IgA, and 4 IgM). Patients with IgG or IgA MGUS had a prominent motor impairment with electrophysiologic and morphologic findings suggestive of predominant axonal degeneration. No deposit of the M-protein in sural nerve and no reactivity of the M-protein with nerve was detected in these patients. Patients with IgM MGUS had a prominent sensory impairment with evidence of predominant demyelination. In 6 of these patients the M-protein reacted with the myelin-associated glycoprotein (MAG). The higher prevalence of neuropathy in patients with IgM MGUS may be related to the frequent reactivity of IgM M-proteins with MAG.

CLINICAL EVALUATION AND INVESTIGATION OF NEUROPATHY

The assessment and investigation of a possible neuropathy is one of the most common clinical problems facing the general neurologist. Studies of the prevalence of neuropathy in the community are...

Variations in the care of elderly persons with diabetes among endocrinologists, general internists, and geriatricians.

The American Diabetes Association (ADA) clinical practice recommendations have been widely promoted, but they lack a geriatric-specific approach to care. We aimed to determine the style of care that endocrinologists, general internists, and geriatricians provided to their elderly patients with diabetes and to what extent these medical professionals adhered to the ADA standards. We performed a retrospective cohort study of a stratified sample of 531 diabetic patients aged 65 years and older from the endocrinology, general internal medicine, and geriatrics clinics of an urban academic medical center. Patients of geriatricians were older, had higher comorbidity, and were more likely to be demented. The average number of diabetic complications was similar across the specialties, although patients of endocrinologists had higher prevalence of neuropathy and retinopathy compared with patients of geriatricians. Endocrinologists were more likely to use insulin, multiple types of insulin, and combined oral hypoglycemic and insulin therapies. Most patients had hemoglobin A1c measured, and average values were similarly high across specialties at 8.6%. Blood pressures were above 130/85 mm Hg in 85% of the patients. All specialties rarely measured urine microalbumin; geriatricians seldom performed fractionated cholesterol tests, and ophthalmology visits occurred in only half of the patients. Endocrinologists had the most aggressive, complex diabetes treatment regimens, although geriatricians had older patients with more dementia and lower prevalence of microvascular complications. Average hemoglobin A1c levels and blood pressures were higher than recommended among patients of all three specialties. Screening for diabetic complications and hyperlipidemia was lower than advised.