Michigan Diabetic Neuropathy Score Research Articles

Exploring the connection between diabetes duration, HbA1c levels, and peripheral neuropathy in type 2 diabetes patients

Diabetes mellitus can lead to blood circulation problems, which include both large-scale (macrovascular) and small-scale (microvascular) issues. One specific small-scale problem is the loss of feeling in the feet (known as peripheral neuropathy), which can cause foot ulcers and greatly increase the risk of needing an amputation. The length of time someone has had diabetes and their HbA1c levels (a measure of blood sugar control over time) are linked to the risk of developing diabetic peripheral neuropathy (DPN) in individuals with diabetes. The purpose of this study was to investigate the relationship between how long someone has had type 2 diabetes mellitus (T2DM) and their HbA1c levels with the presence of DPN. We conducted a correlational study with a cross-sectional design. We specifically chose 154 outpatients with T2DM from a hospital clinic for this study. To collect data, we used forms that included demographic information, the Michigan Neuropathy Screening Instrument (MNSI), and the Michigan Diabetic Neuropathy Score (MDNS). We analyzed the data using chi-square tests. Our findings showed a significant link between DPN and both the duration of diabetes and abnormal HbA1c levels in individuals with T2DM, with statistical significance (p=0.001) for both. We suggest that individuals with diabetes should manage their condition carefully to minimize the risk of complications from DPN. It is also recommended that hospitals regularly offer educational programs on neuropathy risks and prevention of severe complications to patients with T2DM.

Electroacupuncture efficacy in diabetic polyneuropathy: Study protocol for a double-blinded randomized controlled multicenter clinical trial

BackgroundDiabetic peripheral neuropathy (DPN) is the most common complication of type 2 diabetes mellitus (T2DM); its diagnosis and treatment are based on symptomatic improvement. However, as pharmacological therapy causes multiple adverse effects, the implementation of acupunctural techniques, such as electroacupuncture (EA) has been suggested as an alternative treatment. Nonetheless, there is a lack of scientific evidence, and its mechanisms are still unclear. We present the design and methodology of a new clinical randomized trial, that investigates the effectiveness of EA for the treatment of DPN.MethodsThis study is a four-armed, randomized, controlled, multicenter clinical trial (20-week intervention period, plus 12 weeks of follow-up after concluding intervention). A total of 48 T2DM patients with clinical signs and symptoms of DPN; and electrophysiological signs in the Nerve Conduction Study (NCS); will be treated by acupuncture specialists in outpatient units in Mexico City. Patients will be randomized in a 1:1 ratio to one of the following four groups: (a) short fibre DPN with EA, (b) short fibre DPN with sham EA, (c) axonal DPN with EA and (d) axonal DPN with sham EA treatment. The intervention will consist of 32 sessions, 20 min each, per patient over two cycles of intervention of 8 weeks each and a mid-term rest period of 4 weeks. The primary outcome will be NCS parameters, and secondary outcomes will include DPN-related symptoms and pain by Michigan Neuropathy Screening Instrument (MNSI), Michigan Diabetic Neuropathy Score (MDNS), Dolour Neuropatique Score (DN-4), Semmes-Westein monofilament, Numerical Rating Scale (NRS) for pain assessment, and the 36-item Short Form Health Survey (SF-36). To measure quality of life and improve oxidative stress, the inflammatory response; and genetic expression; will be analysed at the beginning and at the end of treatment.DiscussionThis study will be conducted to compare the efficacy of EA versus sham EA combined with conventional diabetic and neuropathic treatments if needed. EA may improve NCS, neuropathic pain and symptoms, oxidative stress, inflammatory response, and genetic expression, and it could be considered a potential coadjutant treatment for the management of DPN with a possible remyelinating effect.Trial registrationClinicalTrials.gov. NCT05521737 Registered on 30 August 2022.International Clinical Trials Registry Platform (ICTRP) ISRCTN97391213 Registered on 26 September 2022 [2b].

Correlation of nerve damage and peripheral neuropathy incidence using the MNSI and MDNS instrument approaches

The World Health Organization (WHO) reported that by 2030, diabetes mellitus would become the 7th leading cause of death. Diabetes mellitus is a chronic disease that causes various complications, one of which is peripheral neuropathy. Preventive efforts for peripheral neuropathy involve conducting detection examinations. The purpose of this study was to analyze nerve damage in peripheral neuropathy cases using the MNSI (Michigan Neuropathy Screening Instrument) and MDNS (Michigan Diabetic Neuropathy Score) instruments. The study employed a cross-sectional study approach with a sample of 50 people, using total sampling as the sampling technique. The independent variable in this study was nerve damage, and the dependent variable was peripheral neuropathy. Data collection in the study was carried out using the MNSI and MDNS instruments to link the dependent and independent variables. Hypothesis analysis in this study was conducted using the Spearman's rho correlation test. The study found that autonomic, sensory, and motor damage correlated with peripheral neuropathy, with a P-value of < 0.05. Examinations in the feet of diabetics were significantly related to the level of peripheral neuropathy. However, there was no evidence of a correlation between the characteristics of the respondents and the incidence of peripheral neuropathy. The results of the nerve damage examination demonstrated a correlation between different types of damage, and the MNSI and MDNS instruments proved effective in detecting peripheral neuropathy damage. Future research should focus on more in-depth studies to explore the correlation of nerve damage in patients with diabetes mellitus detected at a young age and consider other variables, such as HbA1c levels, as potential risk factors for peripheral neuropathy.

The effectiveness of neurodynamic techniques in patients with diabetic peripheral neuropathy: Study protocol for a randomized sham-controlled trial

Abstract Background: Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus (DM). DPN is the primary risk factor for diabetic foot ulcers that can cause amputation. Although several observational studies have investigated the morphological and biomechanical characteristics of peripheral nerves in DPN, interventional studies regarding the effectiveness of neurodynamic techniques (NDT) in DPN patients are confined to a handful. The effects of NDT on neuropathy severity, nerve conduction parameters, quality of life (QoL), and mechanosensitivity have not been explored yet in this population. Materials and Methods: Forty type 2 DPN (T2DPN) patients, diagnosed based on an electrodiagnosis study, will be recruited into two groups. The experimental group will receive the tibial nerve’s real proximal and distal slider techniques in addition to DPN standard treatment as a basic treatment, and the control group will receive the tibial nerve’s sham proximal and distal slider techniques along with the basic treatment for eight sessions twice a week. Baseline and post-intervention assessments will be based on the Michigan diabetic neuropathy score (MDNS) (primary outcome), tibial nerve conduction parameters, neuropathy-specific quality of life (Neuro QoL) questionnaire, and straight leg raising range of motion (SLR ROM) (secondary outcomes). Results: This study is expected to last approximately seven months, depending on recruitment. The results of the study will be published in a peer-reviewed journal. Conclusions: The present study will evaluate the efficacy of NDT on the primary and secondary outcome measurements in DPN patients.

The correlation between biomechanical parameters of lower limb and overall risk for diabetic foot ulcer

Background/Aim: Preventing lower limb diabetic complications begins with identifying those at risk for diabetic foot ulceration (DFU). DFU development is related to abnormal pattern of plantar pressure distribution caused by alterations in foot rollover process due to loss of foot-ankle muscular strength, impaired range of motion (ROM) and nervous function, as their integrity is needed to enable proper load absorption on plantar surface. Objective of study was to determine correlation between biomechanical parameters of lower limb: ankle and foot muscle strength, ROM at ankle joint (AJ), subtalar joint (SJ) and first metatarsophalangeal joint (I MTP) and overall risk for DFU assessed by IWGDF 2019 Guidance risk stratification system. Methods: A cross-sectional study included 100 diabetic patients, both types. Patients were classified into 4 DFU risk categories applying IWGDF Guidelines 2019 stratification risk system. Function of ten foot and ankle muscles was evaluated by manual muscle testing applying Michigan Diabetic Neuropathy Score system and was expressed by muscle score (MS) on dominant leg. ROM at AJ, SJ and I MTP was measured with a goniometer on dominant leg and was expressed by degree (°). Results: Average MS in specified categories were as follows: Category 0: 9.2; Category 1: 13.9; Category 2: 13.3; Category 3: 15.2 and they were significantly different. Average ROM at AJ in specified categories were as follows: Category 0: 49.3°; Category 1: 48.8°; Category 2: 45.5°; Category 3: 44.6° and they were not significantly different. Average ROM at SJ in specified categories were as follows: Category 0: 37.8°; Category 1: 31.3°; Category 2: 35.0°; Category 3: 28.7° and they were significantly different. Average ROM at I MTP in specified categories were as follows: Category 0: 78.60 ; Category 1: 74.4°; Category 2: 65.5°; Category 3: 57.9° and they were significantly different. Conclusions: Risk for DFU ulcer significantly correlates with decreased ankle and foot muscle strength and ROM at SJ and I MTP but does not correlate with ROM at AJ.

The Relationship Between Patient Characteristics Diabetes Self-Care Management with Diabetic Peripheral Neuropathy in Type 2 DM Patients in Regional General Hospital in Indonesia

One of the microvascular complications is loss of sensation in the leg area (peripheral neuropathy) which causesfoot ulcers and the risk of amputation. The purpose of this study was to determine the relationship betweenpatient characteristics and Diabetes Self-Care Management (DSCM) with Diabetic Peripheral Neuropathy (DPN)in type 2 diabetes mellitus patients in a regional public hospital in one of the provinces in Indonesia. This studyused a correlative design with a cross-sectional approach to 154 patients with type 2 diabetes mellitus who wereselected using a proportionate stratified random sampling technique. The data were obtained using a Summaryof Diabetes Self-Care Activities and the Michigan Diabetic Neuropathy Score and analyzed using the Chi-squaretest and logistic regression. The results showed that age and duration of diabetes were the sub-variables ofpatient characteristics that were most associated with neuropathy in diabetic patients. Patients are expectedto be able to do diabetes management regularly so that no more diabetes patients are injured due to a lack ofself-management. Hospitals are expected to routinely carry out training and counseling for diabetic patients toprevent serious complications caused by peripheral neuropathy.

Overview of Motor Nerve Damage in People with Diabetes Mellitus

Damage to motor nerves in people with diabetes increases the risk of a foot injury. This occurs because the damage results in changes in foot biomechanics, muscle atrophy, deformity, and increased pressure on the feet. So far, the examination of motor nerve damage in people with diabetes in agricultural areas such as the Jember Regency is still rarely touched by primary health services. The purpose of this study was to identify motor nerve damage in people with diabetes in the agriculture area of ​​the Jember Regency. This type of research is exploratory, descriptive, 102 respondents obtained by purposive sampling technique. Inclusion criteria in this study are age> 18 years; do not have DFU active, and did not experience amputation in both legs. Data collection uses instrument modification from MNSI (Michigan Neuropathy Screening Instrument) and MDNS (Michigan Diabetic Neuropathy Score). MNSI using in inspecting for deformity, while MDNS using for forms of physiological reflex damage and muscle strength. The analysis used in univariate and displayed in the frequency distribution. The results showed that the majority of respondents who suffer from DM are experienced in the middle adulthood category (71.6%), with a length of suffering more than five years (95.1%), and have a history of comorbidities (68.6%). The most common form of motor deformity damage was hallux valgus on the right and left legs (38.2%; 26.4%). Forms of motor damage in the form of muscle strength, severe damage to the abduction of the right and left legs (7.8%), and were found right or left toe extensions (1.9%; 2.9%). Motor damage in the form of no physiological reflexes was found in the right and left Quadriceps femoral (2%; 1%), and right or left leg Achilles (1%). The result of total motor damage assessment is that people with diabetes have decreased muscle strength in the right and left extremities (74.5%; 72.5%). This research shows that the majority of people with diabetes in the agricultur area of ​​the Jember Regency suffer motor nerve damage. Therefore, there is a need for preventive measures to prevent the worsening condition of people with diabetes.
 

Aerobic Training Improves Symptoms of Neuropathy and Quality of Life in Patients with Diabetic Peripheral Neuropathy

Background: Painful symptoms of diabetic peripheral neuropathy (DPN) is common in patients with type 2 diabetes mellitus (T2DM), which can reduce the quality of life. The effect of aerobic training on neuropathic symptoms and quality of life in people with type 2 diabetes with peripheral neuropathy was investigated in the present study. Methods: Twenty-four patients with DPN participated in this randomized controlled study. Participants were randomly assigned to the experimental or control groups. The experimental group underwent exercise training consisting of 20-45 minutes aerobic training on the treadmill at 50%-70% of heart rate reserve over three months. Before and after the experimental period, blood samples were taken in a fasting state, and Michigan Diabetic Neuropathy Score (MDNS), monofilament test and quality of life (QOL), and sleep quality (SQ) questionnaires were completed. Data analysis was performed using repeated-measures ANOVA. Results: In the experimental group MDNS score significantly improved compared with the control condition (P<0.05). There was a significant difference between groups regarding 10 g monofilament test score (P<0.05). Moreover, QOL and SQ significantly improved in the experimental group with a significant inter-group difference (P<0.05). Hemoglobin A1c (HbA1c) level decreased by 7.4% in the experimental group, which was statistically different from the control group (P<0.05). Pearson’s correlation indicated a significant correlation between HbA1c level and monofilament score. Conclusion: Regular aerobic training over a short period potentially improves symptoms of DPN and QOL. Lowered levels of HbA1c were correlated with improved foot sensation.

Oral Administration of East Asian Herbal Medicine for Peripheral Neuropathy: A Systematic Review and Meta-Analysis with Association Rule Analysis to Identify Core Herb Combinations

This review aimed to comprehensively assess the efficacy and safety of oral East Asian herbal medicine (EAHM) for overall peripheral neuropathy (PN). In addition, an Apriori algorithm-based association rule analysis was performed to identify the core herb combination, thereby further generating useful hypotheses for subsequent drug discovery. A total of 10 databases were searched electronically from inception to July 2021. Randomized clinical trials (RCTs) comparing EAHM with conventional analgesic medication or usual care for managing PN were included. The RCT quality was appraised using RoB 2.0, and the random effects model was used to calculate the effect sizes of the included RCTs. The overall quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation. By analyzing the constituent herb data, the potential association rules of core herb combinations were explored. A total of 67 RCTs involving 5753 patients were included in this systematic review. In a meta-analysis, EAHM monotherapy and combined EAHM and western medicine therapy demonstrated substantially improved sensory nerve conduction velocity, motor nerve conduction velocity, and response rate. Moreover, EAHM significantly improved the incidence rate, pain intensity, Toronto clinical scoring system, and Michigan diabetic neuropathy score. The evidence grade was moderate to low due to the substantial heterogeneity among the studies. Nine association rules were identified by performing the association rule analysis on the extraction data of 156 EAHM herbs. Therefore, the constituents of the herb combinations with consistent association rules were Astragali Radix, Cinnamomi Ramulus, and Spatholobi Calulis. This meta-analysis supports the hypothesis that EAHM monotherapy and combined therapy may be beneficial for PN patients, and follow-up research should be conducted to confirm the precise action target of the core herb.

Resistance training improves nerve conduction and arterial stiffness in older adults with diabetic distal symmetrical polyneuropathy: A randomized controlled trial

Diabetes is the main cause of peripheral neuropathy where older patients are at increased risk of diabetic distal symmetrical polyneuropathy (DSPN) due to age-related nerve degeneration and vascular changes. The aim of the study was to investigate the effect of resistance training on nerve conduction, measures of neuropathy and arterial stiffness in older patients with DSPN. In a randomized controlled trial, thirty-four older adults with type-2 diabetes and peripheral neuropathy were enrolled and randomly assigned to experimental and control groups. The experimental group carried out circuit resistance training (1-3 rounds, 11 exercises, 10-15 reps, 50%-60% of 1RM, 3 times per week) for 12weeks. Measurements were performed at baseline and 48h after the intervention. Measures of DSPN including Michigan neuropathy screening instrument (MNSI), Michigan diabetic neuropathy score (MDNS), motor nerve action potential amplitude (APA), sensory and motor nerve conduction velocity (NCV) improved following intervention (p<0.001, p=0.001, p=0.034, p=0.001, and p=0.001, respectively). Sensory APA did not change after the intervention (p=0.139). Cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) improved in the experimental group compared with the control group (p=0.014 and p=0.033, respectively). In addition, HbA1C decreased following the 12-week resistance training program (p=0.002). Older adults with DSPN respond positively to resistance training by improved neuropathy symptoms, nerve conduction, arterial stiffness and glucose regulation. Resistance training offers a positive intervention that can abate the progression of DSPN in older adults.

Effects of foam pad balance exercises on cancer patients undergoing chemotherapy: A randomized control trial

BackgroundThis study sought to investigate the effects of foam pad balance exercises on balance, physical performance, peripheral neuropathy symptoms, and quality of life in cancer patients undergoing taxane-based chemotherapy. MethodsThirty cancer patients receiving chemotherapy were randomly divided into 2 groups (n = 15/group): control group (CG) and balance exercise group (BG). The BG were asked to perform foam pad balance exercises 60 min/day, twice/week for 6 weeks, along with conventional therapy. The CG only received conventional therapy. The Fullerton Advanced Balance (FAB) Score, Short Physical Performance Battery (SPPB), Michigan Diabetic Neuropathy Score (MDNS), and Functional Assessment of Cancer Therapy-Taxane (FACT-Taxane) were used to assess balance, physical performance, peripheral neuropathy symptoms, and quality of life, respectively, at baseline and after 4 and 6 weeks of treatment. ResultsAt 4 and/or 6 weeks, the CG showed a decline in FAB and SPPB Scores, while the BG maintained their baseline levels. There were significant differences in the FAB Scores between the groups at the 4th and 6th week (p = 0.04 and p < 0.01, respectively) and significant differences in SPPB Scores at only the 6th week (p = 0.03). MDNS showed no significant changes between or within groups. For FACT-Taxane between groups, the CG and BG showed significant decreases (p < 0.01) and increases (p < 0.01), respectively, at 6th week. ConclusionsFoam pad balance exercises during chemotherapy can be used to alleviate declining balance and enhance physical performance and quality of life of cancer patients.

Efficacy of Mudan Granule (Combined With Methylcobalamin) on Type 2 Diabetic Peripheral Neuropathy: Study Protocol for a Double-Blind, Randomized, Placebo-Controlled, Parallel-Arm, Multi-Center Trial.

Background: Diabetic peripheral neuropathy (DPN) characterized by nerve damage is a common and disabling chronic microvascular complication in patients with type 2 diabetic mellitus (T2DM), affecting at least half of patients diagnosed with T2DM. Unfortunately, the current treatment for DPN is not ideal. Traditional Chinese medicine (TCM), with a unique theoretical system, has made outstanding contributions in the treatment of T2DM and related complications. Mudan granule, a Chinese patent medicine, has been previously validated that could ameliorate the symptoms, promote nerve tissue repair, increase nerve conduction velocity (NCV) in patients with DPN. However, the previous studies are of variable quality, which limits the clinical application of Mudan granule. Therefore, we designed a double-blind, randomized, placebo-controlled, parallel-arm, multi-center trial to estimate the safety and efficacy of Mudan granule in conjunction with methylcobalamin in individuals suffering from type 2 diabetic peripheral neuropathy. Methods: This work is conducted as a 14-center, double-blind, randomized, placebo-controlled, parallel-arm trial. In all, 402 subjects (aged 30–70 years) will be recruited and randomized in a 1:1 ratio to an intervention group (n = 201; Mudan granule + methylcobalamin) and a control group (n = 201; placebo + methylcobalamin). Treatment is administered in 24 weeks cycles without any treatment interruption between cycles. Michigan Diabetic Neuropathy Score (MDNS) as the primary outcome will be evaluated at baseline, 12 weeks during the intervention period, and after 24 weeks of the intervention. Adverse events and safety assessments will be also documented. The analysis of all data will be carried out based on a predefined statistical analysis plan. Discussion: The outcomes from this study will offer important evidence regarding the safety and efficacy that Mudan granule can be used as an alternative and complementary therapeutic intervention in patients with type 2 diabetic peripheral neuropathy. Clinical trial registration: Registered at https://clinicaltrials.gov/. Trial registration number: NCT04711980. Registered January 2021.

Characteristic Of Demographic Neuropathy Diabetic Perifer In The Agriculture Area

&lt;p&gt;&lt;em&gt;Jember Regency is a superior area in the agricultural sector, but it is contrary to the health conditions of the people. It was noted that Jember experienced an increase in cases of Diabetes Mellitus (DM). DM causes various complications, one of which often occurs is peripheral neuropathy. This study aims to analyze peripheral neuropathy based on the characteristics of people with diabetes in the agriculture area under the auspices of the Health Department of Jember Regency. This type of research is descriptive with the cross-sectional approach. The sampling technique used is total population sampling. The number of respondents in this study was 102 people with diabetes. The instrument used was a modification of the MNSI (Michigan Neuropathy Screening Instrument) and MDNS (Michigan Diabetic Neuropathy Score). Univariate analysis is performed, which is presented in the form of frequency distribution tables and cross-tabulation. The results of this study indicate that all respondents experienced peripheral neuropathy (100%) in the mild (43.1%), moderate (44.2%), and severe (12.7%) categories. Domination of neuropathy by women (53.9%), has comorbidities (68.6%), middle adult age categories (71.6%), blood sugar levels 90-199 mg/dL (57.8%), and duration of DM ≥ 1 to 5 years (58.8%). A small percentage of people with diabetes who have peripheral neuropathy have a history of DFU (9.8%) and a history of smoking (32.4%). This nursing intervention is needed to prevent worsening of peripheral neuropathy.&lt;/em&gt;&lt;/p&gt;

Clinical Features and Rules of Chinese Herbal Medicine in Diabetic Peripheral Neuropathy Patients.

Objective To analyse the clinical features of diabetic peripheral neuropathy (DPN) and employ data mining technology to explore the rules of Chinese herbal medicine (CHM) therapy. Methods The clinical data of 216 patients with DPN and qi-yin deficiency syndrome were obtained, and the clinical features of the patients were assessed by cluster analysis. Relevant information was entered into the clinical diagnosis and treatment collection system, and data mining techniques were used to analyse the drug frequency, core CHM, CHM pair, and so on. Results In this study, glycated haemoglobin (HbA1c) and homocysteine (HCY) were closely related to the pathogenesis of DPN. Overall, 162 patients had typical DPN syndrome characteristics, and we analysed 216 prescriptions, including 182 CHM. The frequencies of prescription of Astragalus membranaceus, Ligusticum wallichii, Poria cocos, and Radix Rehmanniae were greater than 45%. A Bayesian network analysis diagram showed that the 9 most common core CHM included Astragalus membranaceus, Ligusticum wallichii, Poria cocos, atractylodes rhizome, and Salvia miltiorrhiza Bge. According to the association rules of CHM, Radix Ophiopogon is used for Codonopsis pilosula; Astragalus membranaceus and atractylodes rhizome for Rehmannia are also frequently used. Astragalus membranaceus and Cinnamomi Ramulus or Ligusticum wallichii and Moutan bark were highly related to a decreased Michigan Diabetic Neuropathy Score. Conclusion HbA1c and HCY are related risk factors for DPN. Numbness is a typical syndrome characteristic. Astragalus membranaceus is a monarch CHM and is used most frequently.

Cycle Training improves vascular function and neuropathic symptoms in patients with type 2 diabetes and peripheral neuropathy: A randomized controlled trial.

Diabetic peripheral neuropathy (DPN) is associated with peripheral arterial disease and endothelial dysfunction. We investigated the effect of exercise training on the measures of superficial femoral artery (SFA) and neuropathic symptoms in patients with DPN. In a randomized-controlled trial, 31 volunteers with established DPN were randomly assigned to experimental or control groups. Experimental group performed cycling exercise training (50%-70% of heart rate reserve, 30-45min, 3 sessions/week) over 12weeks. Before and 48h after the experimental period a 5-min flow mediated dilation (FMD) response in SFA using Color Doppler Ultrasonography, fasting glucose level, HbA1c and neuropathic score were assessed. FMD% significantly increased in the experimental group (from 3.2±1.1% to 5.7±1.2%) compared to the control condition (P=0.0001). However, no significant alteration occurred in baseline membrane diameter and intima media thickness (P>0.05). We also observed a significant improvement in fasting glucose, HbA1c and Michigan Diabetic Neuropathy Score (MDNS) following exercise intervention (all P<0.05). Linear regression analysis indicated that the change in MDNS was significantly associated with the change in HbA1c (R Square=0.34, standardized coefficients Beta=-0.58, P=.001) and FMD (R Square=0.37, standardized coefficients Beta=0.61, P=.001). This finding may be clinically of considerable importance as metabolic and vascular factors have been indicated to be involved in the development of DPN.

Morning blood pressure surge is associated with autonomic neuropathy and peripheral vascular disease in patients with diabetes.

Although vascular and autonomic nervous system have been involved in the regulation of morning surge in blood pressure (MBPS), data on clinical correlates of MBPS in diabetic population are scarce, in particular with regard to diabetic complications. This study was aimed at investigating predictors and correlates of MBPS in diabetes. In a cross-sectional study including 167 patients with diabetes (age 58.5 ± 11.1 years, duration 15.9 ± 12.1 years), clinical variables, diabetic and neuropathic complications, and MBPS (using 24-h ambulatory blood pressure monitoring) were measured. The upper quartile of MBPS (>30.5 mmHg) was associated with higher values of waist circumference (P = 0.027), triglycerides (P = 0.021), and Michigan Diabetic Neuropathy Score (P = 0.042), with lower HDL cholesterol (P = 0.030), and with the presence of cardiovascular autonomic neuropathy (CAN) (P = 0.016) and peripheral vascular disease (PVD) (P < 0.0001). In a logistic regression analysis, PVD (odds ratio: 10.2, P = 0.001), CAN (odds ratio: 6.09, P = 0.016), and diastolic blood pressure (BP) (odds ratio: 1.06, P = 0.022) predicted MBPS upper quartile (r2 = 0.20, P = 0.0005). In a multiple regression analysis, PVD (P = 0.002) and diastolic BP (P = 0.003) were the only determinants of MBPS (r2 = 0.20). MBPS upper quartile was associated with BP dipping (systolic BP day-night reduction > 10%) (P = 0.012), and MBPS was positively related to systolic (rho = 0.41, P < 0.0001) and diastolic BP day-night reduction. In conclusion, metabolic syndrome stigmata, diastolic BP, CAN and PVD are the main predictors of MBPS in the diabetic population. Excessive MBPS and nondipping are not concurrent 24-h BP alterations. Autonomic dysfunction might exert an exacerbating effect on MBPS phenomenon.

Glycemic Control and Clinico-Electrophysiological Severity of Diabetic Polyneuropathy

Background: Diabetic polyneuropathy (DPN) has a significant positive correlation with poor glycemic&#x0D; control (HbA1c ≥7%). The clinical, biochemical and electrophysiological parameters of DPN in Bangladeshi citizens have not yet been explored elaborately&#x0D; Objective: The purpose of the study was to detect and categorize status of glycemic control of Bangladeshi people and to analyze its impact on clinical severity of DPN using Toronto Clinical Scoring System (TCSS) and electrophysiological severity by modified Michigan diabetic neuropathy score (MDNS).&#x0D; Methodology: This observational study was carried out on diabetic patients having probable DPN by purposive sampling, attending Neurology OPD of Dhaka Medical College Hospital, Dhaka, Bangladesh and Bangladesh Institute of Research &amp; Rehabilitation in Diabetes, Endocrine &amp; Metabolic Disorder (BIRDEM) Hospital, Dhaka, Bangladesh from July 2014 to June 2016. Clinical parameters were recorded and DPN was graded as “no neuropathy”, “mild”, “moderate” and “severe” neuropathy by the Toronto Clinical Scoring System (TCSS). A standard nerve conduction study was performed on each patient and electrophysiological grading according to modified Michigan diabetic neuropathy score (MDNS) was done. Diabetic status of patients was classified into “controlled” (HbA1c &lt;7.0%) and “uncontrolled” (HbA1c ≥7.0%) groups and HbA1c level and the clinical &amp; electrophysiological severity scores were compared and were analyzed.&#x0D; Results: Mean age of the patients was 57.2±9.37 years. 51.0% cases were males and 49% cases were females. The mean HbA1c in the study population was 7.6±0.94% and 56.0% patients had HbA1c≥ 7% .Motor nerve conduction studies revealed that both CMAP amplitudes and MNCV in the ulnar, peroneal and tibial nerves were reduced significantly in patients of uncontrolled (HbA1c≥7%) DM (p&lt;0.001). Sensory nerve conduction studies revealed significant reduction in SNAP amplitudes of median and ulnar sensory and sural nerves in the uncontrolled group (p&lt;0.001). Electrophysiologically, 65.43% patients had mixed sensory-motor neuropathy (p&lt;0.00001). Clinically severe DPN patients were higher (45.2%) within the uncontrolled (HbA1C ≥7%) group (p&lt;0.00001). Similarly, severity in electrophysiological grading was more in patients with uncontrolled DM (48.8%) (p&lt;0.00001).&#x0D; Conclusions: Neuropathic severity, either clinically or electrophysiologically, was associated with higher values of HbA1c.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 177-184

Effects of combination therapy of calcium dobesilate dispersible and monosialotetrahex-osylganlioside sodium on serum inflammatory cytokines IL-6 and MCP-1 in elderly patients with painful diabetic peripheral neuropathy

Objective To observe the efficacy of combination therapy of calcium dobesilate dispersible and monosialotetrahexosylganlioside sodium on interleukin-6(IL-6) and monocyte chemotactic protein-1(MCP-1) in elderly patients with painful diabetic peripheral neuropathy. Methods From January 2012 to May 2017, in the Second People's Hospital of Lianyungang 70 patients of painful diabetic peripheral neuropathy, aged ≥60 years, were analyzed in this study.They were randomly divided into observation group (35 cases) and control group (35 cases). The observation group was treated with 40mg monosialotetrahexosylganlioside sodium dissolved in 250mL physiological saline, intravenous infusion per day, and oral calcium dobesilate dispersible 0.5g twice a day for two weeks.The control group was treated with methylcobalamin injection 0.5mg per day for two weeks.The clinical treatment effects and levels of IL-6 and MCP-1 were observed and compared between the two groups. Results After two weeks of treatment, the MDNS and MNSI scores of the observation group [(13.09±5.38)points, (2.53±1.19)points]were significantly lower than those of the control group[(18.31±6.13)points, (4.19±1.05)points, t=2.036, 2.365, all P<0.05]and those before treatment[(21.26±4.28)points, (5.40±0.89)points, t=3.251, 3.698, all P<0.05]. The VAS-PI scores in the observation group[(6.24±1.25)points, (4.13±1.69)points]were significantly lower than those in the control group[(7.26±1.28)points, (6.34±2.65)points] at the first and second week(t=3.265, 5.395, all P<0.05). The serum levels of inflammatory cytokines IL-6 and MCP-1 in the observation group [(15.16±0.88) ng/L, (157.19±11.22)ng/L] were significantly lower than those in the control group[(17.87±1.19)ng/L, (198.21±12.07)ng/L, t=2.152, 1.365, all P<0.05]and those before treatment[(20.26±1.05)ng/L, (260.44±13.63)ng/L, t=1.235, 0.965, all P<0.05]. Conclusion Combination of calcium dobesilate and monosialotetrahexosyl ganglioside may alleviate the sensory and pain sensations in patients with painful diabetic peripheral neuropathy, possibly by reducing the level of inflammatory cytokines IL-6 and MCP-1. Key words: Diabetic neuropathies; Interleukin-6; Monocyte chemotactic protein-1; Michigan diabetic neuropathy score; Michigan neuropmhy screening instrument; Calcium dobesilate dispersible; Monosialotetrahexosylganlioside sodium

Influence of Diabetic Distal Symmetric Polyneuropathy on the Performance of the Musculoskeletal System of Lower Leg and Foot.

Introduction:Complications on the lower extremities are a major cause of morbidity, disability, emotional and physical suffering in people with diabetes. Diabetic neuropathy (DN) is the most frequent complication of both types of diabetes. Lack of performance of the musculoskeletal system of lower leg and foot can results in high focal plantar pressures with increased ulceration risk in patients with neuropathy.Aim:To determine the impact of the severity of distal symmetric polyneuropathy (DSPN) on the foot and ankle muscle strength and the range of motion (ROM) at ankle joint (AJ), subtalar joint (SJ) and first metatarsophalangeal joint (I MTP).Methods:A cross-sectional study was conducted among 100 diabetic patients. The level of DSPN was assessed using the Neuropathy Disability Score. Function of ten foot and ankle muscles has been evaluated by manual muscle testing. Muscle strength was scored by semiquantitative grading system used in the Michigan Diabetic Neuropathy Score. ROM at the AJ, SJ and I MTP was measured with goniometer.Results:The average patients age was 61.91±10.74 and diabetes duration 12.25±8.60 years. DSPN was present in 45% of patients. The average strength of foot and ankle muscles expressed by muscle score was 11.56±5.08. The average ROM at AJ was 47.85°, at SJ 35.10° and at I MTP 72.70°. Correlations between the severity of the DSPN and muscle function, ROM at AJ, SJ and I MTP were statistically significant. ROM at SJ and I MTP declines significantly with progression of neuropathy but not significant at AJ.Conclusion:The severity of DSPN is significantly associated with foot and ankle muscle weakness and ROM at the SJ and the I MTP, but not significantly with the ROM at the AJ.

Complications of Diabetes Mellitus on Muscles and Joints of Lower Extremities

Introduction: Non-enzymatic protein glycosylation in diabetic patients leads to stiffening of collagen-containing tissues affecting joint mobility. Motor dysfunction in diabetic patients can be detected as muscle weakness or atrophy.Objective: To determine the presence of muscles weakness and limited joint mobility at ankle (AJ), subtalar (SJ) and first metatarsophalangeal joint (I MTP) in diabetic patients and to determine impact of diabetes duration on those changes.Patients and Methods: A cross-sectional study was conducted among 100 diabetic patients in “Primary Health Care Centre Banjaluka” in 2014. Function of ten foot and ankle muscles has been evaluated by manual muscle testing. Muscle strength was scored by semiquantitative grading system used in the Michigan Diabetic Neuropathy Score. Range of motion (ROM) at the AJ, SJ and I MTP was measured with goniometer.Results: The average patients age was 61.91±10.74 and diabetes duration 12.25±8.60 years. The average strength of foot and ankle muscles expressed by muscle score was 11.56±5.08. The average ROM at AJ (47.85°) was significantly decreased compared to the reference value that is 65° (t =-15.378, P=000). The average ROM at SJ (35.10°) was significantly decreased compared to the reference value that is 50° (t =-15.378, P=000). The average ROM at the I MTP (72.70°) was significantly decreased compared to the reference value that is 120° (t =-15.378, P = ,000).Conclusion: Patients with diabetes have decreased foot and ankle muscle strength, and the average values of the range of motion at AJ, SJ and I MTP, but the duration of the diabetes does not correlate significantly with those changes.