Severity Of Diabetic Polyneuropathy Research Articles

Assessment of the severity of diabetic polyneuropathy aids in predicting the risk of developing diabetic complications in patients with untreated diabetes.

This study aimed to determine the efficacy of assessing the severity of diabetic polyneuropathy (DPN) in patients with untreated diabetes. Seventy-two patients with untreated type 2 diabetes who were hospitalized for glycemic control were enrolled and divided into the following two groups: patients who had no prior diagnosis and patients who were unattended or had discontinued treatment. Electrophysiological criteria consistent with Baba's classification were used to diagnose and assess the severity of DPN. The patients were divided into three subgroups: no DPN (stage 0), mild DPN (stage 1), and moderate or more-severe DPN (stages 2-4). Intergroup comparisons were performed for the clinical characteristics and the results of the nerve conduction studies. Twenty-two (30%), 25 (35%), and 25 (35%) patients were categorized into the no DPN, mild DPN, and moderate or more-severe DPN subgroups, respectively. The number of patients who were unattended or had discontinued treatment in the moderate or more-severe DPN subgroup was significantly higher than that in the no DPN subgroup. The patients in the moderate or more-severe DPN subgroup had an increased risk of developing diabetic retinopathy and nephropathy, with odds ratios of 19.5 and 11.0 for advanced stages of retinopathy and nephropathy, respectively. Thus, the assessment of the severity of DPN could aid in the prediction of the risk of developing diabetic complications in patients with untreated diabetes.

Simplified electrophysiological approach combining a point-of-care nerve conduction device and an electrocardiogram produces an accurate diagnosis of diabetic polyneuropathy.

This study aimed to investigate the diagnostic potential of two simplified tests, a point-of-care nerve conduction device (DPNCheck™) and a coefficient of variation of R-R intervals (CVR-R), as an alternative to traditional nerve conduction studies for the diagnosis of diabetic polyneuropathy (DPN) in patients with diabetes. Inpatients with type 1 or type 2 diabetes (n = 167) were enrolled. The study population consisted of 101 men, with a mean age of 60.8 ± 14.8 years. DPN severity was assessed using traditional nerve conduction studies, and differentiated based on Baba's classification (BC). To examine the explanatory potential of variables in DPNCheck™ and CVR-R regarding the severity of DPN according to BC, a multiple regression analysis was carried out, followed by a receiver operating characteristic analysis. Based on BC, 61 participants (36.5% of the total) were categorized as having DPN severity of stage 2 or more. The multiple regression analysis yielded a predictive formula with high predictive power for DPN diagnosis (estimated severity of DPN in BC = 2.258 - 0.026 × nerve conduction velocity [m/s] - 0.594 × ln[sensory nerve action potential amplitude (μV)] + 0.528In[age(years)] - 0.178 × ln[CVR-R], r = 0.657). The area under the curve in receiver operating characteristic analysis was 0.880. Using the optimal cutoff value for DPN with severer than stage 2, the predictive formula showed good diagnostic efficacy: sensitivity of 83.6%, specificity of 79.2%, positive predictive value of 51.7% and negative predictive value of 76.1%. These findings suggest that DPN diagnosis using DPNCheck™ and CVR-R could improve diagnostic efficiency and accessibility for DPN assessment in patients with diabetes.

Early detection of peripheral neuropathy in patients with diabetes mellitus type 2

BackgroundEarly diagnosis of diabetic polyneuropathy (DPN) can significantly improve the prognosis and help prevent severe complications. The aim of this work was to study clinical, radiological, laboratory and neurophysiological findings for early detection of peripheral neuropathy in T2DM.MethodsA total of 60 diabetic patients were classified according to Toronto Clinical Neuropathy Score (TCNS) into: Group 1: 20 diabetic patients with no evident neuropathy. Group 2: 20 diabetic patients with mild neuropathy. Group 3: 20 diabetic patients with moderate and severe neuropathy. All patients underwent a neurological examination, nerve conduction studies and optical coherence tomography (OCT) to assess retinal nerve fiber layer (RNFL) thickness. Additionally, ELISA technique to measure serum interleukin-6 (IL-6).ResultsThe analysis of gender and age distributions among the groups revealed no significant differences. There were statistically significant differences regarding disease duration, HBA1c, body mass index Systolic and diastolic blood pressure. Group 3 had such significant impairment that resulted in an inability to record the measurements of sural nerves. The study's statistical analysis results for OCT variables, and post hoc comparisons revealed significant differences between all three groups. The results demonstrated significant variations in Serum IL6 levels among the groups, with Group 3 having the highest IL6 levels. In groups 1, 2, and 3 the area under the curve for IL-6 and RNFL showed a good differentiation ability between groups.ConclusionWe conclude that the total thickness RNFL and serum IL-6 levels are a potential biomarker in prediction the severity of DPN.

Serum neurofilament light chain – A potential biomarker for polyneuropathy in type 2 diabetes?

AimsTo investigate the relationship between neurofilament light chain (NfL) and the presence and severity of diabetic polyneuropathy (DPN). MethodsWe performed cross-sectional analysis of data from 178 participants of the ADDITION-Denmark cohort of people with screen-detected type 2 diabetes and 32 healthy controls. Biobank serum samples were analyzed for NfL using single-molecule array. DPN was defined by Toronto criteria for confirmed DPN. Original and axonal nerve conduction study (NCS) sum z-scores were used as indicators of the severity of DPN and peripheral nerve damage. Results39 (21.9%) participants had DPN. Serum NfL (s-NfL) was significantly higher in participants with DPN (18.8 ng/L [IQR 14.4; 27.9]) than in participants without DPN (15.4 ng/L [IQR 11.7; 20.1]). There were no unadjusted s-NfL differences between controls (17.6 ng/L [IQR 12.7; 19.8]) and participants with or without DPN. Higher original and axonal NCS sum z-scores were associated with 10% higher s-NfL (10.2 and 12.1% [95% CI’s 4.0; 16.8 and 6.6; 17.9] per 1 SD). The AUC of s-NfL for DPN was 0.63 (95% CI 0.52; 0.73). ConclusionsS-NfL is unlikely to be a reliable biomarker for the presence of DPN. S-NfL is however associated tothe severity of the nerve damage underlying DPN.

IDF21-0468 Correlation between severity of diabetic polyneuropathy and retinopathy using a point-of-care nerve conduction device

Background: The prevalence of blindness due to diabetic retinopathy have been decreasing, primarily due to improvements in diabetes care. However, there are still cases in which patients do not visit an ophthalmologist for diagnosis and treatment of diabetic retinopathy, resulting in severe visual impairment and even blindness. Because diabetic retinopathy often lacks subjective symptoms even in advanced stages, periodic fundus examinations are desirable and strongly recommended. However, many patients fail to visit an ophthalmologist for fundus examinations; and there are needs for quantitative evaluation to predict severity of diabetic retinopathy that can be used in clinical settings to encourage patients to visit an ophthalmologist.

The characteristics of pain and dysesthesia in patients with diabetic polyneuropathy.

Introduction/aimsPatients with diabetic polyneuropathy (DPN) may experience paresthesia, dysesthesia, and pain. We aimed to characterize the predictors, symptoms, somatosensory profile, neuropathy severity, and impact of painful DPN and dysesthetic DPN.MethodsThis study was a cross-sectional study of type 2 diabetes patients with confirmed DPN, diagnosed using widely accepted methods including a clinical examination, skin biopsy, and nerve conduction studies.FindingsOf 126 patients with confirmed DPN, 52 had DPN without pain or dysesthesia, 21 had dysesthetic DPN, and 53 painful DPN. Patients with painful DPN were less physically active and suffered from more pain elsewhere than in the feet compared to patients with DPN without pain. Patients with painful DPN had the largest loss of small and large sensory fiber function, and there was a gradient of larger spatial distribution of sensory loss from DPN without dysesthesia/pain to dysesthetic DPN and to painful DPN. This could indicate that patients with dysesthesia had more severe neuropathy than patients without dysesthesia but less than patients with painful DPN. Patients with dysesthetic and painful DPN had higher symptom scores for depression and fatigue than those without dysesthesia/pain with no difference between dysesthetic and painful DPN.ConclusionsThere was a gradient of increasing sensory loss from DPN without dysesthesia/pain to dysesthetic DPN and to painful DPN. Pain and dysesthesia are common in DPN and both interfere with daily life. It is therefore important to consider dysesthesia when diagnosing and treating patients with neuropathy.

Risk factors for depression and anxiety in painful and painless diabetic polyneuropathy: A multicentre observational cross-sectional study.

BackgroundDespite the high prevalence of depression and anxiety in chronic pain conditions, current knowledge concerning emotional distress among painful diabetic polyneuropathy (pDSPN) and other diabetes mellitus (DM) sufferers is limited.MethodsThis observational multicentre cohort study employed the Hospital Anxiety and Depression Scale, the Beck Depression Inventory II and the State‐Trait Anxiety Inventory to assess symptoms of depression and anxiety in several groups with diabetes, as well as in a control group. The study cohort included 347 pDSPN patients aged 63.4 years (median), 55.9% males; 311 pain‐free diabetic polyneuropathy (nDSPN) patients aged 63.7 years, 57.9% males; 50 diabetes mellitus (DM) patients without polyneuropathy aged 61.5 years, 44.0% males; and 71 healthy controls (HC) aged 63.0 years, 42.3% males. The roles played in emotional distress were explored in terms of the biological, the clinical (diabetes‐, neuropathy‐ and pain‐related), the socio‐economic and the cognitive factors (catastrophizing).ResultsThe study disclosed a significantly higher prevalence of the symptoms of depression and anxiety not only in pDSPN (46.7% and 60.7%, respectively), but also in patients with nDSPN (24.4% and 44.4%) and DM without polyneuropathy (22.0% and 30.0%) compared with HCs (7.0% and 14.1%, p < 0.001). Multiple regression analysis demonstrated the severity of pain and neuropathy, catastrophic thinking, type 2 DM, lower age and female sex as independent contributors to depression and anxiety.ConclusionsIn addition to the severity of neuropathic pain and its cognitive processing, the severity of diabetic polyneuropathy and demographic factors are key independent contributors to emotional distress in diabetic individuals.SignificanceIn large cohorts of well‐defined painless and painful diabetic polyneuropathy patients and diabetic subjects without polyneuropathy, we found a high prevalence of the symptoms of depression and anxiety, mainly in painful individuals. We have confirmed neuropathic pain, its severity and cognitive processing (pain catastrophizing) as dominant risk factors for depression and anxiety. Furthermore, some demographic factors (lower age, female sex), type 2 diabetes mellitus and severity of diabetic polyneuropathy were newly identified as important contributors to emotional distress independent of pain.

Integrated analysis of gene expression of solute carrier gene SLC19A3 with proven risk factors of microvascular complications in patients with type 2 diabetes

Diabetes mellitus (DM) is a chronic progressive disorder which leads to significant disability, morbidity and is likely to progress to become one of the most widespread conditions worldwide and as an additional burden to the healthcare system already reeling under the effects of the COVID-19 pandemic worldwide. Aim — to study the correlative variation in gene expression of SLC19A3 in type 2 diabetes patients with proven risk factors of diabetes complications. Materials and methods. In the study, 190 patients with type 2 DM were screened for diabetic peripheral neuropathy (DPN). DPN was confirmed in (n = 105) patients displaying symptoms of diabetic polyneuropathy with the involvement of small nerve fibers and large nerve fibers. Out of the total cohort, 45 patients with type 2 DM were shortlisted and randomized according to the severity of diabetic polyneuropathy, for assessment of the expression of the gene SLC19A3 in stage 1 of the gene expression study. &#x0D; Results. In the first stage of the study in patients with type 2 diabetes with diabetic polyneuropathy with the involvement of small nerve fibers and large nerve fibers we found that the difference in expression of the solute carrier gene SLC19A3 in patients with variable levels of neuropathy was not significant. As evident from the CT values and the value of ΔCT there was no statistically valid difference between the groups. The CT value of the target gene (SLC19A3) in all the three groups, in comparison to each other did not have significant difference in the initial phase of the investigation. In correlation to duration of disease the trend was similar, showing that duration of disease does not play an altering role in the expression of the target gene. In correlation to risk factor glycemic control (level of HbA1c) the expression of the target gene was slightly more profound in patients with an HbA1c of &lt; 8.9 % as compared to the patients with HbA1c value &gt; 9.0 %. Conclusions. Taking into consideration the results of the study it can be stated the expression of SLC19A3 is independent of the severity of diabetic polyneuropathy, duration of diabetes and the glycemic compensation in patients with type 2 diabetes. &#x0D;

Zinc deficiency correlates with severity of diabetic polyneuropathy.

ObjectivesThere are controversies about the role of zinc in the development of both types 1 and 2 diabetes. The aim of this study was to assess serum zinc level in diabetic patients with and without peripheral neuropathy in comparison to healthy controls and to explore the possible relationship between serum zinc level and severity of peripheral neuropathy.MethodsThis case control study was conducted on 120 subjects: 40 patients fulfilled the criteria for diagnosis of probable diabetic polyneuropathy (DPN), 40 diabetic patients without polyneuropathy (N‐DPN) and 40 healthy controls. DPN patients were submitted to clinical assessment of diabetic neuropathy using neuropathy symptom and change (NSC) scale, Michigan Neuropathy Screening Instrument Physical Assessment (MNSI) scale and electrophysiological assessment using nerve conduction study. Zinc serum level was measured in all subjects included in this study using direct colorimetric test method.ResultsDiabetic patients with and without neuropathy were found to have significantly lower mean values of serum zinc than healthy controls (p = .025, .03 respectively). There is a statistically significant negative correlation between zinc serum level and hemoglobin A1C (HA1C) (p ˂ .001), NSC score (p = .001) and MNSI score (p = .003) in DPN group. There were also statistically significant correlations between zinc serum level and nerve conduction study values.ConclusionZinc deficiency significantly correlates with the severity of DPN and glycemic control.

ВЛИЯНИЕ АЛЬФА-ЛИПОЕВОЙ КИСЛОТЫ НА ЧАСТОТУ ОСЛОЖНЕНИЙ И ПОСЛЕДСТВИЯ ИНФАРКТА МИОКАРДА У ПАЦИЕНТОВ С САХАРНЫМ ДИАБЕТОМ II ТИПА И ДИАБЕТИЧЕСКОЙ ПОЛИНЕЙРОПАТИЕЙ

Type II diabetes mellitus poses numerous negative factors affecting the course of myocardial infarction, including both metabolic indicators (glycated hemoglobin levels, lipid spectrum indicators) and neurological factors (severity of diabetic polyneuropathy, including cardiac autonomic neuropathy).

FEATURES OF THE DYNAMICS OF THE II DEGREE OF SEVERETY BACTERIAL KERATITES IN DIABETIC PATIENTS AT DIFFERENT STAGES OF DIABETIC POLYNEYROPATHY

Summary. The neuro-trophic condition of the cornea affects the healing process of corneal defects in patients with keratitis, causing the severity, duration and consequences of the disease.&#x0D; The aim was to identify the features of the dynamics of the II degree of severity bacterial keratitis in patients with diabetes mellitus (DM) at different stages of the severity of diabetic polyneuropathy (DPN).&#x0D; Materials and methods. The results of treatment of 19 patients with bacterial keratitis of the II degree of severity and type 1 DM were analyzed. II degree of severity of bacterial keratitis was determined according to our proposed scheme at a sum of points 15-21. All patients were treated with instillations of the antibiotic ofloxacin, antiseptics, antioxidants, reparants, artificial tears, mydriatics, systemic anti-inflammatory therapy. Patients were divided into two groups according to the severity of DPN: with symptomatic (first group) and stage with impaired DPN (second group). In addition to standard, ophthalmic examination methods included bacteriological examination, fluorescein test, OCT of the anterior segment of the eye, non-contact corneal esthesiometry.&#x0D; Results and discussion. In most patients of the second group, corneal sensitivity and depth of edema of the corneal tissues surrounding the ulcer, the size of the ulcer defect and the depth of corneal infiltration, the degree of pericorneal injection, the depth of the corneal ulcer defect from the 1st, 7th, 10th and 14th days of observation, respectively, were higher than in patients of the first group (p&lt;0,05). The consequence of the disease in patients of the second group was more severe than in patients of the first group.&#x0D; Conclusions. In patients with the stage of impaired DPN, bacterial keratitis is characterized by a longer duration and severity of clinical symptoms, as well as worse consequences of the disease than in patients with symptomatic DPN.

Зміни морфометричних параметрів макули як неінвазивний біомаркер ступеня тяжкості діабетичної полінейропатії

Diabetic polyneuropathy (DPN) is one of the most common complications of diabetes mellitus (DM), affecting up to a quarter of all patients with DM, and in asymptomatic form it is present in all patients. A number of changes in the retina, optic nerve, corneal nerve fibers, and visual function may correlate with DPN, so their evaluation may provide additional information on the detection and determination of its severity. The aim. To determine the peculiarities of changes in morphometric parameters of the central zone of the retina depending on the severity of DPN. Materials and methods. In total, 575 patients with type II DM were examined (1150 eyes). In 365 (63.5 %) DM patients, the diagnosis of DPN was excluded (stage N0). DPN was diagnosed in 210 (36.5 %) DM patients. Asymptomatic DPN was observed in 101 (17.5 %) DM patients: N1A stage – in 47 (8.1 %) patients, N1B stage – in 54 (9.4 %) patients; symptomatic DPN – in 89 (15.5 %) DM patients: N2A stage – in 46 (8.0 %) patients, N2B stage – in 43 (7.5 %) patients; stage of severe complications (N3 stage) – in 20 (3.5 %) DM patients. The control group consisted of 50 healthy individuals (100 eyes). In addition to standard ophthalmic examination methods, optical coherent tomography of the retina and optic nerve was performed. Results. Patients with type 2 DM had morphometric features of macular lesions depending on the severity of DPN: the index of focal loss volume (FLV) of retinal ganglion cells was 8.4 times higher in asymptomatic stage A DPN, 8.7 times higher in asymptomatic stage B DPN, 14.1 times higher in symptomatic stage A DPN, 14.3 times higher in symptomatic stage B DPN, 15.3 times higher at the stage of severe DPN complications (p &lt;0.05), and the thickness of the retina in the foveolar zone in patients with asymptomatic stage A DPN was 9.1 % lower, with asymptomatic stage B DPN it was 8.9 % lower, and at the stage of severe complications of DPN it was 12.7 % lower than the respective indices in healthy age-matched individuals. Conclusions. The obtained data indicate the relationship between morphometric parameters of the macula and the severity of DPN. The identified morphometric features of the macula in type 2 DM can serve as a non-invasive ophthalmic biomarker of the severity of DPN.

Reduced microvascular reactivity in patients with diabetic neuropathy.

Neurogenic regulation is involved in the development of microcirculation response to local heating. We suggest that microvascular reactivity can be used to estimate the severity of diabetic polyneuropathy (DPN). To evaluate the prospects for using the parameters of skin microvascular reactivity to determine the severity of DPN. 26 patients with diabetes mellitus were included in the study (patients with retinopathy (n = 15), and without retinopathy (n = 11)). The severity of DPN was assessed using Michigan Neuropathy Screening Instrument (MNSI) and Norfolk QOL-DN (NQOLDN). Skin microcirculation was measured by laser Doppler flowmetry with local heating test. There were revealed moderate negative correlations between microvascular reactivity and the severity of DPN (for MNSI (Rs = -0.430), for NQOLDN (Rs = -0.396)). In patients with retinopathy, correlations were stronger than in the general group (for MNSI (Rs = -0.770) and NQOLDN (Rs = -0.636)). No such correlations were found in patients without retinopathy. Correlation of the microvascular reactivity and DPN was revealed in patients with registered structural disorders in microvessels (retinopathy). The lack of such correlation in patients without retinopathy may be explained by the intact compensatory mechanisms of microvessels without severe disorders.

Alterations of retinal thickness measured by optical coherence tomography correlate with neurophysiological measures in diabetic polyneuropathy.

Aims/IntroductionDiabetic polyneuropathy (DPN) and diabetic retinopathy (DR) are traditionally regarded as microvascular complications. However, these complications may share similar neurodegenerative pathologies. Here we evaluate the correlations in the severity of DPN and changes in the thickness of neuroretinal layers to elucidate whether these complications exist at similar stages of progression.Materials and MethodsA total of 43 patients with type 2 diabetes underwent a nerve conduction study (NCS), a macular optical coherence tomography, and a carotid artery ultrasound scan. Diabetic polyneuropathy was classified according to Baba’s classification using NCS. The retina was automatically segmented into four layers; ganglion cell complex (GCC), inner nuclear layer/outer plexiform layer (INL/OPL), outer nuclear layer/photoreceptor inner and outer segments, and retinal pigment epithelium (RPE). The thickness of each retinal layer was separately analyzed for the fovea and the parafovea.ResultsFourteen patients were classified as having moderate to severe diabetic polyneuropathy. The thicknesses of the foveal and parafoveal INL/OPL increased in patients with diabetic polyneuropathy compared with patients without. The thickness of the parafoveal retinal pigment epithelium decreased in patients with diabetic polyneuropathy. The thinning of parafoveal ganglion cell complex and foveal and parafoveal retinal pigment epithelium were positively correlated with deterioration of nerve functions in the nerve conduction study, but the thickening of INL/OPL was positively correlated with the nerve function deterioration. The thinning of parafoveal ganglion cell complex and foveal retinal pigment epithelium were positively correlated with the thickening of the carotid intima‐media.ConclusionsDepending on the progression of diabetic polyneuropathy, the ganglion cell complex and retinal pigment epithelium became thinner and the INL/OPL became thicker. These retinal changes might be noteworthy for pathological investigations and for the assessment of diabetic polyneuropathy and diabetic retinopathy.

Long Noncoding RNA MALAT-1 and Mirna-9 Expression Profile Levels in Patients with Diabetic Polyneuropathy (DPN) and Their Correlations with The Severity of Painful DPN

Background: Diabetic polyneuropathy (DPN) is the major microvascular complication of type 2 diabetes mellitus (T2DM). Painful-DPN is a major cause of mortality as well as morbidity. Long non-coding RNAs (lncRNAs) and microRNAs (miRNA) have emerged as critical regulators of many diseases, however, little is known about their expression patterns and functions in T2DM and its complications. Objective: To investigate the expression profile levels of lncRNA MALAT-1 and miRNA-9 in Egyptian patients with T2DM and to explore their associations with clinical and electrophysiological tests of both painful and painless DPN. Patients and Methods: This cross-sectional controlled study enrolled 55 patients with DPN and 40 controls. All participants were subjected to a complete neurological examination and electrophysiological tests involving nerve conduction studies. The expression levels of lncRNA MALAT-1 and miRNA-9 were measured by quantitative real-time polymerase chain reaction (qRT-PCR). Results: The relative expression levels of MALAT-1 and miRNA-9 were significantly upregulated in patients with DPN (0.219±0.061, 0.006454±0.0018, respectively) compared to controls (0.111±0.013, 0.0033±0.004, respectively). Interestingly, the relative expression levels of MALAT-1 and miRNA-9 were significantly upregulated in patients with painful DPN (0.206±0.037, 0.0045±0.0008, respectively) compared to patients with painless DPN 0.219±0.083, 0.0058±0.0017, respectively). Patients with DPN had sensory-motor axonal polyneuropathy which was affecting both lower limbs more than upper limbs. P<0.001*. Conclusions: The relative expression levels of MALAT-1 and miRNA-9 were significantly upregulated in patients with DPN more specifically in patients with painful DPN groups, hence, MALAT-1 and miRNA-9 could be used as useful and reliable diagnostic biomarkers of DPN.

Relationship between the Diabetic Polyneuropathy Index and the Neurological Findings of Diabetic Polyneuropathy.

Objective To achieve an accurate quantification in diabetic polyneuropathy (DPN), we developed a new electrophysiological index that we called the DPN index. The relationship between the DPN index and the neurological findings in diabetic patients was assessed. Methods The DPN index was calculated by the mean value of percentages of four parameters (tibial compound muscle action potential amplitude / F wave minimum latency, sural sensory nerve action potential amplitude / sensory nerve conduction velocity) against the mean normal values. Twenty healthy subjects were recruited as a control group. Patients A total of 348 diabetic patients who were hospitalized in our hospital during the period from December 2016 to August 2019 were retrospectively studied. The correlations between the DPN index and five neurological findings (subjective sensory symptoms, diminished or absent Achilles tendon reflex, impaired tactile and vibration sense, low coefficient of variation of R-R interval) were evaluated. Results The DPN index in healthy subjects was 129.3±32.7%. The DPN index in diabetic patients with one or more neurological findings was significantly lower than that in diabetic patients without any neurological findings (p<0.01: 89.3±27.8% vs. 118.4±21.2%). For each of the five neurological findings, the DPN index in the group with an abnormality was significantly lower than that in the group without any abnormality (each p<0.01). Spearman's correlation coefficients indicated that a greater number of neurological findings resulted in a lower DPN index (r=-0.711, p<0.01). Conclusion Our study suggested that the DPN index is useful for evaluating the severity of DPN.

OUR EXPERIENCE OF USING AUTOLOGICAL BLOOD SERUM IN COMPLEX TREATMENT OF BACTERIAL CORNEAL ULCERS IN PATIENTS WITH DIABETES MELLITUS DEPENDING ON THESEVERETY OF DIABETIC POLYNEUROPATHY

Summary. Diabetic keratopathy, which develops against the background of diabetic corneal neuropathyshould be taken into account when choosing tactics for the treatment of bacterial corneal ulcers in patients with diabetes mellitus.&#x0D; The aim of the study was to determine the effectiveness of treatment of bacterial corneal ulcers with the help of additional local use of autological serum eye drops in patients with type 1 diabetes depending on the severity of diabetic polyneuropathy (DPN).&#x0D; Materials and methods. The results of observation of 10 patients (10 eyes) with bacterial corneal ulcer and type 1 diabetes mellitus, in which delayed healing of corneal ulcer defect were noted and the absence of microorganisms ware confirmed by repeated bacteriological examinations of corneal smears and scrapings,were analyzed. In addition to standard therapy, all patients 2 weeks after the start of treatment were additionally prescribed eye drops with autologous serum. Patients were divided into 2 groups according to the stage of severity of DPN: the first group consisted of 5 patients with symptomatic stage, the second - 5 patients with a stage of severe complications. In addition to standard, ophthalmic examination methods included bacteriological examination, fluorescein test, OCT of the anterior segment of the eye on the device TOPCON 3D OCT-2000, non-contact examination of corneal sensitivity.&#x0D; Results and discussion. It was found that the threshold of corneal sensitivity in patients with bacterial corneal ulcer at the stage of severe complications of DPN was higher than that in symptomatic DPN by an average of 16.6 % during the observation. The degree of pericorneal injection and infiltration of the cornea, as well as the size and depth of the ulcerative defect of the cornea at the stage of severe complications exceeded the corresponding indicators of patients with symptomatic DPN during the observation. Normalization of conjunctival color and reepithelialization of the cornea in all patients with severe complications occurred 3 days later than in patients with symptomatic DPN.&#x0D; Conclusions. The course of bacterial keratitis in patients with diabetes mellitus depends on the severity of DPN: a pronounced violation of corneal innervation at the stage of severe complications of DPN, manifested by a decrease in its sensitivity, leads to prolongation of treatment, even with additional use of eye drops with autologous serum.

Ефективність лікування бактеріальних кератитів у хворих із цукровим діабетом залежно від тяжкості діабетичної полінейропатії

The aim of the study was to identify the features of bacterial keratitis in patients with diabetes mellitus, depending on the severity of diabetic polyneuropathy in complex treatment with eye drops which contain alpha-lipoic acid, citicoline, cyanocobalamine and hyaluronic acid. Materials and methods. 15 patients with type 1 diabetes mellitus and bacterial keratitis were observed. Ophthalmological examination except of standard methods, included bacteriological examination, fluorescein test, noncontact corneal esthesiometry. All patients were treated with instillations of the antibiotic ofloxacin, standard anti-inflammatory therapy, and instillations of eye drops Tioretin A and OMK 2 twice a day locally. Observations were made on the first, third, seventh, tenth, fourteenth, eighteenth and twenty-second days. Results and discussion. In all periods of observation, the severity of conjunctival hyperemia and corneal edema, as well as the size of corneal erosion at the stage of severe complications diabetic polyneuropathy exceeded the corresponding rates of patients with asymptomatic and symptomatic degree. Normalization of conjunctiva color, reepithelialization of the cornea and disappearance of corneal opacification in all patients with severe complications diabetic polyneuropathy occurred 4 days later than in patients with asymptomatic and symptomatic degree. Conclusions. The course of bacterial keratitis depends on the severity of diabetic polyneuropathy: more pronounced violation of corneal innervation is marked at the stage of severe complications diabetic polyneuropathy, which manifested by decrease in its sensitivity, and led to the prolongation of the disease.

Diabetic polyneuropathy: Progress in diagnostic strategy and novel target discovery, but stagnation in drug development.

Diagnostic strategy of diabetic polyneuropathy has progressed. In particular, Baba's classification on the severity of diabetic polyneuropathy using nerve conduction study and a point-of-care device of nerve conduction study will realize the objective quantitative evaluation of diabetic polyneuropathy.

Evaluation of spatio-temporal gait parameters and gait symmetry in diabetic polyneuropathic patients with burn injury: A pilot study.

The purpose of this study was to investigate the effects of burn injury on spatio-temporal gait parameters and gait symmetry in individuals with diabetic polyneuropathy (DPN)-related lower extremity burn injury. Demographic information and the physical examinations of the lower extremities of 14 patients with unilateral lower extremity burn injury due to DPN (DPNB) and 14 uninjured patients with DPN (DPN0) were recorded. The GAITRite computerized gait analysis system was used to evaluate the spatio-temporal parameters of gait. Symmetry Index (SI) was calculated to determine gait symmetry. The Mann Whitney U test was used to determine the demographical and clinical differences between the groups, the Wilcoxon's test was used to compare both sides of all the participants for all gait parameters and linear regression analysis was used to find the variables that affect gait parameters. The groups were similar in terms of their demographic information except for age. Compared with the DPN0 group, DPNB group had increased extent of area with sensory loss and severity of DPN, decreased ankle joint range of motions and intrinsic foot muscles strength and they displayed lower gait speed, step length, stride length and swing percentage but their double support and stance percentage were increased. This study results have shown that, spatio-temporal gait parameters of DPNB patients are different. These differences in spatiotemporal parameters are found on both sides, probably owing to the symmetric and bilateral sensory loss is superior to unilateral burn injury due to symmetrical and bilateral sensory loss. Gait analysis should be considered in order to reveal the changes in gait parameters and to improve appropriate healing process of patients with DPN-related lower extremity burn injury.