Algunos aspectos actualizados sobre la polineuropatía diabética / Some up-to-date aspects on the diabetic polyneuropathy

La diabetes mellitus es una enfermedad crónica que puede causar complicaciones multiorgánicas como la polineuropatía diabética, con el consecuente trastorno invalidante a quienes la padecen. Por tal motivo, se realizó una revisión bibliográfica exhaustiva con el objetivo de actualizar algunos aspectos importantes sobre esta afección, tales como concepto, factores de riesgo, mecanismos patogénicos, clasificación, diagnóstico y tratamiento, entre otros. Se concluye que esta enfermedad se asocia con varios factores de riesgo, su diagnóstico es fundamentalmente clínico y como tratamiento se considera el control glucémico, el cuidado de los pies y el uso de fármacos.

The diabetes mellitus is a chronic disease that can cause multiorganic complications as the diabetic polyneuropathy, with the consequent invalidant disorder to whom suffer from it. For such a reason, an exhaustive literature review was carried out with the objective of upgrading some important aspects on this affection, such as concept, risk factors, pathogenic mechanisms, classification, diagnosis and treatment, among others. It was concluded that this disease is associated with several risk factors, its diagnosis is fundamentally clinical and the glycemic control, the care of feet and the use of medicines are considered as treatment.

The efficacy of alpha-lipoic acid and/or gabapentin on the oxidant-antioxidant system in patients with diabetic polyneuropathy

Background: Diabetic peripheral sensorimotor polyneuropathy is the most common complication seen in patients with diabetes mellitus (DM). Oxidant system plays a crucial role in its physiopathology. We investigated the changes in the serum levels of total antioxidant status (TAS), total oxidant status (TOS), paraoxonase-1 (PON1) and oxidative stress index (OSI) to evaluate the antioxidant efficacy of alpha lipoic acid (ALA) and/or gabapentin in patients with diabetic polyneuropathy (DPN).Methods: Sixty-three type 2 DM patients with diabetic polyneuropathy (DPN) were enrolled in the study. Patients with DPN were divided into four groups in terms of their treatment: Group 1 consisted of treatment-naive patients; patients treated with ALA, gabapentin or combination of ALA and gabapentin comprised groups 2, 3, and 4, respectively. The patients received the medications for at least six weeks.  Serum levels of TAS, TOS, PON1 and OSI were analyzed.Results: No significant difference was observed between the groups according to the oxidative stress parameters studied.Conclusions: The use of ALA and/or gabapentin in patients with DPN did not significantly affect the oxidative stress parameters, including TAS, TOS, PON1, and OSI.

Utilization of Nerve Conduction Study for the Detection of Diabetic Polyneuropathy in a Tertiary Care Center in Madhya Pradesh

Introduction: Diabetes mellitus is a group of metabolic disorders that share the phenotype of hyperglycemia. The clinical and economic burden of diabetic polyneuropathy (DPN) stems from its central role in the pathophysiology of foot ulceration and lower limb amputation, reduction in quality of life. Simple screening methods are of limited value in early neuropathy. Nerve conduction studies (NCSs) are the most sensitive and specific DPN detection method. Material and Method: This study was conducted to detect the sensory-motor neuropathy in type 2 diabetes mellitus by clinical examination and nerve conduction study. In this study, 50 cases of type 2 diabetes were taken. Results: Majority of patients presented with tingling sensation and followed by burning feet. In 50 patients of type 2 diabetes mellitus on clinical examination, most of the patients had involvement of both upper and lower limbs followed by only lower limb involvement, whereas on NCS, there were more patients with both upper and lower limbs involvement as compared to clinical studies. Maximum patients had symmetrical limb involvement clinically, but on NCS, the number of patients with symmetrical limb involvement was even more. Conclusion: It was found that patients with diabetes mellitus, diabetic peripheral neuropathy is highly prevalent, but in the majority of patients, it is subclinical. Sensitivity and negative predictive values of the neurological examination are low. Therefore, routine nerve conduction velocity measurement for the assessment of diabetic peripheral neuropathy appears to be warranted in these patients. Thus, the author concluded in this study, detection of neuropathy is earlier and significant with NCS compared to clinical.

To Compare The Functional Balance Between Normal Elderly, Elderly With Diabetes, Elderly With Diabetic Polyneuropathy

Background: We aimed in this study to compare functional balance using berg balance scale amongst three groups namely elderly without diabetes, elderly with diabetes and elderly with diabetic polyneuropathy. There were total 108 patients included in the study. Purpose: The main objective of the study was to compare functional balance by using berg balance scale among the three groups namely elderly without diabetes, elderly with diabetes and elderly with diabetic polyneuropathy. Methodology: A total of 108 patients were taken for the study, were divided into three groups namely: Group A- Elderly without diabetes, Group B- Elderly with diabetes and Group C- Elderly with diabetic polyneuropathy. Berg balance scale was administered in the above mentioned three groups. Results: The mean of age, gender and duration since diabetes was calculated in all groups. Berg balance scale scores were calculated and in that high fall risk there were 20(55.56%) participants in elderly with diabetic polyneuropathy. In medium fall risk there was 1(2.78%) participant in elderly with diabetes and 16(44.44%) participants in elderly with diabetic polyneuropathy. While in low fall risk there were 36 (100%) participants in normal elderly, 35(97.22%) participants in elderly with diabetes and 0(0%) in elderly with diabetic polyneuropathy. One way Anova was done and all the three groups were having significant difference in their BBS scores. Conclusion: this study concluded that elderly with diabetic polyneuropathy were at high risk of fall than the other two groups; however elderly with diabetics were also at low risk of fall compared to elderly without diabetes though the result was not significant.

Study of clinical and nerve conduction study correlation in patients of diabetic neuropathy in diabetes mellitus type 2

Background: Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia with disturbance of carbohydrate, fat, and protein metabolism resulting from defects in insulin secretion, insulin action or both with an increased risk of neuropathy. Early diagnosis and management of diabetic polyneuropathy (DPN) are crucial as failure to diagnose can lead to serious consequences, including disability and amputation. Present study aimed at investigating the demographic profile and correlation of clinical features with nerve conduction studies in patients with diabetic neuropathy in type 2 diabetes mellitus.Methods: The cross-sectional study design with total 66 patients of type 2 DM were selected in 30 to 60-year age groups, from Pt. Jawaharlal Nehru Memorial Medical College, Department of Medicine, Raipur (C.G.) (Pt. JNMMC) and associated hospital. Descriptive statistics and χ2 test were used for analysing the data.Results: Total 66 patients were selected, Most of the patients are presenting with tingling sensation (n=64, 97.0%) and burning feet (n=52, 78.8%), NCV is mostly absent in the tibial nerve (n=52, 78%), sural nerve (n=63, 95.5%) and planter nerve (n=41, 62.1%) while it is largely normal in median nerve (n=54, 81.8%) and ulner nerve (n=61, 92.4%). Tingling sensation, burning feet, diminished vibration sensation and diminished light touch are significantly associated (p=0.00) with NCV in different nerves.Conclusions: Limitations of study includes small sample size, lack of general population, and a control group. Diabetes mellitus is a chronic illness with an increased risk of neuropathy. NCS having high sensitivity and specificity for detection of DPN. Understanding the NCS and its correlates in patients with DPN is crucial for early detection and development of effective management and strategies to prevent its complications.

Diagnosis and Management of Diabetic Peripheral Neuropathy / 임상당뇨병

Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes and is diagnosed as the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes. The prevalence of DPN was reported at 33.5% of type 2 diabetes patients by the Korean diabetes neuropathy study group. Early diagnosis is recommended to prevent diabetic foot ulcers, amputation, or disability. A questionnaire asking about symptoms and neurologic examination of feet is commonly used as a screening tool. However, complete diagnostic tests for DPN are not well established because of incomplete understanding of the pathogenetic mechanisms leading to the nerve injury, the various clinical manifestations, and the unclear natural history. Therefore, DPN has not been paid sufficient attention by clinicians. The roles of glycemic control and management of cardiovascular risk factors in the prevention and treatment of neuropathic complications are well known. Pathogenetically oriented or symptomatic agents are other options, though such treatments do not always produce a satisfactory outcome. Therefore, DPN remains a challenge for physicians to screen, diagnose, and treat. There have been recent advances in understanding the mechanisms underlying DPN and in the development of new diagnostic modalities and treatments. In this review, diagnosis and management of DPN will be discussed.

Comparison of Somatic and Sudomotor Nerve Fibers in Type 2 Diabetes Mellitus

BACKGROUND AND PURPOSE: The objective of this study was to find a sensitive method for the early detection of diabetic polyneuropathy (DPN) and determine the relationship between the functions of somatic and autonomic small nerve fibers in DPN. METHODS: Patients with type 2 diabetes mellitus and DPN based on clinical symptoms, signs, intraepidermal nerve fiber density (IENFD), and findings in the quantitative sudomotor axon reflex test (QSART) were enrolled retrospectively. Neurological examinations and nerve conduction studies were performed on all patients. Heart-rate variability during deep breathing (DB ratio) and the Valsalva maneuver (Valsalva ratio) were used to quantify the cardiovagal function. Patients were divided into two groups: 1) normal nerve conduction, defined as small-fiber neuropathy (SFN) and 2) abnormal nerve conduction, defined as mixed-fiber neuropathy. RESULTS: In total, 82 patients were enrolled (age: 60.7±10.7 years, mean±SD). A decreased IENFD was the most frequent abnormality across all of the patients, followed by abnormalities of the QSART and cardiovagal function. A decreased IENFD was more sensitive than the QSART, DB ratio, and Valsalva ratio for detecting diabetic SFN. The DB ratio was significantly correlated with the duration of diabetes mellitus and clinical symptoms and signs. There was no correlation between the IENFD and the findings of the QSART for the distal leg. CONCLUSIONS: Measuring the IENFD was a more sensitive method than the QSART for the early detection of DPN. The degree of involvement of the somatic small nerve fibers and sudomotor nerve fibers was independent in DPN.

Factores de riesgo asociados al pie diabético

Introducción: El pie diabético representa una de las causas de mayor morbilidad e incapacidad en las personas con Diabetes Mellitus. Esta población abarca hasta el 70% de las amputaciones, en su mayoría desencadenada por la infección. La vasculopatía periférica, la neuropatía periférica asociadas al control metabólico juegan un rol importante en su génesis. El conocimiento de los mismos en la atención primaria asociadas a las medidas de prevención colaborarán en la disminución de este flagelo que aqueja a millones en la actualidad. Objetivos: Determinar los factores de riesgo asociados a las lesiones del pie diabético. Describir las características demográficas y clínicas de los pacientes con lesiones del pie diabético. Material y métodos: estudio de casos y controles. No probabilístico, de casos consecutivos. Se incluyeron pacientes adultos internados en el Departamento de Medicina Interna durante el 2015, diabéticos, con y sin lesiones en pie, sin amputaciones previas e independientes del tratamiento farmacológico. Resultados: se incluyeron 86 sujetos, de los cuales 59% de los casos presentaron onicomicosis, el 57% neuropatía, el 67% vasculopatía, 45% algún tipo de deformidad y un 63% utilizaban calzados inadecuados. Conclusiones: La onicomicosis representó un factor de riesgo significativo para el desarrollo del pie diabético (p=0,02). En lo que respecta a la vasculopatía, la neuropatía y el control glicémico no se pudo establecer un riesgo significativo.

Introduction: The diabetic foot is one of the main causes of higher morbidity and disability in people with Diabetes Mellitus. This population comprises up to 70% of amputations, mostly triggered by infections. The peripheral vascular disease and the peripheral neuropathy associated with metabolic control play an important role in its genesis. The knowledge about them associated with prevention measures in primary care contribute to reduce this scourge that currently afflicts millions. Objectives: To determine risk factors associated with diabetic food lesions and to describe the demographic and clinical characteristics of patients with diabetic foot lesions. Material and methods: Case-control study with non-probabilistic consecutive sampling. Adult diabetic patients with and without foot lesions, without previous amputations, independent of pharmacological treatment and admitted into the Department of Internal Medicine during 2015 were included. Results: 86 subjects were included, 59% of the cases had onychomycosis, 57% neuropathy, 67% vasculopathy, 45% some deformity and 63% used inadequate footwear. Conclusions: Onychomycosis represented a significant risk factor for the development of diabetic foot (p = 0.02). Concerning vasculopathy, neuropathy and glycemic control, a significant risk could not be established.

Comparative Assessment of Motor Nerve Conduction Velocity among Non-Diabetic, Diabetic Non-Smoker and Sub Groups of Diabetic Smoker.

Background: Neuropathy is one of the most common complications affecting individuals with diabetes mellitus. The best evidence indicates that the etiology of neuropathy is multifactorial and is a key area of current research. Hence, this study was undertaken to test the hypothesis of alteration in MNCV (motor nerve conduction velocity) of nerves before the actual manifestation of neuropathy in type II diabetic patients and also to analyze the effect of smoking on MNCV in diabetic subjects. Methods: In the present study, 120 diagnosed diabetics were taken as cases while 30 non diabetic healthy subjects were taken as controls. Case group was divided into diabetic non-smokers and diabetic smokers. Diabetic smokers were further subdivided into light, moderate and heavy smokers, according to smoking index. After detailed history and physical examination MNCV of median and ulnar nerve in upper limb and common peroneal nerve in lower limb was performed. Result: The MNCV of median and ulnar nerves in upper limb showed no significant bilateral decreased in diabetic non-smokers and subgroup of diabetic smokers when compared with control. However, there was a significant bilateral decrease in MNCV of common peroneal nerves in the lower limb of diabetic heavy smokers when compared with control. A negative, but statistically non-significant correlation was found between MNCV and smoking index. The decrease in MNCV was dependent on smoking index by 3%, 1%, 1%, 1%, 3% and 1% in median nerve (right), median nerve (left), ulnar nerve (right), ulnar nerve (left), common peroneal nerve (right) and common peroneal nerve (left) respectively. Conclusion: The present study indicates that MNCV is more resistant to hyperglycemia induced local metabolic and microvascular changes. However, the coalition of diabetes and smoking can augment their effects many folds and can lead to motor neuropathy, reiterating the fact that smoking itself is an independent risk factor for diabetic neuropathy.

Correlation Between the Severity of Diabetic Peripheral Polyneuropathy and Glycosylated Hemoglobin Levels: A Quantitative Study

OBJECTIVE: To investigate risk factors for diabetic peripheral polyneuropathy and their correlation with the quantified severity of nerve dysfunction in patients with diabetes mellitus (DM). METHODS: A total of 187 diabetic patients with clinically suspected polyneuropathy (PN) were subclassified into 2 groups according to electrodiagnostic testing: a DM-PN group of 153 diabetic patients without electrophysiological abnormality and a DM+PN group of 34 diabetic patients with polyneuropathy. For all patients, age, sex, height, weight, duration of DM, and plasma glycosylated hemoglobin (HbA1c) level were comparatively investigated. A composite score was introduced to quantitatively analyze the results of the nerve conduction studies. Logistic regression analysis and multiple regression analysis were used to evaluate correlations between significant risk factors and severity of diabetic polyneuropathy. RESULTS: The DM+PN group showed a significantly higher HbA1c level and composite score, as compared with the DM-PN group. Increased HbA1c level and old age were significant predictive factors for polyneuropathy in diabetic patients (odds ratio=5.233 and 4.745, respectively). In the multiple linear regression model, HbA1c and age showed a significant positive association with composite score, in order (β=1.560 and 0.253, respectively). CONCLUSION: Increased HbA1c level indicative of a state of chronic hyperglycemia was a risk factor for polyneuropathy in diabetic patients and a quantitative measure of its severity.

Thalassotherapy in Diabetic Polyneuropathy: a Study in Pomorie, Bulgaria / 日本温泉気候物理医学会雑誌

Background: Diabetes mellitus and its complications are a source of considerable morbidity and mortality, with important medical and social implications. The aim of our study was to establish the efficacy of combined application of seawater, Pomorie therapeutic mud and lye in diabetic polyneuropathy rehabilitation. Materials and methods: The study was carried out during the 2011 and 2012 summer seasons in 43 patients (18 male and 25 female) with diabetic polyneuropathy from Germany, Russia and Bulgaria. The average age was 62±2.15 years and the average duration of diabetes was 16±3.4 years. All patients underwent combined treatment with mud baths (temp 37°C, duration 15-20min, 10 applications) and 10 lye electrophoresis procedures to the lower limbs, and sea water baths. The visual analogue scale (VAS) was used before and after the course of treatment to objectively measure the pain and parasthesiae of the lower limbs. Results: Following a 2 week treatment course there was significant improvement in the clinical symptoms of diabetic polyneuropathy. 90% of patients reported improvement in pain, with VAS decreasing from 4.85±0.31 to 2.75±0.24, p<0.05. There was also a decrease in lower limb parasthesiae in 95% of patients, with VAS decreasing from 5.61±0.65 to 3.26±0.31, p<0.05. Conclusion: The clnical symptoms and quality of life of patients with diabetic polyneuropathy imroved significantly following combined treatment with Pomorie natural resources as a result of the trophic and pain-reducing properties of therapeutic mud, lye and sea water. We support the combined application of these treatments in the rehabilitation of patients with diabetic polyneuropathy.

Thalassotherapy in Diabetic Polyneuropathy: a Study in Pomorie, Bulgaria / 日本温泉気候物理医学会雑誌

<b>Background:</b> Diabetes mellitus and its complications are a source of considerable morbidity and mortality, with important medical and social implications. The aim of our study was to establish the efficacy of combined application of seawater, Pomorie therapeutic mud and lye in diabetic polyneuropathy rehabilitation.<BR><b>Materials and methods:</b> The study was carried out during the 2011 and 2012 summer seasons in 43 patients (18 male and 25 female) with diabetic polyneuropathy from Germany, Russia and Bulgaria. The average age was 62±2.15 years and the average duration of diabetes was 16±3.4 years. All patients underwent combined treatment with mud baths (temp 37°C, duration 15-20min, 10 applications) and 10 lye electrophoresis procedures to the lower limbs, and sea water baths. The visual analogue scale (VAS) was used before and after the course of treatment to objectively measure the pain and parasthesiae of the lower limbs.<BR><b>Results:</b> Following a 2 week treatment course there was significant improvement in the clinical symptoms of diabetic polyneuropathy. 90% of patients reported improvement in pain, with VAS decreasing from 4.85±0.31 to 2.75±0.24, p<0.05. There was also a decrease in lower limb parasthesiae in 95% of patients, with VAS decreasing from 5.61±0.65 to 3.26±0.31, p<0.05.<BR><b>Conclusion:</b> The clnical symptoms and quality of life of patients with diabetic polyneuropathy imroved significantly following combined treatment with Pomorie natural resources as a result of the trophic and pain-reducing properties of therapeutic mud, lye and sea water. We support the combined application of these treatments in the rehabilitation of patients with diabetic polyneuropathy.

15-2 Thalassotherapy in diabetic polyneuropathy: a study in Pomorie, Bulgaria / 日本温泉気候物理医学会雑誌

Objectives: The Bulgarian Black Sea coastline is 378km long and offers many opportunities for prophylactic and rehabilitation treatments in a number of conditions of significant social impact. Of special importance is the favourable temperate continental climate, the calm and safe sea ideal for swimming, with low salinity and endless beaches. Another key factor for the development of Black Sea rehablitation and balenology is the abundance of mineral waters and therapeutic mud, which has excellent physical-chemical indicators.   Diabetes mellitus and its complications are a source of considerable morbidity and mortality, with important medical and social implications. The aim of our study was to establish the efficacy of combined application of seawater, Pomorie therapeutic mud and lye in the diabetic polyneuropathy prophylaxis and rehabilitation. Materials and methods: The study was carried out during the 2011 and 2012 summer seasons in 43 patients (18 male and 25 female) with diabetic polyneuropathy from Germany, Russia and Bulgaria. The average age was 62±2.15 years and the average duration of diabetes was 16±3.4 years.   All patients underwent combined treatment with mud baths (temp 37°C, duration 15-20min, 10 applications) and 10 lye electrophoresis procedures to the lower limbs, and sea water baths.   The visual analogue scale (VAS) was used before and after the course of treatment to objectively measure the pain and parasthesiae of the lower limbs. Results: Following a 2 week treatment course there was significant improvement in the clinical symptoms of diabetic polyneuropathy. 90% of patients reported improvement in pain, with VAS decreasing from 4.85±0.31 to 2.75±0.24, p<0.05. There was also a decrease in lower limb parasthesiae in 95% of patients, with VAS decreasing from 5.61±0.65 to 3.26±0.31, p<0.05. Conclusion: The clnical symptoms and quality of life of patients with diabetic polyneuropathy imroved significantly following combined treatment with Pomorie natural resources as a result of the trophic and pain-reducing properties of therapeutic mud, lye and sea water. We support the combined application of these treatments in the prevention and rehabilitation of patients with diabetic polyneuropathy.

The Quantitative Relationship Between Physical Examinations and the Nerve Conduction of the Carpal Tunnel Syndrome in Patients With and Without a Diabetic Polyneuropathy

OBJECTIVE: To understand the quantitative correlation between the clinical severity and physical examinations along with the electrodiagnostic findings by subjects with carpal tunnel syndrome (CTS) and also the influence of diabetic polyneuropathy (DPN) on physical examinations by subjects with CTS. METHODS: Among 200 patients suffering from hand tingling sensations, 68 patients were diagnosed with CTS on at least one hand by nerve conduction tests. Therefore, the Phalen test (PT), hand elevation test (HET), Tinel sign (TS) results were recorded on both hands. The physical examination grades were compared with the electrophysiological CTS grades in 126 hands of 68 patients. Also the comorbidity effect of DPN to CTS was evaluated. For the evaluation of the severity correlations between CTS, PT, HET, and TS, the Spearman analysis was used. An attempt was started to create a formula which could depict the electrophysiological severity of CTS. RESULTS: Out of the 68 tested subjects, 31 were diagnosed with both DPN and CTS, and 37 with CTS only. Both PT and HET correlated well with the severity of CTS where the correlation of PT was higher than that of HET. The formula were the motor distal latency (MDL)=(72.4-PT)/5.3 and MDL=(76-HET)/7.2. Both PT and HET showed in the presence of DPN a relatively higher relation with CTS without significance. CONCLUSION: PT and HET would be useful screening tools for the diagnosis and treatment of CTS as the grade of PT and HET present the severity of CTS well. During this study, a formula was created expecting the severity of nerve conduction study with PT and HET through the time domain value of physical examinations.

Subclinical Ulnar Neuropathy at the Elbow in Diabetic Patients

OBJECTIVE: To demonstrate the prevalence and characteristics of subclinical ulnar neuropathy at the elbow in diabetic patients. METHODS: One hundred and five patients with diabetes mellitus were recruited for the study of ulnar nerve conduction analysis. Clinical and demographic characteristics were assessed. Electrodiagnosis of ulnar neuropathy at the elbow was based on the criteria of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM1 and AANEM2). The inching test of the ulnar motor nerve was additionally performed to localize the lesion. RESULTS: The duration of diabetes, the existence of diabetic polyneuropathy (DPN) symptoms, the duration of symptoms, and HbA1C showed significantly larger values in the DPN group (p<0.05). Ulnar neuropathy at the elbow was more common in the DPN group. There was a statistically significant difference in the number of cases that met the three diagnostic criteria between the no DPN group and the DPN group. The most common location for ulnar mononeuropathy at the elbow was the retrocondylar groove. CONCLUSION: Ulnar neuropathy at the elbow is more common in patients with DPN. If the conduction velocities of both the elbow and forearm segments are decreased to less than 50 m/s, it may be useful to apply the AANEM2 criteria and inching test to diagnose ulnar neuropathy.

Application values of electromyography in diagnosis and differential diagnosis of diabetic polyneuropathy and alcoholic peripheral neuropathy / 吉林大学学报(医学版)

Objective To study the features and differences of electromyography of diabetic polyneuropathy (DPN) and alcoholic peripheral neuropathy (APN ), and to provide reference basis for the clinical application of electromyography.Methods 58 patients with DPN and 30 patients with APN were used as subjects. Nerve conduction studies (NCS)and sympathetic skin response (SSR)were performed in the patients, all data were analyzed.Results In the patients with DPN, the abnormalities of NCS and SSR were increased with the prolongation of the time diabetes,and the abnormality of SSR was higher than that of NCS(P<0.05).In the patients with APN, both demyelination and axonal loss in motor and sensory nerves were significantly involved, and the abnomalities of NCS and SSR were higher than those of the DPN patients (P<0.05 or P<0.01);but the proximal nerves were just involoved mildly. Conclusion Both DPN and APN have characteristic electrophysiological features.Early electromyography is useful for the early diagnosis of DPN and APN.According to the electrophysiological features of DPN and APN,the reason of peripheral neuropathy in the patients who have diabetes mellitus and alcoholism could be differentiated.

Peripheral Nerve Abnormalities in Patients with Newly Diagnosed Type I and II Diabetes Mellitus / 대한임상신경생리학회지

BACKGROUND: Early detection of neuropathy may prevent further progression of this complication in the diabetic patients. The purpose of this study was to evaluate the prevalence of early neuropathic complication in patients with newly diagnosed type 1 and type 2 diabetes. METHODS: Nerve conduction studies (median, ulnar, posterior tibial, peroneal, and sural nerves) were performed for 49 type 1 (27 males, mean 14.1+/-7.5 years) and 40 type 2 (27 males, 42.0+/-14.1 years) diabetic patients at onset of diabetes. Children with age at onset under 4 years and adults over 55 years were excluded to eliminate the aging effect and the influence of obstructive arteriosclerosis. Neuropathy was defined as abnormal nerve conduction findings in two or more nerves including the sural nerve. RESULTS: Mean HbA1c level was 12.6+/-3.3% for type 1 and 10.5+/-2.9% for type 2 diabetes. The prevalence of neuropathy was 12.2% for type 1, and 35.0% for type 2 diabetes, respectively. There were significant trends in the prevalence of neuropathy with increasing age (p<0.05). The effect of the mean level of glycosylated hemoglobin on the prevalence of polyneuropathy at onset of diabetes was borderline (p=0.0532). Neither sex of the patients nor the type of diabetes affected the neurophysiologic abnormalities at the diagnosis. CONCLUSIONS: Even in a population with diabetes at the diagnosis, the prevalence of subclinical neuropathy was not low. Neuropathy has been significantly associated with increasing age indicating the possibility of longer duration of undetected diabetes among them, especially in type 2 diabetes.

Static balance in patients presenting diabetes mellitus type 2 with and without diabetic polyneuropathy / Equilíbrio estático em pacientes com diabetes melito tipo 2 com ou sem polineuropatia diabética

OBJECTIVES: To contrast the static balance in patients presenting diabetes mellitus type 2 (DM2) with and without polyneuropathy (DPN); and to correlate the rates from the scale Diabetic Neuropathy Examination (DNE) with the mean ratio of the center of pressure (CoP). SUBJECTS AND METHODS: Twenty patients, aged between 40 and 54, presenting DM2 and classified, according to DNE scale, in groups with (n = 10) and without (n = 10) DPN, were compared. Static balance was evaluated by means of the CoP mean ratio on a Wii Balance Board® under the conditions of open and closed eyes. After normality verification (Shapiro-Wilk), balance between both groups was compared by means of the Student t test and Mann-Whitney U test, as applicable. DNE rating was correlated with the mean ratio of CoP in the group with DPN, considering a significance level p < 0.05. RESULTS: Significant differences (p = 0.049) were found under the condition of closed eyes, with greater CoP ratio in the group with DPN (0.548 cm vs. 0.442 cm). The group with DPN showed a tendency (p = 0.059) towards a greater CoP mean ratio under the open eyes condition (0.351 cm vs. 0.239 cm). There was a strong correlation (r = 0.751) between the DNE rating and the CoP mean ratio under the closed eyes condition (p = 0.012). CONCLUSIONS: Patients showing DPN demonstrated worse static balance than patients without DPN in the closed eyes condition. Furthermore, the higher the rating in DNE, the stronger the displacement of CoP, which may be associated with higher risk of falls.

OBJETIVOS: Comparar o equilíbrio estático em pacientes com diabetes melito tipo 2 (DM2) com ou sem polineuropatia diabética (PND) e correlacionar os escores da escala de Exame da Neuropatia Diabética (EDN) com a média da relação do centro de pressão (CoP). SUJEITOS E MÉTODOS: Vinte pacientes, com idades entre 40 e 54 anos, que apresentavam DM2 e classificados, de acordo com a escala EDN, em grupos com (n = 10) e sem (n = 10) PDN foram comparados. O equilíbrio estático foi avaliado segundo a média da relação do CoP em um Wii Balance Board® na condição com os olhos abertos e os olhos fechados. Depois da verificação da normalidade (Shapiro-Wilk), o equilíbrio entre os dois grupos foi comparado por meio dos testes t de Student e U de Mann-Whitney, como aplicável. O escore na EDN foi correlacionado com a média da relação do CoP no grupo com PND, considerando um nível de significância de p < 0,05. RESULTADOS: Diferenças significativas (p = 0,049) foram observadas nas condições de olhos fechados, com uma maior média da relação do CoP no grupo com PND (0,548 cm vs. 0,442 cm). O grupo com PND mostrou uma tendência (p = 0,059) para maior média da relação do CoP na condição com os olhos abertos (0,351 cm vs. 0,239 cm). Foi observada uma forte correlação (r = 0,751) entre o escore EDN e a média da relação do CoP na condição com os olhos fechados (p = 0,012). CONCLUSÕES: Os pacientes com PND demonstraram pior equilíbrio estático do que os pacientes sem PND na condição com os olhos fechados. Além disso, quanto maior o escore no EDN, mais forte o deslocamento do CoP, o que pode estar associado com maior risco de quedas.

Diabetic patients with and without peripheral neuropathy reveal different hip and ankle biomechanical strategies during stair descent / Pacientes diabéticos com e sem a neuropatia periférica mostram diferentes estratégias biomecânicas de quadril e tornozelo ao descer escada

BACKGROUND: The progression of diabetes and the challenge of daily tasks may result in changes in biomechanical strategies. Descending stairs is a common task that patients have to deal with, however it still has not been properly studied in this population. OBJECTIVES: We describe and compare the net joint moments and kinematics of the lower limbs in diabetic individuals with and without peripheral neuropathy and healthy controls during stair descent. METHOD: Forty-two adults were assessed: control group (13), diabetic group (14), and neuropathic diabetic group (15). The flexor and extensor net moment peaks and joint angles of the hip, knee, and ankle were described and compared in terms of effect size and ANOVAs (p<0.05). RESULTS: Both diabetic groups presented greater dorsiflexion [large effect size] and a smaller hip extensor moment [large effect size] in the weight acceptance phase. In the propulsion phase, diabetics with and without neuropathy showed a greater hip flexor moment [large effect size] and smaller ankle extension [large effect size]. CONCLUSION: Diabetic patients, even without neuropathy, revealed poor eccentric control in the weight acceptance phase, and in the propulsion phase, they showed a different hip strategy, where they chose to take the leg off the ground using more flexion torque at the hip instead of using a proper ankle extension function.

CONTEXTUALIZAÇÃO: A progressão do Diabetes Mellito e as atividades desafiadoras do dia a dia podem resultar em mudanças da estratégia biomecânica adotada. Descer escadas é uma tarefa comum do dia a dia, vivenciada pelos pacientes, mas ainda não foi satisfatoriamente estudada nessa população. OBJECTIVOS: Descrever e comparar os momentos articulares e a cinemática de membros inferiores em indivíduos diabéticos com e sem a neuropatia periférica e controles saudáveis durante o descer escadas. MÉTODO: Quarenta e dois adultos foram avaliados: grupo controle (13), grupo diabético (15) e grupo de diabéticos neuropatas (14). Os picos flexores e extensores dos momentos articulares e os ângulos articulares de quadril, joelho e tornozelo foram comparados e descritos por análise do tamanho do efeito e ANOVAs (p<0,05). RESULTADOS: Na fase de aceitação do peso, ambos os grupos diabéticos apresentaram maior ângulo de dorsiflexão de tornozelo [tamanho de efeito grande] e menor momento extensor de quadril [tamanho de efeito grande]. Na fase de propulsão, diabéticos com e sem a neuropatia apresentaram maior momento flexor de quadril [tamanho de efeito grande] e menor ângulo de extensão de tornozelo [tamanho de efeito grande]. CONCLUSÃO: Pacientes diabéticos, mesmo antes da neuropatia instalada, revelaram um pobre controle excêntrico na fase de aceitação do peso e, na fase de propulsão, esses pacientes mostraram uma estratégia diferente ao levar o membro inferior à frente a partir de um maior torque flexor de quadril ao invés de usar uma função extensora apropriada de tornozelo.

Clinical Characteristics of Carpal Tunnel Syndrome in Patients With Diabetes

BACKGROUND: The clinical symptoms and signs of carpal tunnel syndrome (CTS) were investigated in patients with diabetes. METHODS: The nondominant hands of 105 consecutive patients with diabetes or CTS were divided into three groups: diabetic CTS, diabetic non-CTS, and nondiabetic CTS. The symptoms of CTS (pain, paresthesias, numbness, awakening, weakness, and clumsiness) were scored using the Global Symptom Score. The following signs of CTS were evaluated: Tinel's sign, Phalen's sign, thenar atrophy, and weakness of the abductor pollicis brevis (APB). The severity of the diabetic neuropathy was evaluated using the Michigan Diabetic Neuropathy Score. The score on the neuropathy scale, number of nerves involved, and the score for each CTS symptom and sign were compared among the groups. RESULTS: The duration of diabetes was longer (p=0.000) and diabetic polyneuropathy was more severe (p=0.014) in the diabetic CTS group than in the diabetic non-CTS group. The mean scores for pain and paresthesias were lower in the diabetic CTS group than in the nondiabetic CTS group (p=0.047 and p=0.049, respectively), whereas the mean scores for numbness and weakness did not differ significantly between these two groups (p=0.528 and p=0.638, respectively). In addition, APB weakness was more frequent whereas Phalen's sign was less frequent in the diabetic CTS group than in the nondiabetic CTS group (p=0.002 and p=0.02, respectively). CONCLUSIONS: Patients with diabetic CTS complained less of pain and paresthesias, but their intrinsic hand function did not differ significantly from that of patients with nondiabetic CTS.