Severity Of Diabetic Neuropathy Research Articles

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.

Artificial light at night alters progression of cold neuropathy in a sex-dependent manner in a mouse model of type II diabetes mellitus

Artificial light at night (ALAN) is a pervasive circadian rhythm disruptor. Exposure to ALAN is associated with detrimental effects on physiology and behavior, including disrupted metabolism, immune function, endocrine function, and pain behavior. Given the detrimental effects of ALAN and other circadian rhythm disruptors on pain, we sought to understand how ALAN may alter the progression and severity of diabetic neuropathy. To do this, we used a previously reported high-fat diet and streptozotocin injection protocol to induce a type II diabetic phenotype in ∼8 week old female and male mice and then exposed the mice to either control or ALAN lighting conditions in 14:10 h light-dark cycles for 4 weeks. Male mice housed in control conditions exhibited reduced responsiveness to cold pain; in contrast, ALAN blunted this effect in male mice. ALAN exposure also elevated blood glucose and altered body mass loss in male mice. These effects were not present in female mice. The results of this study highlight the need to consider and study ALAN exposure and sex as a biological variable as risk factors in the treatment and mitigation of pain.

Sarcopenia: features of manifestation in patients with diabetes mellitus

Objective. To evaluate the parameters of sarcopenia (SP) and the factors affecting them in patients with diabetes mellitus (DM).Materials and methods. A study of 87 hospitalized patients with DM (29 men — 33% and 58 women — 67%) aged 21 to 61 years was conducted. The study included the determination of clinical and laboratory parameters, including anthropometric data, laboratory parameters, determination of sarcopenia parameters (muscle mass, muscle strength, muscle function), ultrasound examination of skeletal muscles.Results. A decrease in muscle mass was observed in 11% of patients with DM and depends on the composition of the body. A decrease in muscle function was observed in 30% of patients with DM and depends on the patient’s age (over 41 years; AUS — 0.826; p < 0.001) and the degree of excess body weight (in 87% of patients, BMI is more than 30 kg/m2). A decrease in muscle strength was noted in 44% of patients and depends on the severity of diabetic neuropathy (more than 1 point according to the results of the NDSm scale; AUS — 0.876; p < 0.001). The circumference of the lower leg is positively correlated with the thickness of the intermediate broad thigh muscle (rs = 0.44; p < 0.05) and the thickness of the musculoskeletal fold (rs = 0.70; p < 0.05), determined by ultrasound technique.Conclusion. The probability of SP was noted in 44% of patients with DM and depends on the length of DM and the severity of diabetic neuropathy. Muscle function is reduced in 30% of patients with DM and is associated with the patient’s age and overweight. A decrease in muscle mass was observed in 11% of patients with DM and depends on the composition of the body. The thickness of the intermediate broad thigh muscle and the thickness of the musculoskeletal fold at the hip level (according to ultrasound results) are significantly interrelated with muscle mass.

Effects of Foot Dry Cupping in Diabetic Distal Polyneuropathy: A Pilot Controlled Clinical Trial

Background: Distal polyneuropathy is a common complication of diabetes mellitus with a considerable negative impact on the quality of life. This study aimed to evaluate the effect of dry cupping on distal polyneuropathy in diabetic patients. Methods: This controlled clinical trial was performed on 34 patients with diabetic polyneuropathy (DPN) for eight weeks. The non-invasive dry, fixed cupping therapy was performed on the sole of the right foot in the patients three times a week for 10 minutes, and the left foot of the same patient was considered as a control. The severity of diabetic neuropathy was measured using the modified Toronto Clinical Neuropathy Score (mTCNS), and the symptom and sensory test scores were determined. Results: Twenty patients (40 feet) completed the study. There was a significant difference between the control foot and the treated foot in terms of the mTCNS after four and eight weeks (P values=0.004 and 0.001, respectively), in terms of the sensory test scores after four and eight weeks (P values=0.007 and 0.005, respectively), and in terms of the symptom scores after eight weeks (P value=0.002). Conclusion: For the first time, this study demonstrated that cupping therapy might be effective as a complementary treatment in alleviating the symptoms of DPN, although understanding the underlying mechanism requires further investigation.

Prevalence of Hearing Loss in Type 2 Diabetes Mellitus and Its Association with Severity of Diabetic Neuropathy and Glycemic Control.

This study assessed the prevalence of hearing loss (HL) in patients with type 2 diabetes mellitus (T2DM) and its relationship with the presence and severity of diabetic neuropathy. Patients between the ages of 30 and 60 years (both ages inclusive) with T2DM were recruited and divided into three groups. Group I included patients without neuropathy. Group II had patients with mild neuropathy. Group III had patients with moderate and severe neuropathy. After informed consent hearing threshold was assessed using pure tone audiometry (PTA). Of the 200 patients recruited, the prevalence of HL was overall 81%. The prevalence was 66.7% in group I, 80.9% in group II, and 87.6% in group III (p = 0.009). Among patients with moderate to severe neuropathy (group III), 33.3% had clinically significant HL (CSHL) (p = 0.015). Age, gender, presence of neuropathy, and severity of neuropathy were associated with an increased risk of developing HL. Among patients with diabetes, age, nephropathy, and neuropathy were associated with HL. The severity of HL worsened with the worsening severity of neuropathy and increase in glycated hemoglobin (Hba1c) levels. Patients with moderate to severe neuropathy might benefit from screening for HL.

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<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 < 0.01.

The Relationship between Hba1c Levels and Body Mass Index with Severity of Diabetic Neuropathy at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Introduction: Diabetic neuropathy is the most common microvascular complication in diabetes mellitus patients. Diabetic neuropathy is known to be associated with conditions of hyperglycemia and obesity that occur in diabetic patients. Hyperglycemia in diabetic patients can be monitored through HbA1c levels. This study aimed to assess the relationship between HbA1C values and body mass index with the severity of diabetic neuropathy based on nerve conduction velocity examination.
 Methods: A study with a cross-sectional design with a total of 25 subjects with diabetes mellitus. The severity of diabetic neuropathy was determined based on Baba's diabetic neuropathy classification (BDC), degrees 0 to 4. In all study subjects, plasma HbA1c levels were examined, and body mass index was assessed. The relationship between categorical variables was tested with the chi-square test, and the relationship between numerical and categorical variables with a one-way ANOVA test, the value was considered statistically significant if the p-value <0.05.
 Results: The 25 subjects with diabetes found a mean age of 54.88 (±SD 8.918) years, with a gender distribution of 46.4% for women and 42.9% for men. The average HbA1c level was 8.9560 (± 2.21850), and the highest body mass index was obese (50%). There was a significant relationship between HbA1c levels and the severity of diabetic neuropathy based on electrophysiological examination (p<0.05), but there was no significant relationship between the value of body mass index and the severity of diabetic neuropathy.
 Conclusion: Increased HbA1c levels are associated with increased severity of peripheral neuropathy in patients with diabetes mellitus.

Impact of Diabetic Neuropathy on Ankle Dorsiflexion in Older Adults

Background: Diabetes mellitus is increasing among the population. If early diagnosis and treatment can be done, complications can be reduced. Although there are studies evaluating the impact of diabetes on joint motion, there are limited studies examining the ankle range of motion and its correlation with duration or severity of diabetic neuropathy symptoms. This study aims to examine the impact of diabetic neuropathy on angle of ankle dorsiflexion and it’s correlation with duration or severity of diabetic neuropathy symptoms Methods: Descriptive study in Government medical college, Thoothukudi. 72 patients attending the outpatient department of Medicine and Neuromedicine of a tertiary care hospital, ranging from 40 to 75 years were included in the study out of which 36 were diabetic with symptoms of diabetic neuropathy and 36 were non-diabetic. Ankle range of motion was measured using goniometer. Severity of neuropathy assessed using Toronto Clinical Neuropathy score and duration of diabetic neuropathy symptoms recorded. Results: Mean Age (Diabetic group) 59.28±8.06 Vs 56.08±10.16 (Non-Diabetic group). Proportion of patients with decreased angle of dorsiflexion among the patients with diabetic neuropathy (77.8%) was significantly higher than non-diabetic patients (47.2%) (Z=4.52;p<0.0001). Chi-square (2χ) test showed that there was significantassociation between severity of diabetic neuropathy and angle of dorsiflexion (in degree) of the patients with diabetic neuropathy (p<0.0001). Angle of dorsiflexion decreased significantly with severity of diabetic neuropathy. Pearson correlation co-efficient showed that there was significant negative correlation between duration of diabetic neuropathy and angle of dorsiflexion (r=-0.61;p<0.001). Thus with the increase in duration of diabetic neuropathy angle of dorsiflexion decreased significantly.Conclusions: It was found that the angle of ankle dorsiflexion was lower in diabetic patients as compared to non-diabetic patients It was also concluded that the duration of diabetic neuropathy and severity of sensory symptoms have an inverse relationship with ankle range of motion.

The Effectiveness of Leech Therapy in the Severity of Diabetic Neuropathy: A Randomized Controlled Trial

Diabetic peripheral neuropathy is one of the most common causes of disability in diabetic patients. Applying a method to achieve the highest therapeutic effect in patients is desirable. Therefore, this study aimed to evaluate the impact of leech therapy on diabetic neuropathy of lower limbs in comparison to gabapentin as a standard method. This randomized controlled parallel-group clinical trial was conducted among 40 patients with type II diabetes who were diagnosed with lower limb diabetic neuropathy and referred to specialized outpatient clinics in Babol, Mazandaran province, Iran from 23 September 2020 to 17 March 2021. The patients were randomly divided into two groups. One group was treated with leech therapy and the other group was treated with gabapentin as the standard method. The severity of neuropathy was assessed every 15 days until the 45th day. The Visual Analog Scale (VAS), Neuropathy Symptom Score (NSS), Neuropathy Disability Score (NDS), and Nerve Conduction Velocity (NCV), and Electromyography (EMG) were used for assessing the study outcomes. The repeated measure and Friedman tests were used by SPSS.V.23. The results of our study indicated that pain (P value:0.03), numbness (P value˂0.0001), and paranesthesia (P value:0.01) significantly reduced in patients undergoing leech therapy versus patients taking gabapentin on the 45th day. The total NSS (P value˂0.0001) and total NDS (P value˂0.0001) improved significantly for patients with leech therapy over 45 days compared to the patients with gabapentin. The results of our study showed that using leech therapy for patients with diabetic neuropathy was more effective in improving clinical symptoms and the functions of lower limb muscles and nerves in comparison to gabapentin. The severity and symptoms of neuropathy greatly improved for the patients treated with leech therapy versus patients taking gabapentin.

Hubungan Kadar Magnesium Serum Dan Hba1c dengan Severitas Neuropati Diabetik

Low magnesium levels are known to be associated with increased risk of diabetes mellitus and its complications. In addition, HbA1c levels are also known to have a correlation with further diabetes complications such as diabetic neuropathy. Diabetic neuropathy is the most common microvascular complication in diabetes mellitus, whose incidence is associated with disability and mortality rates in diabetic patients. This study aimed to assess the correlation between serum magnesium levels and HbA1c with the severity of diabetic neuropathy. This was a cross-sectional study. Severity of diabetic neuropathy is classified according to the Baba's Diabetic Neuropathy Classification (BDC). All subjects were examined for serum magnesium and HbA1C levels. This study consisted of 46 diabetes mellitus subjects, with 69.6% of the subjects suffering from diabetic neuropathy. The average magnesium level in this study was 1.87 mg/dl ± 0.245 and the median HbA1c level was 8.6 %. There was no significant correlation between serum magnesium levels and HbA1c with the incidence and severity of diabetic neuropathy (p>0.05). However, there was a significant negative correlation between magnesium levels and HbA1c levels in diabetic neuropathy patients.

Plasmalogen levels are associated with the severity of diabetic neuropathy

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

Diabetic Neuropathy Severity Assessment: A Neutrosophic approach

In this work a Neutrosophic approach has been implemented to assess the severity of diabetic neuropathy. Vibratory Perception Threshold (VPT) data was acquired from 600 participants. The acquired data was utilised to obtain the various criteria to assess the severity of diabetic neuropathy which is a fatal consequence of Diabetes mellitus. A single valued Neutrosophic set was employed to assess and evaluate the given medical condition. Multi Criteria Decision Making (MCDM) was used to address the severity. The hybrid score accuracy function and the collective correlation of the decision matrices were calculated and were used to estimate the weights which ultimately aided in the ranking process. The results corroborated that Grade II neuropathy is the most severe condition and needs more conscientious diagnosis.

Updates in diabetic neuropathy: A call for new diagnostic and treatment approaches.

Diabetic polyneuropathy (DPN) is a serious complication of both type 1 and type 2 diabetes. The major clinical manifestations of DPN are neuropathic pain, diabetic foot (which is associated with ulcers, gangrene, and amputation), and autonomic neuropathy. Diabetic sensorimotor peripheral neuropathy (DSPN) is the most common form of DPN and affects approximately 50% of people with type 1 or 2 diabetes during their lifetime (1) . Despite its major clinical impact, DPN remains underdiagnosed and undertreated. To reduce the burdens of DPN, there is an urgent need to develop both novel diagnostic procedures that enable to improve the early detection of the disease and new treatments that address multiple mechanistic pathways (Figure) (2) .

Effect of Cyperus squarrosus plant extracts on diabetic neuropathy in Streptozotocin (STZ)–induced diabetic rats

The present study was designed to evaluate the effects of Cyperus squarrosus plant extracts in streptozotocin-induced diabetic neuropathy. Diabetes was induced by a single administration of streptozotocin (65 mg/kg/intraperitoneally). After 72 hours to measure the fasting blood glucose levels, blood glucose levels more than 220 mg/dl, consider diabetic rats. Animals were divided into six groups, animals untreated with STZ were kept in a normal control group. STZ-induced diabetic rats orally administered with ethanolic and aqueous plant extracts (EECS & AECS) dose 200 & 400 mg/kg, p.o. for eight weeks, Rats were subjected to evaluate serum glucose, biochemical parameters, and test were performed on the initial day, 2n, 4th 6th and 8th week in all groups to evaluate the neuropathy by Eddy’s hot plate and tail immersion test respectively. Diabetic animals were treated with Glibenclamide (5 mg/kg) and plant extracts (200 & 400 mg/kg )for 8 weeks. Groups treated with Glibenclamide (5 mg/kg) and Cyperus squarrosus extracts (200 and 400 mg/kg) significantly reduced elevated serum glucose level & lipid profiles and restored the reduced body weight. After completion of work, we observe the changes in fasting serum glucose, triglysaroids LDL, cholesterol levels are significantly reduced in animals treated with aqueous extract 400mg/kg. Other side animals treated with extracts decrease in the severity of diabetic neuropathy compare with untreated diabetic rats. Finally concluded that Cyperus squarrosus plant exhibit anti-diabetic property and beneficial protection against neuropathy in STZ induced diabetic rats.

The relationship between the severity of peripheral diabetic neuropathy and sleep quality in type 2 diabetic mellitus patients

ObjectiveThis study aims to determine the relationship between the severity of peripheral diabetic neuropathy and sleep quality in patients with type 2 diabetes. MethodsThis study is an observational analytic cross-sectional design. Data collected consisted of age, gender, HbA1c level, duration of DM, Diabetic Neuropathy Symptom (DNS) score, the severity of diabetic neuropathy, and sleep quality. Diabetic Neuropathy Symptom (DNS) score is a diabetic neuropathy screening consisting of scores from 1 to 4, and a score of ≥1 is considered significant. The severity of diabetic neuropathy was measured using an England score consisting of mild, moderate, and severe. While sleep quality is measured by the Pittsburgh Sleep Quality Index (PSQI), which consists of 7 components, namely subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleeping drugs and dysfunction of daily activities. Each component has a value of 0–3. The score of the seven components added to the value between 0 and 21. The number of samples that meet the research criteria is 18 samples. Sampling by consecutive sampling method for three months at the neurologic clinic of Wahidin Sudirohusodo Hospital Makassar. The data obtained were recorded and grouped according to the purpose and type of data, then the statistical method was chosen following the significance limit p<0.05, namely by using the Spearman correlation test. ResultThe majority of respondents had moderate diabetic neuropathy, 11 patients, and seven patients with severe neuropathy. The lowest PSQI score is three, and the highest is 17, with the global average PSQI score obtained 8.72±4.22. The results showed that there was a significant relationship between the severity of peripheral diabetic neuropathy with sleep quality (global PSQI score) with a value of p=0.001. The relationship between the two variables is unidirectional and has a strong correlation with the positive coefficient correlation, r=0.724. ConclusionThere is a significant relationship between the severity of peripheral diabetic neuropathy and sleep quality (global PSQI score). The more severe the degree of peripheral diabetic neuropathy, the worse the quality of sleep.

Risk factors of the development of vascular and neuropathic complications in patients with type 2 diabetes mellitus and autoimmune thyroiditis

Issues of the formation and progression of late complications of diabetes mellitus remain interesting and foreground today, especially in cases of type 2 diabetes mellitus (dm) combined with other endocrine diseases. The pathogenetic relation between the mechanisms leading to blood vessels and nerves damage against the background of diabetes mellitus, and, for example, mechanisms of autoimmune thyroid abnormality (ait), is far from being unambiguous, but the very fact of its existence cannot be denied.Purpose: to determine the predominant type of comorbidity (trans-syndromal, trans-nosological or chronological) and the level of comorbidity according to the disease rating scale (cirs) in patients with type 2 diabetes and ait, to study the structure of later complications of diabetes mellitus in this group of patients and to assess the contribution of certain factors to increased risk of complications.Methods. 428 patients were examined in a specialized endocrinology department, and two groups were formed: an observation group — 213 people with diagnosed type 2 diabetes and ait, and a comparison group — 215 people with a diagnosis of type 2 diabetes. These groups were comparable in age, the duration of diabetes, body mass index, correction of the disease. The analysis included clinical and laboratory parameters, the results of hormones level studies (tsh, free t4, insulin, c-peptide) and antibodies (at-tpo), thyroid ultrasonography, calculation of the insulin resistance index (homa) and the comorbidity index (cirs — cumulative illness rating scale) followed by a correlation-regression analysis of statistical data. The state of the peripheral nervous system was evaluated with the use of electromyography in patients of both groups, and the severity of diabetic neuropathy was evaluated with the use of the neuropathy disability score and vas (visual analogue scale) scales. The state of the vascular system was studied according to the data of ultrasound examination of the vessels of the lower extremities, echocardiography, and ophthalmoscopy.Results. The obtained data made it possible to determine the factors infl uencing the risk of type 2 diabetes complications developement, and to establish that neuropathic complications begin and progress faster in patients with comorbid endocrine pathology, however, there is no such dependence for vascular complications. According to the linear regression equation of the dependence of total complications on the duration of the disease, it was revealed that the development of vascular complications in patients with combined endocrinopathy occurs even more slowly than in patients with diabetes. The contribution of diabetes compensation and identifi ed risk factors to the progression of diabetic complications was less important for patients with endocrinopathies. As for evaluating the contribution of individual parameters, the most signifi cant were the duration of diabetes mellitus, albuminuria, atherosclerosis of the vessels of the lower extremities.Conclusion. In addition to the known risk factors for the development and progression of vascular complications, in patients with overlapping endocrinopathy, the preservation of residual insulin secretion and renal function (chronic kidney disease, proteinuria) were important. the prevalence of “total” Complications in the group of patients with combined endocrine pathology was lower, however, neuropathic complications in the same group were observed more often,т which indicates the primary eff ect of thyroid dysfunction on the structure of the nervous tissue.

Anti-inflammatory effect of resveratrol attenuates the severity of diabetic neuropathy by activating the Nrf2 pathway.

The mechanisms underlying the development of neuropathy associated with diabetes mellitus are not fully understood. Resveratrol, as a nonflavonoid polyphenol, plays a variety of beneficial roles in the treatment of chronic diseases such as Alzheimer's disease, coronary heart disease and obesity. In our study, the role of nuclear erythroid 2-related factor 2 (Nrf2) in resveratrol-mediated protection against streptozotocin-induced diabetic peripheral neuropathy (DPN) was investigated, and the antioxidant effect of resveratrol in diabetic peripheral nerves was studied. The STZ-treated model mice were divided into two groups. The resveratrol group was intragastrically administered 10 ml/kg 10% resveratrol once a day until the 12th week after STZ injection. The vehicle-treated mice were injected with the same volume of DMSO. Analysis of the effects of resveratrol in DPN revealed the following novel findings: (i) the pain and temperature sensitivities of diabetic mice were improved after treatment with resveratrol; (ii) Nrf2 expression was increased in the diabetic peripheral nerves of resveratrol-treated mice, and NF-KB pathway inhibition protected nerves upon resveratrol treatment in peripheral neuropathy; and (iii) resveratrol modulated the anti-inflammatory microenvironment of peripheral nerves by increasing Nrf2 activation and the expression of p-p65, and these changes may have been responsible for the neuroprotective effect of resveratrol in DPN, which was confirmed by Nrf2 knockout in diabetic mice. Overall, this study demonstrates that resveratrol may attenuate the severity of DPN by protecting peripheral nerves from apoptosis by inhibiting the NF-KB pathway and increasing Nrf2 expression.

Clinical correlation of diabetic retinopathy with nephropathy and neuropathy.

Purpose:To evaluate the presence of nephropathy and neuropathy in patients with diabetic retinopathy (DR) and to correlate the severity of DR to that of diabetic nephropathy and diabetic neuropathy.Methods:This prospective noninterventional hospital-based study included 57 consecutive cases of DR of either sex, presenting to the eye OPD between January 2019 and November 2020 with minimum 5-year duration of Type 1 and 2 DM. Complete ophthalmic examination was done and DR was classified according to early treatment diabetic retinopathy study classification. Severity of diabetic nephropathy was based on urine albumin creatinine ratio and estimated glomerular filtration rate. Severity of diabetic neuropathy was based on nerve conduction velocity.Results:The study was conducted on 57 patients of whom patients 45 were males and 12 were females. Mild nonproliferative diabetic retinopathy was present in 22 patients, moderate in 14 patients, severe in 18 patients, and proliferative diabetic retinopathy in 3 patients. In our study, group 30 patients of DR presented without clinically significant macular edema (CSME) and 27 patients presented with CSME. The distribution of severity of DR according to CSME was observed to be statistically significant (P<<0.05). The association of severity of DR with severity of diabetic nephropathy was observed to be statistically significant (P<<0.05). The association of severity of DR with that of diabetic neuropathy was inconclusive.Conclusion:The association of severity of DR with severity of diabetic nephropathy and diabetic neuropathy can be used as a marker for future chronic kidney diseases progression and also to prognosticate neurological outcomes in diabetic patients.

Corneal confocal microscopy compared with quantitative sensory testing and nerve conduction for diagnosing and stratifying the severity of diabetic peripheral neuropathy

IntroductionDiabetic neuropathy can be diagnosed and assessed using a number of techniques including corneal confocal microscopy (CCM).Research design and methodsWe have undertaken quantitative sensory testing, nerve conduction studies and CCM...

Association Between Severity of Diabetic Neuropathy and Success in Weight Loss During Hospitalization Among Japanese Patients with Type 2 Diabetes: A Retrospective Observational Study.

IntroductionThis study aimed to examine the association between severity of diabetic neuropathy and weight loss during hospitalization in overweight participants with type 2 diabetes.Patients and MethodsParticipants of this study comprised 193 patients who were hospitalized for type 2 diabetes treatment. The participants were divided into two groups in the study, based on whether or not reduction of bodyweight was at least 3% during hospitalization. Using Cox models, the association between severity of neuropathy and effectiveness of weight loss under a controlled diet was analyzed. Autonomic neuropathy was assessed on patient admission by R-R interval, as measured in an electrocardiogram (CVRR), and sensory neuropathy was assessed using both 128-Hz tuning-fork vibration and Achilles tendon reflex (ATR).ResultsThe adjusted hazard ratio for weight loss of at least 3% for CVRR was 1.17 (95% confidence interval 1.07–1.28, P=0.0006) and for vibration time 1.93 (1.01–3.68, P=0.045). After dividing CVRR and vibration time into tertiles based on participant number, the adjusted hazard ratio for the high tertile of CVRR was 2.17 (1.29–3.62, P=0.003), and for the long tertile of vibration time 1.84 (1.10–3.08, P=0.02), compared with the low and short tertiles, respectively. No association was detected between ATR category and weight loss.ConclusionSeverity of diabetic neuropathy was found to be a determinant in weight loss under a caloric restriction regimen for patients with type 2 diabetes. The results of the study suggest that the peripheral nervous system is involved in responses to medical intervention for treatment for type 2 diabetes including bodyweight management.