Diabetes mellitus does not increase the risk of knee stiffness after total knee arthroplasty: a meta-analysis of 7 studies including 246 053 cases

PURPOSE@#The association of diabetes mellitus with knee stiffness after total knee arthroplasty is still being debated. The aim of this study was to assess through meta-analysis the impact of diabetes mellitus on the prevalence of postoperative knee stiffness after total knee arthroplasty.@*METHODS@#We conducted a literature search for terms regarding postoperative knee stiffness and diabetes mellitus on Embase, CINAHL, and PubMed NCBI.@*RESULTS@#Of 1142 articles, seven were suitable for analysis. Meta-analysis showed that diabetes mellitus does not confer an increased risk of primary or revision total knee arthroplasty-induced postoperative knee stiffness when compared to nondiabetic patients (primary total knee arthroplasty, estimated odds ratio [OR] 1.474 and 95% confidence interval [CI] 0.97–2.23; primary and revision total knee arthroplasty, OR 1.340 and 95% CI 0.97–1.83).@*CONCLUSION@#There is no strong evidence that diabetes mellitus increases the risk of knee stiffness after total knee arthroplasty. The decision to proceed with total knee arthroplasty, discussion as part of the consent process, and subsequent rehabilitation should not differ between patients with and without diabetes mellitus with regards to risk of stiffness.LEVEL OF EVIDENCE: Level III (meta-analysis)

Diagnosing Diabetic Neuropathy: Something Old, Something New

There are potentially many ways of assessing diabetic peripheral neuropathy (DPN). However, they do not fulfill U.S. Food and Drug Administration (FDA) requirements in relation to their capacity to assess therapeutic benefit in clinical trials of DPN. Over the past several decades symptoms and signs, quantitative sensory and electrodiagnostic testing have been strongly endorsed, but have consistently failed as surrogate end points in clinical trials. Therefore, there is an unmet need for reliable biomarkers to capture the onset and progression and to facilitate drug discovery in DPN. Corneal confocal microscopy (CCM) is a non-invasive ophthalmic imaging modality for in vivo evaluation of sensory C-fibers. An increasing body of evidence from multiple centers worldwide suggests that CCM fulfills the FDA criteria as a surrogate endpoint of DPN.

Diabetic neuropathy and painful diabetic neuropathy in the Middle East and North Africa [MENA] region: Much work needs to be done

The prevalence of diabetic peripheral neuropathy and painful diabetic peripheral neuropathy in the Middle East shows huge variability. This reflects the differing diagnostic techniques employed to diagnose neuropathy, but also the heterogeneity of the populations studied and the selection of populations from primary and secondary care. The treatment of diabetic neuropathy per se is inadequate as reflected by the poor control of risk factors such as glucose control, blood pressure and lipids in this region, which translates into the high rates of foot ulceration and amputation. In relation to symptomatic treatment, recommendations based on trials conducted in the West are without question, endorsed for the treatment of populations in the Middle East. Surely the demographics and patient responses both in terms of efficacy and side effects differ and therefore warrant local clinical trials. There is an over reliance on the prescription of B vitamins with the claim that they induce nerve repair. Whilst there is evidence for the relief of neuropathic symptoms with both vitamin B and D, again clinical trials are required in this region to establish their role in the treatment of diabetic neuropathy and painful diabetic neuropathy

Pancreatic islet cell transplantation as a treatment for brittle type 1 diabetes: a case report and review of the literature

Hypoglycaemia is the most common life-threatening acute complication in patients with type 1 diabetes mellitus [T1DM]. Approximately 30% of patients with T1DM will suffer from one episode per year of severe hypoglycaemia in which third-party assistance is required, and is associated with significant morbidity and mortality. Islet cell transplantation was approved by the National Commissioning Group [UK] for reducing the frequency of lifethreatening hypoglycaemic attacks in patients with impaired hypoglycaemia awareness. To date, five patients have undergone this procedure in Manchester, UK, since its approval in 2010. We present the case of a 56-year-old man with T1DM for 30 years on approximately 50 units of insulin per day with a glycated haemoglobin [HbA1c] of 9% [75 mmol/mol]. He scored 7 on the Gold Score and 6 on the Modified Clarke Scale for hypoglycaemia, making him eligible to undergo islet cell transplantation. He received two islet transplants, one in 2010 and the second in 2011. The patient did not achieve complete insulin independence post-transplant but reduced his daily insulin to approximately 17 U. However, the episodes of severe hypoglycaemia were reduced from approximately 50/year to 0.25/year, and he now has excellent glycaemic control with an HbA1c of 6.8% [51 mmol/mol]. The long-term microvascular complications, especially neuropathy, assessed by the novel technique of corneal confocal microscopy have not shown progression. He developed side effects from the immunosuppressive therapy, which included mouth ulcers, hypertension and moderate deterioration of renal function