Diabetic Peripheral Neuropathy Patients Research Articles

The Effectiveness of Massage Therapy on Healing of Diabetic Neuropathy in Diabetes Mellitus Patients

BACKGROUND: Diabetic neuropathy reduces the patient’s quality of life and the quality of diabetes management itself and, as a result, worsens the prognosis of other diabetic complications. Various complaints that are often felt by diabetes mellitus (DM) patients due to neuropathy include pain in the legs, numbness, and weakness in the affected leg, paresthesia, or numbness, and the absence of tendon reflexes in the affected leg. AIM: This study aimed to determine the effectiveness of electric massage therapy on neuropathy healing in DM patients. METHODS: The pre-test and post-test experimental design without a control group was employed. Patients with neuropathy diabetic were recruited as the subject of the study. The total number of participants in the study was 30 people. All the subjects were assessed for neuropathy using the neuropathy assessment instrument and the monofilament test. The Kolmogorov–Smirnov test was employed to analyze the normality of the data. The Wilcoxon signed-rank test was employed for non-normally distributed data. The study used a 95% confidence interval, and significance was assessed at alpha <0.05. RESULTS: Mean difference test resulted that the Z value was −4.791; (p < 0.01). These results indicate that there was a statistically significant difference in the level of neuropathy before and after the massage therapy intervention. CONCLUSIONS: Foot massage therapy has a significant effect in reducing the complaints of diabetic peripheral neuropathy (DPN). It is recommended for the DPN patients to conduct foot massage independently regularly as an alternative treatment in-home care treatment.

Non-Pharmacological Balance Therapy on Diabetic Peripheral Neuropathy Patients with Balance Disorders

ABSTRACTBackground: Patients with diabetic peripheral neuropathy (DPN) suffers from propioceptive ability and mobility disturbance which can potentially affects balance. There are various balance therapy options for DPN patients. The purpose of this study was to determine the effectiveness of various non-pharmacological therapies (surgery, traditional medicine, exercise and assistive devices) in DPN patients with balance disorders.Aim(s): To determine the effectiveness of non-pharmacological balance therapy in people with diabetic peripheral neuropathyMaterial and methods: A systematic review was conducted using randomized controlled trial study articles found using PICO characteristics in ScienceDirect and PubMed in the last 10 years. All articles were selected based on PRISMA and descriptive analysis was carried out on the selected articles.Result: Significant balance improvement found in traditional Thai massage, physical exercise therapy, assistive device therapy with whole-body vibration, and assistive device therapy with electrical stimulation. Surgical therapy with unilateral nerve decompression did not provide a significant measurable balance improvement.Conclusions: Physical exercise therapy, traditional Thai foot massage, WBV and electrical stimulation therapy (with the exception of TENS on the knee) significantly improve balance. Meanwhile, unilateral nerve decompression surgical therapy did not improve the balance significantly.

Plasma 1,5-anhydro-d-glucitol is associated with peripheral nerve function and diabetic peripheral neuropathy in patients with type 2 diabetes and mild-to-moderate hyperglycemia

BackgroundPlasma 1,5-anhydro-d-glucitol (1,5-AG) may be a easily accessible marker for glycemic variability under mild-to-moderate hyperglycemia. The present study was to investigate the association of 1,5-AG with peripheral nerve function and diabetic peripheral neuropathy (DPN) in patients with T2D and mild-to-moderate hyperglycemia.MethodsWe recruited 574 T2D patients with mild-to-moderate hyperglycemia (HbA1c < 8.0%) for this cross-sectional study, with plasma 1,5-AG synchronously detected. All patients were questioned for neurologic symptoms, examined for neurologic signs and screened for peripheral nerve function. Nerve function included the latency, amplitude and nerve conduction velocity (NCV) of limbs nerves (median, ulnar nerve, common peroneal, superficial peroneal, tibial and sural nerve). Besides, composite Z-score of latency, amplitude and NCV were calculated. DPN was identified as both at least a neurologic symptom/sign and an abnormality of peripheral nerve function.ResultsAmong the recruited patients, 23.9% (n = 137) were identified to be with DPN, and the prevalence of DPN decreased from 36.6%, 24.5%, 21.2%, 13.3% from first (Q1), second (Q2), and third (Q3) to fourth quartile (Q4) of 1,5-AG. Moreover, multivariable linear regression analysis showed 1,5-AG was associated with composite Z-score of nerve latency (β = − 0.18, t = − 3.84, p < 0.001), amplitude(β = 0.26, t = 5.35, p < 0.001) and NCV (β = 0.24, t = 5.61, p < 0.001), respectively. Furthermore, compared to Q4 of 1,5-AG as reference, the adjusted odds ratios and 95% CIs for DPN of Q3, Q2, and Q1 were 1.29(0.59–2.81), 1.85(0.87–3.97), and 2.72(1.16–6.34), respectively. Additionally, receiver operating characteristic analysis revealed that optimal cutoff value of 1,5-AG to indicate DPN was ≤ 30.8 μmol/L, with sensitivity of 56.20% and specificity of 66.36%.ConclusionsLow plasma 1,5-AG is closely associated with impaired peripheral nerve function and DPN in T2D patients under mild-to-moderate hyperglycemia.

Status of Analgesic Drugs and Quality of Life Results for Diabetic Peripheral Neuropathy in China.

ObjectiveThe purpose of this study is to describe the current clinical situation of patients with painful diabetic peripheral neuropathy (DPN) and related anxiety, depression, and the quality of life of patients in mainland China, and to report the current status of the use of analgesics.MethodsBetween June 15, 2021, and October 15, 2021, a total of 401 participants participated in the study. Recruitment was carried out using a multi-level sampling method. Participants’ demographics, medical history, analgesic use, Michigan Symptom Score (MNSI), Numerical Rating Scale (NRS) pain score, Patient Health Questionnaire 9 (PHQ-9) score, Generalized Anxiety Disorder 7 (GAD) -7) Score, quality of life score (SF-12) and diabetes treatment status were collected.ResultsAmong the participants, there were 236 male patients and female patients. Participants were 322 patients over 40 years old. Regarding the use of analgesics: 132 patients reported using analgesics, 221 patients reported not using analgesics, and 48 patients reported having used analgesics. The results of the scale showed that the scores of NRS, GAD-7, PHQ-9 and SF-12 were 5.12 ± 2.15, 6.33 ± 3.67, 8.46 ± 4.07 and 47.84 ± 19.92 for patients who used analgesics, Compared with patients who did not use analgesics (NRS: 1.99 ± 1.7, GAD-7: 1.81 ± 2.81, PHQ-9: 3.13 ± 4.10, SF-12: 78.34 ± 21.66) there are significant differences (p< 0.001). In addition, patients’ NRS scores are also closely related to GAD-7, PHQ-9 and SF-12 scores.ConclusionThe severity of symptoms, mental status and quality of life of patients who used analgesics were more severe than those of patients who did not use analgesics. Pregabalin is still the preferred analgesic for patients with painful DPN, and the use of opioids in my country is extremely low, which is consistent with current international guidelines. Age, diabetic duration, DPN duration, PHQ-9 score, GAD-7 score and SF-12 scores are closely related to NRS pain scores. In addition, there are still a considerable number of patients who have not used analgesics due to financial burdens and other reasons, suggesting that China still has insufficient pain management in DPN patients.

Assessment of Prevalence and the Risk Factors of Diabetic Peripheral Neuropathy at Primary Health Care Level at Nawab Shah(

Background: Diabetic Peripheral Neuropathy (DPN) is a common and difficult complication of diabetes and poses significant burden to many diabetics and the public health-care system. Diabetic patients in rural areas have higher risk of developing diabetes related complications and have inadequate access to proper treatment especially low-income countries. Objectives: To determine prevalence of diabetic peripheral neuropathy in patients with Type II diabetes in rural areas of Nawab Shah and to determine various risk factors the development of diabetic peripheral neuropathy in Type II diabetic patients. Study Design: Cross-sectional study Place and Duration of Study: Study was done in rural areas of Nawab Shah District (SBA), 06 months from September 2020 to February 2021 Methodology: One thousand and fifty-seven diabetic patient’s demographic parameters and diagnostic criteria depend on primary care setup first three were enrolled. Results: The overall prevalence rate in rural areas the Nawab Shah was almost 57.42%. Conclusion: The prevalence of diabetic peripheral neuropathy increased with increasing age and it is observed to be associated with duration of diabetes, physical activity, smoking habit and systemic hypertension. Keywords: Diabetes mellitus, Peripheral neuropathy, Risk factors, Rural population, Prevalence

Study of Diabetic Peripheral Neuropathy in Adults of Telangana

Background: Diabetic peripheral neuropathy (DPN) predisposes to foot ulceration and gangrene. It has been reported thatprevalence of DPN is lower in Indians relative to Caucasians. Studies among recent onset patients with type 2 diabetesmellitus (Type2-M) are very few. We studied the prevalence and risk factors of DPN in patients with newly diagnosedType2DM.Methods: We prospectively studied 80 consecutive patients over age 30 with a duration of diabetes ≤1 year. Every patientunderwent a clinical and biochemical evaluation and was screened for DPN using TCSS scale (Toronto clinical scoringsystem) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale.Results: The cases had a mean age of 60.28 years and duration of symptoms of DM is &lt;1year prior to presentation. Theoverall prevalence of DPN was 12.5%. The prevalence of DPN showed an increasing trend with FBS (trend chi-square=3.517, P = 0.0304). A logistic regression analysis showed that DPN was independently associated with Fasting Blood Sugar(P = 0.0304), Body mass index (P= 0.0389), HbA1c (P = 0.0451), family history (P= 0.0426) and physical activity (P= 0.0219)but not with age, sex and education.Conclusions: Our study showed high prevalence of PN in recently diagnosed patients with Type2DM, which wasindependently associated with age and duration of symptoms of diabetes prior to the diagnosis. FBS, HbA1c, BMI, werefound to be risk factors for prevalence of Diabetic Neuropathy.

Diabetic peripheral neuropathy in diabetic patients attending an urban health and training centre.

Introduction:Diabetic neuropathy is a complication affecting almost 50% of the diabetic patients. Diabetic Peripheral Neuropathy (DPN) predominantly affects the hands and lower limbs. It leads to loss of protective sensation resulting in continuous injury to insensitive feet. The early detection of DPN using an objective screening test followed by its appropriate management is important as up to 50% of the patients may be asymptomatic.Objectives:To screen Diabetic patients attending an Urban Health and Training Centre of a medical college in Tamilnadu for Diabetic Peripheral Neuropathy. To assess the association between DPN and selected variables such as socio-demographic factors, glycaemic control, duration of diabetes, physical activity, body mass index, smoking and consumption of alcohol.Methods:The study was conducted among 204 diabetic patients attending an Urban Health and Training Centre. Participants were assessed using Michigan Neuropathy Screening Instrument (MNSI), which involves using a questionnaire followed by a physical examination.Results:Of the 204 patients, 58.8% were male. The mean age was 54.8 years (SD = 8.8 years). About 79.9% were employed of which 29.4% were skilled labourers. Mean duration of diabetes was 6.2 years (SD = 5.3 years). The proportion of diabetics who screened positive for Peripheral Neuropathy was 23% and 45.6% using MNSI questionnaire and examination, respectively. An age of 60 years and above was significantly associated with DPN (OR = 2.505, P value = 0.003). A duration of more than 4 years of diabetes was also significantly associated with DPN (OR = 1.872, P value = 0.02820).Conclusion:A high proportion of diabetics with peripheral neuropathy did not express symptoms specific for diabetics. Thus, a simple tool like MNSI would be useful in primary care settings to screen for peripheral neuropathy, and hence prevent disability”.

Correlation between Diabetic Retinopathy and Diabetic Peripheral Neuropathy in Patients with Type II Diabetes Mellitus.

Background and Objectives:The two most common complications of diabetes mellitus are retinopathy and neuropathy which are dealt by two different medical departments. Early detection and management are therefore necessary to prevent progression of these two diseases and will give a knowledgeable idea regarding the both. Thus, this study was done to know the association of diabetic peripheral neuropathy and diabetic retinopathy.Methods:This was a cross sectional study comprised of 200 cases of type 2 diabetes mellitus selected from the ophthalmology department and referred cases from other departments. A thorough history and examination was done in both departments, that is, complete ophthalmic and neurological examination respectively. Relevant investigations, if needed, were done and diabetic retinopathy was classified according to ETDRS classification.Results:Of the 200 patients having type 2 diabetes for more than 5 years, 28% of cases had diabetic retinopathy and 59% of cases had peripheral neuropathy. Peripheral neuropathy was twice more common than retinopathy. 33.1% had retinopathy and 65.46% had peripheral neuropathy among the uncontrolled diabetics. The prevalence of retinopathy increased 1.3 times in patients with neuropathy (16%) than in patients without peripheral neuropathy (12%).Conclusion:As there was higher incidence of peripheral neuropathy, it is important as ophthalmologists to look for peripheral neuropathy in diabetics which will help in reducing diabetes-related morbidities.

Postural Control in Diabetic Peripheral Neuropathy: A Narrative Review

Diabetes mellitus is a metabolic disease of chronic hyperglycaemia which leads to neurological complications such as Diabetic Peripheral Neuropathy (DPN). When compared to healthy persons, those with DPN are more likely to fall, especially in geriatric population. Present review aims to provide an insight to the pathophysiology, outcome measures, and physiotherapy treatment of impaired postural control in DPN. Searches for relevant articles were conducted using Google Scholar, PubMed, Ovid, Springerlink, Science Direct (SD), Seniorcare Ageing Growth Engine (SAGE), Elton B. Stephens Company (EBSCO) Discovery Service and Web of Science. Keywords used were diabetes, DPN, diabetic foot, postural control, balance, postural sway, physiotherapy intervention. Irrespective of their year of publication, studies and reports published in English, that provide data of postural control in individuals with DPN and its physiotherapy management were included in the study. The included publications were reviewed and a narrative review was formulated. A total of 35 studies were included in this review. All studies suggest that there is postural instability in people with DPN which increases with age and duration of diabetes. Multidirectional postural sway was observed in most of the studies with medio-lateral instability encountered in more cases. Significant improvement in timed up and go test, single leg stance test, Berg balance scale, and other outcome measures post physiotherapy intervention were reported. Literature suggests that multidirectional postural instability is present in DPN patients. Physiotherapy, offloading devices and diabetic foot care education improve postural stability in individuals with DPN.

Comparative study of two integrated traditional Chinese and Western medicine treatment methods on treatment compliance of patients with diabetic peripheral neuropathy.

This study aims to compare the treatment satisfaction and compliance of two integrated traditional Chinese and Western medicine methods for diabetic peripheral neuropathy (DPN) patients with cold coagulation and blood stasis. A total of 120 patients with cold coagulation and blood stasis type of distal symmetric polyneuropathy (DSPN), the most common form of diabetic neuropathy, were selected from the urology department of a hospital and randomly divided into a control group (60 patients), who were given external medicinal liquid application with Tangbiling（Magic Diabetic Arthralgia Treating Paste) herbs, and an observation group (60 patients), who were treated with modified Tangbiling herbs (Tangbiling herbs mixed with mud moxibustion substrate) for external medicinal liquid application. Both groups were treated with a TDP therapeutic apparatus at the same time as the external medicinal liquid application. After three courses of treatment (14 days/course of treatment), the efficacy was evaluated by the score of traditional Chinese medicine (TCM), and the questionnaires were used to compare the treatment compliance of the two groups. After the external medicinal liquid application with modified traditional Chinese medicine, the moulding and cleaning degree of TCM and the symptoms of the two groups were improved. The effective rate of the observation group was 91.7%, which was higher than the control group (86.7%). The compliance of the observation group was higher than the control group, and the differences were statistically significant (p < 0.05). The external medicinal liquid application with modified Tangbiling herbs improved the treatment compliance and satisfaction of DPN patients and effectively improved the symptoms of pain and numbness in the lower limbs of patients, which is worth promoting.

The synergistic effect of palmitic acid and glucose on inducing endoplasmic reticulum stress-associated apoptosis in rat Schwann cells.

Diabetic peripheral neuropathy (DPN) is a common long-term complication of diabetes mellitus accompanied with hyperglycemia and hyperlipidemia. Both high blood glucose and high blood lipids are key pathogenies for DPN. This research aims to investigate whether the combination of glucose (Glu) and palmitic acid (PA) played a synergistic role in the pathogenesis of DPN. The proliferation rate of Rat Schwann cell line RSC96 cells stimulated by different concentrations of Glu and PA were analyzed by CCK-8 assay. After the IC50 was detected for each drug, the RSC96 cells were divided into control, Glu, Glu+PA, PA, and BSA groups. The apoptosis of RSC96 cells in different groups were detected by flow cytometry. The effects of Glu and/or PA on endoplasmic reticulum (ER) stress-associated apoptotic signaling pathways were determined by Western blot and qPCR. Both Glu and PA showed similar inhibition on the proliferation of RSC96 cells in a dose-dependent manner. However, PA induced stronger apoptosis of RSC96 cells than glucose and significantly increased the levels of X-box-binding protein-1 (XBP1), C/EBP homologous protein (CHOP), and eIF2α phosphorylation, which are key proteins regulating endoplasmic reticulum (ER) stress-associated apoptotic signaling pathways. The combination of Glu and PA induced the strongest apoptosis in RSC96 cells and also activated ER stress-associated apoptotic signaling pathways. These results verified the synergistic effect of Glu and PA on inducing ER stress-associated apoptosis in RSC96 cells, and PA even induced stronger apoptosis in RSC96 cells than Glu. The present research indicated that hyperglycemia and hyperlipidemia might exert a synergistic damage during the pathogenesis of DPN, suggesting that blood lipid control is as important as blood glucose control for DPN patients.

Rehabilitation Interventions for Gait Problems in Patients With Diabetic Peripheral Neuropathy: A Scoping Review

Background and Objectives: Gait and balance disturbances are challenging conditions in patients with Diabetic Peripheral Neuropathy (DPN). The overall literary consensus is that rehabilitation interventions are effective in improving gait performance in this patient group. This review sought to highlight and assess the literature and provide a scoping review on the current knowledge gaps in the rehabilitation interventions for the gait problems of patients with DPN. Methods: An electronic databases search was done between 2001 and May 2020. Besides, a hand-search method was used for grey literature. Two experts reviewed the results and screened them based on the subject’s diagnosis with DPN and gait problems. Results: Of 87 studies obtained, nine met the inclusion criteria. The frequent components of the rehabilitation interventions included exercise therapy, dual-task intervention, and the use of assistive devices. The outcomes utilized most frequently included changes in balance and stability, muscle strength, proprioception, function, and gait parameters. Conclusion: Evidence was formed as a scoping review to guide rehabilitation for DPN patients with gait problems. Rigorous comparative studies with clearly defined interventions are needed.

Bone Markers (BMKs) and its Relation with Peripheral Neuropathy (PNP) in Type 2 Diabetic Patient (T2DM) in Basrah

The aim of this study was to evaluate differences in bone metabolism by calculating markers of bone turnover (C-terminal telopeptide and osteocalcin) with type 2 diabetes and patients in diabetic peripheral neuropathy patients compared with those without diabetic peripheral neuropathy.

Association between serum Sestrin2 level and diabetic peripheral neuropathy in type 2 diabetic patients.

BACKGROUNDDiabetic peripheral neuropathy (DPN) is a chronic and serious microvascular complication of diabetes linked to redox imbalance. Sestrin2, a novel inducible stress protein, participates in glucose metabolic regulation and redox homeostasis. However, the association between serum Sestrin2 and DPN is unknown.AIMTo explore the association between serum Sestrin2 and DPN in patients with type 2 diabetes mellitus (T2DM).METHODSA total of 96 T2DM patients and 39 healthy volunteers, matched by age and sex, participated in this cross-sectional study. Clinical features and metabolic indices were identified. Serum Sestrin2 was measured by ELISA. The association between Sestrin2 and DPN was studied. Correlation and logistic regression analyses were used to evaluate the associations of different metabolic indices with Sestrin2 and DPN.RESULTSThe 96 patients with T2DM were divided into DPN (n = 47) and patients without DPN (n = 49). Serum Sestrin2 was significantly lower in healthy volunteers than in all T2DM patients combined [9.10 (5.41-13.53) ng/mL vs 12.75 (7.44-23.80) ng/mL, P < 0.01]. T2DM patients without DPN also had significantly higher levels of Sestrin2 than healthy volunteers [14.58 (7.93-26.62) ng/mL vs 9.10 (5.41-13.53) ng/mL, P < 0.01]. However, T2DM patients with DPN had lower circulating Sestrin2 levels compared to T2DM patients without DPN [9.86 (6.72-21.71) ng/mL vs 14.58 (7.93-26.62) ng/mL, respectively, P < 0.01]. Bivariate correlation analysis revealed that serum Sestrin2 was positively correlated with body mass index (r = 0.672, P = 0.000), hemoglobin A1c (HbA1c) (r = 0.292, P = 0.000), serum creatinine (r = 0.206, P = 0.016), triglycerides (r = 0.731, P = 0.000), and fasting glucose (r = 0.202, P = 0.040), and negatively associated with estimated glomerular filtration rate (r = -0.230, P = 0.007). After adjustment for sex, age, HbA1c, and diabetes duration, multiple regression analysis revealed that Sestrin2 was independently correlated with body mass index and triglyceride levels (P = 0.000). Logistic regression analyses indicated that Sestrin2, diabetes duration, and high-density lipoprotein were strongly associated with DPN (odds ratio = 0.855, 1.411, and 0.041, respectively).CONCLUSIONOur results show Sestrin2 is decreased in T2DM patients with DNP. As lower Sestrin2 is independently associated with DPN, Sestrin2 may contribute to progression of DPN in T2DM patients.

Keratinocyte Biomarkers Distinguish Painful Diabetic Peripheral Neuropathy Patients and Correlate With Topical Lidocaine Responsiveness.

This study investigated quantifiable measures of cutaneous innervation and algesic keratinocyte biomarkers to determine correlations with clinical measures of patient pain perception, with the intent to better discriminate between diabetic patients with painful diabetic peripheral neuropathy (PDPN) compared to patients with low-pain diabetic peripheral neuropathy (lpDPN) or healthy control subjects. A secondary objective was to determine if topical treatment with a 5% lidocaine patch resulted in correlative changes among the quantifiable biomarkers and clinical measures of pain perception, indicative of potential PDPN pain relief. This open-label proof-of-principle clinical research study consisted of a pre-treatment skin biopsy, a 4-week topical 5% lidocaine patch treatment regimen for all patients and controls, and a post-treatment skin biopsy. Clinical measures of pain and functional interference were used to monitor patient symptoms and response for correlation with quantitative skin biopsy biomarkers of innervation (PGP9.5 and CGRP), and epidermal keratinocyte biomarkers (Nav1.6, Nav1.7, CGRP). Importantly, comparable significant losses of epidermal neural innervation (intraepidermal nerve fibers; IENF) and dermal innervation were observed among PDPN and lpDPN patients compared with control subjects, indicating that innervation loss alone may not be the driver of pain in diabetic neuropathy. In pre-treatment biopsies, keratinocyte Nav1.6, Nav1.7, and CGRP immunolabeling were all significantly increased among PDPN patients compared with control subjects. Importantly, no keratinocyte biomarkers were significantly increased among the lpDPN group compared with control. In post-treatment biopsies, the keratinocyte Nav1.6, Nav1.7, and CGRP immunolabeling intensities were no longer different between control, lpDPN, or PDPN cohorts, indicating that lidocaine treatment modified the PDPN-related keratinocyte increases. Analysis of the PDPN responder population demonstrated that increased pretreatment keratinocyte biomarker immunolabeling for Nav1.6, Nav1.7, and CGRP correlated with positive outcomes to topical lidocaine treatment. Epidermal keratinocytes modulate the signaling of IENF, and several analgesic and algesic signaling systems have been identified. These results further implicate epidermal signaling mechanisms as modulators of neuropathic pain conditions, highlight a novel potential mode of action for topical treatments, and demonstrate the utility of comprehensive skin biopsy evaluation to identify novel biomarkers in clinical pain studies.

Prevalence and Clinical Significance of Subclinical Hypothyroidism in Diabetic Peripheral Neuropathy.

Background and AimDiabetic peripheral neuropathy (DPN) is one of the most common and disabling complications of DM. Many studies documented the prevalence of clinical and subclinical hypothyroidism (SCH) in diabetic patients but not in the particular group of patients with DPN. The present study aimed to determine the prevalence of SCH in DPN patients and to evaluate its association with severity of DPN.Patients and MethodsThe present cross-sectional study was conducted on 300 consecutive patients with DPN. The clinical manifestations of DPN were documented according to the validated Arabic version of the Michigan Neuropathy Screening Instrument. Severity of DPN was categorized into mild (6–8 points), moderate (9–11 points) or severe (12+ points) according to the Toronto Clinical Scoring System. All patients were submitted to careful history-taking and full clinical and neurological examination. Patients were diagnosed with SCH if they had TSH level above the upper limit of the normal reference range in association with normal free thyroxine (FT4) level.ResultsSCH was prevalent in 53 patients (17.7%, 95% CI: 13.5%–22.5%). Patients with SCH had significantly higher frequency of severe DPN (52.8% versus 28.3%, p=0.003). It was also shown that patients with SCH had significantly higher HbA1c (8.4 ± 1.0 versus 7.3 ± 1.2%, p<0.001) and HOMA-IR (3.7 ± 0.8 versus 2.7 ± 0.9, p<0.001) when compared with patients without SCH. Logistic regression analysis identified patients’ age [OR (95% CI): 1.06 (1.03–1.08), p<0.001], HbA1c [OR (95% CI): 2.2 (1.7–2.9), p<0.001] and SCH [OR (95% CI): 7.7 (3.6–15.5), p<0.001] as independent predictors of DPN severity.ConclusionThe present study showed that SCH is highly prevalent in DPN patients and is independently related to its severity.

Tocotrienol-Rich Vitamin E (Tocovid) Improved Nerve Conduction Velocity in Type 2 Diabetes Mellitus Patients in a Phase II Double-Blind, Randomized Controlled Clinical Trial

Diabetic peripheral neuropathy (DPN) is the most common microvascular complication of diabetes that affects approximately half of the diabetic population. Up to 53% of DPN patients experience neuropathic pain, which leads to a reduction in the quality of life and work productivity. Tocotrienols have been shown to possess antioxidant, anti-inflammatory, and neuroprotective properties in preclinical and clinical studies. This study aimed to investigate the effects of tocotrienol-rich vitamin E (Tocovid SuprabioTM) on nerve conduction parameters and serum biomarkers among patients with type 2 diabetes mellitus (T2DM). A total of 88 patients were randomized to receive 200 mg of Tocovid twice daily, or a matching placebo for 12 months. Fasting blood samples were collected for measurements of HbA1c, renal profile, lipid profile, and biomarkers. A nerve conduction study (NCS) was performed on all patients at baseline and subsequently at 2, 6, 12 months. Patients were reassessed after 6 months of washout. After 12 months of supplementation, patients in the Tocovid group exhibited highly significant improvements in conduction velocity (CV) of both median and sural sensory nerves as compared to those in the placebo group. The between-intervention-group differences (treatment effects) in CV were 1.60 m/s (95% CI: 0.70, 2.40) for the median nerve and 2.10 m/s (95% CI: 1.50, 2.90) for the sural nerve. A significant difference in peak velocity (PV) was also observed in the sural nerve (2.10 m/s; 95% CI: 1.00, 3.20) after 12 months. Significant improvements in CV were only observed up to 6 months in the tibial motor nerve, 1.30 m/s (95% CI: 0.60, 2.20). There were no significant changes in serum biomarkers, transforming growth factor beta-1 (TGFβ-1), or vascular endothelial growth factor A (VEGF-A). After 6 months of washout, there were no significant differences from baseline between groups in nerve conduction parameters of all three nerves. Tocovid at 400 mg/day significantly improve tibial motor nerve CV up to 6 months, but median and sural sensory nerve CV in up to 12 months of supplementation. All improvements diminished after 6 months of washout.

Prevalence and Clinical Significance of Subclinical Hypothyroidism in Diabetic Peripheral Neuropathy

Background and Objective: The diabetic Mellitus common and spiking complication is Diabetic peripheral neuropathy (DPN). It is frequently associated with thyroid dysfunction. The subclinical hypothyroidism prevalence and clinical outcomes have been investigated by various studies. The present study aims to determine the prevalence of subclinical hypothyroidism in diabetic peripheral neuropathy patients. Methods: This cross-sectional study was carried out on 164 diabetic neuropathy patients attending the medicine department of Qazi Hussain Ahmad Medical Complex, Nowshera KPK during the study period from 2020 to 2021. Patients’ demographic details, clinical history, and neurological examination were recorded. Normal free thyroxin value was set as a referential standard for subclinical hypothyroidism diagnosis among all the patients. Diabetic neuropathy patients’ clinical manifestations were recorded as per neurological screening instrument. The clinical scoring system was utilized for DPN severity categorization into mild (6-8), moderate (9-11), and severe (&gt;12). SPSS version 20 and a logistic regression model were used for data analysis. Results: This study enrolled 164 diabetic peripheral neuropathy patients. Of the total 164, 69 (42.1%) were male and 95 (57.9%) were female. The overall mean age was 49.61±13.72 years. The prevalence of subclinical hypothyroidism was 32 [19.5%; 95% CI; 14.3%-23.7%]. The diabetic peripheral neuropathy patients with subclinical hypothyroidism had a higher prevalence of severity 86 [52.4%; 95%CI] compared to DNP patients without SCH 46 [28.04%; 95% CI] with a 3% level of significance. A higher HbA1c and HOMA-IR was found in patients with their respective values were (8.3±1.1 against 7.2±1.3) where p-value &lt;0.001 and (3.5 ± 0.9 vs. 2.6 ± 0.8, p&lt;0.001) respectively. Conclusion: The diabetic peripheral neuropathy patients are susceptible to have frequent subclinical hypothyroidism independently associated with severity and complications of DPN. Thyroid function should be tested in DM patients and given to DM patients with SCH. Keywords: Diabetes mellitus; Subclinical hypothyroidism; Diabetic peripheral neuropathy

Value of shear wave elastography combined with the Toronto clinical scoring system in diagnosis of diabetic peripheral neuropathy.

To evaluate the diagnostic values of shear wave elastography (SWE) alone and in combination with the Toronto clinical scoring system (TCSS) on diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM).The study included 41 DPN patients, 42 non-DPN patients, and 21 healthy volunteers. Conventional ultrasonography and SWE were performed on the 2 sides of the tibial nerves, and cross-sectional area (CSA) and nerve stiffness were measured. TCSS was applied to all patients. A receiver operating characteristic curve analysis was performed.The stiffness of the tibial nerve, as measured as mean, minimum or maximum elasticity, was significantly higher in patients in the DPN group than the other groups (P < .05). The tibial nerve of subjects in the non-DPN group was significantly stiffer compared to the control group (P < .05). There was no significant difference of the tibial nerve CSA among the 3 groups (P > .05). Mean elasticity of the tibial nerve with a cutoff of 71.3 kPa was the most sensitive (68.3%) and had a higher area under the curve (0.712; 0.602–0.806) among the 3 shear elasticity indices for diagnosing DPN when used alone. When combining SWE with TCSS in diagnosing DPN, the most effective parameter was the EMax, which yielded a sensitivity of 100.00% and a specificity of 95.24%.SWE is a better diagnostic tool for DPN than the conventional ultrasonic parameter CSA, and a higher diagnostic value is attained when combining SWE with TCSS.

A Study on Peripheral Neuropathy and Its Related Risk Factors Associated With hba1c Levels

Diabetic peripheral neuropathy (DPN) patients frequently feel persistent pain, which is described as painful diabetic peripheral neuropathy (PDPN), which begins in both feet and frequently spreads to the calves, fingers, and hands. PDPN not only causes pain, but also affects patients' sleep, emotions, mental state, and everyday activities, resulting in a low quality of life and a significant financial burden. The goal of this study was to monitor if there was a link between the prevalence, pattern, and related risk factors of diabetic peripheral neuropathy and hemoglobin A1C (HbA1c) levels. In this crosssectional study, 150 type-2 diabetic patients were screened for DPN with PDPN and their HbA1c level was measured in every three months. DPN, PDPN and non-painful DPN were confirmed in patients displaying both clinical manifestations of neuropathy and neurological abnormalities assessment. DPN was detected in 24% (n = 36), while PDPN was found at 15% (n = 23) of the total patients. The prevalence of PDPN is 63.88% (n = 23) and non-painful DPN is 36.11% (n = 13) of total DPN (n = 36). Out of total PDPN (n = 23), the prevalence of symmetrical pain is 65% (n = 15), asymmetrical 35% (n = 8), sensory 26% (n = 6), motor 13% (n = 3), mixed (sensorimotor) 61% (n = 14), lower limb involvement 48% (n = 11), upper limb13% (n = 3) and both limb 39% (n = 9). In comparison to patients without DPN, both PDPN and non-painful DPN, patients had greater HbA1c levels (p&lt;0.05). Furthermore, advanced age and longer diabetes duration were considerable and significant (p&lt;0.05) risk factors for DPN with PDPN and non-painful DPN respectively. Overall, the findings imply that elevated HbA1c levels are closely linked to DPN, PDPN and non-painful DPN in type-2 diabetic patients and that HbA1c might be used as a predictive marker for DPN with PDPN and non-painful DPN in the patients studied. J. Bio-Sci. 29(2): 123-138, 2021 (December)