Impact Of Diabetic Peripheral Neuropathy Research Articles

Impact of diabetic peripheral neuropathy on gait abnormalities in patients with type 2 diabetes mellitus.

Many patients with type 2 diabetes (T2DM) suffer from diabetic peripheral neuropathy (DPN) and impaired muscle coordination. These changes may lead to walking instability, and gait abnormalities resulting in increased fall risk and lower limb amputations. The aim of this study was to assess the impact of DPN and patient footwear on the gait in patients with diabetes, in addition to Comparing the peak plantar pressure (PPP) in patients with and without DPN and assessing its association with gait abnormalities. This is an observational case-control study. Forty Subjects with T2DM were divided into two age and sex-matched groups, 20 subjects each. Group A: subjects with DPN. Group B: subjects without DPN. All study participants were subjected to a thorough history taking, clinical examinations focusing on detailed foot examination, PPP assessment, and functional gait evaluation. The results obtained in this study showed a median gait assessment score of 21 (17.0-22.5) for group A and 26 (23.5-26.0) for group B which was statistically significant (p < 0.001). There was no statistically significant difference between both groups (p > 0.05) regarding the assessment of footwear appropriateness. Comparing the PPP measurement among both studied groups, the prevalence of an elevated PPP was 80% in group A compared to 65% in group B, which was statistically non-significant, p = 0.288. Gait abnormalities are common among patients with T2DM even in the absence of DPN. However, the presence of DPN was the strongest independent risk factor for gait abnormalities among the studied factors.

IDF21-0106 Peripheral neuropathy and Health Related Quality of Life in adults with diabetes mellitus type 2

Background: Diabetic peripheral neuropathy (DPN) is the most common long-term complication of diabetes and is the main initiating factor for foot ulceration and lower extremity amputation. Diabetic peripheral neuropathy has significant impact on the quality of life of the patients with diabetes and can result in early death. Aim: The purpose of this study was to evaluate the impact of diabetic peripheral neuropathy (DPN) with and without pain on the Health-related Quality of Life (HRQoL) of individuals with diabetes mellitus type 2 (DMT2). Method: A cross-sectional study of adults with DMT2 was conducted in Plovdiv, Bulgaria. We collected socio-economic, demographic, health status, therapeutic and metabolic control data. EuroQol-5 dimensions questionnaire (EQ-5D) and Visual Analog Scale (VAS) were employed to measure HRQoL. Patients were divided into three groups: group 1 = DPN with pain; group 2 = DPN without pain; group 3 = lack of DPN. Results: The study group included 51 (52.57%) males and 46 (47.43%) females with DMT2. The mean age of subjects was 59.9years (SD = 11.7) and had 8.08 years (SD = 6.7) known duration of diabetes. The prevalence of DPN varied among ethnic subgroups (P = 0.002), being highest among Bulgarian, followed by Roma, Turkish and Armenian subgroups. The prevalence of DPN is 44.25 % among the study group. DPN with pain was 14% among all subjects with diabetic peripheral neuropathy. The mean EQ-5D-3L index score for group 1 was 0.69, in group 2 was 0.73 and in group 3 – 0.82. Patients in group 3 (lack of DPN) report a better QoL than in group 1 and group 2. Discussion: The study findings indicate that patients with diabetic peripheral neuropathy with pain have low HRQOL. The burden from DPN appears to be higher with increasing pain severity. Despite its profound impact on QoL, painful diabetic neuropathy remains under-studied.

The Impact of Diabetic Peripheral Neuropathy on Patient's Balance Ability and Stepping Strategy -- a Virtual Obstacle Crossing Study

To investigate the gait adjustment during an obstacle crossing task (OCT) between diabetic population and healthy age-matched group through the virtual environment. This study also examined the relationships between the OCT success rate and and clinical functional balance tests.

The impact of diabetic peripheral neuropathy on pinch proprioception.

This study aims to investigate the impact of type 2 diabetes (T2D) and diabetic peripheral neuropathy (DPN) on pinch proprioception and to establish the correlations with sensory impairments. We collected data from a total of 36 participants (healthy, n = 12; T2D without DPN, n = 11; and T2D + DPN, n = 13), all matched for age, 60 ± 6years. Pinch proprioception was determined through 3 trials of attempts to actively reproduce 15° of pinch position without visual feedback. Target accuracy and precision was compared between groups using Kruskal-Wallis test. Sensation was tested through the two-point discrimination and Semmes-Weinstein monofilaments applied on the fingers. Sensory measures were correlated with pinch proprioception measures via Spearman's rank test. The T2D + DPN group showed significant decrements in accuracy and precision as compared to the T2D-only (p = 0.003 and p = 0.006, respectively) and the healthy groups (both p = 0.002); no significant differences were found between T2D-only and healthy. Spearman's rank showed moderate (r = 0.45-0.66, p < 0.001) correlations between pinch proprioception and sensory measures. Our results showed pinch proprioception disruption in people with T2D + DPN, but not in people with T2D-only. The awareness of pinch proprioceptive deficits is paramount for the safety of individuals with T2D and DPN. Moderate correlations between sensory impairments and pinch proprioceptive deficits suggest that not only superficial/discriminative sensation is implicated in proprioceptive decrements. Other mechanisms such as damage to muscle spindles or central nervous system associated with T2D + DPN warrant further investigations.

The Impact of Diabetic Peripheral Neuropathy on Pinch Proprioception

Background: Deficits in finger proprioception might impact the ability to perform tasks such as picking up pills, monitoring blood sugar and injecting insulin. However, no tests are available for finger proprioception with functional relevance for tasks using pinch between the index finger and thumb. This study investigates the impact of diabetic peripheral neuropathy (DPN) on pinch proprioception in people with type 2 diabetes (T2D). Methods: This study tested pinch proprioception in 8 healthy participants (3 males, 57±5.6 years), 11 participants with T2D without DPN (T2D-only) (5 males, 61±5.9 years), and 13 participants with T2D and DPN (T2D+DPN) (6 males, 59.9±6.4 years). We used a device previously tested for reliability. Following familiarization with a 15° target position of the index finger and thumb, subjects performed 3 trials where they attempted to reproduce the target position without visual feedback. The average of the absolute error matching the 15° target represented accuracy, and the standard deviation from the trials denoted precision. Results: Descriptive statistics presented as Means ± SD. Accuracy: healthy (0.67±0.64), T2D-only (0.94±1.2), and T2D+DPN (3.51±2.24). Precision: healthy (0.59±0.41), T2D-only (0.79±0.53), and T2D+DPN (2.81±2.4). Kruskal-Wallis test was significant for accuracy (p = .003) and precision (p = .001). Pinch proprioception was significantly different between the T2D+DPN group and the T2D-only group (accuracy and precision: p = .003) as well as between the T2D+DPN group and the healthy group (accuracy: p = .006; precision: p = .001). There were no significant differences between the T2D-only group and the healthy group: accuracy (p = .98) and precision (p = .5). Conclusion: Our results showed that pinch proprioception was disrupted in people with DPN, but not in people with T2D without DPN. Detection of pinch proprioceptive deficits will potentially improve the neurological screening and can be used in future studies for other neurological populations. Disclosure A. Yahya: None. P. Kluding: None. M. Pasnoor: None. M. Santos: None.

The Effect of Diabetic Peripheral Neuropathy on Ground Reaction Forces during Straight Walking in Stroke Survivors.

Purpose. The aim of this present study was to investigate the ground reaction forces (GRFs) alterations in stroke survivors with diabetic peripheral neuropathy (DPN). Methods. Ten stroke survivors with DPN, 10 stroke survivors without DPN, and 10 healthy controls with matched body weight between groups participated in this case-control cross-sectional study. Three-dimensional GRFs (anterior-posterior, medial-lateral, and vertical) were collected at a comfortable walking speed using the Nexus Vicon motion analysis system and force plate. The Kruskal–Wallis test was used to analyze GRFs parameters. Results. We found significant alterations of medial-lateral forces of the nonparetic side and vertical forces of the paretic side in stroke survivors with DPN compared to stroke survivors without DPN and healthy controls. In addition, there were smaller braking and lower propulsion peak in anterior-posterior forces, smaller magnitude of medial-lateral forces, and lower first and second peak of vertical forces in stroke survivors with DPN compared to stroke survivors without DPN and healthy controls. Conclusion. The study findings identified that GRFs were affected in stroke survivors with DPN on both the paretic and the nonparetic sides. Further investigations are warranted to explore the impact of DPN on the kinematics and muscle activity related to the gait performance in stroke survivors with DPN.

The development and validation of a neuropathy- and foot ulcer-specific quality of life instrument.

The purpose of this study was to develop a questionnaire that measures patients' perceptions of the impact of diabetic peripheral neuropathy and foot ulcers on their quality of life and to assess the psychometric properties of this instrument in a sample of patients with varying severity and symptomatology of diabetic peripheral neuropathy. The neuropathy- and foot ulcer-specific quality of life instrument (NeuroQoL), generated from interviews with patients with (n = 47) and without (n = 15) diabetic peripheral neuropathy, was administered to 418 consecutive patients with diabetic peripheral neuropathy (35% with foot ulcer history) attending either U.K. (n = 290) or U.S. (n = 128) diabetes centers. Psychometric tests of NeuroQoL included factor analyses and internal consistency of scales; a series of multivariate analyses were performed to establish its criterion, construct, and incremental validity. Results were compared with those obtained using the Short Form (SF)-12 measure of health-related functioning. Factor analyses of NeuroQoL revealed three physical symptom measures and two psychosocial functioning measures with good reliability (alpha = 0.86-0.95). NeuroQoL was more strongly associated with measures of neuropathic severity than SF-12, more fully mediated the relationship of diabetic peripheral neuropathy with overall quality of life, and significantly increased explained variance in overall quality of life over SF-12. NeuroQoL reliably captures the key dimensions of the patients' experience of diabetic peripheral neuropathy and is a valid tool for studying the impact of neuropathy and foot ulceration on quality of life.