Symptoms Of Diabetic Neuropathy Research Articles

Comparison of therapeutic effects of N-Acetylcysteine with pregabalin in improving the clinical symptoms of painful diabetic neuropathy: a randomized, double-blind clinical trial

ObjectivesPainful diabetic neuropathy (PDN) is highly prevalent and annoyingly in patients with diabetes. The aim of this study was to investigate the effects of oral N-acetylcysteine (NAC) compared to pregabalin in PDN.MethodsOne hundred two eligible patients with type 2 diabetes and PDN were randomly recievied pregabalin (150 mg/day) or N-Acetylcysteine (NAC) (600 mg/ twice a day) for 8 weeks. Mean pain score, Sleep interference score (SIS), Patient Global Impression of Change (PGIC), Clinical Global Impression of Change (CGIC), and also, serum levels of total antioxidant capacity (TAC), total thiol groups (TTG), catalase activity (CAT), nitric oxide (NO), and malondialdehyde (MDA) were assessed at baseline and at the end of the study.ResultsNAC was well tolerated in all patients. The decrease in mean pain scores and increase in SIS was similar between two groups. More improvement in PGIC and CGIC from the baseline was reported in NAC group. NAC, significantly, decreased serum levels of MDA, and NO, but increased TAC, TTG, and CAT. Pregabalin, significantly, decreased serum levels of MDA, and NO and increased TAC.DiscussionNAC is efficacious in alleviate symptoms of PDN which is probably related to its antioxidant effects.Trial registrationThe research protocol received approval from the Ethics Committee of Hamadan University of Medical Sciences (IR.UMSHA.REC.1397.137). The trial registry URL and number in Iranian Registry of Clinical Trials (IRCT): https://www.irct.ir/trial/33313, IRCT20180814040795N2 (Registration date: 2019-01-21, Retrospectively registered)

In patients with type II diabetes mellitus, is gabapentin or an SNRI more effective at treating symptoms of diabetic neuropathy?

In patients with type II diabetes mellitus, is gabapentin or an SNRI more effective at treating symptoms of diabetic neuropathy?

Ayurvedic Treatment Modalities of Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy is the damage of the nerves due to the uncontrolled diabetes. It can affect any of the neurons can affect any of the neurons. Diabetic distal symmetric sensory and sensorimotor polyneuropathy is the most prevalent type of diabetic neuropathy. The symptoms appear as sensory loss, first in the toes and progressively moving up the legs, fingers, and arms over time. Tingling sensation, Burning sensation, Deep aching pain are other related symptoms. A patient age 54 years with diabetes for past 15 years, hypertension, dyslipidemia, complains of burning sensation of both feet (right>left), numbness, pricking pain, unsteadiness while walking, brownish red discolouration of both lower limbs. The symptoms were gradual in onset. Nerve Conduction Study showed axonal type of motor and sensory affecting peroneal nerve neuropathy. He admitted in Vaidyaratnam Ayurveda College Hospital, done Vibrotherm Neuropathy Analyzer and revealed small and large fibre neuropathy with severe loss of sensations. The main intention of the study is to improve the quality of life of the patient by reducing the symptoms that is disturbing his day today routine. Patient given with anti diabetic Ayurvedic formulations internally. Externally Rookshana, Vatahara, Brimhana treatments were done. After the treatment, Michigan neuropathy screening instrument, diabetic Neuropathy symptom score, Toronto clinical scoring system score were reduced. Neuropathy Analyzer showed mild to moderate loss of sensation. By adopting Prameha hara chikitsa coupled with Vata vyadhihara chikitsa, complications of diabetes can be managed. It is important to focus on diet and regimen since diabetes is a lifestyle disorder and, in ayurveda it is considered as an Anushangi Vyadhi.

Evaluation of Protective Effect of Gemigliptin and Rizatriptan in Streptozotocin induced Diabetic Neuropathy in Rats.

ABSTRACT: A typical micro-vascular consequence of diabetes mellitus is diabetic neuropathy. The prevalence of diabetic neuropathy patients is rising in spite of strict glycemic control, blood pressure, and lipid lowering medication. New prevention and treatment methods are required because of the drawbacks and side effects of current medicines. Serotonin, a neurotransmitter implicated in the transmission of pain, is being investigated for its potential to process pain and to reduce inflammatory responses. Gemigliptin and rizatriptan are being studied for the treatment of hyperglycemic mortality. In this investigation, STZ (60 mg/kg) was injected intraperitoneally once to cause diabetic neuropathy. Tests were conducted on the neuroprotective potential of Gemigliptin (5 mg/kg p,o) alone and in combination with variable dosages of Rizatriptan (0.5, 1 mg/kg, i.p.) administered at intervals of 72 hours and one month. According to the study, a medicine combination of gemigliptin and rizatriptan successfully reduces the symptoms of diabetic neuropathy by lowering cholesterol, triglycerides, and serum glucose levels—all of which contribute to diabetes complications. Additionally, the combination reduces nerve damage-related hyperalgesia and significantly increases locomotor activity. Oxidative stress is decreased, which helps prevent additional difficulties, and the combination raises levels of antioxidants like SOD and CAT. Overall, Gemigliptin and Rizatriptan work well together to reduce diabetic neuropathic pain.

A review on comparative study of effectiveness of pregabalin and carbamazepine in painful diabetic peripheral neuropathy using mc gill's pain questionnaire

Diabetic neuropathy is a unique degenerative disorder of the peripheral nervous system that preferentially targets sensory axons and autonomic axons. The loss of sensory function that begins distally in the lower extremities is known as Diabetic neuropathy. It is characterized by burning pain, paresthesias and numbness in stocking glove pattern that progress proximally from the feet and hands. Diabetic neuropathy is a highly prevalent condition that substantially affects patients by increasing falls causing pain and reducing quality of life. The major risk factors for diabetic neuropathy is hyperglycemia. In addition to poor glycemic control, more-severe symptoms of diabetic neuropathy are associated with advanced age, hypertension, the duration of diabetes, dyslipidemia, smoking and heavy alcohol intake. Diabetic neuropathy is a major cause for disability of feet and hands globally. Anti-convulsants like pregabalin and carbamazepine are the medications used in the treatment of painful diabetic neuropathy.

Current Concepts in the Molecular Mechanisms and Management of Diabetic Neuropathy by Pharmacotherapeutics and Natural Compounds.

One of the most crippling effects of diabetes mellitus is diabetic neuropathy, which can cause discomfort, loss of movement, and even amputation. Diabetic neuropathy manifests in a variety of ways, ranging from pain to death. Diagnosing diabetic neuropathy can be challenging since it often goes unnoticed for many years following the onset of diabetes. In addition to oxidative stress in neurons, hyperglycemia activates a number of metabolic pathways that are important sources of damage and possible targets for treatment in diabetic neuropathy. Downstream metabolic cascades caused by prolonged hyperglycemia include activation of protein kinase C, increased production of advanced glycation end products, excessive release of cytokines, increased oxidative stress, and injury to peripheral nerves. Despite the fact that these metabolic anomalies are considered the main cause of diabetes-related microvascular issues, the diverse mechanistic processes of neuropathy are characterized by organ-specific histological and biochemical features. Although the symptoms of diabetic neuropathy can be treated, there are few options to correct the underlying problem. Diabetic neuropathy exerts a tremendous financial, psychological, and physical burden on society, emphasizing the need for efficient and focused treatment. The major goal of this review is to shed light on the multiple mechanisms and pathways that contribute to the onset of diabetic neuropathy and to provide readers with a comprehensive understanding of emerging therapeutic strategies to postpone or reverse various forms of diabetic neuropathy. The article discusses available medications and provides the latest guidelines for the treatment of pain and distal symmetric polyneuropathy, including diabetic autonomic neuropathy, which may help the patients control pain well and assess alternatives for treatment that might be more successful in preventing or delaying the course of a disease.

Vitamin D therapy's preventive effect in type 2 diabetes mellitus

Diabetes type II (DM II) is becoming more common, and it is highly harmful to several bodily systems. It's critical to keep DM II under control in order to avoid consequences like diabetic nephropathy, peripheral neuropathy, and damage to the retina. The fact that vitamin D lowers hemoglobin A1c (HbA1c) levels is just one of its many benefits. It boosts insulin's sensitivity and secretion. To find pertinent data, we thoroughly searched PubMed, a Medline, PMC, and Google Scholar. Following the application process of the inclusion and exclusion criteria, the studies' quality was assessed using the Cochrane bias analysis, the SANRA (Scale for the Testing of Narrative Review Articles) checklist, the AMSTAR (A Measuring Tool to Assess A Systematic Reviews) criteria, and the AMSTAR criteria. Data has been collected from 14 studies, of which 5 case reports, 3 general articles about DM II and vitamin D, 1 review of the literature, and 8 systematic reviews or meta-analyses.
 Three were narrative reviews and three were randomized controlled studies. The clinical significance of vitamin D treatment in type 2 diabetes is also evaluated in this study from the perspectives of glucose metabolism and adverse effects such retinopathy, neurotoxicity, and proteinuria. In terms of hemoglobin A1c (HbA1c) reduction, the relief of diabetic neuropathy and nephropathy symptoms, and the reduction of oxidative stress brought on by hypoglycemia in the retinal cells, vitamin D improved glucose levels clinically.
 One of the essential vitamins for diabetics is vitamin D..

Prevalence and Predictors of Diabetic Peripheral Neuropathy in Newly Diagnosed Type 2 Diabetes Mellitus Patients.

The present study aimed to determine the prevalence and predictors of DPN in newly diagnosed T2DM patients. Diabetic Peripheral Neuropathy (DPN) is the most common and debilitating complication of Type 2 Diabetes Mellitus (T2DM). Newly diagnosed T2DM patients visiting the outpatient department were recruited. Detailed demographic parameters, histories, physical examinations, and biochemical investigations were carried out. Patients were screened for DPN using the Diabetic Neuropathy Symptom (DNS) score, the revised Disability Neuropathy Score (NDS), Vibration Perception Threshold (VPT) using a biosthesiometer, and the 10g SW Monofilament Test (MFT). A total of 350 newly diagnosed T2DM patients (mean age 46.4±13.6 years) were included. The prevalence of DPN was found to be 34% using the combined DNS and NDS scores. VPT was moderately impaired in 18.3% and severely impaired in 12% patients, while MFT revealed a loss of protective sensation in 35.4% patients. After logistic regression analysis, DPN was significantly associated with increasing age (OR 1.08, 95%CI 1.06-1.11), increasing HbA1C levels (OR 1.23, 95%CI 1.05-1.42), increasing TSH levels (OR 1.23, 95%CI 1.05-1.44), presence of hypertension (OR 2.78, 95%CI 1.51-5.11), and reduced BMI (OR 0.9, 95%CI 0.84- 0.99). The sensitivity and specificity of detecting DPN by combining VPT and MFT were 91.6% and 84.2%, respectively. The prevalence of DPN was high even in newly diagnosed T2DM and associated significantly with increasing age, HbA1C levels, TSH levels, hypertension, and reduced BMI. Earlier screening for DPN, along with aggressive control of glycemia, blood pressure, and hypothyroidism, may be beneficial.

The systematic review on Madhumeha w.r.t. Diabetic Neuropathy and its management: A review article

The world's fastest-growing major illness is diabetes mellitus. It's a metabolic illness that could lead to an insufficiency or malfunction in the production of insulin. Many of the Samhitas contain detailed descriptions of Madhumeha. Diabetic neuropathy is most common complication of Diabetes, approximately 50% of patients with diabetes eventually develop neuropathy. Symptoms of diabetic neuropathy not directly mentioned in Ayurveda but symptoms like Suptata, Chumchumayan, Karpada Daha, seen in Prameha either in Prameha prodomal stage, exhibition stage or in complication stage. As Samprapti of diabetic neuropathy not clearly mentioned in Samhitas so, after reviewing different Samhitas, a Samprapti has been suggested with possible management of Diabetic neuropathy in Ayurveda i.e., Shodhan and Samana Chikitsa and mode of action of Shodhan Chikitsa.

Effect of Sensory Re-Education with Aerobic Training on Sensation and Balance among Diabetic Peripheral Neuropathy Patients: A Pilot Study

Background: People with diabetes have 10 to 30 times higher risk of lower limb amputation than people without thedisease. 85% of non-traumatic amputations in diabetic patients begin with a foot ulcer. Therefore, early interventionis necessary to control the symptoms of diabetic peripheral neuropathy and improve balance. Resistance andaerobic training reduce diabetic symptoms by lowering HbA1C levels. In order to restore functional sensibility,improve adaptive functioning, and improve balance, sensory re-education and aerobics are combined. Therefore,the aim of this study is to find out the effect of Sensory re-education and aerobics on sensation and balance amongdiabetic peripheral neuropathy patients.Purpose: The Purpose of the study is to determine the effects of sensory re-education with aerobic training onsensory perception and balance in Diabetic peripheral neuropathy patients.Material and Method: This study included diabetic individuals of both genders between the ages of 45-60, lowPAR-Q risk scores and Toronto clinical neuropathy scores (TCNS) between 6 and 11. A total of 20 participantswere randomly selected and received sensory re-education with aerobics for six weeks.Results: Individuals with diabetic peripheral neuropathy experienced statistically significant improvement inTCNS from 9.3±1.25 to 4.5± 1.3, in BBS 48.5 ± 2.70 to 41.7±1.41, in TUG 8.12±1.28 to 6.95 ±1.30, with a P value of <0.01.Conclusion: Sensory re-education with aerobic training for 6 weeks of duration reported improvement in sensoryperception and balance among people with diabetic peripheral neuropathy patients.

Ankle reflex and neurological symptom score: a primary level screening method for diabetic peripheral neuropathy.

Herein, we aimed to develop an easily available and efficient screening method for diabetic peripheral neuropathy (DPN) suitable for primary care settings, emphasizing simplicity, speed, and accuracy. Nerve conduction studies were conducted on 214 patients with diabetes, encompassing the outcomes of five distinct assessments: diabetic neuropathy symptom (DNS), vibration perception threshold (VPT), and nerve screening. The diagnostic accuracy of the VPT and nerve screening was evaluated by comparing them with that of the nerve conduction study. To assess diagnostic efficacy, various combinations were examined, including DNS combined with VPT, pain, temperature, touch, and ankle reflex. The diagnostic performance of DNS was superior to that of the five neurological screening items and VPT, with sensitivity, specificity, and accuracy of 0.68, 0.81, and 0.73, respectively. Among the two combined methods, "DNS + ankle reflex" was identified as having the highest diagnostic value, with an area under the curve, a sensitivity, a specificity, and an accuracy of 0.81, 0.89, 0.70, and 0.80, respectively. Furthermore, a combination of "DNS + ankle reflex + touch + pain + VPT" achieved the best performance among the five combinations, with an area under the curve, sensitivity, specificity, and accuracy of 0.85, 0.93, 0.68, and 0.81, respectively. The combination of DNS, ankle reflex, touch, pain, and VPT methods showed the highest diagnostic value for DPN. However, considering factors including accuracy, time, and economic cost, we recommend using a simpler combination of DNS and ankle reflex for large-scale screening of patients with DPN.

Analysis of determinant diabetic neuropathy symptom score factors in diabetes mellitus patients

Background: Diabetes peripheral neuropathy (DPN) is a set of signs and symptoms of peripheral nervous system dysfunction in diabetes mellitus patients. Abdominal obesity is one of the main risk factors for DPN. Diabetic neuropathy symptom (DNS) is a reliable instrument with consistent results for the diagnosis of neuropathy. Objective: This study aimed to determine the correlation of abdominal obesity with scores. Methods: This research was a quantitative study with a cross-sectional approach. The sample of this study was 92 type 2 diabetes mellitus (T2DM) patients aged range 30-60 years who participated in the chronic disease management program (Prolanis) and the integrated healthcare center (Posbindu) for people in the area of three public health centers (Puskesmas) in Pekalongan Regency which purposively selected. Instruments used to measure DPN were DNS sheets, and abdominal obesity was measured by waist circumference using a midline. The bivariate analysis was performed using the Pearson correlation and linear regression tests. Results: There was a correlation between abdominal obesity and DNS scores with a p value of 0.043 with a correlation coefficient of 0.212. The DNS score was influenced by age, gender, duration of diabetes, and body mass index by 13.4%. Conclusion: There was a correlation between abdominal obesity and DNS scores. It indicated that the higher the value of abdominal obesity was, the higher DNS scores increased.

Reliability of a novel point of care device for monitoring diabetic peripheral neuropathy

We aimed to assess DPNCheck’s reliability for repeated sural nerve conduction (NC) parameters. This post hoc analysis used data from the randomized controlled ACUDPN trial assessing NC of the N. Suralis every eight weeks over a 6-month period in 62 patients receiving acupuncture against diabetic peripheral neuropathy (DPN) symptoms. The reliability of DPNCheck for nerve conduction velocity and amplitude was assessed using intraclass correlation coefficients (ICC) and was calculated using data from single time points and repeated measures design. The results of the NC measurements were correlated with the Total Neuropathy Score clinical (TNSc). Overall, for both nerve velocity and amplitude, the reliability at each measurement time point can be described as moderate to good and the reliability using repeated measures design can be described as moderate. Nerve velocity and amplitude showed weak correlation with TNSc. DPNCheck’s reliability results question its suitability for monitoring DPN’s progression. Given the limitation of our analysis, a long-term, pre-specified, fully crossed study should be carried out among patients with DPN to fully determine the suitability of the device for DPN progression monitoring. This was the first analysis assessing the reliability of the DPNCheck for DPN progression monitoring using data from multiple collection time points.

The relationship between pesticide exposure and neuropathy in farmers in Wuluhan district

Farmers rely heavily on pesticides to protect crops from pests. Pesticides exposure will inhibit the acetylcholinesterase enzyme and will cause cholinergic symptoms which manifest as neuropathy. The research was conducted in March-April 2023 in Wuluhan District, Jember Regency. Pesticide exposure was evaluated through interviews using a pesticide exposure questionnaire, while neuropathy was evaluated through interviews and physical examination using the Diabetic Neuropathy Symptom Score-Indonesian version (DNS-Ina) and Diabetic Neuropathy Examination-Indonesian version (DNE-Ina) questionnaires. Univariate data analysis and bivariate analysis using the Chi-Square test. The results of this study showed that most of the study subjects had worked 10 years, the frequency of using pesticides ≤2 times per week, the duration of using pesticides ≤3 hours per day, the use of PPE is lacking. Bivariate analysis showed that neuropathy occurred in the farmer group, and there was a significant relationship between length of service and neuropathy, as well as the completeness of PPE use and neuropathy. However, there was no relationship between the frequency of pesticide use and neuropathy and the duration of pesticide use and neuropathy. The conclusion of this study is that the variable length of service and the completeness of the use of PPE have a relationship with the symptoms of neuropathy in farmers. While the variables of frequency and duration of use of pesticides are not related to neuropathy in farmers. 

Ayurveda Management in Diabetic Neuropathy vis-à-vis Prameha Upadrava–A Case Study

Background- Diabetes mellitus (DM) in India has a higher prevalence (4.3%) than in the west (1-2%) and its complication rate is also high.  Diabetic neuropathy symptoms include pain, numbness, reduced sensation of touch or oversensitivity, uncomfortable tingling and burning, skin ulcer and reduced reflexes. Diabetic neuropathies are seen in approximately 50% of individuals with long standing type 1 and type 2 DM and it often goes undiagnosed. This article presents a case study of patient with signs and symptoms of neuropathy who came with the complaint of lower back pain, bilateral lower limb pain, pricking sensation and burning sensation. Diabetic Neuropathy Examination score (DNE) along with other neuropathy screening parameters was more than 60% indicating functional loss. The Nerve conduction study also revealed demyelinating polyneuropathy.
 Observations and Results: The patient was treated with ayurvedic oral medication, Abhyanga (~application of medicated oils), swedana (~fomentation), and basti (~medicated enema). After ayurvedic treatment the patient showed good remission in pain, burning sensation and DNE along with all neuropathy screening were less than 20%. Patient got marked relief in all the symptoms.

Evaluating the effect of acupuncture on symptoms of diabetic peripheral neuropathy (DPN) among individuals with diabetic neuropathy: A single-blind, randomized trial study.

This study aimed to investigate the impact of acupuncture on Diabetic peripheral neuropathy (DPN) symptoms among individuals with diabetic neuropathy. In a single-blind, randomized trial conducted between 2019 and 2020, 60 patients diagnosed with diabetic neuropathy were enrolled. These participants were randomly assigned to either the intervention or control group. The intervention group received real acupuncture alongside routine treatment once a week for seven sessions, each lasting 20min. Meanwhile, the control group received sham acupuncture as an adjunct to their routine treatment, following the same schedule. To evaluate treatment efficacy, the study assessed primary outcomes, such as pain intensity measured using the Visual Analogue Scale (VAS). Secondary outcomes included evaluating fatigue severity and diabetic peripheral neuropathy (DPN) side effects, measured using the multidimensional fatigue inventory (MFI-20) and a standard questionnaire after each session. No statistically significant differences in pain and fatigue scores were observed between the two groups throughout all visits, even after adjusting for baseline characteristics, age, sex, type of diabetes, discopathy, and carpal tunnel syndrome parameters (P > 0.05). The findings did not provide strong evidence supporting a significant effect of real acupuncture compared to sham acupuncture on pain and fatigue values (P = 0.267 and 0.634, respectively). However, the 95% confidence interval for pain scores (-0.35, 1.28) was inconclusive, encompassing effect sizes favoring sham acupuncture. Findings suggest that using acupuncture as an adjunctive therapy alongside routine treatment may not lead to a significant reduction in the symptoms of peripheral neuropathy and fatigue severity among individuals with diabetic neuropathy. The online version contains supplementary material available at 10.1007/s40200-023-01314-1.

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

Background & 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<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.

Diabetes-Induced Amplification of Nociceptive DRG Neuron Output by Upregulation of Somatic T-Type Ca2+ Channels.

The development of pain symptoms in peripheral diabetic neuropathy (PDN) is associated with the upregulation of T-type Ca2+ channels (T-channels) in the soma of nociceptive DRG neurons. Moreover, a block of these channels in DRG neurons effectively reversed mechanical and thermal hyperalgesia in animal diabetic models, indicating that T-channel functioning in these neurons is causally linked to PDN. However, no particular mechanisms relating the upregulation of T-channels in the soma of nociceptive DRG neurons to the pathological pain processing in PDN have been suggested. Here we have electrophysiologically identified voltage-gated currents expressed in nociceptive DRG neurons and developed a computation model of the neurons, including peripheral and central axons. Simulations showed substantially stronger sensitivity of neuronal excitability to diabetes-induced T-channel upregulation at the normal body temperature compared to the ambient one. We also found that upregulation of somatic T-channels, observed in these neurons under diabetic conditions, amplifies a single action potential invading the soma from the periphery into a burst of multiple action potentials further propagated to the end of the central axon. We have concluded that the somatic T-channel-dependent amplification of the peripheral nociceptive input to the spinal cord demonstrated in this work may underlie abnormal nociception at different stages of diabetes development.

Relationships of blood pressure and control with microvascular dysfunction in type 2 diabetes

BackgroundIn type 2 diabetes mellitus (T2D), cardiovascular risk factors including glycemic control differentially affect various microcirculatory beds. To date, studies comparing the impact of blood pressure (BP) on various microvascular beds in T2D are limited. We assessed the associations of BP and its control with neural, renal, and retinal microvascular dysfunction. MethodsThis was a cross-sectional study among 403 adults with T2D. Microvascular dysfunction was based on nephropathy (albumin-creatinine ratio ≥ 30 mg/g), neuropathy (vibration perception threshold ≥ 25 V and/or Diabetic Neuropathy Symptom score > 1), and retinopathy (based on retinal photography). Logistic regression was used to examine the associations of hypertension, systolic BP, and diastolic BP with microvascular dysfunction with adjustments for age, sex, diabetes duration, smoking pack years, HbA1c concentration, total cholesterol concentration, and BMI. ResultsThe mean age (± SD), proportion of females, and proportion of hypertensives were 56.35 (± 9.91) years, 75.7%, and 49.1%, respectively. In a fully adjusted model, hypertension was significantly associated with neuropathy [odds ratio 3.44, 95% confidence interval 1.96–6.04, P < 0.001] and nephropathy [2.05 (1.09–3.85), 0.026] but not for retinopathy [0.98 (0.42–2.31), 0.970]. Increasing Z-score systolic BP was significantly associated with nephropathy [1.43 (1.05–1.97), 0.025] but not for neuropathy [1.28 (0.98–1.67), 0.075] or retinopathy [1.27 (0.84–1.91), 0.261]. Increasing Z-score diastolic BP was significantly associated with nephropathy [1.81 (1.32 – 2.49), < 0.001] but not retinopathy [1.38 (0.92–2.05), 0.120] or neuropathy [0.86 (0.67–1.10), 0.230]. ConclusionOur study shows varying strengths of associations of hypertension, systolic BP, and diastolic BP with microvascular dysfunction in different microcirculatory beds. Hypertension prevention and/or control may be valuable in the prevention/treatment of microvascular disease, especially nephropathy, and neuropathy.

Pathology of carbohydrate metabolism in primary hyperparathyroidism: epidemiological and clinical characteristics

Primary hyperparathyroidism (PHPT) is characterized by disorders of not only mineral metabolism, but also other kinds of the human metabolism. Due to the increased frequency of cardiovascular risk factors among patients with PHPT, the study of the carbohydrate metabolism pathology in this cohort of patients will allow developing optimal approaches to their timely diagnosis and treatment.Aim. To determine the frequency and describe the clinical features of carbohydrate metabolism disorders in patients with PHPT.Material and methods. A single-center retrospective study of adults with PHPT was carried out with an assessment of the main parameters of mineral and carbohydrate metabolism before surgical treatment of the disease. The exclusion criteria were the absence of PHPT remission or a recurrence of the disease after parathyroidectomy; pregnancy, lactation. The frequency of various disorders of carbohydrate metabolism in PHPT, the comparative characteristics of mineral parameters in patients with and without them, as well as the severity of type 2 diabetes mellitus in PHPT were determined. In addition, potential relationships between the parameters of various types of metabolism have been studied.Results. The study was based on a clinical information of 367 patients with PHPT, most of whom had a symptomatic form of the disease. The overall incidence of prediabetic disorders was 4,9% (95% CI: 3-8). Type 2 diabetes mellitus was previously diagnosed in 45 patients (12%, 95% CI: 9-16), there were no cases of first diagnosed diabetes mellitus. Individuals with impaired carbohydrate metabolism had a statistically significantly higher body mass index and lower values of osteocalcin (27,2 [24,2; 30,4] kg/m2 vs 32,7 [28,1; 39,4 kg/m2 and 48,1 [34; 76,3] ng/mL vs 33,1 [20,8; 51,8] ng/mL, respectively, for all parameters p&lt;0,001). Among patients with type 2 diabetes mellitus, 36 people (80%) took hypoglycemic therapy, 14 of which received metformin monotherapy and 8 received two-component therapy, including metformin. 5 people were on insulin therapy. Diabetic nephropathy was diagnosed in 36,4% of patients, 15,4% had signs of diabetic retinopathy, symptoms of diabetic distal neuropathy were observed in 61,9% of patients with PHPT. Fasting glucose and glycated hemoglobin were negatively correlated with bone metabolism, and also expectedly depended on the glomerular filtration rate.Conclusion. Among patients with PHPT, type 2 diabetes mellitus is more common than in the general population. The likely reason of this may be insulin resistance, that can be caused by the effects of bone metabolites, primarily osteocalcin. In most cases, metformin makes it possible to achieve compensation for diabetes mellitus in PHPT.