151
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Xiong W, Feng X, Liu J, Chen W. Electroacupuncture for treatment of diabetic peripheral neuropathy: A systematic review of randomized controlled trials. JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2016. [DOI: 10.1016/j.jtcms.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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152
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Bakker SF, Tushuizen ME, von Blomberg BME, Bontkes HJ, Mulder CJ, Simsek S. Screening for coeliac disease in adult patients with type 1 diabetes mellitus: myths, facts and controversy. Diabetol Metab Syndr 2016; 8:51. [PMID: 27478507 PMCID: PMC4966870 DOI: 10.1186/s13098-016-0166-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 07/10/2016] [Indexed: 12/23/2022] Open
Abstract
This review aims at summarizing the present knowledge on the clinical consequences of concomitant coeliac disease (CD) in adult patients with type 1 diabetes mellitus (T1DM). The cause of the increased prevalence of CD in T1DM patients is a combination of genetic and environmental factors. Current screening guidelines for CD in adult T1DM patients are not uniform. Based on the current evidence of effects of CD on bone mineral density, diabetic complications, quality of life, morbidity and mortality in patients with T1DM, we advise periodic screening for CD in adult T1DM patients to prevent delay in CD diagnosis and subsequent CD and/or T1DM related complications.
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Affiliation(s)
- Sjoerd F. Bakker
- Department of Gastroenterology and Hepatology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Maarten E. Tushuizen
- Department of Gastroenterology and Hepatology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | | | - Hetty J. Bontkes
- Department of Pathology, Unit Medical Immunology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Chris J. Mulder
- Department of Gastroenterology and Hepatology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Suat Simsek
- Department of Internal Medicine, North West Clinics, Alkmaar, The Netherlands
- Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
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153
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Houten JK, Lenart C. Diabetes and cervical myelopathy. J Clin Neurosci 2015; 27:99-101. [PMID: 26747704 DOI: 10.1016/j.jocn.2015.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/12/2015] [Accepted: 07/01/2015] [Indexed: 11/29/2022]
Abstract
Diabetes may affect the typical physical findings associated with cervical spondylotic myelopathy, as coexisting diabetic neuropathy may dampen expected hyperreflexia and also produce non-dermatomal extremity numbness. Most large studies of surgically treated diabetic patients with cervical spondylotic myelopathy have focused upon infection rates rather than exploring any differences in the presenting physical signs. We conducted a retrospective study of the pattern of presenting neurological signs and symptoms and of the clinical outcomes in 438 patients surgically treated for cervical spondylotic myelopathy, 79 of whom had diabetes. Compared with non-diabetic patients, those with diabetes were slightly older and had lower preoperative modified Japanese Orthopaedic Association (mJOA) scores. Those with diabetes also had a significantly higher incidence of hyporeflexia and a higher incidence of a positive Babinski sign, but there was no difference in the appearance of the Hoffman sign. The magnitude of mJOA improvement after surgery was comparable. We conclude that diabetes may alter the typical signs and symptoms of cervical spondylotic myelopathy and suggest that knowledge of the differences may aid in securing a prompt and accurate diagnosis.
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Affiliation(s)
- John K Houten
- Marcus Neuroscience Institute at the Boca Raton Regional Hospital, Boca Raton, FL 33486, USA.
| | - Christopher Lenart
- Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, 111 E. 210th Street Bronx, NY 10467, USA
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154
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Opioid use in the management of diabetic peripheral neuropathy (DPN) in a large commercially insured population. Clin J Pain 2015; 31:414-24. [PMID: 25853725 DOI: 10.1097/ajp.0000000000000124] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the proportion of diabetic peripheral neuropathy (DPN) patients receiving pharmacologic DPN treatments and specifically to identify the rates and factors associated with opioid use and first-line opioid use. METHODS A 10% sample of IMS-LifeLink claims data from 1998 through 2008 was used. The study population consisted of diabetic patients who met DPN criteria using a validated DPN algorithm. Multivariable logistic regression controlling for demographics, comorbidities, and other clinical characteristics was used to identify factors associated with any DPN pharmacologic treatment, any opioid use, and first-line opioid treatment. Sensitivity analyses were conducted to explore variations in exclusion criteria as well as opioid use definitions. RESULTS A total of 666 DPN patients met inclusion criteria and pharmacologic treatment was received by 288 patients (43.24%) and of those, 154 (53.47%) had DPN-related opioid use and 96 (33.33%) received opioid as first-line treatment. Persons with diabetic complications were more likely to use opioids (odds ratio=4.53; 95% confidence interval, 1.09-18.92). Food and Drug Administration-approved DPN agents duloxetine 1.04% (n=3) and pregabalin 5.56% (n=16) had much lower rates of use. DPN-related drug use and DPN-related opioid usage increased as we used less restrictive samples in sensitivity analyses. CONCLUSIONS Opioids were the most frequently prescribed first-line agents for DPN. More than 50% of DPN patients remained untreated with pharmacologic agents 1 year after a DPN diagnosis.
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155
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Abstract
Peripheral neuropathies are frequent in association with systemic diseases as well as isolated disorders. Recent advances in the therapy of specific neuropathies led to the approval of new drugs/treatments. This review selected those peripheral neuropathies where the most recent approvals were provided and revised the potential future developments in diabetic and toxic-induced neuropathies, although they do not have a currently available causal therapy in view of their epidemiological and social relevance. Data have been extracted from the most important published trials and from clinical experience. In addition, data from the Food and Drug Administration and European Medicine Agency indications on the treatment of the selected peripheral neuropathies and from recently updated international guidelines have also been included. The website of the U.S. National Institutes of Health www.clinicaltrials.gov registry has been used as the reference database for phase III clinical trials not yet published or ongoing. This review gives a general overview of the most recent advances in the treatment of amyloid, inflammatory, and paraproteinemic peripheral neuropathies. Moreover, it briefly describes the unmet medical need in disabling and frequent conditions, such as diabetic and chemotherapy-induced neuropathy, highlighting the most promising therapeutic approaches to their treatment.
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Affiliation(s)
- Paola Marmiroli
- a Experimental Neurology Unit, School of Medicine and Surgery and Milan Center for Neuroscience , University of Milano-Bicocca , Monza , Italy
| | - Guido Cavaletti
- a Experimental Neurology Unit, School of Medicine and Surgery and Milan Center for Neuroscience , University of Milano-Bicocca , Monza , Italy
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156
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Lin IC, Wang YH, Lin CL, Chang YJ, Lee SH, Wang IJ. Diabetic polyneuropathy and the risk of developing diabetic retinopathy: a nationwide, population-based study. Acta Ophthalmol 2015; 93:713-8. [PMID: 25989925 DOI: 10.1111/aos.12746] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 04/05/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess the relationship between diabetic polyneuropathy (DPN) and the risk of diabetic retinopathy (DR). METHODS From 1997 to 2010, we identified 5031 newly diagnosed DPN patients and 20 124 controls matched for sex, age, and index year. Cox proportional hazards regression analyses were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of DR between the DPN patients and the non-DPN group. The adjusted hazard ratio was calculated and adjusted for age, sex, duration of diabetes and comorbidities of hypertension, cardiovascular disease and diabetic nephropathy. RESULTS The incidence rate of DR was 5.87-fold higher in the DPN patients than in the non-DPN group (44.0 vs. 7.22 per 1000 person-years), with an adjusted HR of 5.41(95% CI = 4.92-5.94). The DPN-to-non-DPN DR incidence rate ratio decreased with age (adjusted HR = 6.63 for subgroup younger than 65 years and adjusted HR = 3.91 for subgroup aged 65 years or older). Compared with the non-DPN group, the DPN patients had a 5.63-fold risk of non-proliferative DR (adjusted HR = 5.63, 95% CI = 5.11-6.21) and a 3.67-fold risk of proliferative DR (adjusted HR = 3.67, 95% CI = 2.57-5.23). CONCLUSION The patients with DPN had an increased risk of developing DR and advanced DR compared with the non-DPN group, particularly among the subgroup aged younger than 65 years.
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Affiliation(s)
- I-Chan Lin
- Department of Ophthalmology; Shuang-Ho Hospital-Taipei Medical University; New Taipei City Taiwan
| | - Yuan-Hung Wang
- Division of Urology; Department of Surgery; Taipei Medical University- Shuang Ho Hospital; New Taipei City Taiwan
- Graduate Institute of Clinical Medicine; College of Medicine; Taipei Medical University; New Taipei City Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data; China Medical University; Taichung Taiwan
| | - Yen-Jung Chang
- Graduate Institute of Clinical Medical Science; China Medical University; Taichung Taiwan
| | - Shwu-Huey Lee
- Department of Ophthalmology; Cathay General Hospital; Taipei Taiwan
| | - I-Jong Wang
- Department of Ophthalmology; National Taiwan University Hospital; School of Medicine; Taipei Taiwan
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157
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Taheri A, Farbood A, Heshmat R, Samadi A, Khashayar P, Qorbani M, Ghorbani M, Ebrahimi Khaneqah G. The effect of transdermal nitroglycerin on pain control in diabetic patients with peripheral neuropathy. J Diabetes Metab Disord 2015; 14:86. [PMID: 26629480 PMCID: PMC4665823 DOI: 10.1186/s40200-015-0217-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/19/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Despite high prevalence of diabetic peripheral neuropathy there is no definite treatment for the condition. The present study was conducted to assess the efficacy of transdermal nitroglycerin patch in pain control of patients with DPN. METHODS This randomized, double-blind, crossover study was conducted on 30 patients with symmetric distal peripheral neuropathy and good glycemic control. The patients were randomly assigned to receive nitroglycerin transdermal and placebo patches in two 4-week stages. The severity of pain and other neuropathic sensory symptoms were assessed at the end of each course. RESULTS Mean reduction of pain severity was more prominent in the NTG group compared to placebo group of the study (p = 0.048) at least during the first phase of the study. Except for mood and sleep, a significant reduction in all Brief Pain Inventory scores was noted in the drug group (all corrected p < 0.05). SF-MPQ also showed the drug patch to be effective in improving different aspects of pain measured using McGill Pain Questionnaire, except for Role-emotional. CONCLUSIONS It could be concluded that nitroglycerin plasters can effectively help alleviate pain in patients with diabetic neuropathy. TRIAL REGISTRATION IRCT201308223213N1.
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Affiliation(s)
- Arman Taheri
- Department of Anesthesiology, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Farbood
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ; Department: Anesthesiology and Critical Care Medicine, Institution: Shiraz University of Medical Sciences, Shiraz, Iran ; Department of Anesthesiology, Shahid Faghihi Hospital, Zand Boulevard, Shiraz, Fars Iran
| | - Ramin Heshmat
- Endocrinology and Metabolism Research Institute, Chronic Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Samadi
- Department of Anesthesiology, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Patricia Khashayar
- Osteoporosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Ghorbani
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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158
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Abstract
Length-dependent neuropathy is the most common and costly complication of diabetes and frequently causes injury primarily to small-diameter cutaneous nociceptive fibers. Not only persistent hyperglycemia but also metabolic, endocrine, and inflammatory effects of obesity and dyslipidemia appear to play an important role in the development of diabetic neuropathy. Rational therapies aimed at direct control of glucose or its increased entry into the polyol pathway, oxidative or nitrosative stress, advanced glycation end product formation or signaling, microvascular ischemia, or adipocyte-derived toxicity have each failed in human trials of diabetic neuropathy. Aerobic exercise produces salutary effects in many of these pathogenic pathways simultaneously and, in both animal models and human trials, has been shown to improve symptoms of neuropathy and promote re-growth of cutaneous small-diameter fibers. Behavioral reduction in periods of seated, awake inactivity produces multimodal metabolic benefits similar to exercise, and the two strategies when combined may offer sustained benefit to peripheral nerve function.
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Affiliation(s)
| | - A Gordon Smith
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Robin L Marcus
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
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159
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Javed S, Alam U, Malik RA. Burning through the pain: treatments for diabetic neuropathy. Diabetes Obes Metab 2015; 17:1115-25. [PMID: 26179288 DOI: 10.1111/dom.12535] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 07/02/2015] [Accepted: 07/05/2015] [Indexed: 01/17/2023]
Abstract
The rise in the global burden of diabetes is spurring an increase in the prevalence of its complications. Diabetic peripheral neuropathy (DPN) is a common and devastating complication of diabetes, with multiple clinical manifestations. The most common is a symmetrical length-dependent dysfunction and damage of peripheral nerves. The management of DPN rests on three tenets: intensive glycaemic control, even though the evidence of benefit is questionable in people with type 2 diabetes; pathogenetic therapies; and symptomatic treatment. A number of pathogenetic treatments have been evaluated in phase III clinical trials, including α-lipoic acid (stems reactive oxygen species formation), benfotiamine (prevents vascular damage) and aldose-reductase inhibitors (reduce flux through the polyol pathway), protein kinase C inhibitors (prevent hyperglycaemia-induced activation of protein kinase C), nerve growth factors (stimulate nerve regeneration) and Actovegin® (improves tissue glucose and oxygen uptake). However, none have gained US Food and Drug Administration or European Medicines Agency (EMA) approval, questioning the validity of current trial designs and the endpoints deployed to define efficacy. For painful diabetic neuropathy, clinical guidelines recommend: atypical analgesics for pain relief, including duloxetine and amitriptyline; the γ-aminobutyric acid analogues gabapentin and pregabalin; opioids, including Tapentadol; and topical agents such as lidocaine and capsaicin. No single effective treatment exists for painful DPN, highlighting a growing need for studies to evaluate more potent and targeted drugs, as well as combinations. A number of novel potential candidates, including erythropoietin analogues and angiotensin II type 2 receptor anatagonists are currently being evaluated in phase II clinical trials.
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Affiliation(s)
- S Javed
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, UK
| | - U Alam
- Central Manchester University Hospitals, Manchester, UK
| | - R A Malik
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, UK
- Weill-Cornell Medical College-Qatar, Doha, Qatar
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160
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Qiao X, Zhang S, Zhao W, Ye H, Yang Y, Zhang Z, Miao Q, Hu R, Li Y, Lu B. Serum Phosphorylated Neurofilament-Heavy Chain, a Potential Biomarker, is Associated With Peripheral Neuropathy in Patients With Type 2 Diabetes. Medicine (Baltimore) 2015; 94:e1908. [PMID: 26554790 PMCID: PMC4915891 DOI: 10.1097/md.0000000000001908] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/02/2015] [Accepted: 10/05/2015] [Indexed: 12/13/2022] Open
Abstract
Neurofilament (NF), one of the major axonal cytoskeletal proteins, plays a critical role in degenerative diseases in both the central and the peripheral nervous systems. The aim of this study is to explore the relationship between serum phosphorylated neurofilament-heavy chain (pNF-H) and diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes.Serum pNF-H concentrations were measured by ELISA in hospitalized patients with and without DPN (n = 118). DPN was assessed by clinical symptoms, signs, and electromyography.Compared with the non-DPN group (311.98 [189.59-634.12] pg/mL), the confirmed group (605.99 [281.17-1332.78] pg/mL) patients had the higher serum pNF-H levels (P = 0.007). DPN was significantly correlated with C-peptide (r = -0.269), total cholesterol (TC) (r = 0.185), and pNF-H (r = 0.258). Serum pNF-H levels were independently associated with DPN (P = 0.004), even after adjusting for age, sex, duration of diabetes, fasting plasma glucose, glycosylated hemoglobin A1c, TC, C-peptide, urinary albuminto/creatinine ratio, and estimated glomerular filtration rate. Compared with pNF-H quartile 1 (referent), patients in quartile 3 (odds ratio [OR], 3.977; 95% confidence interval [CI], 1.243-12.728; P = 0.021) and quartile 4 (OR, 10.488; 95% CI, 3.020-34.429; P = 0.000) had the higher risk of DPN after adjusting for the confounders.Serum pNF-H levels might be associated with the DPN, and the correlationship between serum pNF-H and DPN should be further studied.
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Affiliation(s)
- Xiaona Qiao
- From the Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
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161
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Ogbera AO, Adeleye O, Solagberu B, Azenabor A. Screening for peripheral neuropathy and peripheral arterial disease in persons with diabetes mellitus in a Nigerian University Teaching Hospital. BMC Res Notes 2015; 8:533. [PMID: 26435536 PMCID: PMC4592746 DOI: 10.1186/s13104-015-1423-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 09/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying the risk factors for diabetes mellitus related foot ulceration would save more limbs from amputation. This report focuses on the determining the burden of peripheral arterial disease and neuropathy in persons with diabetes mellitus (DM). METHODS This is a descriptive study carried out in the Diabetic Clinic of the Lagos State University Teaching Hospital in patients with DM who had no past/present history of foot ulceration. Biothesiometry was employed and ankle brachial pressure indices were measured to evaluate for neuropathy and peripheral arterial disease (PAD) respectively. RESULTS A total of 225 persons living with DM who met inclusion criteria were recruited consecutively over a 3 months period. Age range was 28-87 years with the mean [61.4 (10.8)] and median (63) years respectively. Patients symptomatic for neuropathy and PAD were 37 and 40 % respectively of the study population. An older age of >60 years and poor glycaemic control were potential predictors of neuropathy. Neuropathy and PAD occurred commonly in the seventh decade of life. CONCLUSION Given the fairly high proportions of neuropathy and PAD in our patients with DM, we recommend that they be routinely examined in persons with DM.
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Affiliation(s)
- Anthonia O Ogbera
- Department of Medicine, Lagos State University College Of Medicine, Ikeja, Lagos, Nigeria.
| | - Olufunmilayo Adeleye
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.
| | - Babatunde Solagberu
- Department of Surgery, Lagos State University College Of Medicine, Ikeja, Lagos, Nigeria.
| | - Alfred Azenabor
- Department of Medical Laboratory Sciences, University of Lagos, Idi-araba, Lagos, Nigeria.
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162
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Chun J, Hong J. Relationships between presynaptic inhibition and static postural sway in subjects with and without diabetic neuropathy. J Phys Ther Sci 2015; 27:2697-700. [PMID: 26504271 PMCID: PMC4616072 DOI: 10.1589/jpts.27.2697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/25/2015] [Indexed: 12/02/2022] Open
Abstract
[Purpose] Diabetic peripheral neuropathy can often lead to balance impairment. The spinal
reflex is a mechanism that is reportedly important for balance, but it has not been
investigated in diabetic peripheral neuropathy patients. Moreover, inhibitory or
facilitatory behavior of the spinal reflex—known as presynaptic inhibition—is essential
for controlling postural sway. The purpose of this study was to compare the differences in
as presynaptic inhibition and balance in subjects with and without diabetic peripheral
neuropathy to determine the influence of presynaptic inhibition on balance in diabetic
peripheral neuropathy patients. [Subjects and Methods] Presynaptic inhibition and postural
sway were tested in eight patients (mean age, 58±6 years) and eight normal subjects (mean
age, 59±7 years). The mean percent difference in conditioned reflex amplitude relative to
the unconditioned reflex amplitude was assessed to calculate as presynaptic inhibition.
The single-leg balance index was measured using a computerized balance-measuring device.
[Results] The diabetic peripheral neuropathy group showed lower presynaptic inhibition
(47±30% vs. 75±22%) and decreased balance (0.65±0.24 vs. 0.38±0.06) as compared with the
normal group. No significant correlation was found between as presynaptic inhibition and
balance score (R=0.37). [Conclusion] Although the decreased as presynaptic inhibition
observed in diabetic peripheral neuropathy patients may suggest central nervous system
involvement, further research is necessary to explore the role of presynaptic inhibition
in decreased balance in diabetic peripheral neuropathy patients.
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Affiliation(s)
- Jihyun Chun
- Department of Sports and Health Rehabilitation, Kookmin University, Republic of Korea
| | - Junggi Hong
- Department of Sports and Health Rehabilitation, Kookmin University, Republic of Korea
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163
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Influence of GSTM1, GSTT1, and GSTP1 Polymorphisms on Type 2 Diabetes Mellitus and Diabetic Sensorimotor Peripheral Neuropathy Risk. DISEASE MARKERS 2015; 2015:638693. [PMID: 26435566 PMCID: PMC4578743 DOI: 10.1155/2015/638693] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 08/26/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Diabetic neuropathy is a frequent complication of type 2 diabetes mellitus (T2DM). Genetic susceptibility and oxidative stress may play a role in the appearance of T2DM and diabetic neuropathy. We investigated the relation between polymorphism in genes related to oxidative stress such as GSTM1, GSTT1, and GSTP1 and the presence of T2DM and diabetic neuropathy (DN). METHODS Samples were collected from 84 patients with T2DM (42 patients with DN and 42 patients without DN) and 98 healthy controls and genotyped by using polymerase chain reaction and restriction fragment length polymorphism method. RESULTS GSTP1 Ile105Val polymorphism was associated with the risk of developing T2DM (p = 0.05) but not with the risk of developing DN in diabetic cases. GSTM1 and GSTT1 gene polymorphisms were associated with neither the risk of developing T2DM nor the risk of DN occurrence in diabetic patients. No association was observed between the patients with T2DM and DSPN (diabetic sensorimotor peripheral neuropathy) and T2DM without DSPN regarding investigated polymorphism. CONCLUSION Our data suggest that GSTP1 gene polymorphisms may contribute to the development of T2DM in Romanian population. GSTM1, GSTT1, and GSTP1 gene polymorphisms are not associated with susceptibility of developing diabetic neuropathy in T2DM patients.
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164
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Nisar MU, Asad A, Waqas A, Ali N, Nisar A, Qayyum MA, Maryam H, Javaid M, Jamil M. Association of Diabetic Neuropathy with Duration of Type 2 Diabetes and Glycemic Control. Cureus 2015; 7:e302. [PMID: 26430576 PMCID: PMC4571902 DOI: 10.7759/cureus.302] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: Diabetes mellitus is associated with severe microvascular and macrovascular complications with major implications for public health. Diabetic neuropathy is a very problematic complication of diabetes mellitus. It is associated with severe morbidity, mortality, and a huge economic burden. The present study was designed with two aims: 1) to analyze the association of diabetic neuropathy with the glycemic index (levels of fasting blood glucose, random blood glucose, and Hb1Ac) in patients with Type 2 diabetes, and 2) to analyze the association of diabetic neuropathy with time passed since the diagnosis of diabetes. Methods: This case-control study was undertaken between June 2013 and February 2015 in the Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, Pakistan. Type 2 diabetics with an age range of 30-60 years were recruited from outpatient departments of AFIRM, Rawalpindi. Data were collected and recorded on a form with four sections recording the following: 1) demographics of patients and number of years passed since diagnosis of diabetes; 2) clinical examination for touch, pressure, power, pain, vibration, and ankle reflex; 3) nerve conduction studies for motor components of the common peroneal nerve and tibial nerve and the sensory component of median nerve and sural nerve; 4) glycemic index, including fasting blood glucose levels (BSF), random blood glucose (BSR) levels, and HbA1c levels. Data were analyzed in SPSS v. 20. Chi-square and phi statistics and logistic regression analysis were run to analyze associations between diabetic neuropathy and time passed since diagnosis of diabetes and glycemic index. Results: In total, 152 patients were recruited. One-half of those patients had neuropathy (76 patients) and the other half (76 patients) had normal nerve function. The mean (standard deviation [SD]) duration of diabetes was nine years (6.76), BSF levels 7.98 mmol/l (2.18), BSR 9.5 mmol/l (3.19), and HbA1c 6.5% (2.18). Logistic regression analysis predicted 87.5% of the model correctly. Duration since the diagnosis of diabetes and HbA1c levels were significantly associated with the diagnosis of neuropathy in diabetics. Conclusion: The presence of diabetic neuropathy was significantly associated with HbA1c levels and the duration of diabetes.
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Affiliation(s)
- Muhammad Umer Nisar
- Final year MBBS Student, Yusra Medical & Dental College Near Kahuta Morr, GT Road, P.O Humak, Islamabad
| | - Ambreen Asad
- Associate Professor, Dept. of Physiology, Yusra Medical & Dental College Near Kahuta Morr, GT Road, P.O Humak, Islamabad
| | - Ahmed Waqas
- Final year MBBS Student, CMH Lahore Medical College and Institute of Dentistry, Shami Road, Lahore Cantt
| | - Nazia Ali
- Fourth year MBBS Student, Yusra Medical & Dental College Near Kahuta Morr, GT Road, P.O Humak, Islamabad
| | - Anam Nisar
- Wah Medical College, , POF Hospital Wah Cantt. Pakistan
| | - Mohsin A Qayyum
- Fourth year MBBS Student , Yusra Medical & Dental College Near Kahuta Morr, GT Road, P.O Humak, Islamabad
| | - Hafsa Maryam
- Fourth year MBBS, Yusra Medical & Dental College Near Kahuta Morr, GT Road, P.O Humak, Islamabad
| | - Mohsin Javaid
- Fourth year MBBS Student, Yusra Medical & Dental College Near Kahuta Morr, GT Road, P.O Humak, Islamabad
| | - Mohsin Jamil
- Fourth year MBBS Student, Yusra Medical & Dental College Near Kahuta Morr, GT Road, P.O Humak, Islamabad
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165
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Papanas N, Ziegler D. Risk Factors and Comorbidities in Diabetic Neuropathy: An Update 2015. Rev Diabet Stud 2015; 12:48-62. [PMID: 26676661 PMCID: PMC5397983 DOI: 10.1900/rds.2015.12.48] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 04/27/2015] [Accepted: 05/07/2015] [Indexed: 01/01/2023] Open
Abstract
Distal symmetric sensorimotor polyneuropathy (DSPN) is the most common neurological manifestation in diabetes. Major risk factors of DSPN include diabetes duration, hyperglycemia, and age, followed by prediabetes, hypertension, dyslipidemia, and obesity. Height, smoking, insulin resistance, hypoinsulinemia, and others represent an additional risk. Importantly, hyperglycemia, hypertension, dyslipidemia, obesity, and smoking are modifiable. Stringent glycemic control has been shown to be effective in type 1, but not to the same extent in type 2 diabetes. Antilipidemic treatment, especially with fenofibrate, and multi-factorial intervention have produced encouraging results, but more experience is necessary. The major comorbidities of DSPN are depression, autonomic neuropathy, peripheral arterial disease, cardiovascular disease, nephropathy, retinopathy, and medial arterial calcification. Knowledge of risk factors and comorbidities has the potential to enrich the therapeutic strategy in clinical practice as part of the overall medical care for patients with neuropathy. This article provides an updated overview of DSPN risk factors and comorbidities.
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Affiliation(s)
- Nikolaos Papanas
- Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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166
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Clair C, Cohen MJ, Eichler F, Selby KJ, Rigotti NA. The Effect of Cigarette Smoking on Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis. J Gen Intern Med 2015; 30:1193-203. [PMID: 25947882 PMCID: PMC4510224 DOI: 10.1007/s11606-015-3354-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 01/22/2015] [Accepted: 04/07/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Studies suggest that smoking may be a risk factor for the development of microvascular complications such as diabetic peripheral neuropathy (DPN). The objective of this study was to assess the relationship between smoking and DPN in persons with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS A systematic review of the PubMed, Embase, and Cochrane clinical trials databases was conducted for the period from January 1966 to November 2014 for cohort, cross-sectional and case-control studies that assessed the relationship between smoking and DPN. Separate meta-analyses for prospective cohort studies and case-control or cross-sectional studies were performed using random effects models. RESULTS Thirty-eight studies (10 prospective cohort and 28 cross-sectional) were included. The prospective cohort studies included 5558 participants without DPN at baseline. During follow-up ranging from 2 to 10 years, 1550 cases of DPN occurred. The pooled unadjusted odds ratio (OR) of developing DPN associated with smoking was 1.26 (95% CI 0.86-1.85; I(2) = 74%; evidence grade: low strength). Stratified analyses of the prospective studies revealed that studies of higher quality and with better levels of adjustment and longer follow-up showed a significant positive association between smoking and DPN, with less heterogeneity. The cross-sectional studies included 27,594 participants. The pooled OR of DPN associated with smoking was 1.42 (95% CI 1.21-1.65; I(2) = 65%; evidence grade: low strength). There was no evidence of publication bias. CONCLUSIONS Smoking may be associated with an increased risk of DPN in persons with diabetes. Further studies are needed to test whether this association is causal and whether smoking cessation reduces the risk of DPN in adults with diabetes.
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Affiliation(s)
- Carole Clair
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland,
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167
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Veresiu AI, Bondor CI, Florea B, Vinik EJ, Vinik AI, Gâvan NA. Detection of undisclosed neuropathy and assessment of its impact on quality of life: a survey in 25,000 Romanian patients with diabetes. J Diabetes Complications 2015; 29:644-9. [PMID: 25922309 DOI: 10.1016/j.jdiacomp.2015.04.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/03/2015] [Accepted: 04/03/2015] [Indexed: 12/13/2022]
Abstract
AIMS The objective of this cross-sectional survey was to capture undiagnosed neuropathy in Romanian patients with self-reported diabetes using Norfolk QoL-DN as a screening tool and to assess its impact on quality of life (QoL). METHODS 25,000 Romanian-translated, validated Norfolk QoL-DN questionnaires were distributed between June and December 2012. 21,261 patients who self-reported diabetes and answered questions related to neuropathy, ulceration, gangrene and amputation were included in the analysis. RESULTS 52% of diabetic patients (n = 6615) who answered "no" to the question "Do you have neuropathy?" had total QoL scores above the cut-off, suggesting the presence of diabetic neuropathy. 13,854 (65.2%) patients answered "yes" to the question "Do you have neuropathy?" and 3,150 (14.8%) reported at least one episode of ulceration, gangrene or amputation. Total QoL score was 3-fold higher (worse) for patients who answered "yes" to the question "Do you have neuropathy?" than for those who answered "no" (38.39 vs. 13.71; p < 0.001) and 1.4-fold worse for patients who reported ulceration, gangrene or amputation than for those who did not report any of these (50.38 vs. 34.87; p < 0.001). CONCLUSIONS We found a high prevalence of undisclosed diabetic neuropathy in this population and showed that neuropathy severity has an increasing impact on total QoL and its domains.
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Affiliation(s)
- Andrei I Veresiu
- Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Department of Diabetes, Nutrition and Metabolic Diseases, 4-6 Clinicilor Street, Cluj-Napoca, Romania
| | - Cosmina I Bondor
- Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Department of Medical Informatics and Biostatistics, 6 Pasteur Street, Cluj-Napoca, Romania.
| | - Bogdan Florea
- Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babes Street, IMOGEN Research Center, Cluj-Napoca, Romania
| | - Etta J Vinik
- Eastern Virginia Medical School, Strelitz Diabetes Center, 855 West Brambleton Avenue, Norfolk, VA, USA
| | - Aaron I Vinik
- Eastern Virginia Medical School, Neuroendocrine Unit, 855 West Brambleton Avenue, Norfolk, VA, USA
| | - Norina A Gâvan
- Wörwag Pharma GmbH&Co.KG, Romanian Representative Office, Society of Diabetic Neuropathy, 11 Fagului Street, Cluj-Napoca, Romania
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168
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Younis BB, Shahid A, Arshad R, Khurshid S, Masood J. Charcot osteoarthropathy in type 2 diabetes persons presenting to specialist diabetes clinic at a tertiary care hospital. BMC Endocr Disord 2015; 15:28. [PMID: 26065885 PMCID: PMC4465003 DOI: 10.1186/s12902-015-0023-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 06/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Charcot osteoarthropathy or charcot foot is a rare, chronic, non-communicable condition of bones and joints which may results into severe deformity and more prone to develop ulcers possibly leading to amputation. The purpose of this study was to determine the prevalence of Charcot osteoarthropathy and its association with age, BMI, gender, duration of diabetes, HBA1c and peripheral neuropathy. METHODS A total of 1931 subjects with type 2 diabetes having mean age 50.72 ± 10.66 years presenting in a specialist diabetes clinic at shalamar hospital, Lahore, Pakistan were enrolled. The diagnosis of Charcot osteoarthropathy was made by examination of both dorsal and plantar surfaces of foot for swelling, erythema, increase in temperature and any musculoskeletal deformity which was later confirmed by radiographs. Assessment of neuropathy was carried out by checking the sense of pressure, joint position and vibration. BMI (Body Mass Index), fasting blood glucose (FBG) and HbA1C were determined. RESULTS In all subjects including male 704 (36.45 %) and female 1227 (63.55 %), 0.4 % subjects had charcot deformity, while 0.2 %, 0.15 % and 0.05 % subjects having right, left and bilateral deformity respectively. Bilaterally symmetrical neuropathy was diagnosed in 25.4 % in subjects. There was a significant association (p < 0.05) of deformity with duration of diabetes, HbA1C and neuropathy, however no significant association (p > 0.05) was found with age, BMI, weight, height and gender. CONCLUSION There is a need to have a special care of persons with diabetes regarding blood glucose control and development of peripheral neuropathy. Early identification and management of risk factors may prevent the occurrence of charcot deformity. Patients must be educated about the foot care.
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Affiliation(s)
- Bilal Bin Younis
- Department of Endocrinology Medicine, Shalamar Medical and Dental College Lahore, Shalamar Link Road Lahore, Postal address: 2-J Gulberg III, Lahore, Pakistan.
| | - Adeela Shahid
- Department of Physiology, Shalamar Medical and Dental College, Lahore, Pakistan.
- Department of Physiology and Cell Biology, University of Health Sciences, Lahore, Pakistan.
| | - Rozina Arshad
- Department of Endocrinology Medicine, Shalamar Medical and Dental College Lahore, Shalamar Link Road Lahore, Postal address: 2-J Gulberg III, Lahore, Pakistan.
| | - Saima Khurshid
- Department of Endocrinology Medicine, Shalamar Medical and Dental College Lahore, Shalamar Link Road Lahore, Postal address: 2-J Gulberg III, Lahore, Pakistan.
| | - Junaid Masood
- Department of Endocrinology Medicine, Shalamar Medical and Dental College Lahore, Shalamar Link Road Lahore, Postal address: 2-J Gulberg III, Lahore, Pakistan.
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169
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Abstract
Distal symmetric polyneuropathy (DSPN), the most common form of diabetic neuropathy, has a complex pathophysiology and can be a major source of physical and psychologic disability. The management of DSPN can be frustrating for both patient and physician. This article provides a general overview of typical patient pathways in DSPN, and highlights variations in diagnosis, management, and referral patterns among different providers. DSPN is managed in several settings by primary care physicians (PCPs), specialists, and nurse practitioners. The initial clinical management of the patient is often dependent on the presenting complaint, the referral pattern of the provider, level of comfort of the PCP in managing diabetic complications, and geographic access to specialists. The primary treatment of DSPN focuses mainly on glycemic control and adjustment of modifiable risk factors, but other causes of neuropathy should also be investigated. Several pharmacologic agents are recommended by treatment guidelines, and as DSPN typically exists with comorbid conditions, a multimodal therapeutic approach should be considered. Barriers to effective management include failure to recognize DSPN, and misdiagnosis. Patient education also remains important. Referral patterns vary widely according to geographic location, access to services, provider preferences, and comfort in managing complex aspects of the disease. The variability in patient pathways affects patient education, satisfaction, and outcomes. Standardized screening tools, a multidisciplinary team approach, and treatment algorithms for diabetic neuropathy should improve future care. To improve patient outcomes, DSPN needs to be diagnosed sooner and interventions made before significant nerve damage occurs.
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Affiliation(s)
- Michelle Kaku
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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170
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Li L, Chen J, Wang J, Cai D. Prevalence and risk factors of diabetic peripheral neuropathy in Type 2 diabetes mellitus patients with overweight/obese in Guangdong province, China. Prim Care Diabetes 2015; 9:191-195. [PMID: 25163987 DOI: 10.1016/j.pcd.2014.07.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 01/19/2023]
Abstract
AIMS To investigate the prevalence and risk factors of diabetic peripheral neuropathy (DPN) in Type 2 diabetes mellitus (T2DM) patients with overweight or obese in Guangdong province in China. METHODS A cross-sectional study was carried out on T2DM patients with overweight/obese in 60 hospitals in Guangdong province. Methods of data collection included questionnaire, clinical examination, blood draw and clinical measurement. Demographic characteristics, diagnosis of diabetes and DPN, disease history, life styles and self-management, most recent laboratory test results and physical examination were collected. Binary logistic regression was used to assess risk factors of DPN. RESULTS A total of 3359 T2DM patients (age range 20-90 years) were recruited. The overall prevalence of DPN was 33.1%. Binary logistic regression identified age (odds ratio [OR]: 1.016, 95% confidence interval [CI]: 1.008, 1.024), duration of diabetes mellitus (OR: 1.072, 95% CI: 1.056, 1.087) and HbA1c (OR: 1.053, 95% CI: 1.013, 1.095) as risk factors for the presence of DPN. CONCLUSIONS DPN is prevalent in T2DM patients with overweight or obese in Guangdong province in China and is significantly associated with age, HbA1c and duration of diabetes.
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Affiliation(s)
- Li Li
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China; Department of Nursing, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China.
| | - Jiali Chen
- Department of Nursing, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China
| | - Jiao Wang
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China
| | - Dehong Cai
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China
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171
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Kuate-Tegueu C, Temfack E, Ngankou S, Doumbe J, Djientcheu VP, Kengne AP. Prevalence and determinants of diabetic polyneuropathy in a sub-Saharan African referral hospital. J Neurol Sci 2015; 355:108-12. [PMID: 26048049 DOI: 10.1016/j.jns.2015.05.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/02/2015] [Accepted: 05/25/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diabetic peripheral neuropathy is the commonest complication of diabetes mellitus, and a major cause of limb amputations. In general however, the magnitude of diabetic neuropathy in sub-Saharan Africans with diabetes has been less reliably quantified. We assessed the prevalence and determinants of diabetic polyneuropathy in hospital settings in Cameroon. METHODS We conducted a cross-sectional survey at the Douala Laquintinie Hospital, which is one of the main reference hospital in the economic capital of Cameroon (3 million populations). Participants included all patients with type 1 (T1DM) or type 2 (T2DM) diabetes who reported to the hospital regardless of the reason, during a 5-month recruitment period. Polyneuropathy was defined as diabetic in a patient with a Diabetic Neuropathy Examination score of >3/16 and/or a monofilament score of <5/9. RESULTS A total of 306 patients were recruited, including 196 women (64%) and 294 (96%) with T2DM. The mean (standard deviation) values were 59.8 (11.2) years for age and 8.4 (8.2) years for diabetes duration. Clinical signs of polyneuropathy were present in 102 (crude prevalence rate: 33.3%) patients. The polyneuropathy was symptomatic in 79/102 (77.4%) patients. Determinants of polyneuropathy were urban residence (p=0.02), infection with hepatitis C virus (p=0.002), infection with HIV (p=0.012) and presence of albuminuria (p=0.0001). CONCLUSION About one in three patients with diabetes reporting to the hospital in our setting has prevalent diabetes related polyneuropathy. This emphasizes the importance of routine implementation of therapeutic education and other measures to limit the complications.
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Affiliation(s)
- C Kuate-Tegueu
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Cameroon; Neurology Department, Douala Laquintinie Hospital, Cameroon.
| | - E Temfack
- Department of Internal Medicine, Douala General Hospital, Cameroon
| | - S Ngankou
- Neurology Department, Douala Laquintinie Hospital, Cameroon
| | - J Doumbe
- Neurology Department, Douala Laquintinie Hospital, Cameroon; Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon
| | - V P Djientcheu
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Cameroon
| | - A P Kengne
- South African Medical Research Council & University of Cape Town
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172
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Aslam A, Singh J, Rajbhandari S. Prevalence of Painful Diabetic Neuropathy Using the Self-Completed Leeds Assessment of Neuropathic Symptoms and Signs Questionnaire in a Population with Diabetes. Can J Diabetes 2015; 39:285-95. [PMID: 25935401 DOI: 10.1016/j.jcjd.2014.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 11/17/2014] [Accepted: 12/09/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study assessed the feasibility of diagnosing painful diabetic neuropathy (PDN) using a postal self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire, and it compared the prevalence of PDN in patients with diabetes attending primary and secondary care. METHODS This was an observational study in northwest England, United Kingdom (n=204). S-LANSS were used by post to diagnose PDN. Consent for participation and access of blood results were obtained from the subjects with diabetes. Ethical approval was granted to do the work. RESULTS In this study the prevalence of PDN was 30.3%, comprising 33.1% of patients with type 2 diabetes compared to 14.1% patients with type 1 diabetes. The overall prevalence of PDN was 33% (n=43) in the secondary care group and 25.6% (n=19) in the primary care group; the rates were not statistically significant. There were no gender differences between the primary and secondary care populations. There was a significant association of obesity, smoking and height in males with PDN compared to the non-PDN group (p<0.05). There was a significant trend toward increasing prevalence of PDN with duration of diabetes, increasing glycated hemoglobin and increasing body mass index (p<0.05). CONCLUSION The overall prevalence of PDN in this study was 30.3%. The results demonstrated the use of self-administered S-LANSS was easy and can be used for epidemiologic surveys of PDN. The results are comparable to and similar to other published series, in both primary and secondary care settings.
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Affiliation(s)
- Amir Aslam
- Eaton Centre Medical Clinic, Calgary, Alberta, Canada.
| | - Jaipaul Singh
- School of Pharmacy and Biomedical Sciences and School of Forensic and Investigative Sciences, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Satyan Rajbhandari
- School of Pharmacy and Biomedical Sciences and School of Forensic and Investigative Sciences, University of Central Lancashire, Preston, Lancashire, United Kingdom; Department of Diabetology and Endocrinology, Lancashire Teaching Hospital NHS Trust, Chorley and South Ribble District General Hospital, Preston Road, Chorley, United Kingdom
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173
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Sadosky A, Mardekian J, Parsons B, Hopps M, Bienen EJ, Markman J. Healthcare utilization and costs in diabetes relative to the clinical spectrum of painful diabetic peripheral neuropathy. J Diabetes Complications 2015; 29:212-7. [PMID: 25498300 DOI: 10.1016/j.jdiacomp.2014.10.013] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/30/2014] [Accepted: 10/31/2014] [Indexed: 12/29/2022]
Abstract
AIMS Diabetic peripheral neuropathy (DPN) accompanied by painful symptoms is known as painful DPN (pDPN). This study characterized healthcare resource utilization and costs in patients with DPN, pDPN, and severe pDPN relative to diabetes only. METHODS Four adult cohorts were identified from the Humedica database: type 2 diabetes without DPN (n=288,328); DPN (n=35,050); pDPN (DPN subjects with a pain score ≥1 on a 0-10 numeric rating scale; n=3449); and severe pDPN (pain scores 7-10; n=1824). Resource utilization and costs for 12-months post-diagnosis were compared for diabetes relative to the other cohorts. RESULTS Demographic characteristics were different across cohorts. Relative to diabetes alone, DPN, pDPN, and severe pDPN were characterized by significantly higher proportions of patients with resource utilization for all resource categories (all P<0.0001); the highest resource use generally observed for severe pDPN. Total annual direct medical costs were $6632 for diabetes only, with costs for DPN ($12,492), pDPN ($27,931), and severe pDPN ($30,755) significantly higher (all P<0.0001); outpatient costs were consistently the primary driver of total costs. CONCLUSIONS Patients with DPN, pDPN, and severe pDPN had significantly greater healthcare resource utilization and costs than patients with diabetes only, with the highest burden associated with severe pDPN.
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Affiliation(s)
| | | | | | | | | | - John Markman
- Translational Pain Research Program, Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
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174
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Morey-Vargas OL, Smith SA. BE SMART: strategies for foot care and prevention of foot complications in patients with diabetes. Prosthet Orthot Int 2015; 39:48-60. [PMID: 25614501 DOI: 10.1177/0309364614535622] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Diabetic foot ulcers and lower extremity amputations are common complications of diabetes mellitus that are associated with substantial morbidity, loss of quality of life, disability, and a high social and economic burden. The implementation of strategies to prevent these complications is a key aspect of diabetes care. OBJECTIVES The objective of this article is to provide an overview of the available evidence on preventive diabetic foot care. STUDY DESIGN Literature review. METHODS Narrative review based on a thorough search of previous relevant studies, systematic reviews, and clinical guidelines on diabetic foot care published in English. RESULTS We describe diabetic foot care strategies that can be categorized within defined domains for the purpose of helping clinicians to remember them. We use the mnemonic "BE SMART" (Be aware of the risk factors, Educate patients and health providers, Structured clinical assessment, Metabolic evaluation and management, Assessment of Risk, and Team care) to organize these domains. CONCLUSION Diabetic foot ulcers and lower extremity amputations are potentially preventable complications. Clinicians taking care of patients with diabetes should know, understand, and remember the multiple aspects of diabetic foot care. CLINICAL RELEVANCE This review can be used as a reference source for those interested in the care of diabetic foot. It highlights the importance of risk factor recognition, education, a structured clinical and metabolic evaluation, and also the importance of assigning patients a risk category that can help guiding multidisciplinary management efforts.
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Affiliation(s)
- Oscar L Morey-Vargas
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Steven A Smith
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
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175
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Abstract
Hyperglycemia is the unifying metabolic abnormality for all forms of diabetes mellitus, forming the basis for its diagnosis and treatment. The strong epidemiologic associations between hyperglycemia and the complications of diabetes have given rise to the glucose hypothesis-that the complications of diabetes are caused by hyperglycemia and that they can be prevented by normalizing glucose levels. Herein the authors review the epidemiologic relationships between hyperglycemia and the complications of diabetes, the major trials of glucose lowering, and the extent to which the glucose hypothesis is supported by these studies and how this information can be translated into clinical practice.
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Affiliation(s)
- Silvio Inzucchi
- Department of Endocrinology, Yale University School of Medicine, New Haven, CT; Medical Director, Yale Diabetes Center, Yale-New Haven Hospital, New Haven, CT.
| | - Sachin Majumdar
- Department of Endocrinology, Yale University School of Medicine, New Haven, CT; Section of Endocrinology, Bridgeport Hospital, Yale New Haven Health System, Bridgeport, CT
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176
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Javed S, Petropoulos IN, Alam U, Malik RA. Treatment of painful diabetic neuropathy. Ther Adv Chronic Dis 2015; 6:15-28. [PMID: 25553239 DOI: 10.1177/2040622314552071] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Painful diabetic neuropathy (PDN) is a debilitating consequence of diabetes that may be present in as many as one in five patients with diabetes. The objective assessment of PDN is difficult, making it challenging to diagnose and assess in both clinical practice and clinical trials. No single treatment exists to prevent or reverse neuropathic changes or to provide total pain relief. Treatment of PDN is based on three major approaches: intensive glycaemic control and risk factor management, treatments based on pathogenetic mechanisms, and symptomatic pain management. Clinical guidelines recommend pain relief in PDN through the use of antidepressants such as amitriptyline and duloxetine, the γ-aminobutyric acid analogues gabapentin and pregabalin, opioids and topical agents such as capsaicin. Of these medications, duloxetine and pregabalin were approved by the US Food and Drug Administration (FDA) in 2004 and tapentadol extended release was approved in 2012 for the treatment of PDN. Proposed pathogenetic treatments include α-lipoic acid (stems reactive oxygen species formation), benfotiamine (prevents vascular damage in diabetes) and aldose-reductase inhibitors (reduces flux through the polyol pathway). There is a growing need for studies to evaluate the most potent drugs or combinations for the management of PDN to maximize pain relief and improve quality of life. A number of agents are potential candidates for future use in PDN therapy, including Nav 1.7 antagonists, N-type calcium channel blockers, NGF antibodies and angiotensin II type 2 receptor antagonists.
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Affiliation(s)
- Saad Javed
- Centre for Endocrinology and Diabetes, University of Manchester, Core Technology Facility (3rd floor), 46 Grafton Street, Manchester, M13 9NT, UK
| | - Ioannis N Petropoulos
- School of Medicine, Institute of Human Development, Centre for Endocrinology and Diabetes, Manchester, UK
| | - Uazman Alam
- School of Medicine, Institute of Human Development, Centre for Endocrinology and Diabetes, and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Rayaz A Malik
- School of Medicine, Institute of Human Development, Centre for Endocrinology and Diabetes, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, and Weill Cornell Medical College, Qatar
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177
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Sanada LS, Tavares MR, Sato KL, Ferreira RDS, Neubern MCM, Castania JA, Salgado HC, Fazan VPS. Association of chronic diabetes and hypertension in sural nerve morphometry: an experimental study. Diabetol Metab Syndr 2015; 7:9. [PMID: 25717348 PMCID: PMC4339238 DOI: 10.1186/s13098-015-0005-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prospective studies have shown incidence rates of hypertension in diabetes mellitus to be three times that of subjects without diabetes mellitus. The reverse also applies, with the incidence of diabetes two to three times higher in patients with hypertension. Despite this common clinical association, the contribution of each isolated entity in the development of a neuropathy is still not well understood. The aims of the present study were to investigate the presence of peripheral neuropathy in spontaneously hypertensive rats (SHR) and SHR with chronically induced diabetes, using a morphological and morphometric study of the sural nerves. METHODS Female SHR and normotensive Wistar rats (WR), 8 weeks old, received a single intravenous injection of streptozotocin (STZ) through the tail vein. Controls from both strains received vehicle. Twelve weeks after the injection, sural nerves were dissected and prepared for light microscopy. Morphometry of sural nerve fascicles and myelinated fibers was performed with the aid of computer software. RESULTS The sural nerve myelinated fibers were highly affected by experimental diabetes in normotensive rats, causing mainly the reduction of the fiber size. Hypertensive rats showed characteristics of small fiber neuropathy and a severe reduction of the number and density or Schwann cells. The association between diabetes and hypertension caused an increase on the average size of the myelinated fibers, pointing to a small fiber loss, associated to axonal atrophy. CONCLUSIONS Our study gives morphological support to the existence of a neuropathy due to hypertension, which is among one of the most common risk factors for diabetic neuropathy. The association between the two neuropathies showed to be a complex alteration, involving and including both, large and small fibers neuropathy. Hypertension caused, indeed, an exacerbation of the alterations already observed in experimental models of diabetic neuropathy.
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Affiliation(s)
- Luciana Sayuri Sanada
- />Department of Neuroscience and Behavioral Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
| | | | - Karina Laurenti Sato
- />Departament of Physical Therapy, Federal University of Sergipe, Aracaju, SE Brazil
| | - Renata da Silva Ferreira
- />Department of Neuroscience and Behavioral Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Milena Cardoso Maia Neubern
- />Department of Neuroscience and Behavioral Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Jaci Ayrton Castania
- />Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Helio Cesar Salgado
- />Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Valéria Paula Sassoli Fazan
- />Department of Neuroscience and Behavioral Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
- />Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto, USP, Av. Bandeirantes 3900, Ribeirão Preto, SP Brazil
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Podnar S, Vodušek DB. Sexual dysfunction in patients with peripheral nervous system lesions. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:179-202. [PMID: 26003245 DOI: 10.1016/b978-0-444-63247-0.00011-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Peripheral nervous system (PNS) disorders may cause sexual dysfunction (SD) in patients of both genders. These disorders include mainly polyneuropathies (particularly those affecting the autonomic nervous system (ANS)) and localized lesions affecting the innervation of genital organs. Impaired neural control may produce a malfunction of the genital response consisting of loss of genital sensitivity, erectile dysfunction, loss of vaginal lubrication, ejaculation disorder, and orgasmic disorder. In addition, there is often a loss of desire which actually has a complex pathogenesis, which goes beyond the mere loss of relevant nerve function. In patients who have no manifest health problems - particularly men with erectile dysfunction - one should always consider the possibility of an underlying polyneuropathy; in patients with SD after suspected denervation lesions of the innervation of genital organs within the lumbosacral spinal canal and in the pelvis, clinical neurophysiologic testing may clarify the PNS involvement. SD can alter self-esteem and lower patients' quality of life; opening up a discussion on sexual issues should be a part of the management of patients with PNS disorders. They may greatly benefit from counseling, education on coping strategies, and specific treatments.
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Affiliation(s)
- Simon Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.
| | - David B Vodušek
- Division of Neurology, University Medical Center Ljubljana, and Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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Müller-Stich BP, Billeter AT, Fleming T, Fischer L, Büchler MW, Nawroth PP. Nitrosative stress but not glycemic parameters correlate with improved neuropathy in nonseverely obese diabetic patients after Roux-Y gastric bypass. Surg Obes Relat Dis 2014; 11:847-54. [PMID: 25862183 DOI: 10.1016/j.soard.2014.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Diabetic neuropathy is common in type 2 diabetic patients (T2DM) but tight glycemic control does not improve the symptoms. In contrast, Roux-Y gastric bypass (RYGB) has a positive effect on active neuropathic symptoms, independent from glycemic control. The purpose of the present study was to identify potential mechanisms of improved diabetic neuropathic symptoms after RYGB. METHODS A prospective cohort of 20 patients with insulin-dependent T2DM and BMI < 35 kg/m(2) were treated with RYGB. Nineteen patients had complete follow-up. Fasting glucose, HbA1c (glycated hemoglobin), markers for nitrosative, carbonyl, and oxidative stress (nitrotyrosine, carboxylated-lysine (CML), methylglyoxal, oxidized low-density-lipoprotein (oxLDL)) as well as Neuropeptid Y and Neurokinin A were investigated over 12 months. Neuropathy was assessed using the Neuropathy Deficit Score (NDS). RESULTS The preoperative NDS improved within twelve months (5.1 ± 0.6 to 2.6 ± 0.4, P = .010). Fasting glucose and HbA1c also improved compared to preoperative values (201.1 ± 16.6 mg/dL to 128 ± 8.7 mg/dL, P = .004 and 8.5 ± 0.3% (53 ± 3.3 mmol/mol) to 7 ± 0.3% (67 ± 3.3 mmol/mol), P = .001, respectively). Nitrotyrosine, CML, and methylglyoxal all 3 decreased postoperatively (1067.3 ± 266.9 nM to 355.8 ± 36.4 nM, P = .003; 257.1 ± 10.2 ng/ml to 215.3 ± 18.3 ng/ml, P = .039; 402.3 ± 3.9 nM to 163.4 ± 10.3 nM, P = .002). OxLDL remained unchanged. Fasting glucose and HbA1c did not correlate with improved neuropathy. The decrease in nitrotyrosine correlated with improvement in the NDS after 6 and twelve months (r = .9, P < .001 and r = .68, P = .03). The decrease in methylglyoxal after 6 months correlated with decrease in NDS after twelve months (r = 0.897, P = .003). CONCLUSION RYGB seems to improve oxidative, nitrosative and carbonyl stress, known to have a causal role in diabetic neuropathy.
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Affiliation(s)
- Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
| | - Adrian T Billeter
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Fleming
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - Lars Fischer
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Peter P Nawroth
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
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Singhal K, Sandhir R. L-type calcium channel blocker ameliorates diabetic encephalopathy by modulating dysregulated calcium homeostasis. J Neurosci Res 2014; 93:296-308. [DOI: 10.1002/jnr.23478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 07/20/2014] [Accepted: 08/07/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Kirti Singhal
- Department of Biochemistry; Panjab University; Chandigarh India
| | - Rajat Sandhir
- Department of Biochemistry; Panjab University; Chandigarh India
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Alsunousi S, Marrif HI. Diabetic neuropathy and the sensory apparatus "meissner corpuscle and merkel cells". Front Neuroanat 2014; 8:79. [PMID: 25177276 PMCID: PMC4132297 DOI: 10.3389/fnana.2014.00079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/22/2014] [Indexed: 01/30/2023] Open
Affiliation(s)
- Salma Alsunousi
- Department of Histology, Faculty of Medicine, Benghazi University Benghazi, Libya
| | - Husnia I Marrif
- Department of Pharmaceutical Sciences, Princess Noura University Riyadh, Saudi Arabia
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Abstract
INTRODUCTION Diabetic peripheral neuropathy (DPN) is a debilitating complication of diabetes and accounts for significant morbidity by pre-disposing the foot to ulceration and lower extremity amputation. Using a large US commercial claims database, this study analyzes the drug class usage and co-morbidities associated with DPN as well as estimates the associated economic burden. METHODS Patients older than 18 and diagnosed with DPN were followed longitudinally for 2 years pre- and post-diagnosis date. Patients were analyzed for age, gender, hospital visits, ER and doctor's office visits, pharmacy claims, co-morbidities, and drug classes prescribed pre- and post-DPN diagnosis. The economic impact post-diagnosis of DPN was compared to the patients' pre-diagnosis resource use. RESULTS In total, 10,982 incident DPN patients were identified, with a median age of 61 years, and an equal gender distribution. Post-DPN diagnosis, there was a 20% increase in the number of patients visiting hospitals and a 46% increase in the number of visits to hospitals. Further, there was a 46% increase in the annual cost per patient associated with visits to the hospitals, emergency room (ER), doctor's office, and pharmacy claims. As per the analysis presented in this study, increase in the number of visits, cost per visit, and number of patients visiting hospitals, ER and doctor's offices added up to a 46% increase in aggregated cost associated with Medical Resource Utilization (MRU) owing to DPN, with the highest increase (60%) in costs associated with hospitalization of patients with DPN. CONCLUSION This study highlights the high economic burden associated with DPN. The results indicate that resource use significantly increases post-diagnosis of DPN, which leads to an increase in costs for payers. A noticeable proportion of patients with DPN had a pain co-diagnosis signifying the need for treatments that can effectively manage painful DPN.
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Affiliation(s)
- Maneesha Mehra
- Janssen Global Services, LLC, Market Access Analytics, Global Market Access & Commercial Strategy Organization , Raritan, NJ , USA
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Abstract
There is now little doubt that poor blood glucose control is an important risk factor for the development of diabetic peripheral neuropathy (DPN). Furthermore, traditional cardiovascular risk factors for macrovascular disease appear to be associated with an increased risk of DPN. The recently established International Expert Group on Diabetic Neuropathy has recommended new criteria for the diagnosis of DPN in the context of clinical and research settings. Studies in experimental diabetes examining the pathogenesis of DPN have identified a number of metabolic abnormalities including polyol pathway hyperactivity, increased advanced glycation end‐point formation, alterations in the protein kinase C beta pathway through diacylglycerol and oxidative stress. There is now strong evidence implicating nerve ischemia as the cause of DPN. Studies in human and animal models have shown reduced nerve perfusion and endoneurial hypoxia. These endoneurial microvascular changes strongly correlate with clinical severity and the degree of nerve‐fiber pathology. Unfortunately, many compounds that have been effective in animal models of neuropathy have not been successful in human diabetic neuropathy. The only compounds found to be efficacious in human diabetic neuropathy, and are in clinical use, are the anti‐oxidant, α‐lipoic acid and the aldose reductase inhibitor, epalrestat. Overall, the evidence emphasizes the importance of vascular dysfunction, driven by metabolic change, in the etiology of DPN, and highlights potential therapeutic approaches. Epidemiological data on diabetic painful neuropathic pain (DPNP) are limited. In one population‐based study, the prevalence of DPNP, as assessed by a structured questionnaire and examination, was estimated at 16%. It was notable that, of these patients, 12.5% had never reported symptoms to their doctor and 39% had never received treatment for their pain. Thus, despite being common, DPNP continues to be underdiagnosed and undertreated. Pharmacological treatment of DPNP include tricyclic compounds, serotonin noradrenalin reuptake inhibitors, the anti‐oxidant α‐lipoic acid, anticonvulsants, opiates, membrane stabilizers, topical capsaicin and so on. Management of the patient with DPNP must be tailored to individual requirements and will depend on the presence of other comorbidities. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00083.x)
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Abstract
PURPOSE OF REVIEW Diabetes mellitus has become a modern global epidemic, with steadily increasing prevalence rates related to lifestyle such that 27% of individuals aged 65 years or older have diabetes mellitus, 95% of whom have type 2. This article reviews the effects of diabetes mellitus on the neuromuscular system. RECENT FINDINGS Diabetes mellitus leads to diverse forms of peripheral neuropathy as the major neuromuscular complication. Both focal and diffuse types of neuropathy can develop, with the most common form being diabetic sensorimotor polyneuropathy. Small fibers are damaged early in the development of diabetic sensorimotor polyneuropathy and are not assessed by nerve conduction studies. Small fiber damage occurs even in the prediabetes stage. No disease-modifying therapy for diabetic sensorimotor polyneuropathy is available at this time, but this complication can be limited in patients who have type 1 diabetes mellitus with strict glycemic control; the same outcome is not clearly observed in patients who have type 2 diabetes mellitus. Recently, the evidence base for symptomatic treatments of painful diabetic sensorimotor polyneuropathy underwent systematic review. Effective evidence-based treatments include some anticonvulsants (eg, pregabalin, gabapentin), antidepressants (eg, amitriptyline, duloxetine), opioids (eg, morphine sulfate, oxycodone), capsaicin cream, and transcutaneous electrical nerve stimulation. SUMMARY This article reviews the increasing prevalence of diabetes mellitus and diabetic sensorimotor polyneuropathy and discusses recent consensus opinion on the objective confirmation needed for the diagnosis in the clinical research setting. The evidence from clinical trials shows that intensive glycemic control reduces prevalence of diabetic sensorimotor polyneuropathy in patients with type 1 diabetes mellitus, but variable outcomes are observed in patients with type 2 diabetes mellitus. Finally, despite the lack of disease-modifying treatment, effective evidence-based therapy can control painful symptoms of diabetic sensorimotor polyneuropathy.
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Kasznicki J. Advances in the diagnosis and management of diabetic distal symmetric polyneuropathy. Arch Med Sci 2014; 10:345-54. [PMID: 24904671 PMCID: PMC4042056 DOI: 10.5114/aoms.2014.42588] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 03/24/2013] [Accepted: 04/14/2013] [Indexed: 11/17/2022] Open
Abstract
Distal symmetric polyneuropathy (DSPN) is the most common chronic complication of diabetes mellitus. The pathogenesis of DSPN is not fully elucidated, but it is certainly multifactorial in nature and attributable to metabolic and microvessel disorders related to chronic hyperglycemia, diabetes duration, and several cardiovascular risk factors. Early diagnosis and appropriate management are extremely important, since up to 50% of DSPN cases may be asymptomatic, and patients are unaware of foot injury leading to foot ulcers and amputation. Simple, validated tests such as the Neuropathy Disability Score and/or Vibration Perception Threshold may be used to diagnose DSPN. Similarly, neurological dysfunction screening questionnaires should be used to assess the quality and severity of DSPN symptoms. Using both methods enables prediction of the prognosis of diabetic patients with DSPN. No causative treatment of DSPN is known, but the results of clinical trials indicate that several treatment options are highly effective in symptomatic treatment of painful DSPN. The appropriate treatment of DSPN may improve the outcome, preventing or delaying the development of numerous diabetic complications.
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Affiliation(s)
- Jacek Kasznicki
- Department of Internal Medicine, Diabetology and Clinical Pharmacology, Medical University of Lodz, Poland
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186
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Pathogenesis of painful diabetic neuropathy. PAIN RESEARCH AND TREATMENT 2014; 2014:412041. [PMID: 24891949 PMCID: PMC4026988 DOI: 10.1155/2014/412041] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/31/2014] [Accepted: 04/15/2014] [Indexed: 12/13/2022]
Abstract
The prevalence of diabetes is rising globally and, as a result, its associated complications are also rising. Painful diabetic neuropathy (PDN) is a well-known complication of diabetes and the most common cause of all neuropathic pain. About one-third of all diabetes patients suffer from PDN. It has a huge effect on a person's daily life, both physically and mentally. Despite huge advances in diabetes and neurology, the exact mechanism of pain causation in PDN is still not clear. The origin of pain could be in the peripheral nerves of the central nervous system. In this review, we discuss various possible mechanisms of the pathogenesis of pain in PDN. We discuss the role of hyperglycaemia in altering the physiology of peripheral nerves. We also describe central mechanisms of pain.
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Long-term effects of goshajinkigan in prevention of diabetic complications: a randomized open-labeled clinical trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:128726. [PMID: 24812564 PMCID: PMC4000675 DOI: 10.1155/2014/128726] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 11/29/2013] [Accepted: 02/16/2014] [Indexed: 12/26/2022]
Abstract
Objective. This clinical trial was designed to investigate whether goshajinkigan reduces the onset of diabetic complications or not. Materials and Methods. A total of 332 type 2 diabetic mellitus patients were registered from 9 clinical centers from March 2000 to August 2007. Patients were randomly assigned to take goshajinkigan extract powder, 2.5 grams for 3 times a day or no kampo therapy, additionally to the regular treatment. The primary endpoints were the onset of macrovascular diseases or progression of nephropathy or retinopathy. Statistical analysis was performed by the intention-to-treat method. Results. After 5 years of observation, 116 patients were submitted to analysis. Among them, no macrovascular events were observed in both groups. Although 43 participants had upstaging of retinopathy or nephropathy in total, there was no significant difference between goshajinkigan group and control group. Deterioration of ankle reflex was suppressed in goshajinkigan group. Also glycated hemoglobin, and fasting plasma glucose were decreased in the goshajinkigan group. Conclusion. Although the power of analysis was too low to demonstrate any effects of goshajinkigan on the progression of macrovascular diseases, retinopathy or nephropathy, goshajinkigan may be beneficial for diabetic neuropathy and glycemic control.
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188
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Petropoulos IN, Alam U, Fadavi H, Marshall A, Asghar O, Dabbah MA, Chen X, Graham J, Ponirakis G, Boulton AJM, Tavakoli M, Malik RA. Rapid automated diagnosis of diabetic peripheral neuropathy with in vivo corneal confocal microscopy. Invest Ophthalmol Vis Sci 2014; 55:2071-8. [PMID: 24569580 DOI: 10.1167/iovs.13-13787] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To assess the diagnostic validity of a fully automated image analysis algorithm of in vivo confocal microscopy images in quantifying corneal subbasal nerves to diagnose diabetic neuropathy. METHODS One hundred eighty-six patients with type 1 and type 2 diabetes mellitus (T1/T2DM) and 55 age-matched controls underwent assessment of neuropathy and bilateral in vivo corneal confocal microscopy (IVCCM). Corneal nerve fiber density (CNFD), branch density (CNBD), and length (CNFL) were quantified with expert, manual, and fully-automated analysis. The areas under the curve (AUC), odds ratios (OR), and optimal thresholds to rule out neuropathy were estimated for both analysis methods. RESULTS Neuropathy was detected in 53% of patients with diabetes. A significant reduction in manual and automated CNBD (P < 0.001) and CNFD (P < 0.0001), and CNFL (P < 0.0001) occurred with increasing neuropathic severity. Manual and automated analysis methods were highly correlated for CNFD (r = 0.9, P < 0.0001), CNFL (r = 0.89, P < 0.0001), and CNBD (r = 0.75, P < 0.0001). Manual CNFD and automated CNFL were associated with the highest AUC, sensitivity/specificity and OR to rule out neuropathy. CONCLUSIONS Diabetic peripheral neuropathy is associated with significant corneal nerve loss detected with IVCCM. Fully automated corneal nerve quantification provides an objective and reproducible means to detect human diabetic neuropathy.
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Affiliation(s)
- Ioannis N Petropoulos
- School of Medicine, Institute of Human Development, Centre for Endocrinology and Diabetes, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Jin HY, Piao MH, Park JH, Baek HS, Lee S, Kim W, Park SK, Kim CH, Koh GY, Park TS. Effect of cartilage oligomeric matrix protein angiopoietin-1 on peripheral nerves in db/db diabetic mice. CURRENT THERAPEUTIC RESEARCH 2014; 69:343-55. [PMID: 24692811 DOI: 10.1016/j.curtheres.2008.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Vascular and inflammatory processes have been reported to be factors in the pathogenesis of diabetic neuropathy. Angiopoietin-1 (Ang1) plays essential roles in regulating vascular growth, development, maturation, permeability, and inflammation. OBJECTIVE The aim of this study was to investigate the effect of cartilage oligomeric matrix protein (COMP)-Ang1, which is a soluble, stable, potent Ang1 variant, on peripheral nerves in db/db diabetic mice. METHODS The db/db diabetic mice were randomized into 2 groups based on their weight and glucose level and treated with recombinant adenovirus (Ade), expressing either COMP-Ang1 or the β-galactosidase gene (LacZ) (control), for 8 weeks. Immunohistochemistry was performed using a polyclonal antibody of antiprotein gene product and a secondary antibody. Intraepidermal nerve fiber density (IENFD) was quantified as nerve fiber abundance per unit length of epidermis (IENF/mm). In addition, the total capillary length (TCL) per unit length of epidermis was summed (mm/mm(2)). All slides were coded and the capillary length and the number of nerve fibers were calculated by a blinded observer. RESULTS Ten diabetic db/db mice (mean [SD] weight, 38.7 [1.95] g) were randomized to receive Ade-COMP-Ang1 or Ade-LacZ. IENFD was significantly greater in the Ade-COMP-Ang1 group compared with the Ade-LacZ group (mean [SD] 8.95 [3.30] vs 3.57 [0.73]/mm; P < 0.05). TCL was also significantly greater in the Ade-COMP-Ang1 group (2.79 [0.99] vs 2.04 [0.58] mm/mm(2); P < 0.05). Compared with baseline, fasting blood glucose concentration after 8 weeks of treatment decreased significantly more in the Ade-COMP-Ang1 group than in the Ade-LacZ group (489 [45] to 361 [81] vs 495 [48] to 521 [70] mg/dL; P < 0.05). CONCLUSIONS These results suggest that Ade-COMP-Ang1 might have had proliferative effects on peripheral nerve and cutaneous capillaries in this small animal study. Further investigation of the metabolic effect, target site, and related mediator of COMP-Ang1 is needed.
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Affiliation(s)
- Heung Yong Jin
- Endocrinology and Metabolism and Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, South Korea
| | - Ming Han Piao
- Endocrinology and Metabolism and Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, South Korea
| | - Ji Hyun Park
- Endocrinology and Metabolism and Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, South Korea
| | - Hong Sun Baek
- Endocrinology and Metabolism and Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, South Korea
| | - Sik Lee
- Renal Regeneration Laboratory and Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, South Korea
| | - Won Kim
- Renal Regeneration Laboratory and Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, South Korea
| | - Sung Kwang Park
- Renal Regeneration Laboratory and Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, South Korea
| | | | - Gou Young Koh
- Biomedical Research Center and Department of Biological Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Tae Sun Park
- Endocrinology and Metabolism and Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, South Korea
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190
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Length dependent loss of motor axons and altered motor unit properties in human diabetic polyneuropathy. Clin Neurophysiol 2014; 125:836-843. [DOI: 10.1016/j.clinph.2013.09.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/26/2013] [Accepted: 09/30/2013] [Indexed: 12/14/2022]
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191
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Anderson SG, Malipatil NS, Roberts H, Dunn G, Heald AH. Socioeconomic deprivation independently predicts symptomatic painful diabetic neuropathy in type 1 diabetes. Prim Care Diabetes 2014; 8:65-69. [PMID: 24211151 DOI: 10.1016/j.pcd.2013.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 07/30/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Painful peripheral neuropathy in people with type 1 diabetes is a disabling and costly complication. A greater understanding of predisposing factors and prescribing may facilitate more effective resource allocation. METHODS The Townsend index of deprivation (numerically higher for greater disadvantage) was examined in the pseudonymised records of 1621 (684 females) individuals with type 1 diabetes and related to prevalence of drug treated severe diabetes related neuropathic pain. RESULTS Treatment for neuropathic pain was initiated in 280 patients, who were older at 57.1 vs 45.6 years and had greater BMI (29.8 vs 27.8kg/m(2); p<0.0001). HbA1C was similar between groups, whilst eGFR was lower in the neuropathic pain group. Amitriptyline was the most commonly prescribed agent (46.8% of total prescriptions). Duloxetine (60mg daily) was prescribed in 9.3% of cases. There were significant differences between the groups for the Townsend index, with a greater proportion (34.3% vs 21.7%) of patients with treated neuropathic pain having a score of ≥1 (X(2)=19.9, p<0.001). Multivariate logistic regression analyses indicated that each unit increment in Townsend index was associated with a 11% increased odds of requiring neuropathic pain treatment [odds ratio (95% CI) 1.11 (1.05-1.17), p<0.001]. This was independent of age: 1.04 (1.02-1.05), BMI: 1.03 (1.01-1.05), HbA1C: 1.15 (1.05-1.24), male gender: 0.74 (0.55-0.98), systolic BP and eGFR. Inclusion of depression and mixed anxiety/depressive disorder did not change the risk estimates. CONCLUSION Amitriptyline was the most commonly used agent for treatment of diabetes related neuropathic pain with Duloxetine much less used. A higher level of socioeconomic deprivation may predispose to severe neuropathic pain in diabetes. Differential allocation of resources may benefit this group.
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Affiliation(s)
- Simon G Anderson
- Cardiovascular Sciences Research Group, Core Technology Facility (3rd Floor), University of Manchester, 46 Grafton Street, Manchester, United Kingdom
| | | | - Hugh Roberts
- Department of Medicine, Leighton Hospital, Crewe, United Kingdom
| | - George Dunn
- Podiatry, East Cheshire NHS Trust, Macclesfield, United Kingdom
| | - Adrian H Heald
- Department of Medicine, Leighton Hospital, Crewe, United Kingdom; School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom.
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Yang Z, Chen R, Zhang Y, Huang Y, Hong T, Sun F, Ji L, Zhan S. Scoring systems to screen for diabetic peripheral neuropathy. Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd010974] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Zhirong Yang
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
- Shantou University Medical College; Shantou-Oxford Clinical Research Unit; Shantou, Guangdong China 515041
| | - Ru Chen
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
| | - Yuan Zhang
- McMaster University; Department of Clinical Epidemiology and Biostatistics; 1280 Main Street West Hamilton Ontario Canada L8S4K1
| | - Yuansheng Huang
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
| | - Tianpei Hong
- Peking University Third Hospital; Department of Endocrinology; 49 North Huayuan Road Haidian District Beijing China 100191
| | - Feng Sun
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
| | - Linong Ji
- Peking University People's Hospital; Department of Endocrinology; 11 Xizhimen South Street Xicheng District Beijing China 100044
| | - Siyan Zhan
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
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Kaplan Y, Kurt S, Karaer Ünaldi H, Erkorkmaz Ü. Risk Factors For Diabetic Polyneuropathy. Noro Psikiyatr Ars 2014; 51:11-14. [PMID: 28360589 DOI: 10.4274/npa.y6303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 12/04/2012] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the risk factors for distal symmetric sensory-motor polyneuropathy (DSP) in patients with type 2 diabetes mellitus (DM). METHOD Sixty seven patients with type 2 DM (33 males and 34 females) were included in the study. In addition to a detailed neurological examination, the Michigan Neuropathy Screening Instrument was administered to all patients and their total neuropathy scores were calculated. Nerve conduction examinations were performed for all patients. RESULTS The mean age of the patients was 52.83±.87 years. The mean glycosylated hemoglobin (HbA1C) value was 8.56±2.07% (normal: 3-6.5%). The total neuropathy score significantly correlated with diabetes duration, hypertension, retinopathy, and HbA1C. CONCLUSION This study confirms the previous reports regarding the association of neuropathy with poor glycaemic control and duration of the disease. The association of neuropathy with retinopathy and hypertension is important.
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Affiliation(s)
- Yüksel Kaplan
- Department of Neurology, İnönü University Faculty of Medicine, Turgut Özal Medical Center, Malatya, Turkey
| | - Semiha Kurt
- Department of Neurology, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey
| | - Hatice Karaer Ünaldi
- Department of Neurology, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey
| | - Ünal Erkorkmaz
- Department of Biostatistics, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey
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194
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Yang Z, Zhang Y, Chen R, Huang Y, Ji L, Sun F, Hong T, Zhan S. Simple tests to screen for diabetic peripheral neuropathy. Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd010975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Zhirong Yang
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
- Shantou University Medical College; Shantou-Oxford Clinical Research Unit; Shantou, Guangdong China 515041
| | - Yuan Zhang
- McMaster University; Department of Clinical Epidemiology and Biostatistics; 1280 Main Street West Hamilton Ontario Canada L8S4K1
| | - Ru Chen
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
| | - Yuansheng Huang
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
| | - Linong Ji
- Peking University People's Hospital; Department of Endocrinology; 11 Xizhimen South Street Xicheng District Beijing China 100044
| | - Feng Sun
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
| | - Tianpei Hong
- Peking University Third Hospital; Department of Endocrinology; 49 North Huayuan Road Haidian District Beijing China 100191
| | - Siyan Zhan
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
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195
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Rajguru P, Kolber MJ, Garcia AN, Smith MT, Patel CK, Hanney WJ. Use of Mindfulness Meditation in the Management of Chronic Pain. Am J Lifestyle Med 2014. [DOI: 10.1177/1559827614522580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Chronic pain is a major health condition that has significant financial and lifestyle implications. Due to the complex etiologies of pain, it is difficult to find treatment modalities that would be universally applicable to the general population presenting for care. Mindfulness meditation is a complimentary treatment modality that has some preliminary, inconclusive evidence in support of its benefit on patients with chronic pain. Objectives. The purpose of this article is to systematically review the current literature for randomized controlled trials that assess the outcomes of mindfulness as an intervention for individuals with chronic pain. Methods. An electronic database search was performed for studies investigating the efficacy of mindfulness in treatment for chronic pain. The studies included were randomized controlled trials, published in English, from a peer-reviewed journal that identified mindfulness as the primary treatment focus for chronic pain in at least one group, and included participants with at least a 12-week history of symptoms. Results. The database search revealed 283 articles, of which 6 met the inclusion criteria. Conclusion. Mindfulness meditation appears to have minimal or statistically insignificant effects on chronic pain according to the current data. However, the effects of mindfulness on mental health scores are significant and may be an area for future trials to target. Well-conducted research is necessary before the effects of mindfulness on chronic pain can be definitively determined.
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Affiliation(s)
- Parth Rajguru
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - Morey J. Kolber
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - Ashley N. Garcia
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - Matthew T. Smith
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - Chetan K. Patel
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - William J. Hanney
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
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196
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Tamayo T, Rosenbauer J, Wild SH, Spijkerman AMW, Baan C, Forouhi NG, Herder C, Rathmann W. Diabetes in Europe: an update. Diabetes Res Clin Pract 2014; 103:206-17. [PMID: 24300019 DOI: 10.1016/j.diabres.2013.11.007] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes is among the leading causes of death in the IDF Europe Region (EUR), continues to increase in prevalence with diabetic macro- and microvascular complications resulting in increased disability and enormous healthcare costs. In 2013, the number of people with diabetes is estimated to be 56 million in EUR with an overall estimated prevalence of 8.5%. However, estimates of diabetes prevalence in 2013 vary widely in the 56 diverse countries in EUR from 2.4% in Moldova to 14.9% in Turkey. Trends in diabetes prevalence also vary between countries with stable prevalence since 2002 for many countries but a doubling of diabetes prevalence in Turkey. For 2035, a further increase of nearly 10 million people with diabetes is projected for the EUR. Prevalence of type 1 has also increased over the past 20 years in EUR and there was estimated to be 129,350 cases in children aged 0-14 years in 2013. Registries provide valid information on incidence of type 1 diabetes with more complete data available for children than for adults. There are large differences in distribution of risk factors for diabetes at the population level in EUR. Modifiable risk factors such as obesity, physical inactivity, smoking behaviour (including secondhand smoking), environmental pollutants, psychosocial factors and socioeconomic deprivation could be tackled to reduce the incidence of type 2 diabetes in Europe. In addition, diabetes management is a major challenge to health services in the European countries. Improved networking practices of health professionals and other stakeholders in combination with empowerment of people with diabetes and continuous quality monitoring need to be further developed in Europe.
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Affiliation(s)
- T Tamayo
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - J Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - S H Wild
- Centre for Population Health Sciences, University of Edinburgh, UK
| | - A M W Spijkerman
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - C Baan
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - N G Forouhi
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - C Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - W Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
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198
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Abstract
We aimed to summarize the etiology, clinical characteristics, diagnosis, and possible treatment options of sexual dysfunction in diabetic patients of both sexes. Details of dysfunction in diabetic women are less conclusive than in men due to the lack of standardized evaluation of sexual function in women. Male sexual dysfunction is a common complication of diabetes, including abnormalities of orgasmic/ejaculatory function and desire/libido in addition to penile erection. The prevalence of erectile dysfunction (ED) among diabetic men varies from 35% to 75%. Diabetes-induced ED has a multifactorial etiology including metabolic, neurologic, vascular, hormonal, and psychological components. ED should be regarded as the first sign of cardiovascular disease because it can be present before development of symptomatic coronary artery disease, as larger coronary vessels better tolerate the same amount of plaque compared to smaller penile arteries. The diagnosis of ED is based on validated questionnaires and determination of functional and organic abnormalities. First-, second- and third-line therapy may be applied. Phosphodiesterase-5 (PDE-5) inhibitor treatment from the first-line options leads to smooth muscle relaxation in the corpus cavernosum and enhancement in blood flow, resulting in erection during sexual stimulus. The use of PDE-5 inhibitors in the presence of oral nitrates is strictly contraindicated in diabetic men, as in nondiabetic subjects. All PDE-5 inhibitors have been evaluated for ED in diabetic patients with convincing efficacy data. Second-line therapy includes intracavernosal, trans- or intraurethral administration of vasoactive drugs or application of a vacuum device. Third-line therapies are the implantation of penile prosthesis and penile revascularization.
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Affiliation(s)
- Várkonyi Tamás
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary.
| | - Peter Kempler
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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199
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Ziegler D, Papanas N, Vinik AI, Shaw JE. Epidemiology of polyneuropathy in diabetes and prediabetes. ACTA ACUST UNITED AC 2014; 126:3-22. [DOI: 10.1016/b978-0-444-53480-4.00001-1] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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200
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Lee-Kubli CA, Mixcoatl-Zecuatl T, Jolivalt CG, Calcutt NA. Animal models of diabetes-induced neuropathic pain. Curr Top Behav Neurosci 2014; 20:147-70. [PMID: 24510303 DOI: 10.1007/7854_2014_280] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Neuropathy will afflict over half of the approximately 350 million people worldwide who currently suffer from diabetes and around one-third of diabetic patients with neuropathy will suffer from painful symptoms that may be spontaneous or stimulus evoked. Diabetes can be induced in rats or mice by genetic, dietary, or chemical means, and there are a variety of well-characterized models of diabetic neuropathy that replicate either type 1 or type 2 diabetes. Diabetic rodents display aspects of sensorimotor dysfunction such as stimulus-evoked allodynia and hyperalgesia that are widely used to model painful neuropathy. This allows investigation of pathogenic mechanisms and development of potential therapeutic interventions that may alleviate established pain or prevent onset of pain.
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