Presence Of Neuropathy Research Articles

Amazon Amandaba-Prevalence, Risk Factors and Self-Care Perception Associated with Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes: A Cross-Sectional Study.

Diabetic peripheral neuropathy (DPN) is one of the most common complications of type 2 diabetes mellitus. There is a gradual loss of protective sensation in the skin and the function of the foot joints, increasing the risk of injury as the disease progresses. The objective of this study was to verify whether socioeconomic factors, health risk factors, and self-care are associated with DPN. Observational cross-sectional with 228 individuals of ≥30 years in Family Health Strategies in a city in the eastern Amazon, in northern Brazil, using questionnaires containing socioeconomic information, clinical and laboratory parameters, the Summary of Diabetes Self-Care Activities Questionnaire, and the Michigan Neuropathy Screening Instrument. The prevalence of DPN was 66.6%. The presence of neuropathy is associated with male gender, dyslipidemia, and increased microalbuminuria. Logistic regression analysis revealed male subjects' increased BMI and altered HDL levels were associated with DPN. In men with altered BMI, and dysregulation in biochemical parameters, neuropathy is more prevalent.

Vitamin B12 Status in Long-Term Metformin Treated Type 2 Diabetes Mellitus Patients

Background: The association between long-term use of metformin and low vitamin B12 levels in patients with type 2 diabetes mellitus (T2DM) has been proven. However, the prevalence among metformin induced vitamin B12 deficiency in T2DM patients showed considerable variations among the studies. The potential of deficiency to cause new onset or worse preexisting peripheral neuropathy in T2DM patients has been investigated with conflicting results.The objective of this study is to determine the frequency of vitamin B12 deficiency among patients with T2DM patients on metformin therapy compared to those who are not taking metformin. Methods: This crosssectional analytical study was conducted at the Department of Medicine, in Sylhet M. A. G. Osmani Medical College &Hospital, Sylhet. Total 100 patients’ withT2DM were selected according to inclusion and exclusion criteria following informed written consent. They were divided into two groups; each groups contains 50 patients. Group-I included patients who were taking metformin for e”1 year and Group-II included patients who were not taking metformin for at least 1 year. Detailed history taking, proper clinical examinations and relevant investigations were done. After collection of all the required data, final analysis was carried out by using the SPSS version 22.0. Results: Among 100 patients of T2DM, mean age were 55.4±15.62 and 55.24±16.76 years, respectively among Group- I and Group-II. They were similar in terms of demographic profile. About 16.0% patients of group- I had vitamin B 12 deficiency and 6.0% had vitamin B 12 deficiency in Group-II. The mean serum Vitamin B 12 was 481.52±283.37 (pgm/mL) in group-I and 600.85±294.2 (pgm/mL) in group-II. The difference of serum Vitamin B 12 was statistically significant (p<0.041) between two groups. Reduced vitamin B 12 also found to be positively associated with duration of metformin intake (p<0.05) and presence of neuropathy (p<0.05). Conclusion: Metformin is significantly associated with decrease the level of vitamin B12. Bangladesh J Medicine 2022; 33: 43-48

Distal symmetrical polyneuropathy is present in all individuals with diabetes and foot ulcers - and does not associate with healing time

We estimated the occurrence of diabetic neuropathy using six different diagnostic modalities in individuals with newly diagnosed diabetic foot ulcers (DFUs) and assessed the association with DFU healing time. All individuals with DFU had distal symmetrical polyneuropathy. Presence of neuropathy did not associate with ulcer healing time (p ≥ 0.12).

Chemotherapy-Induced Peripheral Neuropathy (CIPN) in Patients Receiving 4-6 Cycles of Platinum-Based and Taxane-Based Chemotherapy: A Prospective, Single-Center Study from Kosovo.

BackgroundChemotherapy-induced peripheral neuropathy (CIPN) is most commonly associated with platinum-based drugs, taxanes, and vinca alkaloids. This prospective study from a single center in Kosovo aimed to evaluate CIPN in 120 patients receiving 4–6 cycles of platinum-based and taxane-based chemotherapy.Material/MethodsOne hundred twenty patients underwent neurological examination and nerve conduction studies (NCS) before chemotherapy, and after 4 to 6 cycles of treatment. Sixty patients were treated with platinum-based chemotherapy, 30 were treated with taxane-based chemotherapy, and 22 patients received a combination of platinum- and taxane-based chemotherapy. The most commonly used platinum-based compounds were oxaliplatin and carboplatin, whereas the most commonly used taxane medications were paclitaxel and docetaxel. Presence of neuropathy was confirmed with neurological examination of electrophysiological criteria applicable for polyneuropathies. Total Neuropathy Score (TNSr) was used to combine clinical and electrophysiological values.ResultsAround 90% of patients self-reported neuropathic symptoms, and in 60% of them polyneuropathy was present in NCS. All sensory and motor nerves had significantly lower amplitudes (P<0.01). Platinum-based agents caused more pronounced decrease in ulnar nerve compound motor action potential (CMAP) (P<0.05); when used solely or in combination with taxanes, they caused significant decrease in tibial nerve CMAP (P<0.01). TNSr did not reach statistical significance between groups; only clinical muscle strength showed pronounced weakness in the combined protocol (P<0.05).ConclusionsThese findings support previous studies and show that CIPN, including sensory and motor symptoms, is commonly associated with chemotherapy. Platinum-based chemotherapy agents were more commonly associated with ulnar and tibial nerve damage in this study population.

Exploring the Needs of Adults Living With Type 1 or Type 2 Diabetes Distress Using the Problem Areas in Diabetes 5 Tool

ObjectivesThis study investigated the feasibility and acceptability of implementing a screening tool as a part of routine care and the subsequent screening experiences of patients and clinicians. Additionally, potential sources of diabetes distress (DD) were identified in this clinical population. MethodsOur investigation was a cross-sectional, mixed-methods, convenience sample of 203 patients living with type 1 or type 2 diabetes from 2 Canadian tertiary hospital–based clinics. The Problem Areas in Diabetes 5 (PAID5) scale was used to assess DD. Structured telephone interviews of patients with high DD scores and care provider focus group transcriptions were analyzed using a deductive thematic content analysis. ResultsThe prevalence of DD was 45%. Lack of medication coverage (p=0.02) and presence of neuropathy (p=0.04) were approximately 5- and 2-fold more likely to be predictors of high DD, respectively. Patient interviews identified DD screening as an opportunity to share and feel supported but demonstrated their fear of discussing mental health concerns. Patients found discussion about mental health helpful and often did not require a referral to a mental health specialist. Staff focus groups discussed screening as a feasible tool, but also acknowledged barriers and knowledge gaps that preclude DD screening integration in routine clinical practice. Specialized training for clinicians may help increase confidence and improve uptake of DD screening into routine clinical practice. ConclusionsThe prevalence of DD in outpatient care settings is high. Findings suggest that integrating the PAID5 screening tool into regular clinical practice is feasible by patients and care providers.

Comparison of hematological parameters between type 2 diabetes mellitus patients and healthy controls at Dessie comprehensive specialized hospital, Northeast Ethiopia: Comparative cross-sectional study.

Diabetes mellitus (DM) is a chronic condition associated with raised levels of blood glucose due to the body cannot produce any or enough insulin hormone or cannot be effectively utilized the produced insulin by the body. Patients with poorly controlled diabetes show a significant alteration in various parameters including metabolic, cellular, immunological, and hematological disturbances that leads to vascular complications. Thus, the main aim of this study is to compare hematological parameters between type 2 diabetes mellitus (T2DM) patients and healthy controls. A comparative cross-sectional study was conducted in Dessie comprehensive specialized hospital from January to June 2021. A total of 240 study participants consisting of 120 T2DM patients and 120 healthy controls were recruited using a systematic random sampling technique. Hematological parameters were determined using the DIRUI BF6500 automated hematology analyzer. Independent T-test was used to compare the mean of hematological parameters between T2DM patients and healthy controls. Pearson correlation test was used to determine the correlation between FBG, BMI, SBP, DBP, and hematological parameters in T2DM patients. Multivariate logistic regression was used to assess the association between socio-demographic and clinical variables with anemia. The result was expressed in mean and standard deviation and presented in texts and tables. P-value < 0.05 was considered to be statistically significant. The mean and standard deviation of monocyte count, basophil count, monocyte %, basophil %, RBC count, hematocrit, MCV, MCH, RDW-SD, MPV, PDW, PLC-R, and plateletcrit showed a significant difference between T2DM patients and healthy control group. Pearson correlation coefficient showed that the total WBC count, neutrophil count, monocyte count, basophil count, RDW-CV, PDW, MPV, PLC-R, and plateletcrit were statistically positively correlated with FBG whereas RBC count, Hgb, hematocrit, MCV, MCH, and RDW-SD were statistically negatively correlated with FBG in T2DM patients. Moreover, total WBC count, neutrophil count, monocyte count, basophil count, Hgb, and plateletcrit were statistically positively correlated with BMI while RBC count, Hgb, hematocrit, MCV, MCH, and RDW-SD were statistically negatively correlated with BMI in T2DM patients. On the other hand, DBP was significantly positively correlated with platelet count and RDW-CV whereas SBP also significantly positively correlated with total WBC count, neutrophil count, basophil count, and PDW. Besides, DBP and SBP showed statistically significant negative correlations with RBC count, Hgb level, and Hct value in T2DM patients. The overall prevalence of anemia was 25.8% in T2DM patients with a higher prevalence of anemia (16.7%) in female patients. Multivariate logistic regression revealed that being non-employee worker (AOR: 3.6, 95% CI, 1.4-46.0, P = 0.002), presence of neuropathy (AOR: 13.40, 95% CI, 6.83-26.28, P = 0.00), and duration of the disease ≥ 5 years (AOR = 3.2, 95% CI, 1.2-15.3, P = 0.03) have had statistically significant association with anemia inT2DM patients. Patients with T2DM may have significant alterations in various hematological parameters. Hematological parameters should be regularly tested for early diagnosis and proper management of diabetes-related complications.

Diabetic foot ulcer in Southern Jordan: A cross-sectional Study of Clinical and Microbiological Aspects

BackgroundDiabetes mellitus (DM) is a common metabolic disorder that significantly affects public health. Diabetic foot ulcer (DFU) is one of the serious complications of diabetes. DFU has a wide spectrum of bacterial isolates comprising Gram-positive, Gram-negative, aerobic bacteria and anaerobes. In the last two decades there has been an increase in the multidrug-resistant isolates (MDR). Materials and methodsThis cross-sectional prospective observational study was conducted in southern Jordan among patients with DFU. The included variables are sociodemographic and clinical information. Isolates from swab culture of ulcers and antimicrobial susceptibility pattern are also recorded. ResultsA total of 64 diabetic patients with DFU were included in this study. Most patients included in the study were males with male-to-female ratio of (2.2:1). The mean age was 54 years (SD ± 10.7). The mean duration of DM was 16.4 years (SD ± 7.5) and the mean HbA1c was 9.9% (SD ± 2.1). Neuropathy and anemia were noted in 72% and 44% of patients, respectively. The most frequent bacterial isolates were gram negative bacteria accounts for 29 isolates (45.3%). About 37.5% (24) of bacterial isolates showed MDR pattern. Previous antibiotic use in the last 30 days showed significant association with MDR bacteria (p-value <0.05). Previous history of amputations, presence of neuropathy, renal impairment, retinopathy, presence of anemia, limited joint mobility and presence of foot deformity were significantly associated with Wagner's grade ≥ three. ConclusionMany factors affect and increase the risk of having high grade diabetic foot ulcer. The most frequent bacterial isolates from diabetic foot ulcers were gram negative bacteria. High rates of MDR in this study reflect the loose implementation of regulations in Jordan regarding antibiotics dispensing.

Synthesis and evaluation of wound healing properties of hydro-diab hydrogel loaded with green-synthetized AGNPS: in vitro and in ex vivo studies

In diabetic patients, the presence of neuropathy, peripheral vascular diseases and ischemia, leads to the formation of foot ulcerations with a higher risk of infection because the normal response to bacterial infection is missing. In the aim to control and treat diabetic foot ulcerations (DFUs), wound dressings that are able to absorb exudate, to prevent infections, and to promote wound healing are needed. For this reason, the aim of the present research was to synthetize a biocompatible hydrogel (called HyDrO-DiAb) composed of carboxymethylcellulose loaded with silver nanoparticles (AgNPs) for the treatment of diabetic foot ulcers. In this study, AgNPs were obtained by a green synthesis and, then, were dissolved in a CMC hydrogel that, after a freeze drying process, becomes a flexible and porous structure. The in vitro and in ex vivo wound healing activity of the obtained HyDrO-DiAb hydrogel was evaluated.Graphical abstract

STUDY OF FACTORS INFLUENCING MAJOR AMPUTATION IN DIABETIC FOOT

Introduction Diabetes becoming progressively dominant global due to decreased physical activity, westernizing food behaviours, obesity; consequently, rising the diabetic foot incidence. Patients with diabetes predicted to have 25% possibility of getting at least a single episode of diabetic foot ulcer through their lifespan further ulcer progress and ends in Amputation .The main aim of study is to determine various factors that are inuencing Major amputation in diabetic foot Methodology Prospective observational study of diabetic patients undergoing amputation in JSS hospital Mysore over period of 18 months with sample size of 45 was done. Data was collected from patients by History taking, clinical examination and relevant investigations. Factors like age, duration of diabetes, previous history of amputation, smoking were collected from patient. Arterial insufciency, neuropathy were assessed by Peripheral pulse, ABPI and monolament test respectively. Investigations like HBA1c, Haemoglobin, serum albumin ,Renal function test ,Xray were obtained. After collection of data statistical analysis was made by mean, median, SD, proportion and Inter-quartile range q1 -q3 and determine various factors inuencing amputation in diabetic foot Result Total of 45 patients undergoing amputation were studied of which Gender, Smoking, Previous history of minor amputation, Elevated HBa1c, Presence of neuropathy, Vasculopathy, Hypo albuminemia were statistically signicant Conclusion In this study history of smoking, history of minor amputation, Elevated HBa1c, Presence of neuropathy, Vasculopathy, Hypo albuminemia are signicant factors inuencing/ Predicting amputation in Diabetic patients

Gastrocolic Reflex Is Delayed and Diminished in Adults with Type 1 Diabetes.

Constipation is a prevalent gastrointestinal complication in diabetes. The pathophysiology may include neural dysfunction and impaired gastrocolic reflex; however, investigation of the latter has been limited in diabetes. Using the wireless motility capsule, we investigated whether the gastrocolic reflex was impaired in adults with type 1 diabetes compared to healthy. One hundred and four adults with type 1 diabetes underwent investigation with the wireless motility capsule and recorded sleep cycle, eating habits, and bowel movements in a diary. Colonic motility index, contraction amplitudes, time-to-peak, peak motility, and colonic transit time were investigated directly in response to a meal. Diagnosis of peripheral (nerve conduction) and autonomic (orthostatic hypotension) polyneuropathy was verified. In comparison with health, people with diabetes had at the time of ingestion decreased motility index and contraction amplitudes (p < 0.001), prolonged time-to-peak (p = 0.01), and borderline decreased peak motility (p = 0.06), which taken together indicate impaired coordination of the gastrocolic reflex. These features were most prominent in those with concomitant peripheral or autonomic neuropathy. Additionally, they were associated with prolonged colonic transit time (p > 0.01). In type 1 diabetes, the gastrocolic reflex was delayed and diminished and further associated with the presence of neuropathy and constipation. These results suggest that impaired reflex is part of the underlying pathogenesis in the development of constipation.

Reflux, dysphonia, and dysphagia symptoms in patients with diabetes and their association with diabetic complications.

Diabetes mellitus (DM) could influence various organs, especially the eyes, kidneys, nerves, heart, and blood vessels, and finally results in many irreversible disease-related complications. In this paper, the association between reflux, swallowing, and voice symptoms in patients with DM and the possible effect of diabetic complications on these symptoms were investigated. A total of 179 patients with diabetes were included to the study. Three self-reported questionnaires; Reflux Symptom Index (RSI), Eating Assessment Tool-10 (EAT-10), and Voice Handicap Index-10 (VHI-10) were administrated to the patients and, their association with DM-related neuropathy and nephropathy were examined. The scores of each questionnaire were significantly correlated with each other (p < 0.001). There was not any statistically significant association between the score of T-RSI and the diabetic complications (p = 0.077), while a statistically significant association was found between the T-EAT-10 score and neuropathy (p < 0.001). Neither neuropathy nor nephropathy alone had an association with the T-VHI-10 score. However, the presence of nephropathy and neuropathy together was found to be associated with the T-VHI-10 score (p = 0.027). It is possible to conclude that gastrointestinal symptoms such as reflux, dysphonia, and dysphagia are associated with each other and they may possibly be related to the microvascular complications of DM. The clinicians should be aware of the possible reflux, voice, and swallowing complaints and also inquire about the presence of neuropathy and nephropathy in the diabetic population.

AACE2021-A-1081: Prevalence and Risk Factors for Urinary Incontinence Among Women with Diabetes in Taif City, Saudi Arabia

Urinary incontinence is a detected complication of diabetes mellitus. Studies about UI among diabetic women in Saudi Arabia are limited. The aim of this study was to assess the prevalence of UI in women with diabetes in Taif city, Saudi Arabia and to determine its risk factors. A cross-sectional study was done on 398 diabetic women who attended the diabetes clinic at Prince Mansour Military Hospital, Taif city, Saudi Arabia. A checklist was used gathering data about socio-demographic characteristics, type and duration of diabetes, chronic diseases, parity, BMI, presence of neuropathy, retinopathy and nephropathy, level of HbA1c and fasting blood glucose (FBG). The prevalence of UI was 34%. In the last four weeks, 48.9%, 25.9%, 6,7%, 12.6% and 34.1% of studied women had frequent urination, urine leakage drops, difficulty in urinating or emptying, pain or discomfort in lower abdomen, leakage related to urgency, and leakage related to physical activity, respectively. Among them, 11.1%, 11.9%, 12,6%. 19.3%, 15.6%, 19.3%, and 20.7% suffered effects of UI on the ability to do household chores, physical recreation, entertaining activities, ability to travel in car or bus more than 30 minutes, participation in social activities outside, emotional health, and feeling frustrated, respectively. Participants with an age ≥ 50 year, and having DM type 2, UTI, Ovarian cyst, and neuropathy higher levels of HbA1 and FBG, had a significantly higher percentage of those having UI. Participants’ older age and high HbA1c level were independent predictors for UI. There is a need for educating diabetic women about UI and methods of management.

Clinical and apparative investigation of large and small nerve fiber impairment in mixed cohort of ATTR-amyloidosis: impact on patient management and new insights in wild-type

Introduction Neuropathy in transthyretin (ATTR) amyloidosis is frequently underdiagnosed, delaying effective treatment. Early detection of large- and small-nerve fiber damage via a comprehensive diagnostic algorithm impacts on clinical management. Methods A mixed cohort of patients with ATTR amyloidosis (wild type-wt, hereditary-v and TTR gene mutation carriers) of the Interdisciplinary Amyloidosis Centre of Northern Bavaria underwent clinical examination, nerve conduction studies (NCS), quantitative sensory testing (QST), sympathetic skin response (SSR), quantitative sudomotor axon reflex testing (QSART), and skin punch biopsies. Results Out of 30 study participants (7 ATTRv/asymptomatic gene carriers, 23 ATTRwt) large-fiber neuropathy was found in 43% patients with ATTRv and 70% with ATTRwt. QST revealed a mixed small and large fiber impairment in all ATTRv/asymptomatic gene carriers and in 78% of ATTRwt. Autonomic tests were pathological in the majority of ATTRv and over 50% of ATTRwt patients. Skin biopsies (sampled from 19 patients) showed reduced intraepidermal nerve fiber density (IENFD) in all ATTRv/asymptomatic gene carriers and over 80% of ATTRwt. Two ATTRwt patients had a pure small fiber neuropathy. After reviewing for relevant co-morbidities, 44% of ATTRwt patients exhibited neuropathy (large and/or small fiber) without evidence of any other underlying cause. Disease manifestation in the peripheral nervous system was newly diagnosed in three ATTR gene mutation carriers, thereby influencing clinical management. Conclusion This comprehensive test program gives new insights regarding the presence of neuropathy in ATTRv and ATTRwt, which impact on patient management.

Correlation of Peak Systolic Velocity Value with Wagner Score in Diabetic Foot Ulcer patients in RSUP Dr. M. Djamil Padang

Background: Diabetic foot ulcers are one of the chronic complications of diabetes mellitus (DM) in the form of wounds on the skin surface of the feet of DM patients accompanied by internal tissue damage or tissue death, either with or without infection, which is associated with the presence of neuropathy and or peripheral arterial disease in patients with DM. The World Health Organization (WHO) states that at least 422 million people suffer from DM A new alternative parameter for assessing the degree of peripheral ischemia is ankle peak systolic velocity (PSV). The rationale for PSV is based on the observation that in the ischemic limb, blood travels at a much slower rate in the distal leg arteries than in the nonischemic limb. PSV is a quick and easy test to assess the patient's vascular status and monitor the development of diabetic foot ulcers, and can assess the degree of ischemia and predict healing of diabetic foot ulcers. This study aims to determine the Correlation of Peak Systolic Velocity Value with Wagner Score in Diabetic Foot Ulcer patients in RSUP Dr. M. Djamil Padang.&#x0D; Methods: This research is analytic observational with cross sectional design, the research uses primary data. This research will be conducted at the RSUP Dr. M. Djamil Padang from July 2021 to October 2021. The population in this study were diabetic foot ulcer patients who came for treatment at Dr. M. Djamil Padang. A sample of 32 patients Diabetic foot ulcer met the inclusion criteria. Univariate analysis was conducted to describe each of the variables studied. Numerical data is normally distributed, then it is presented in the form of mean ± standard deviation (SD), whereas if the numerical data is not normally distributed then it is presented in the form of median, minimum and maximum. Categorical data is presented in the form of frequency and percentage of each category. Bivariate analysis was started by using the data normality test using the Shapiro Wilk test (n&lt;50). In testing the correlation between Peak Systolic Velocity and Wagner Score in diabetic foot ulcer patients, the Pearson correlation test is used if the data is normally distributed. Data analysis using SPSS version 22.0.&#x0D; Results: more than half of the subjects (65.6%) are male. The mean age of the subjects was 60.46±10.06 years. More than half of the subjects (62.5%) had a normal body mass index. The average length of suffering from diabetes mellitus was 5.48 ± 2.26 years. Half had a history of smoking (59.4%), a small proportion of subjects had hypertension (21.9%), hypercholesterolemia (6.3%) and neuropathy (12.5%). More than half of the subjects (53.1%) had immunopathies. There is a correlation between the popliteal PSV value and the Wagner score in diabetic ulcer patients (p&lt;0.05), with a moderate correlation strength (r=-0.463) and a negative direction. There is a correlation between the PSV dorsali pedis value and the Wagner score in diabetic ulcer patients (p&lt;0.05), with a strong correlation strength (r=-0.720) and in a negative direction. Furthermore, there is a correlation between the posterior tibial PSV value and the Wagner score in diabetic ulcer patients (p&lt;0.05), with a moderate correlation strength (r=-0.530) and a negative direction.&#x0D; Conclusion: There is a correlation between the popliteal, tibialis posterior, dorsalis pedis PSV value and the Wagner score in diabetic foot ulcer patient

Нейропатическая боль на ранних этапах химиотерапии у детей с острыми лейкозами. Эффективность обезболивающей терапии и сроки астенизации

Актуальность. Проблема нейропатической боли у детей приобретает все большую актуальность вследствие роста распространенности патологии и трудности в достижении терапевтического эффекта. Нейропатическая боль в детской онкологии может возникнуть в результате различных повреждений соматосенсорной системы. В Украине в настоящее время нет проведенных исследований касательно нейропатической боли у детей с гемобластозами на ранних этапах лечения. Именно поэтому наше исследование направлено на решение вопроса о ранней реализации нейропатии и улучшении обезболивающей терапии. Цель исследования. Проведение анализа болевого синдрома у детей с гемобластозами на первом этапе химиотерапии и сравнение эффективности различных методов обезболивания, определение взаимосвязи методов обезболивания и степени астенизации. Материалы и методы. Проведено когортное проспективное исследование, в которое вошли 60 детей с впервые диагностированными гемобластозами в возрасте от 6 до 18 лет. Все дети были разделены на три группы в зависимости от степени выраженности болевого синдрома. І группа (n = 20) — дети, у которых интенсивность боли по ВАШ составила ≥ 7 баллов и которым с целью обезболивания вводился морфин. II группа (n = 20) — дети с интенсивностью боли ≥ 7 баллов, которым с целью обезболивания вводился морфин в комбинации с габапентином. III группа (n = 20) — дети с интенсивностью боли ≤ 6 баллов, которым с целью обезболивания вводился парацетамол в сочетании с габапентином. 40 детям проведено исследование венозной крови на активность супероксиддисмутазы (СОД) и каталазы, содержание сиаловых кислот (СК) и малонового диальдегида (МДА). Проводилось определение интенсивности боли, наличия нейропатии и астении на 1-е сутки поступления в отделение анестезиологии и интенсивной терапии, далее — на 30, 64 и 78-е сутки химиотерапии. Результаты. При определении нейропатии на 1-е сутки манифестации боли у 8 детей (13 %) результат был отрицательный, у 48 детей (80 %) — сомнительный и у 4 детей (7 %) — положительный. На 30-е сутки химиотерапии у 2 детей (3 %) данные о нейропатии негативные, у 56 детей (91 %) — сомнительные и у 4 детей (6 %) — положительные. На 64-е и 78-е сутки химиотерапии данные о нейропатии были одинаковыми и у 53 детей (88 %) являлись сомнительными, а у 7 (12 %) — положительными. В результате биохимического исследования крови обнаружены признаки оксидативного стресса: активность СОД ниже нормы в 35,4 раза, количество МДА и СК превышает норму в 7,5 и 1,8 раза соответственно. Интенсивность боли по ВАШ на 30-е сутки составляла в I группе ≤ 5 баллов, в II группе ≤ 4 баллов и в III группе ≤ 3 баллов. На 78-е сутки интенсивность боли в I группе составляла ≤ 5 баллов, во II и III группах ≤ 3 баллов. Выраженная астения отмечалась у 6 детей (10 %), умеренная — у 45 детей (75 %) и реакция утомления — у 9 детей (25 %). Выводы. Формирование нейропатического компонента боли начинается уже на 1-м этапе химиотерапии, следовательно, применение габапентина в комплексной терапии боли является целесообразным. Тщательный мониторинг боли позволяет вовремя выявить наличие болевого синдрома и более точно корректировать обезболивающую терапию для достижения положительного эффекта.

The Effect of Neuropathy and Diabetes Type on Multisegment Foot Kinematics: A Cohort Study on 70 Participants with Diabetes

While lower limb biomechanics of people with diabetes are well described, the effects of diabetes type and of peripheral neuropathy on foot joint kinematics have not been addressed in depth. A total of 70 patients with type 1 (n = 25) and type 2 (n = 45) diabetes mellitus, with and without peripheral neuropathy, underwent functional evaluation via gait analysis using an established multisegment foot kinematic model. ANCOVA was performed to assess differences in foot joints’ range of motion (ROM) between groups with diabetes and a control group by accounting for the effects of age, body mass index (BMI) and normalized walking speed. Statistical parametric mapping was used to assess differences in temporal patterns of foot joint motion across normalized gait cycle. Small but significant correlations were found between age, BMI, speed and foot joints’ ROM. Regardless of diabetes type and presence of neuropathy, all subgroups with diabetes showed limited ROM at the midtarsal and tarsometatarsal joints. Increased midtarsal joint dorsiflexion and adduction was associated with increased tarsometatarsal joint plantarflexion. After accounting for the effect of covariates, diabetes is associated with reduced ROM and to alterations of the kinematic patterns, especially at the midtarsal and tarsometatarsal joints, irrespective of type and neuropathy.

Relationship Between Time in Range, Glycemic Variability, HbA1c, and Complications in Adults With Type 1 Diabetes Mellitus.

Real-time continuous glucose monitoring (RT-CGM) provides information on glycemic variability (GV), time in range (TIR), and guidance to avoid hypoglycemia, thereby complimenting HbA1c for diabetes management. We investigated whether GV and TIR were independently associated with chronic and acute diabetes complications. Between September 2014 and January 2017, 515 subjects with type 1 diabetes using sensor-augmented pump therapy were followed for 24 months. The link between baseline HbA1c and CGM-derived glucometrics (TIR [70-180 mg/dL], coefficient of variation [CV], and SD) obtained from the first 2 weeks of RT-CGM use and the presence of complications was investigated. Complications were defined as: composite microvascular complications (presence of neuropathy, retinopathy, or nephropathy), macrovascular complications, and hospitalization for hypoglycemia and/or ketoacidosis. Individuals with microvascular complications were older (P < 0.001), had a longer diabetes duration (P < 0.001), a higher HbA1c (7.8 ± 0.9 vs 7.5 ± 0.9%, P < 0.001), and spent less time in range (60.4 ± 12.2 vs 63.9 ± 13.8%, P = 0.022) compared with those without microvascular complication. Diabetes duration (odds ratio [OR] = 1.12 [1.09-1.15], P < 0.001) and TIR (OR = 0.97 [0.95-0.99], P = 0.005) were independent risk factors for composite microvascular complications, whereas SD and CV were not. Age (OR = 1.08 [1.03-1.14], P = 0.003) and HbA1c (OR = 1.80 [1.02-3.14], P = 0.044) were risk factors for macrovascular complications. TIR (OR = 0.97 [0.95-0.99], P = 0.021) was the only independent risk factor for hospitalizations for hypoglycemia or ketoacidosis. Lower TIR was associated with the presence of composite microvascular complications and with hospitalization for hypoglycemia or ketoacidosis. TIR, SD, and CV were not associated with macrovascular complications.

Ankle Proprioception in Patients with Type 2 Diabetes Mellitus.

Ankle position sense may be reduced before the appearance of the clinical manifestation of diabetic peripheral neuropathy. This is known to impair gait and cause falls and foot ulcers. Early detection of impaired ankle proprioception is important because it allows physicians to prescribe an exercise program to patients to prevent foot complications. Forty-six patients diagnosed as having type 2 diabetes mellitus and 22 control patients were included in the study. Presence of neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Level of foot care awareness was determined using the Nottingham Assessment of Functional Footcare (NAFF). Joint position sense was measured using a dynamometer. Mean absolute angular error (MAAE) values were significantly higher in the neuropathy group compared with the control group (P < .05). Right plantarflexion MAAE values were significantly lower in the group without neuropathy compared with the group with neuropathy (P < .05). No correlation was found between MAAE values (indicating joint position sense) and age, educational level, disease duration, glycemic control, NAFF score, and MNSI history and examination scores in the groups with and without neuropathy (P > .05). Educational level and disease duration were found to be correlated with NAFF scores. Increased MNSI history scores and increased deficits in ankle proprioception demonstrate that diabetic foot complications associated with reduced joint position sense may be seen at an increased rate in symptomatic patients.

425-P: Association between Neuropathy and Periodontitis among Type 2 Diabetes Patients

Introduction: Among the oral mucosal infections such as Periodontal Diseases, (PD) there is a strong correlation between systemic metabolic conditions such as type 2 diabetes (T2D). Moreover, there is growing evidence that Diabetic Neuropathy (DN) is associated with increased risk for foot ulceration. However, little is known how DN would correlate with the PD status. Aim: The aim of this study was to determine how the diabetes status as exemplified by the state of HbA1c levels and DN would correlate with the status of PD. Materials and Methods: T2D patients with and without PD, who visited the dental department of a diabetes hospital were included in the study. Patients without PD (n = 494) and with PD (n = 493) were recruited based on probing depth of >4mm/clinical attachment loss of >3mm (mild to moderate PD) according to the diagnostic criteria of the American Academy of Periodontology. Body mass index, fasting blood glucose, postprandial blood glucose and HbA1c were measured. Neuropathy was assessed by biothesiometry. Results: There was a significant difference in the age, duration of diabetes, glycemic levels and presence of neuropathy between the 2 groups (Table). In the regression analysis, neuropathy was highly significant (p Conclusion: The study shows a strong association between PD and DN among T2D patients. Disclosure R. Vinitha: None. A. Ramachandran: None. M. Muthukuru: None. K. Satheesh: None. R. Yogalakshmi: None. A. Rajeswari: None. L. Sundar: None. A. Nanditha: None. A. Raghavan: None. C. Snehalatha: None. Funding India Diabetes Research Foundation

Sexual Dysfunction in Women with Diabetes: Prevalence and Associated Factors in The Diabetes Center in Cotonou - Benin

Diabetic complications occur in both sexes but impaired sexual function in people with diabetes, largely debated in men, is less documented in women. Objective: The aim of the study was to evaluate the prevalence of sexual dysfunction in women with diabetes and to investigate associated factors. Patients and Methods: In a cross-sectional study, Women living with diabetes attending the outpatient diabetes center of Cotonou completed the validated questionnaires of the Female Sexual Function Index. After clinical examination, Medical records of patients were consulted to complete information on the diabetes, its control and complications. Square Chi test was used for statistical analysis. Difference observed were considered significant for p&lt;0.05. Results: A total of 184 women with diabetes were included in the study. Mean age of patients was 52.9 ± 10.3 years with extremes of 24 and 80 years. The mean duration of the diabetes was 6.9 ± 5.8 years (extremes: one month and 27 years. The prevalence of sexual dysfunction was 84.2% (155/184). Factors associated with high prevalence of sexual dysfunction were age of patient higher or equal to 50 years (p=0.003), low instruction level (p=0.03), low monthly income (p=0.04), Parity or gestity higher or equal to 4 (p=0.01), high blood pressure (p=0.0001), the presence of neuropathy (p=0.013), diabetes duration higher or equal to 5 years (p=0.007). There was no association of sexual dysfunction with body mass index or with central obesity. In multivariate analysis, only diabetes duration and gestity remained significantly associated with sexual dysfunction. Conclusion: Sexual function impairment is very frequent in women with diabetes but not often investigated. It can constitute a major cause of alteration of quality of life. More attention must be paid to this condition in clinical practice.