The indicator test Neuropad in the assessment of small and overall nerve fibre dysfunction in patients with type 2 diabetes: a large multicentre study.

We examined the diagnostic utility of the indicator test Neuropad in the assessment of overall and small fibre dysfunction in 1,010 patients with type 2 diabetes mellitus (T2DM) (608 men, mean age 63.9 ± 10.3 years) from 5 diabetes clinics. Sudomotor function was diagnosed by the Neuropad® test. Overall and small nerve fibre dysfunction was diagnosed through clinical examination and symptoms. Patients were divided into Groups A (441 patients with sudomotor dysfunction) and B (569 patients without sudomotor dysfunction). The former were older (p<0.05) and had longer T2DM duration (p<0.05) than the latter. For overall nerve fibre dysfunction, abnormal Neuropad defined as patchy/blue had 94.9% sensitivity, 70.2% specificity and 98.1% negative predictive value (NPV), while for small fibre dysfunction the corresponding values were 85.6%, 71.2% and 93.3%. For overall nerve fibre dysfunction, abnormal Neuropad defined as blue had 64% sensitivity, 96% specificity and 91% NPV, while for small fibre dysfunction the corresponding values were 52%, 96% and 85%. The odds ratios (ORs) of Neuropad patchy/blue for overall and for small fibre dysfunction were 43.7 and 14.7, respectively. The ORs of Neuropad blue for overall and for small fibre dysfunction were 45.7 and 24.9, respectively. In conclusion, Neuropad patchy/blue response exhibited better diagnostic performance both for overall and small nerve fibre dysfunction. Its very high NPV renders it an excellent screening tool primarily to exclude neuropathy in T2DM.

Plasma homocysteine levels in patients with type 2 diabetes in a Mediterranean population: relation with nutritional and other factors.

BACKGROUND AND AIM: Hyperhomocysteinemia is a major and independent risk factor for atherothrombotic vascular disease. It may be promoted by genetic factors, nutritional deficiencies of the vitamin cofactors required for homocysteine metabolism, and other modifiable factors. This cross-sectional study investigated the effect of dietary habits and lifestyle on plasma total homocysteine (tHcy) levels in patients with type 2 diabetes in a Mediterranean population. METHODS AND RESULTS: A total of 126 diabetic and 76 healthy subjects were interviewed using a food-frequency questionnaire. Information consisted of dietary and smoking habits, coffee and alcohol consumption and physical activity recording, during the month prior to enrollment. Measurements included blood pressure, body mass index (BMI), waist-to-hip ratio (WHR), plasma tHcy, folate, vitamin B12, lipids, HbA(1c), creatinine, uric acid, and glomerular filtration rate (GFR). Plasma tHcy levels were not different between diabetic and control subjects (11.49+/-3.68 vs 12.67+/-3.79 micromol/l respectively, P = 0.40). Diabetic subjects had significantly higher plasma folate levels and consumed more fish, fruit and vegetables, in comparison with controls. Controls consumed more red meat, coffee, and alcohol. Multivariate analysis in diabetic subjects, after controlling for age, sex, systolic blood pressure, duration of diabetes, GFR, plasma uric acid levels, and the amount of the weekly consumption of fruit and vegetables, demonstrated that age, GFR and the weekly amount of fruit and vegetable consumption were independently associated with plasma tHcy concentrations [regression coefficient (B) = 0.11, SE (B) = 0.03, P = 0.001, B = -0.07, SE (B) = 0.01, P < 0.0001, and B = -0.05, SE (B) = 0.02, P = 0.04, respectively]. The weekly amount of coffee, alcohol and red meat consumption, and physical activity level were not related with plasma tHcy levels in either study group. CONCLUSIONS: 1) Plasma tHcy levels were not different in the diabetic group as compared to the control group. 2) In patients with type 2 diabetes age, GFR and the consumption of fruit and vegetables were strong and independent determinants of plasma tHcy levels.

[Energy expenditure at rest and body composition in obese subjects before and after weight loss]. / Spesa energetica a riposo e composizione corporea in obesi prima e dopo dimagramento.

In 7 obese subjects (3 males and 4 females), before (T0) and after (T60) weight loss, and in 10 nonobese subjects (4 males and 6 females) as controls, resting energy expenditure (REE) and body composition were evaluated. In obese subjects fat-free mass (FFM) and fat mass (FM) were significantly reduced after weight loss. REE, expressed in absolute value, was significantly higher in obese subjects at T0 with respect to controls (1683 +/- 77.3 vs. 1425 +/- 70.5 Kcal/day; p less than 0.05); in obese group REE was significantly lower at T60 (1563 +/- 63.5 Kcal/day) than at T0 (p less than 0.01). The decrease in REE observed in the obese group after weight loss was related only to the loss of FFM (r = 0.88; p less than 0.01). REE, expressed in relation to FFM, was not different between control and obese subjects at T0 (28.64 +/- 0.42 vs 26.40 +/- 1.08 Kcal/Kg-FFM/day; pns); however, this value was significantly lower in the obese group at T60 (25.99 +/- 1.07 Kcal/Kg-FFM/day) with respect to controls (p less than 0.05). It is concluded that a reduction in REE, due at least in part to the loss of FFM, may contribute to the difficulty in the maintenance of body weight often observed in obese subjects after a period on hypocaloric diet.