Peripheral Neuropathy In Type Research Articles

Association of vitamin D deficiency and subclinical diabetic peripheral neuropathy in type 2 diabetes patients.

Diabetic peripheral neuropathy (DPN) contributes to disability and imposes heavy burdens, while subclinical DPN is lack of attention so far. We aimed to investigate the relationship between vitamin D and distinct subtypes of subclinical DPN in type 2 diabetes (T2DM) patients. This cross-sectional study included 3629 T2DM inpatients who undertook nerve conduction study to detect subclinical DPN in Zhongshan Hospital between March 2012 and December 2019. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25(OH)D) level < 50 nmol/L. 1620 (44.6%) patients had subclinical DPN and they were further divided into subgroups: distal symmetric polyneuropathy (DSPN) (n=685), mononeuropathy (n=679) and radiculopathy (n=256). Compared with non-DPN, DPN group had significantly lower level of 25(OH)D (P < 0.05). In DPN subtypes, only DSPN patients had significantly lower levels of 25(OH)D (36.18 ± 19.47 vs. 41.03 ± 18.47 nmol/L, P < 0.001) and higher proportion of vitamin D deficiency (78.54% vs. 72.18%, P < 0.001) than non-DPN. Vitamin D deficiency was associated with the increased prevalence of subclinical DPN [odds ratio (OR) 1.276, 95% confidence interval (CI) 1.086-1.501, P = 0.003] and DSPN [OR 1. 646, 95% CI 1.31-2.078, P < 0.001], independent of sex, age, weight, blood pressure, glycosylated hemoglobin, T2DM duration, calcium, phosphorus, parathyroid hormone, lipids and renal function. The association between vitamin D deficiency and mononeuropathy or radiculopathy was not statistically significant. A negative linear association was observed between 25(OH)D and subclinical DSPN. Vitamin D deficiency maintained its significant association with subclinical DSPN in all age groups. Vitamin D deficiency was independently associated with subclinical DSPN, rather than other DPN subtypes.

Association of serum NF-κB levels with peripheral neuropathy in type 2 diabetes mellitus patients: a pilot study.

Hyperglycaemia-induced inflammation plays a vital role in the development of diabetic peripheral neuropathy (DPN). Recent evidences had reported the involvement of the transcription factor nuclear factor kappa-light-chain-enhancer of activated Bcell (NF-κB) in diabetic experimental models. So, this pilot study aimed to evaluate serum NF-κB levels in DPN patients. We recruited 50 T2DM patients, of which 25 were T2DM with neuropathy and 25 were T2DM without neuropathy. In all the participants peripheral neuropathy was diagnosed based on Total neuropathy score (TNS). Serum NF-κB levels were measured by ELISA. We observed that the serum NF-κB levels were higher in DPN patients in comparison to T2DM patients without neuropathy. On spearman correlation, a positive correlation was found between serum NF-κB levels and TNS in the DPN group (r=0.741, p<0.001). The regression model shows the TNS to be an independent determinant of serum NF-κB levels after adjustment for potential confounders like age, duration of diabetes, and HbA1C (B=81.34; p<0.001). NF-κB activation plays a key role in promoting inflammation which is associated with the progression of DPN. In this respect, the study of NF-κB levels in serum may be an additional diagnostic marker for DPN.

Association between phase angle and diabetic peripheral neuropathy in Type 2 diabetes patients.

Diabetic peripheral neuropathy (DPN), the very prevalent microvascular complication of type 2 diabetes mellitus (T2DM), severely threatens the quality of life of diabetic patients. Thus, prevention of DPN is extremely important for public health, and the identification of potential biomarkers may help with early prevention. Our work determined the association between phase angles (PhAs) and the risk of DPN in T2DM patients. This cross-sectional study recruited 697 T2DM patients from the Third Affiliated Hospital of Soochow University. All patients were divided into the non-diabetic peripheral neuropathy group and diabetic peripheral neuropathy group, and the DPN group was further divided into low, medium, and high diabetic foot ulcer risk groups according to vibration perception threshold results. Using univariate and multivariate logistic regression analyses continuously, the relationship between PhAs (arms, legs, trunk, and whole body) and the risk of DPN were evaluated. Further analysis was conducted on different subgroups of the study population. After adjusting for the potential covariates, multivariate logistic regression analyses indicated that PhAs of the arms, legs, and whole body correlated inversely with the risk of DPN. However, the PhA of the trunk had no significant correlation with DPN. According to the stratified subgroup analysis, the negative association between PhA of the whole body and the risk of DPN remained significant in the sex and BMI group except for participants with BMI ≥ 28 kg/m². For the first time, PhAs were acknowledged to be independently associated with DPN. Further exploration is needed to explain the findings.

Serum SARM1 Levels and Diabetic Peripheral Neuropathy in Type 2 Diabetes: Correlation with Clinical Neuropathy Scales and Nerve Conduction Studies and Impact of COVID-19 vaccination.

Patients with peripheral neuropathy with type 2 diabetes mellitus (T2DM) are more likely to have functional impairments. Recently, the gene for serum sterile alpha and toll/interleukin receptor motif-containing protein 1 (SARM1), which may contribute to the pathogenesis of Wallerian degeneration, was discovered in mice models of peripheral neuropathy. We set out to assess serum SARM1's activity as a potential biomarker for the early identification of diabetic peripheral neuropathy in T2DM patients while also examining the impact of the COVID-19 vaccine on SARM1 levels. We assessed the cross-sectional relationships between the SARM1 biomarker, clinical neuropathy scales, and nerve conduction parameters in 80 participants aged between 30 years and 60 years. The analysis was carried out after the patients were split into two groups since we discovered a significant increase in SARM1 levels following the second dose of the COVID-19 vaccination, where group A received one dose of the COVID-19 vaccine inoculation, and group B received two doses of the COVID-19 vaccine. SARM1 was correlated significantly (p < 0.05) with MNSIe and NSS in group A and showed a consistent positive correlation with the other neuropathy clinical scales in group A and group B without reaching statistical significance. Additionally, SARM1 was negatively correlated significantly (p < 0.05) with the median sensory amplitude in group A and showed a consistent negative correlation with the six other sensory and motor nerves' potential amplitude in group A and group B without reaching statistical significance. In conclusion, SARM1 showed a consistent correlation with clinical neuropathy scales and nerve conduction parameters after accounting for the influence of COVID-19 vaccination doses.

Neuropathic Pain With and Without Diabetic Peripheral Neuropathy in Type 1 Diabetes.

Diabetic peripheral neuropathy (DPN) is common; however, the features and burden of neuropathic pain (NP) in type 1 diabetes (T1D) are poorly understood. We evaluated the incidence of first occurrence, annual prevalence, remission, and risk factors for NP during long-term follow-up of participants with T1D. The Michigan Neuropathy Screening Instrument (MNSI) was administered annually (1994-2020) for 1,324 participants in the Epidemiology of Diabetes Interventions and Complications (EDIC) study. NP with clinical signs of DPN (NP DPN+) was defined according to self-reported NP plus an examination score >2, while NP without clinical signs of DPN (NP DPN-) was defined according to self-reported NP and an examination score ≤2. At EDIC year 1, median age for participants was 36 years (interquartile range 30, 41), diabetes duration 13 years (10, 18), and HbA1c 7.9% (7.2, 8.9). At year 26 (median diabetes duration 39 years), cumulative incidence of NP was 57%, regardless of concomitant clinical signs of DPN (36% NP DPN+ vs. 46% NP DPN-). NP prevalence was 20% at 26 years (11% NP DPN+ and 9% NP DPN-), suggesting frequent remission. Annualized remission rates were similar regardless of pain medication use. In addition to HbA1c, female sex was associated with NP DPN-. NP incidence in T1D was high and frequently occurred in the absence of clinical signs of neuropathy, as assessed with the MNSI. Pain remission was not explained by pain medication use. Effective clinical strategies for identification and management are needed.

Estimated glucose disposal rate predicts the risk of diabetic peripheral neuropathy in type 2 diabetes: A 5-year follow-up study.

Insulin resistance is associated with chronic complications of diabetes, including diabetic peripheral neuropathy (DPN). Estimated glucose disposal rate (eGDR), calculated by the common available clinical factors, was proved to be an excellent tool to measure insulin resistance in large patient population. Few studies have explored the association between eGDR and DPN longitudinally. Therefore, we performed the current study to analyze whether eGDR could predict the risk of DPN. In this prospective study, 366 type 2 diabetes (T2DM) subjects without DPN were enrolled from six communities in Shanghai in 2011-2014 and followed up until 2019-2020. Neuropathy was assessed by Michigan Neuropathy Screening Instrument (MSNI) at baseline and at the end of follow-up. After 5.91 years, 198 of 366 participants progressed to DPN according to MNSI examination scores. The incidence of DPN in the low baseline eGDR (eGDR < 9.15) group was significantly higher than in the high baseline eGDR (eGDR ≥ 9.15) group (62.37% vs. 45.56%, p = .0013). The incidence of DPN was significantly higher in patients with sustained lower eGDR level (63.69%) compared with those with sustained higher eGDR level (35.80%). Subjects with low baseline eGDR (eGDR < 9.15) had significantly higher risk of DPN at the end of follow-up (odds ratio = 1.75), even after adjusting for other known DPN risk factors. The 5-year follow-up study highlights the importance of insulin resistance represented by eGDR in the development of DPN in T2DM. Diabetic patients with low eGDR are more prone to DPN and, therefore, require more intensive screening and more attention.

Diagnostic contribution of multi-frequency vibrometry to detection of peripheral neuropathy in type 1 diabetes mellitus compared with nerve conduction studies.

The aim was to assess the use of multi-frequency vibrometry (MFV) in detecting diabetic peripheral neuropathy (DPN) in type 1 diabetes in comparison to nerve conduction studies (NCS) and neurothesiometer (NT). Our objectives were to examine how VPTs correlated with NCS parameters, evaluate the efficacy of MFV in distinguishing DPN as well as to investigate whether MFV procedure could be based on fewer frequencies. Adults with type 1 diabetes with previous MFV examinations were recruited at Skåne University Hospital in Malmö, Sweden, between 2018 and 2020. Participants were examined regarding nerve function in the lower limbs through MFV, NT and NCS. A total of 66 participants (28 women and 38 men) with a median age of 50 (39 to 64) years were included in the study. Through NCS assessment, 33 participants (50%) were diagnosed with DPN. We found negative correlations between VPTs and all NCS parameters, where the strongest correlation was found between sural nerve amplitude and the 125 Hz frequency of MFV. A combination of four frequencies, two low (4 and 8 Hz) and two high (125 and 250 Hz), showed the highest classification efficacy (AUC 0.83, 95% CI 0.73-0.93). We conclude that a strong correlation exists between the sural nerve amplitude and the VPTs at 125 Hz and that VPT testing with MFV can be focused on only four frequencies instead of seven, thus shortening test time, to distinguish DPN in the lower limb.

Risk Factors for Subclinical Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus.

To investigate the risk factors associated with subclinical diabetic peripheral neuropathy (sDPN) in patients with type 2 diabetes mellitus (T2DM). This cross-sectional, retrospective study involved 311 patients with T2DM who were successively admitted from January 2018 to December 2021 without any neurological symptoms. All participants underwent a nerve conduction study (NCS), and those asymptomatic patients with abnormal nerve conduction were diagnosed with sDPN. Differences between groups were evaluated by the chi-squared, Wilcoxon, or Fisher's exact test. Binary logistic regression analysis was performed to determine the independent risk factors for sDPN. Receiver operating characteristic (ROC) curves were constructed, and the areas under curves (AUCs) were detected. Among 311 asymptomatic patients with T2DM, 142 (45.7%) with abnormal nerve conduction were diagnosed with sDPN. Patients with sDPN significantly differed from those without diabetic peripheral neuropathy (DPN) in age, history of hypertension, duration of diabetes, anemia, neutrophil-to-lymphocyte ratio, fasting C-peptide level, serum creatinine level, and albuminuria (all p<0.05). Furthermore, the duration of diabetes (odds ratio [OR]: 1.062, 95% confidence interval [CI]: 1.016-1.110), fasting C-peptide level (OR: 2.427, 95% CI: 1.126-5.231), and presence of albuminuria (OR: 2.481, 95% CI: 1.406-4.380) were independently associated with the development of sDPN (all p<0.05). The AUCs for fasting C-peptide level, duration of diabetes, and the two factors combined were 0.6229 (95% CI: 0.5603-0.6855, p=0.0002), 0.6738 (95% CI: 0.6142-0.7333, p<0.0001), and 0.6808 (95% CI: 0.6212-0.7404, p<0.0001), respectively. For patients with T2DM and longer duration of diabetes, lower fasting C-peptide levels, and presence with albuminuria, the risk for developing DPN is higher even if they have no clinical signs or symptoms. Identifying potential risk factors for the development of sDPN and effectively controlling them early are critical for the successful management of DPN.

Evaluation of Neopterin as a Neuroinflammatory Marker for Peripheral Neuropathy in Type 2 Diabetic Patients

Background: Elevation of the marker neopterin is associated with the progression and consequences of diabetes. Although the clinical relationship between the high levels and peripheral neuropathies other than diabetic peripheral neuropathy is unknown, it has been linked to them. Objective: To evaluate the difference in serum neopterin levels between diabetic individuals who have peripheral neuropathy and those who do not. Methods: This seven-month cross-sectional study at the Diabetic Center began in December 2022 and included 126 patients with the second type of diabetes mellitus. Following verbal consent, the included patients were subjected to neurological and physical evaluations. Along with the blood pressure, the weight and height were noted. Glucose, TG, CH, HDL-c, fasting insulin, and neopterin were all analyzed using serum. Formulas were used to compute BMI, LDL-c, and VLDC. Results: When diabetic individuals with peripheral neuropathy were compared to those without, the serum levels of neopterin in the former group revealed a marginally higher level than in the latter, but this difference was not statistically significant. Conclusion: Neopterin levels were not altered in diabetic individuals with peripheral neuropathy, indicating that it is not a reliable indicator of the condition.  

Retracted: Balance Analysis of Peripheral Neuropathy in Type 2 Diabetes Mellitus Based on Logistic Regression Equation.

[This retracts the article DOI: 10.1155/2022/2113758.].

Ffectiveness of Resistance Exercise and Diabetic Foot SPA Interventions on Fasting Blood Sugar Levels and Peripheral Neuropathy in Type II Diabetes Mellitus Clients

Background: Diabetes mellitus is one disease that has a distinctive clinical sign, namely an increase in blood sugar levels beyond the normal range. DM can also cause complications such as peripheral neuropathy. Interventions that can be applied in dealing with the above problems are Resistance exercise and Diabetic Foot Spa. Objective: The purpose of this study was to determine the effectiveness of resistance exercise and diabetic foot spa on fasting blood sugar levels and peripheral neuropathy in Type II Diabetes Mellitus clients. Method: This study is a true experimental research using pre test and post test approach with control group design. Sampling was carried out using a simple random sampling technique and obtained 40 DM patients who sought treatment in the work area of the Srondol Health Center, which were divided into 2 groups (Intervention and Control). Statistical analysis Pre-Test Post-Test difference test using Paired T-Test difference test and Wilcoxon test then Inter-group difference test using Independent T-Test and Mann Whitney U-Test. Results: This study showed that there were significant differences before and after the combination treatment of Resistance exercise and Diabetic Foot Spa on fasting blood sugar levels values (p = 0.000), and peripheral sensory neuropathy responses (p = 0.031), Dorsiflexion (p = 0.003), Plantarflexion (p = 0.011), Inversion (p = 0.000), Eversion (p = 0.018), autonomic neuropathy (p = 0.108), while Resistance exercise and Diabetic Foot Spa did not have significant differences in motor neuropathy response foot deformity (p = 1,000) and autonomic neuropathy (p = 0.108). Conclusion: Resistance exercise and Diabetic foot spa interventions are effective against fasting blood sugar levels and peripheral sensory, motor neuropathy (joint area of motion) in type II diabetes mellitus clients.

Relationship among serum TIMP-1, sCD40L and peripheral neuropathy in type 2 diabetes

Purpose: To determine the correlation of serum TIMP-1 and sCD40L with peripheral neuropathy in type 2 diabetes (T2DM), and potential targets for pharmacological intervention.Methods: The study enrolled 97 subjects with T2DM. The 41 subjects with simple diabetes were classified as T2DM group, while 56 subjects with diabetic peripheral neuropathy (DPN) were included in the DPN group. A control group consisting of 50 healthy volunteers who conducted health checks during a similar time-period was also included. Clinical data and parameters were compared among the three groups, and TIMP-1 and sCD40L levels were determined. Univariate and multivariate logistic regression analyses were conducted to identify factors affecting DPN. The diagnostic value of TIMP-1 and sCD40L in DPN was also determined.Results: Body mass index (BMI) varied among the three groups (p &lt; 0.05), but age or gender were not significantly different (p &lt; 0.05). Duration of diabetes was longer in DPN group than in T2DM group (p &lt; 0.05). The study also revealed statistically significant differences in fasting blood glucose (FBS), postprandial blood glucose, and glycosylated hemoglobin among the three groups. Tissue inhibitor of metalloproteinase-1 (TIMP-1) and soluble CD40 ligand (sCD40L) were important factors that affected the occurrence of diabetic peripheral neuropathy (p &lt; 0.05).Conclusion: TIMP-1 and sCD40L levels reflect neurovascular injury in patients with diabetes, with potential as targets for pharmacological intervention for peripheral neuropathy. These findings espouse crucial clinical implications for early identification and treatment in type 2 diabetes.

THU347 Diffusion Tensor Imaging Of The Tibial Nerve Can Detect Peripheral Neuropathy In Type 2 Diabetes

Abstract Disclosure: H. Park: None. E. Oh: None. S. Park: None. H. Kim: None. D. Byun: None. Magnetic resonance imaging (MRI) has played little role for the study of peripheral nerve disease. However, recent technological advances in MRI have provided us more information about neural microstructure and higher resolution in peripheral nerves. The aim of this study is to evaluate whether diffusion tensor imaging (DTI) parameters in MRI can detect peripheral neuropathy in type 2 diabetes (T2D). In this prospective, single-center study, eight T2D patients (mean age, 62.1 ± 10.8 yr; 5 M/ 3F) with peripheral neuropathy and seven healthy controls (65.0 ± 3.3 yr, 7 F) were included. All T2D patients underwent Michigan Neuropathy Screening Instrument questionnaire and quantitative sensory testing. MRI including DTI and axial T2-weight Dixon sequence was performed for each participant. Region of interest analysis was independently performed by one radiologist on each side of tibial nerve at two levels: lower margin of adductor magnus muscle insertion (level 1), and quadriceps femoris tendon at patellar attachment (level 2). DTI parameters including cross-sectional areas (CSA), fractional anisotropy (FA), as well as diffusivity (mean (MD), axial (AD), and radial (RD)) were calculated. FA was significantly lower in T2D patients with peripheral neuropathy than healthy controls at both level 1 (396 ± 74 vs. 541 ± 141, P&amp;lt;0.05) and level 2 (422 ± 65 vs. 565 ± 108, P&amp;lt;0.05). AD was significantly lower in T2D patients with peripheral neuropathy than controls at level 2 (2,207 ± 492 vs. 2,884 ± 497, P&amp;lt;0.05). RD was significantly higher in T2D patients with peripheral neuropathy than controls at level 1 (1,156 ± 313 vs. 867 ± 147, P&amp;lt;0.05). No difference in the CSA of the tibial nerve was seen in both levels between two groups. Our results have shown that DTI parameters can detect nerve abnormalities of the tibial nerve in T2D patients, suggesting DTI may be useful as a biomarker in diabetic peripheral neuropathy. Presentation: Thursday, June 15, 2023

The effect of Tecar therapy on neurological disorders and nerve conduction velocity of lower limbs in peripheral neuropathy of type 2 diabetic patients: A six-week follow-up study

Objectives: This study aimed to investigate the effect of Tecar therapy on neuropathy symptoms and tibial nerve conduction velocity in individuals with diabetes. Patients and methods: The single-blind, randomized, sham-controlled clinical trial was conducted between January 2019 and October 2019. Twenty-four type 2 diabetics (8 males, 16 females; mean age: 60.4±8.9 years; range, 40 to 78 years) with peripheral neuropathy were randomly allocated to control (n=12) and study (n=12) groups. The study group received the capacitive Tecar therapy with 10 to 30% intensity and infrared radiation in 10 sessions. The controls received the same protocol with zero intensity. The neuropathy symptoms and nerve conduction velocity were evaluated at baseline, after 10 sessions, and six weeks after the end of sessions. Results: There were no significant differences in variables (p&gt;0.05). In this way, the homogeneity of the data variables was confirmed. Moreover, the results of two-way mixed analysis of variance showed that improvement of neuropathy symptoms in the study group was significantly more than controls in all stages (p&lt;0.001). After 10 sessions, the results of post hoc analysis showed that the neuropathy symptoms and tibial nerve conduction velocity were significantly improved in both groups (p&lt;0.001). The improvements were still present at six weeks in the study group (p&lt;0.05). However, there was no change in these outcomes after six weeks in the control group (p&gt;0.05). Conclusion: Tecar therapy could improve neuropathy symptoms and tibial nerve conduction velocity in diabetic individuals with peripheral neuropathy. Therefore, the use of this method to control the symptoms of diabetic patients can be recommended.

Urinary acrolein protein conjugates-to-creatinine ratio is positively associated with diabetic peripheral neuropathy in patients with type 2 diabetes mellitus.

Acrolein, an unsaturated aldehyde, plays a pathological role in neurodegenerative diseases. However, less is known about its effects on peripheral neuropathy. The aim of this study was to investigate the association of acrolein and diabetic peripheral neuropathy in patients with type 2 diabetes. We recruited 148 ambulatory patients with type 2 diabetes. Each participant underwent an assessment of the Michigan Neuropathy Screening Instrument Physical Examination. Diabetic peripheral neuropathy was defined as Michigan Neuropathy Screening Instrument Physical Examination score ≥ 2.5. Serum levels and urinary levels of acrolein protein conjugates were measured. Urinary acrolein protein conjugates-to-creatinine ratios were determined. Patients with diabetic peripheral neuropathy had significantly higher urinary acrolein protein conjugates-to-creatinine ratios than those without diabetic peripheral neuropathy (7.91, 95% CI: 5.96-10.50 vs 5.31, 95% CI: 4.21-6.68, P = 0.029). Logarithmic transformation of urinary acrolein protein conjugates-to-creatinine ratios was positively associated with diabetic peripheral neuropathy in univariate logistic analysis, and the association remained significant in multivariate analysis (OR = 2.45, 95% CI: 1.12-5.34, P = 0.025). In conclusion, urinary acrolein protein conjugates-to-creatinine ratio may act as a new biomarker for diabetic peripheral neuropathy in type 2 diabetes. The involvement of acrolein in the pathogenesis of diabetic peripheral neuropathy warrants further investigation.

Clinical evaluation of painful diabetes peripheral neuropathy in type 2 diabetes patients: Lessons from expatriates in the United Arab Emirates

BackgroundThe high prevalence of Type 2 Diabetes (T2D) in the United Arab Emirates makes it imperative to screen and manage diabetes peripheral neuropathy (DPN) as a priority. Considering the high number of expats from different ethnicity a more thorough approach is necessary. Unfortunately, there are very few studies addressing this issue. MethodsThe study uses the chi-square test to investigate the dependence of the progression of DNP on ethnic origin. The study uses Pearson Correlation to find the association between three prevalent scales used for the measurement of painful diabetes peripheral neuropathy. Student t-test was used further to investigate the significance of the association. ResultsWith a p-value (0.004) and p-value (0.015), the study concludes that DPN risk is dependent on the ethnic origin of the residents. The study further found that there is a significant association between three scales for measuring painful diabetes peripheral neuropathy (pDNP), Douleur Neuropathique en 4 questions (DN4), Neurological Symptoms Score (NSS), and Leeds Assessment of Neuropathic Symptoms and Signs (LANNS). The p-value for all pairwise comparisons for the strength of association between scales was found significant at the level of significance 0.05. ConclusionThe study concludes that the risk of DNP is high in Arab-origin residents in UAE and the reasons behind the finding need to be empirically tested to customize its management. The study further finds a significant association between the score of the three scales used for measuring pDNP.

Collagen turnover is associated with cardiovascular autonomic and peripheral neuropathy in type 1 diabetes: novel pathophysiological mechanism?

BackgroundDiabetic cardiovascular autonomic neuropathy (CAN) and distal symmetrical polyneuropathy (DSPN) are severe diabetic complications. Collagen type VI (COL6) and III (COL3) have been associated with nerve function. We investigated if markers of COL6 formation (PRO-C6) and COL3 degradation (C3M) were associated with neuropathy in people with type 1 diabetes (T1D).MethodsIn a cross-sectional study including 300 people with T1D, serum and urine PRO-C6 and C3M were obtained. CAN was assessed by cardiovascular reflex tests: heart rate response to deep breathing (E/I ratio), to standing (30/15 ratio) and to the Valsalva maneuver (VM). Two or three pathological CARTs constituted CAN. DSPN was assessed by biothesiometry. Symmetrical vibration sensation threshold above 25 V constituted DSPN.ResultsParticipants were (mean (SD)) 55.7 (9.3) years, 51% were males, diabetes duration was 40.0 (8.9) years, HbA1c was 63 (11 mmol/mol, (median (IQR)) serum PRO-C6 was 7.8 (6.2;11.0) ng/ml and C3M 8.3 (7.1;10.0) ng/ml. CAN and DSPN were diagnosed in 34% and 43% of participants, respectively. In models adjusted for relevant confounders a doubling of serum PRO-C6, was significantly associated with odds ratio > 2 for CAN and > 1 for DSPN, respectively. Significance was retained after additional adjustments for eGFR only for CAN. Higher serum C3M was associated with presence of CAN, but not after adjustment for eGFR. C3M was not associated with DSPN. Urine PRO-C6 analyses indicated similar associations.ConclusionsResults show previously undescribed associations between markers of collagen turnover and risk of CAN and to a lesser degree DSPN in T1D.

Vitamin B12 and diabetic peripheral neuropathy in type 2 diabetic patients

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

The Association between Waist Hip Ratio and Severity of Diabetic Peripheral Neuropaty in Diabetes Melitus Type 2 by Using Toronto Clinical Scoring System

Introduction: Diabetic neuropathy is a common and progressive microvascular complication of diabetes, so early detection and prevention is very important. Other modifiable risk factors such as hypertension, dyslipidemia, or central obesity can be managed. Central obesity with insulin resistance is a key pathophysiological factor in the metabolic syndrome. Waist hip ratio (WHR) has been proposed as a tool for detecting central obesity. Toronto Clinical Scoring System (TCSS) is a diabetic neuropathy scoring system that has high sensitivity and specificity. The aim of this study was to determine the relationship between waist hip ratio and the severity of peripheral diabetic neuropathy in type 2 Diabetes Melitus (DM) according to the Toronto Clinical Scoring System (TCSS). Method: This study used a cross-sectional design. Sampling was conducted at the Endocrinology Polyclinic and Neurology Polyclinic Hospital H. Adam Malik Medan. The research sample was taken as many as 45 subjects consecutively. TCSS examination is performed to diagnose and determine the severity of diabetic neuropathy Therefore, waist hip ratio was calculated to assess central obesity. Data analysis using Chi Square test. Results: On the demographic characteristics of the research subjects were male, age range 51-60 years, high school education level, not working, history of DM 5-10 years. The mean value of WHR is 0.87±0.051. Median TCSS Score 10 (6-16). The majority of subjects had mild diabetic peripheral neuropathy. Patients with central obesity had a grading of neuropathy that was classified as severe as many as 13 people (56.5%), moderate as many as 7 people (30.4%), and mild as many as 3 people (13.0%). While patients who are not obese have a grading of neuropathy that is classified as severe as many as 1 person (4.5%), moderate as many as 5 people (22.7%), mild as many as 16 people (72.7%). Based on the Chi Square test, it was found that there was a significant association between the waist hip ratio and the severity of diabetic peripheral neuropathy in type 2 DM patients with p&lt;0.01. Conclusion: There is a statistically significant association between waist hip ratio and the severity of diabetic neuropathy in type 2 DM with p &lt; 0.01.

Comparison of Novel Wide-Field InVivo Corneal Confocal Microscopy With Skin Biopsy for Assessing Peripheral Neuropathy in Type 2 Diabetes.

Comparison of intraepidermal nerve fiber density with automated wide-field corneal nerve fiber density in participants with type 2 diabetes revealed no correlation between these parameters. Intraepidermal and corneal nerve fibers both detected neurodegeneration in type 2 diabetes, but only intraepidermal nerve fibers were associated with clinical measures of diabetic peripheral neuropathy. A lack of association of corneal nerves with peripheral neuropathy measures suggests that corneal nerve fibers may be a poor biomarker for diabetic peripheral neuropathy.