Severity Of Diabetic Peripheral Neuropathy Research Articles

Healthcare costs and medical utilization patterns associated with painful and severe painful diabetic peripheral neuropathy.

Painful diabetic peripheral neuropathy (DPN) is a common complication in patients with diabetes. It is associated with a poor quality of life and high costs of care. This study investigated the impact of painful DPN on healthcare costs and resource utilization. This was a retrospective analysis of administrative claims of adult patients with diabetes (type 1 or 2) from Optum's de-identified Clinformatics® Data Mart Database. Patients were assigned to four cohorts by presence of DPN and pain severity, based on diagnoses and prescription patterns in a one-year baseline. All-cause and diabetes-associated costs were calculated for the year following the index DPN diagnosis. Risk factors associated with presence of severely painful DPN were evaluated. Relative to those without DPN, patients who had DPN without pain, painful DPN (PDPN), or severe PDPN incurred respective increases of $3,093, $9,349, and $20,887 in average annual all-cause costs. More than half of costs from painful/severe DPN were for prescriptions and inpatient hospitalization. Severe PDPN was associated with elevated odds of diabetic amyotrophy (OR: 8.09; 95% CI: 6.84-9.56), diabetic foot ulcers (OR: 6.54, 95% CI: 6.32-6.76), and loss of mobility (OR: 2.54, 95% CI: 2.48-2.60), among other complications. Painful DPN is associated with higher healthcare costs and resource utilization, and a greater risk of debilitating conditions that limit quality of life. Future research should focus on better treatment options and more aggressive pain management strategies to reduce the negative impacts of DPN.

Combined effects of strength and balance training versus aerobic training on balance, neuropathy symptoms and quality of life in patients with diabetic peripheral neuropathy.

Diabetic peripheral neuropathy (DPN) occurs in >50% of diabetic patients and is a high risk-factor of balance problems and risk of falls. Impaired balance can lead to reduced function, which has a detrimental effect on patients' quality of life. Structured strength and balance training can result in sustained improvements in muscle strength, coordination, balance, functional status and quality of life. To determine the combined effects of strength and balance training versus aerobic training on balance, severity of symptoms of DPN, and quality of life in patients with DPN. This double blinded, two arm parallel design Randomized Clinical Trial. The study was conducted from March to December 2020 in the AIMS diabetic center Peshawar, Pakistan. Participants were selected through convenience sampling technique and randomly allocated into strength plus balance and aerobic training groups. Type 2 diabetic patients of both sexes, aged 40 to 80years, with a Toronto neuropathy score ≥6 recruited, while patients with ulceration/infection of feet, medical/Surgical conditions, and non-ambulatory patients were excluded from this study. Intervention was applied 3days a week for 8weeks. The Toronto clinical neuropathy system was used to assess neuropathy severity, SF-36 to assess quality of life and the Berg balance scale was used for assessment of balance. Assessment was done at the baseline and after 8weeks of intervention using SPSS. Version 22 was used for analysis. The mean age of the participants was 60.80±9.73. Between group analysis, which showed were statistically insignificant for neuropathy severity, balance and all domains of quality of life (p-value >0.05) except SF-36 General Health Perception Score, with Mean±SD of 62.50±7.54 in group A versus Mean±SD of in group B 60.00±15.98 (p-value=0.05). Within group analysis showed statistically significant results for neuropathy severity, balance and all domains of quality of life (p-value<0.05). This study concluded that there is a statistically significant effect of structured balance and strength training and aerobic training on severity of DPN, balance and quality of life. But there was no statistically significant difference in improvement between the two intervention groups.

Neutrophil-to-Lymphocyte Ratio as a Marker for Cardiac Autonomic Neuropathy in Egyptian Patients With Type 2 Diabetes: A Cross-Sectional Study.

Cardiac autonomic neuropathy (CAN) is one of the most serious complications of diabetes. This study aimed to analyze the correlation between neutrophil-to-lymphocyte ratio (NLR) and CAN in patients with type 2 diabetes (T2D) using 24-hour Holter ECGand to assess the relationship between NLR and severity of diabetic peripheral neuropathy (DPN). Thiscross-sectional studyincluded 90 T2D patients with DPN confirmed by nerve conduction study (NCS). A 24-hour Holter ECG was done to detect the decrease in heart rate variability (HRV). Laboratory parameters, including fasting blood glucose, creatinine, cholesterol, triglyceride, and glycosylated hemoglobin (HbA1c) levels, as well as CBC, neutrophils, lymphocytes, NLR, and platelet-to-lymphocyte ratio (PLR), were calculated accordingly. An albumin-to-creatinine ratio (ACR) test was done and the estimated glomerular filtration rate (eGFR) was calculated. Chronic kidney disease was diagnosed by the presence of albuminuria (≥30 mg/g creatinine) and/or eGFR less than 60. Based on the 24-hourHolter ECG, 25 patients out of 90 (27.7%) had CAN. On comparing both the CAN and non-CAN groups, the CAN group had higher HbA1C (p = 0.005), higher NLR (p = 0.014), and higher neutrophils (p = 0.10). Also, PLR was higher in the CAN group than in the non-CAN group, but this was not statistically significant (p = 0.180). Receiver operator characteristic curve analysis revealed that NLR with a cutoff of 1.7 succeeded in detecting patients with CAN. NLR can be used as an inexpensive and accessible marker to detect patients with diabetes at risk for developing CAN.

Cross-Sectional Study of the Relationship Between Medial Plantar Nerve Conduction Studies and Severity of Diabetic Neuropathy.

Diabetic peripheral neuropathy (DPN), a complication of diabetes, is detected only in later stages. Medial plantar nerve (MPL) can identify earlier stages of neuropathy. We evaluated the correlation of MPL sensory nerve action potentials (SNAPs) and severity of DPN measured using the Toronto Clinical Neuropathy Score (TCNS). In this hospital-based, cross-sectional study, we recruited diabetic subjects referred for suspected DPN. Neuropathy was graded with TCNS. Sural nerve conduction studies were performed using standard techniques. MPL studies were conducted using the modified Ponsford technique. All evaluations were performed on Nihon Kohden (model MEB 9200K). Averaged MPL SNAP was correlated with TCNS using Pearson's correlation coefficient. To estimate a correlation of 0.4 with 80% power (P = 0.05), we needed 46 subjects. Linear regression was conducted to adjust for age, duration, and diabetic control. Receiver operating characteristic (ROC) curve analysis was performed to obtain the cutoff for MPL SNAP values using the Youden index. Fifty-one subjects with a mean age of 53.5 years (8.7) and mean duration of diabetes of 10.2 years (7.2) were included. MPL SNAPs were recordable in 12 patients, and the mean amplitude was 5.15 (2.9) µV. There was correlation between MPL SNAP and TCNS (r = -0.43, P = 0.02). No confounding was seen. Use of MPL SNAP resulted in diagnosis of DPN in an additional six (11.8%) patients. The ROC curve suggested that MPL SNAP cutoff of 1.05 µV had an accuracy of 67% in identifying neuropathy as defined by TCNS. MPL SNAP has a moderate correlation with clinical score and identifies more diabetic neuropathy than sural nerve.

Frequency of Fall Risk in Patients with Diabetic Peripheral Neuropathy and its Impact on Quality of Life

Background: Diabetic Peripheral Neuropathy (DPN) is a common complication of diabetes mellitus, leading to a significant risk of falls and adversely affecting the quality of life (QOL). Understanding the frequency of fall risk and its impact on QOL among patients with DPN is essential for developing targeted interventions. Objective: The study aimed to determine the frequency of fall risk in patients with diabetic peripheral neuropathy and assess its impact on their quality of life. Methods: A descriptive cross-sectional study was conducted over six months at AIMS Diabetic Centre, Hayatabad Peshawar. A total of 246 patients with DPN, aged 40 years and above, were enrolled using a non-probability convenience sampling technique. Fall risk was evaluated using the Functional Reach Test (FRT), and quality of life was assessed through the Short Form-36 (SF-36) questionnaire. Data were analyzed using SPSS version 25, focusing on descriptive and inferential statistics. Results: Among the participants, 69.5% (n=171) were identified at risk of falling. The FRT scores indicated that 13.0% (n=32) had a high fall risk, 45.93% (n=113) had a moderate fall risk, and 10.52% (n=26) had a low fall risk. Quality of life assessments revealed impairments across all domains of the SF-36, with significant variations observed between genders and DPN severity. The mean SF-36 score for physical functioning was notably lower among patients with a high fall risk. Conclusion: The study underscores a significant association between DPN and an increased risk of falls, with a consequential negative impact on the quality of life. These findings highlight the need for integrated care strategies focusing on fall prevention and quality of life improvement for patients with diabetic peripheral neuropathy.

Progression of axonal excitability abnormalities with increasing clinical severity of diabetic peripheral neuropathy

ObjectiveDiabetic peripheral neuropathy (DPN) is a frequent complication for persons with type 2 diabetes. Previous studies have failed to demonstrate any significant impact of treatment for DPN. The present study assessed the role of axonal ion channel dysfunction in DPN and explored the hypothesis that there may be a progressive change in ion channel abnormalities that varied with disease stage. MethodsNeurophysiological studies were conducted using axonal excitability techniques, a clinical method of assessing ion channel dysfunction. Studies were conducted in 178 persons with type 2 diabetes, with participants allocated into four groups according to clinical severity of neuropathy, assessed using the Total Neuropathy Grade. ResultsAnalysis of excitability data demonstrated a progressive and stepwise reduction in two parameters that are related to the activity of Kv1.1 channels, namely superexcitability and depolarizing threshold electrotonus at 10–20 ms (p < 0.001), and mathematical modelling of axonal excitability findings supported progressive upregulation of Kv1.1 conductances with increasing greater disease severity. ConclusionThe findings are consistent with a progressive upregulation of juxtaparanodal Kv1.1 conductances with increasing clinical severity of diabetic peripheral neuropathy. SignificanceFrom a translational perspective, the study suggests that blockade of Kv1.1 channels using 4-aminopyridine derivatives such as fampridine may be a potential treatment for DPN.

Correlation of peripheral neuropathy with serum vitamin D levels and HbA1C variations in type 2 diabetes mellitus patients

Introduction and Aim: The burden of diagnosed and undiagnosed diabetes will increase in the coming decade. Vitamin D deficiency and HbA1C variability are risk factors for diabetic neuropathy, and the association was studied in the present study. Materials and Methods: Data from 346 Type II diabetes patients reporting in a tertiary care Hospital in North India after approval of the ethics committee was analyzed. Michigan Neuropathy Screening Instrument (MNSI) was used to screen the patients for neuropathy. Vitamin D levels were measured. Four HbA1C levels (once every three months) done at least one-year preceding enrolment in the study were analyzed. A nerve conduction study was performed in the Neurophysiology lab. Data were analyzed using SPSS 21.0. Results: Diabetic peripheral neuropathy (DPN) was present in 54.91% of patients. They had a higher BMI, HbA1C %, fasting blood glucose, and low Vitamin D levels. Nerve conduction studies showed more pronounced changes in patients with severe DPN grades. Variability of HbA1C% correlated positively with the duration of diabetes and BMI, and the relation was negative with vitamin D levels. Vitamin D correlated negatively with duration, Hb A1C variability, and BMI. The correlation of HbA1C variability with motor and sensory conduction velocity and amplitude was negative, and with latency, it was positive. Vitamin D correlated positively with amplitude and conduction velocity and negatively with latency. Conclusion: Nerve conduction study, variability in HBA1C, and Vitamin D levels can act as tools to detect DPN. Vitamin D is a modifiable risk factor that needs monitoring in people with diabetes.

The association of vitamin D level with diabetic peripheral neuropathy: A comparative cross- sectional study

Background &amp; Objective: Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (DM). Vitamin D deficiency has been shown to be prevalent among patients with type 2 DM, particularly in those with DPN. This study aimed to look at the association of serum vitamin D level with peripheral neuropathy in patients with type 2 DM. Methods: This was a comparative cross- sectional study conducted in a tertiary hospital in Malaysia. Fifty diabetic patients with DPN and fifty diabetic patients without DPN were recruited. Serum vitamin D level was determined by measuring 25-hydroxyvitamin D [25(OH)D] level. The patients were clinically assessed and screened with Diabetic Neuropathy Symptoms score. Nerve conduction study was performed for patients with DPN. Results: The serum 25(OH)D level was significantly lower in patients with DPN (11.81 [9.09-18.06] vs 18.63 [11.25-22.63] ng/ml; p=0.006). Multiple logistic regression analysis showed that DPN was significantly associated with higher BMI, longer duration of DM, insulin usage and serum 25(OH)D level. The usage of fibrates had negative association with DPN. Subgroup analysis of the DPN group showed that patients with painful DPN had significant lower serum 25(OH)D level (p&lt;0.001) and the clinical severity of DPN negatively correlated with serum 25(OH)D level (p=0.015). Conclusion: Vitamin D deficiency is associated with DPN in patients with type 2 DM. In addition, patients with painful DPN tend to have significantly lower serum 25(OH)D level.

Posterior Tibial Nerve Ultrasound Assessment of Peripheral Neuropathy in Adults with Type 2 Diabetes Mellitus.

Diabetic peripheral neuropathy (DPN) is a common and debilitating complication of type 2 diabetes mellitus (T2DM). Early detection and prompt institution of appropriate therapy could prevent undesirable outcomes such as paresthesia, pain, and amputation. Although the gold standard for diagnosing DPN is nerve conduction studies, high-resolution peripheral nerve ultrasonography may serve as a noninvasive and low-cost alternative for diagnosing and staging DPN. This study investigated the clinical utility of sonographic posterior tibial nerve cross-sectional area (PTN CSA) for diagnosing DPN in individuals with T2DM. Eighty consecutive adults with T2DM and 80 age-/sex-matched controls were recruited. Clinical information was obtained, including symptoms, disease duration, Toronto clinical neuropathy score (TCNS), and biochemical parameters. The left PTN CSA at 1 cm, 3 cm, and 5 cm above the medial malleolus (MM) was measured with a high-frequency ultrasound transducer and compared to the detection of DPN using the TCNS. Based on the TCNS, 58 (72.5%) of the T2DM group had DPN. Of these, 14 (24.1%), 16 (27.6%), and 28 (48.3%) participants had mild, moderate, and severe DPN, respectively. All the mean PTN CSA (aggregate, 1 cm, 3 cm, and 5 cm above MM) of the participants with T2DM and DPN (T2DM-DPN) were significantly higher than those of T2DM without DPN (WDPN) and controls. All the PTN CSA increased significantly with increasing severity of DPN. The PTN CSA at 3 and 5 cm levels correlated weakly but significantly with fasting plasma glucose and glycated hemoglobin levels. The PTN CSA is significantly larger in T2DM-DPN than in T2DM-WDPN and healthy controls. PTN ultrasonography can be an additional tool for screening DPN in patients with T2DM.

Prevalence and risk factors of diabetic peripheral neuropathy: A population-based cross-sectional study inChina.

To assess the prevalence of diabetic peripheral neuropathy (DPN) and its risk factors in the type 2 diabetes mellitus (T2DM) population. This cross-sectional study enroled patients with T2DM between July and December 2017 from 24 provinces in China. Diabetic peripheral neuropathy and its severity were assessed by the Toronto clinical scoring system, neuropathy symptoms score (NSS) and neuropathy disability score. The prevalence of DPN and its risk factors were analysed. A total of 14,908 patients with T2DM were enroled. The prevalence of DPN was 67.6%. Among 10,084 patients with DPN, 4808 (47.7%), 3325 (33.0%), and 1951 (19.3%) had mild, moderate, and severe DPN, respectively. The prevalence of DPN in females was higher than in males (69.0% vs. 66.6%, P=0.002). The prevalence of DPN increased with age and course of diabetes and decreased with body mass index (BMI) and education level (all P for trend <0.05). The comorbidities and complications in patients with DPN were higher than in those without DPN, including hypertension, myocardial infarction, diabetic retinopathy, and diabetic nephropathy (all P<0.001). Age, hypertension, duration of diabetes, diabetic retinopathy, diabetic nephropathy, glycated haemoglobin, high-density lipoprotein cholesterol, and lower estimated glomerular filtration rate were positively associated with DPN, while BMI, education level, fasting C-peptide, and uric acid were negatively associated with DPN. Among patients with T2DM in China, the prevalence of DPN is high, especially in the elderly, low-income, and undereducated patients.

Effect of a Care Bundle on Severity of Diabetic Peripheral Neuropathy

Effect of a Care Bundle on Severity of Diabetic Peripheral Neuropathy

Investigating the prevalence of diabetic peripheral neuropathy in patients diagnosed with type 2 diabetes mellitus

Abstract Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder affecting millions of individuals reaching epidemic proportions globally. diabetic peripheral neuropathy (DPN) is one of the most prevalent and debilitating complications of T2DM, affecting the lower limbs and increasing the risk of foot ulcers, infections, and lower limb amputations. The current study aims to assess the prevalence and severity of DPN using monofilament and MNSI tests in patients diagnosed with T2DM and examine factors associated with the onset and progression of DPN. Objective: To study the prevalence of diabetic peripheral neuropathy in patients with type 2 diabetes mellitus. Materials and Methods: A cross-sectional study was conducted at the Department of Medicine &amp; Diabetology, Marwari Hospital Assam. A total of 226 patients with type 2 diabetes were assessed for DPN using the Michigan Neuropathy Screening Instrument (MNSI). Results: The study assessed the prevalence of DPN among patients with diabetes mellitus. among the 226 participants, 32% had moderate neuropathy and 11% had severe neuropathy. Symptoms such as numbness, burning pain, and muscle cramps were reported by a significant proportion of participants. Examination findings showed foot-related complications and reduced nerve function in a considerable number of participants. The prevalence of neuropathy varied among different duration groups of patients with diabetes. The severity of neuropathy was higher among patients with longstanding diabetes. These findings emphasize the significant burden of DPN and the importance of diabetes management in managing and preventing diabetic neuropathy. Conclusion: This study revealed a considerable prevalence of DPN among patients with diabetes mellitus. The prevalence of neuropathy varied with the duration of diabetes, suggesting an increased risk with a longer disease duration. Timely intervention and appropriate diabetes management strategies are crucial in reducing the burden of DPN and improving patient outcomes.

203-LB: Prevalence and Risk Factors of Diabetic Peripheral Neuropathy—A Population-Based Cross-Sectional Study in China

Aims: To assess the prevalence of diabetic peripheral neuropathy (DPN) and its risk factors in the type 2 diabetes mellitus (T2DM) population. Methods: This cross-sectional study enrolled patients with T2DM between July and December 2017 from 24 provinces in China. DPN and its severity were assessed by the Toronto clinical scoring system, neuropathy symptoms score and neuropathy disability score. The prevalence of DPN and its risk factors were analyzed. Results: A total of 14,908 patients with T2DM were enrolled. The prevalence of DPN was 67.6%. Among 10,084 patients with DPN, 4808 (47.7%), 3325 (33.0%), and 1951 (19.3%) had mild, moderate, and severe DPN, respectively. The prevalence of DPN was over 70% in patients aged ≥60 years, with low income (&amp;lt;5000 RMB) and education level of primary school or below. The comorbidities and complications in patients with DPN were higher than in those without DPN (P&amp;lt;0.001). Age, hypertension, duration of diabetes, diabetic retinopathy, diabetic nephropathy, glycated hemoglobin, high-density lipoprotein cholesterol, and lower estimated glomerular filtration rate were positively associated with DPN, while BMI, education level, fasting C-peptide, and uric acid were negatively associated with DPN. Conclusions: Among patients with T2DM in China, the prevalence of DPN is high, especially in the elderly, low-income, and undereducated patients. Disclosure W. Wang: None. Q. Ji: None. X. Ran: None. C. Li: None. Y. Xue: None. B. Feng: None. D. Zhu: None. Funding Chinese Diabetes Society (2019YJ017)

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.

Treatment of DPN with 8% topical capsaicin without the use of a topical anesthetic

PURPOSEA qualitative study was done to look at the use of 8% topical capsaicin without the use of a topical anesthetic prior to treatment of DPN. In the PI it is indicated to anesthetize the affected area with topical lidocaine prior to the treatment for painful diabetic peripheral neuropathy of the feet. Many patients with diabetic peripheral neuropathy have significant numbness in their feet and limited feeling and there may not be a need for a topical anesthetic prior to application of the topical system. Applying a topical anesthetic can be time consuming to allow it to take full effect and may not be necessary. For the purposes of this study the clinics ethics committee was consulted, and approval was granted. METHODSIs topical anesthetic necessary before the procedure for the treatment of painful diabetic peripheral neuropathy with 8% topical capsaicin? 15 patient charts were reviewed at random that had received treatment with administered 8% topical capsaicin patches for their diabetic peripheral neuropathy. No topical anesthetic was used prior to the procedure. The patient was monitored throughout the procedure and ice was offered to place over the top of the patch, if needed for administration site pain. RESULTSMost patient's that did not have a topical anesthetic prior to their procedure of 8% topical capsaicin for the treatment of painful diabetic peripheral neuropathy, tolerated the procedure well without any significant increased pain or the need for interventions, such as ice. CONCLUSIONTopical anesthetic can be time consuming and cumbersome. In many patients with severe diabetic peripheral neuropathy that has resulted in significant paresthesia, a topical anesthetic is not necessary due to the patient's limited feeling in the feet. This results in a more streamline process with less time for the patient to be in the office.

Impact of vitamin B6 deficiency on the severity of diabetic peripheral neuropathy – A cross sectional study

BackgroundDiabetic Peripheral Neuropathy is one of the most important and significantly prevalent microvascular complications of Diabetes Mellitus. Pyridoxine is a key nutrient for protecting nerve health. The objective of this research is to study the prevalence rate of pyridoxine deficiency in Diabetic neuropathy patients, to understand the correlation between various biochemical and markers of diabetic neuropathy and pyridoxine deficiency. Results249 patients were selected for the study based on the selection criteria participants. 51.8% prevalence of pyridoxine deficiency in Diabetic neuropathy patients. The nerve conduction velocity significantly reduced in pyridoxine deficiency cases (p < 0.05). A strong inverse relationship is observed with fasting blood sugar levels and glycated hemoglobin pyridoxine deficiency might contribute to impaired glucose tolerance. ConclusionThere also exists a strong inverse relationship with glycemic markers. Significant direct correlation is observed with nerve conduction velocity. Pyridoxine also has properties of antioxidant which may be utilized for the management of Diabetic Neuropathy.

Structural Brain Alterations in Key Somatosensory and Nociceptive Regions in Diabetic Peripheral Neuropathy.

Despite increasing evidence demonstrating structural and functional alterations within the central nervous system in diabetic peripheral neuropathy (DPN), the neuroanatomical correlates of painful and painless DPN have yet to be identified. Focusing on structural MRI, the aims of this study were to 1) define the brain morphological alterations in painful and painless DPN and 2) explore the relationships between brain morphology and clinical/neurophysiological assessments. A total of 277 participants with type 1 and 2 diabetes (no DPN [n = 57], painless DPN [n = 77], painful DPN [n = 77]) and 66 healthy volunteers (HVs) were enrolled. All underwent detailed clinical/neurophysiological assessment and brain 3T MRI. Participants with painful DPN were subdivided into the irritable (IR) nociceptor and nonirritable (NIR) nociceptor phenotypes using the German Research Network on Neuropathic Pain protocol. Cortical reconstruction and volumetric segmentation were performed with FreeSurfer software and voxel-based morphometry implemented in FSL. Both participants with painful and painless DPN showed a significant reduction in primary somatosensory and motor cortical thickness compared with HVs (P = 0.02; F[3,275] = 3.36) and participants with no DPN (P = 0.01; F[3,275] = 3.80). Somatomotor cortical thickness correlated with neurophysiological measures of DPN severity. There was also a reduction in ventrobasal thalamic nuclei volume in both painless and painful DPN. Participants with painful DPN with the NIR nociceptor phenotype had reduced primary somatosensory cortical, posterior cingulate cortical, and thalamic volume compared with the IR nociceptor phenotype. In this largest neuroimaging study in DPN to date, we demonstrated significant structural alterations in key somatomotor/nociceptive brain regions specific to painless DPN and painful DPN, including the IR and NIR nociceptor phenotypes.

Differences in motor unit behavior during isometric contractions in patients with diabetic peripheral neuropathy at various disease severities.

The aim of this study was to determine whether HD-sEMG is sensitive to detecting changes in motor unit behavior amongst healthy adults and type 2 diabetes mellitus (T2DM) patients presenting diabetic peripheral neuropathy (DPN) at different levels. Healthy control subjects (CON, n=8) and T2DM patients presenting no DPN symptoms (ABS, n=8), moderate DPN (MOD, n=18), and severe DPN (SEV, n=12) performed isometric ankle dorsiflexion at 30% maximum voluntary contraction while high-density surface EMG (HD-sEMG) was recorded from the tibialis anterior muscle. HD-sEMG signals were decomposed, providing estimates of discharge rate, motor unit conduction velocity (MUCV), and motor unit territory area (MUTA). As a result, the ABS group presented reduced MUCV compared to CON. The groups with diabetes presented significantly larger MUTA compared to the CON group (p<0.01), and the SEV group presented a significantly lower discharge rate compared to CON and ABS (p<0.01). In addition, the SEV group presented significantly higher CoVforce compared to CON and MOD. These results support the use of HD-SEMG as a method to detect peripheral and central changes related to DPN.

Effect of Anaemia on Sensory Nerve Conduction in Diabetic Peripheral Neuropathy: A Cross-sectional Study

Introduction: Diabetic Peripheral Neuropathy (DPN) occurs in more than 50% of patients with Type 2 Diabetes Mellitus (T2DM). Though multi-factorial pathogenesis has been claimed for the occurrence of DPN, the exact mechanism is unclear. Recently, it was found that the prevalence of anaemia is two to three times higher in diabetic patients even with preserved renal function. Aim: To compare the sensory nerve conduction study variables such as latency (ms), amplitude (μV) and Nerve Conduction Velocity (NCV) (m/s) of the median, ulnar and sural nerves in DPN patients with anaemia to those without anaemia. Materials and Methods: This cross-sectional study was conducted in the Department of Neurology, PSG Hospital, Coimbatore, Tamil Nadu, India, December 2017 to December 2018 with 80 DPN subjects, included both males and females of age group from 35 to 70 years, grouped into those without anaemia (n=40) and those with anaemia (n=40). Subjects were considered to have anaemia based on the World Health Organisation (WHO) classification of haemoglobin. Sensory nerve conduction studies were performed on right and left median, ulnar and sural nerves. Logistic regression was performed in DPN without and with anaemia to rule out confounding variables. Independent t-test and Mann-Whitney U test were used to compare the variables between the groups with normal and skewed distribution, respectively. The p-value &lt;0.05 was considered to be statistically significant. Results: Among 80 study participants, 38 (47.50%) were male and 42 (52.50%) were female. About 20 (50%) were male and 20 (50%) were female in group A (DPN without anaemia). Seventeen (42.50%) were male and 23 (57.50%) were female in group B (DPN with anaemia). Among DPN subjects with anaemia, 57.50% had mild anaemia and 42.50% had moderate anaemia. In the present study, normocytic normochromic anaemia was the predominant form of anaemia seen. NCV of right median nerve, right ulnar nerve, right sural nerve and left sural nerve were significantly reduced in DPN with anaemia when compared to DPN without anaemia with values &lt;0.001, &lt;0.001, 0.001 and &lt;0.001, respectively. The amplitude of right sural nerve and left sural nerve were significantly reduced in DPN with anaemia, compared to DPN without anaemia with p-values &lt;0.001 and 0.017, respectively. Conclusion: DPN patients with anaemia had lower NCV and amplitude of sensory nerves, when compared to those without anaemia. Hence, even mild to moderate anaemia could be a possible risk factor that exacerbates the severity of DPN.

The relationship between vascular endothelial growth factor-A serum level and the severity of diabetic peripheral neuropathy

Background and aimsDiabetic peripheral neuropathy (DPN) is a common microvascular complication in type 2 diabetes mellitus (T2DM). The nerve fibers injury is caused by the interaction between metabolic and vascular factors. Vascular endothelial growth factor (VEGF) is an essential growth factor for vascular endothelial cells. We aimed to investigate the relation between VEGF-A serum level and the degree of DPN.ResultsThis cross-sectional study was conducted on 81 patients with T2DM. Based on the combined clinical and electrophysiological assessment, 67 patients (82.7%) were diagnosed with peripheral neuropathy of which 32 patients (39.5%) had subclinical neuropathy, whereas 35 patients (43.2%) were confirmed cases of DPN. Patients with DPN had longer duration of DM and higher values of glycosylated hemoglobin (HbA1c). Although the mean serum VEGF-A level in diabetic patients without neuropathy was higher than that in diabetic patients with DPN, this difference did not reach statistical significance (P = 0.07). However, patients with subclinical DPN had significantly higher serum VEGF-A level compared to patients with confirmed DPN (P < 0.001).ConclusionDPN was found to be a common finding in the studied sample of T2DM patients. Longer duration of DM and poor glycemic control may be risk factors for development of severe DPN. Low VEGF-A serum levels may lead to more severe DPN in patients with T2DM.