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Tu Z, Du J, Ge X, Peng W, Shen L, Xia L, Jiang X, Hu F, Huang S. Triglyceride Glucose Index for the Detection of Diabetic Kidney Disease and Diabetic Peripheral Neuropathy in Hospitalized Patients with Type 2 Diabetes. Diabetes Ther 2024:10.1007/s13300-024-01609-3. [PMID: 38907937 DOI: 10.1007/s13300-024-01609-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 06/05/2024] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION The triglyceride-glucose index (TyG) has been identified as a dependable and simple indicator marker of insulin resistance (IR). Research has demonstrated a correlation between macrovascular complications and TyG. However, limited research exists regarding the relationship between TyG and diabetic microvascular complications. Consequently, the objective of this study is to investigate the association between TyG and diabetic kidney disease (DKD) and diabetic peripheral neuropathy (DPN). METHODS This is a cross-sectional, observational study. A total of 2048 patients from Tongren Hospital, Shanghai Jiao Tong University School of Medicine were enrolled. The primary outcomes are DKD and DPN. Quantile regression analysis was employed to investigate the implicit factors of TyG quartiles. Subsequently, based on implicit factors, logistic regression models were constructed to further examine the relationship between TyG and DKD and DPN. RESULTS In the baseline, TyG exhibited higher values across patients with DKD, DPN, and co-existence of DKD and DPN (DKD + DPN) in type 2 diabetes (T2D). Univariate logistic regressions demonstrated a significant association between an elevated TyG and an increased risk of DKD (OR = 1.842, [95% CI] 1.317-2.578, P for trend < 0.01), DPN (OR = 1.516, [95% CI] 1.114-2.288, P for trend < 0.05), DKD + DPN (OR = 2.088, [95% CI] 1.429-3.052, P for trend < 0.05). Multivariable logistic regression models suggested a statistically significant increase in the risk of DKD (OR = 1.581, [95% CI] 1.031-2.424, p < 0.05), DKD + DPN (OR = 1.779, [95% CI] 1.091-2.903, p < 0.05) after adjusting the implicit factors of TyG quartiles. However, no significant relationship was observed between TyG and DPN in the multivariable regression analysis. CONCLUSIONS Elevated TyG was significantly associated with an increased risk of DKD in T2D, but no significant relationship was shown with DPN. This finding provided further evidence for the clinical significance of integrating TyG into the initial assessment of diabetic microvascular complications.
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Affiliation(s)
- Zhihui Tu
- Department of Endocrinology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, Changning District, Shanghai, China
| | - Juan Du
- Department of Endocrinology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, Changning District, Shanghai, China
| | - Xiaoxu Ge
- Department of Endocrinology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, Changning District, Shanghai, China
| | - Wenfang Peng
- Department of Endocrinology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, Changning District, Shanghai, China
| | - Lisha Shen
- Department of Endocrinology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, Changning District, Shanghai, China
| | - Lili Xia
- Department of Endocrinology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, Changning District, Shanghai, China
| | - Xiaohong Jiang
- Department of Endocrinology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, Changning District, Shanghai, China.
| | - Fan Hu
- Shanghai Jiao Tong University School of Medicine, No. 227, Chongqing South Road, Huangpu District, Shanghai, China.
| | - Shan Huang
- Department of Endocrinology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, Changning District, Shanghai, China.
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Assaad-Khalil SH, Abdel Aaty T, El Feky M, Mohamed Abdel Naby H, Ramadan El Essawy N, Gaber Amin N. Neutrophil-to-Lymphocyte Ratio as a Marker for Cardiac Autonomic Neuropathy in Egyptian Patients With Type 2 Diabetes: A Cross-Sectional Study. Cureus 2024; 16:e61634. [PMID: 38966470 PMCID: PMC11222997 DOI: 10.7759/cureus.61634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVE Cardiac autonomic neuropathy (CAN) is one of the most serious complications of diabetes. This study aimed to analyze the correlation between neutrophil-to-lymphocyte ratio (NLR) and CAN in patients with type 2 diabetes (T2D) using 24-hour Holter ECG and to assess the relationship between NLR and severity of diabetic peripheral neuropathy (DPN). SUBJECTS & METHODS This cross-sectional study included 90 T2D patients with DPN confirmed by nerve conduction study (NCS). A 24-hour Holter ECG was done to detect the decrease in heart rate variability (HRV). Laboratory parameters, including fasting blood glucose, creatinine, cholesterol, triglyceride, and glycosylated hemoglobin (HbA1c) levels, as well as CBC, neutrophils, lymphocytes, NLR, and platelet-to-lymphocyte ratio (PLR), were calculated accordingly. An albumin-to-creatinine ratio (ACR) test was done and the estimated glomerular filtration rate (eGFR) was calculated. Chronic kidney disease was diagnosed by the presence of albuminuria (≥30 mg/g creatinine) and/or eGFR less than 60. RESULTS Based on the 24-hour Holter ECG, 25 patients out of 90 (27.7%) had CAN. On comparing both the CAN and non-CAN groups, the CAN group had higher HbA1C (p = 0.005), higher NLR (p = 0.014), and higher neutrophils (p = 0.10). Also, PLR was higher in the CAN group than in the non-CAN group, but this was not statistically significant (p = 0.180). Receiver operator characteristic curve analysis revealed that NLR with a cutoff of 1.7 succeeded in detecting patients with CAN. CONCLUSION NLR can be used as an inexpensive and accessible marker to detect patients with diabetes at risk for developing CAN.
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Affiliation(s)
- Samir H Assaad-Khalil
- Internal Medicine, Unit of Diabetes, Lipidology & Metabolism, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Talaat Abdel Aaty
- Internal Medicine, Unit of Diabetes, Lipidology & Metabolism, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Mohamed El Feky
- Cardiology, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Hoda Mohamed Abdel Naby
- Rehabilitation & Physical Medicine, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Nada Ramadan El Essawy
- Internal Medicine, Unit of Diabetes, Lipidology & Metabolism, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Noha Gaber Amin
- Internal Medicine, Unit of Diabetes, Lipidology & Metabolism, Faculty of Medicine, Alexandria University, Alexandria, EGY
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Khalil SHA, Deeb HMAE, Ajang MOD, Osman NA, Amin NG. Impact of diabetic peripheral neuropathy on gait abnormalities in patients with type 2 diabetes mellitus. Diabetol Int 2024; 15:58-66. [PMID: 38264222 PMCID: PMC10800313 DOI: 10.1007/s13340-023-00652-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/25/2023] [Indexed: 01/25/2024]
Abstract
Background Many patients with type 2 diabetes (T2DM) suffer from diabetic peripheral neuropathy (DPN) and impaired muscle coordination. These changes may lead to walking instability, and gait abnormalities resulting in increased fall risk and lower limb amputations. The aim of this study was to assess the impact of DPN and patient footwear on the gait in patients with diabetes, in addition to Comparing the peak plantar pressure (PPP) in patients with and without DPN and assessing its association with gait abnormalities. Methodology This is an observational case-control study. Forty Subjects with T2DM were divided into two age and sex-matched groups, 20 subjects each. Group A: subjects with DPN. Group B: subjects without DPN. All study participants were subjected to a thorough history taking, clinical examinations focusing on detailed foot examination, PPP assessment, and functional gait evaluation. Results The results obtained in this study showed a median gait assessment score of 21 (17.0-22.5) for group A and 26 (23.5-26.0) for group B which was statistically significant (p < 0.001). There was no statistically significant difference between both groups (p > 0.05) regarding the assessment of footwear appropriateness. Comparing the PPP measurement among both studied groups, the prevalence of an elevated PPP was 80% in group A compared to 65% in group B, which was statistically non-significant, p = 0.288. Conclusions Gait abnormalities are common among patients with T2DM even in the absence of DPN. However, the presence of DPN was the strongest independent risk factor for gait abnormalities among the studied factors.
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Affiliation(s)
- Samir H. Assaad Khalil
- Department of Internal Medicine, Unit of Diabetes, Lipidology and Metabolism, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Martin Otwang Dak Ajang
- Department of Internal Medicine, Unit of Diabetes, Lipidology and Metabolism, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Department of Internal Medicine, Faculty of Medicine, Upper-Nile University, Juba, South Sudan
| | - Nermin A. Osman
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Noha Gaber Amin
- Department of Internal Medicine, Unit of Diabetes, Lipidology and Metabolism, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Abstract
The term 'diabetic foot disease' (DFD) often signifies the presence of foot ulceration and infection, but one must also be wary of the rarer occurrence of Charcot foot disease. The worldwide prevalence of DFD is 6.3% (95%CI: 5.4-7.3%). Foot complications present a major challenge to both patients and healthcare systems, with increased rates of hospitalisation and an almost trebled 5-year mortality. The Charcot foot often occurs in patients with long-standing diabetes, presenting as an inflamed or swollen foot or ankle, following unrecognised minor trauma. This review focuses on the prevention and early identification of the 'at-risk' foot. DFD is best managed by a multi-disciplinary foot clinic team consisting of podiatrists and healthcare professionals. This ensures a combination of expertise and provision of a multi-faceted evidence-based treatment plan. Current research using endothelial progenitor cells (EPC) and mesenchymal stem cells (MSC) offers a new dimension in wound management.
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Affiliation(s)
| | | | - David V Coppini
- University Hospitals Dorset NHS Trust, Dorset, UK, and visiting fellow, Bournemouth University, Bournemouth, UK
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Jiang J, Zhang P, Zhou Z, Xu Z, Hu X, Yu W, Jiang F, Pan Y, Wang F, Hong J, Ye T, Xu K, Zhu H. Brachial-Ankle Pulse Wave Velocity Mediates the Association between Increased Age and Risk of Sarcopenia among Chinese Patients with Type 2 Diabetes Mellitus. J Diabetes Res 2023; 2023:3786342. [PMID: 36643790 PMCID: PMC9839409 DOI: 10.1155/2023/3786342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND AIMS Arterial stiffness and sarcopenia are commonly seen in patients with type 2 diabetes mellitus (T2DM), and both are age-related diseases. However, few studies have addressed the causal relationship between age, arterial stiffness, and sarcopenia, especially in patients with T2DM. This study is aimed at investigating the relationship among age, arterial stiffness, and sarcopenia in patients with T2DM. METHODS AND RESULTS This cross-sectional study enrolled 557 inpatients with diabetes at the First Affiliated Hospital of Wenzhou Medical University, China, between June 2020 and July 2021. Patients who were diagnosed with T2DM and underwent examination of dual-energy X-ray absorptiometry, handgrip strength, 6-meter walk speed, and brachial-ankle pulse wave velocity (baPWV, a recognized indicator of arterial stiffness) were enrolled. A total of 447 patients were included. A dose-dependent relationship was found between age and sarcopenia. We also found a dose-dependent relationship between age and baPWV. Similarly, significant dose-dependent relationships were found across baPWV tertiles with higher prevalence of sarcopenia. Then, a mediation analysis was performed to explore the mediation effect of arterial stiffness on age-associated sarcopenia. We found that the prevalence of sarcopenia increased by 0.0115 (95% CI, 0.0028-0.0239) per 1 year increase in age by the mediation effect of baPWV and that the direct effect of aging on sarcopenia was 0.0441 (95% CI, 0.0101-0.0909) per 1 year older. baPWV mediated 20.5% of the positive relationship between increased age and the prevalence of sarcopenia. CONCLUSIONS Elevated baPWV partially mediates the association of age and sarcopenia among patients with T2DM.
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Affiliation(s)
- Jiahong Jiang
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Ping Zhang
- The Second People's Hospital of Xining, Xining, Qinghai 816000, China
| | - Zijun Zhou
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Zeru Xu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Xiang Hu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Weihui Yu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Feifei Jiang
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Yang Pan
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Fei Wang
- Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Jing Hong
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Tingting Ye
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Ke Xu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Hong Zhu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
- Wenzhou Key Laboratory of Diabetes Research, Wenzhou, Zhejiang 325000, China
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Akkus G, Sert M. Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities. World J Diabetes 2022; 13:1106-1121. [PMID: 36578865 PMCID: PMC9791571 DOI: 10.4239/wjd.v13.i12.1106] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/21/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic foot ulcer is a devastating complication of diabetes mellitus and significant cause of mortality and morbidity all over the world and can be complex and costly. The development of foot ulcer in a diabetic patient has been estimated to be 19%-34% through their lifetime. The pathophysiology of diabetic foot ulcer consist of neuropathy, trauma and, in many patients, additional peripheral arterial disease. In particular, diabetic neuropathy leads to foot deformity, callus formation, and insensitivity to trauma or pressure. The standard algorithms in diabetic foot ulcer management include assessing the ulcer grade classification, surgical debridement, dressing to facilitate wound healing, off-loading, vascular assessment (status and presence of a chance for interventional vascular correction), and infection and glycemic control. Although especially surgical procedures are sometimes inevitable, they are poor predictive factors for the prognosis of diabetic foot ulcer. Different novel treatment modalities such as nonsurgical debridement agents, oxygen therapies, and negative pressure wound therapy, topical drugs, cellular bioproducts, human growth factors, energy-based therapies, and systematic therapies have been available for patients with diabetic foot ulcer. However, it is uncertain whether they are effective in terms of promoting wound healing related with a limited number of randomized controlled trials. This review aims at evaluating diabetic foot ulcer with regard to all aspects. We will also focus on conventional and novel adjunctive therapy in diabetic foot management.
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Affiliation(s)
- Gamze Akkus
- Department of Endocrinology, Cukurova University, Adana 33170, Turkey
| | - Murat Sert
- Department of Internal Medicine, Cukurova University Medical Faculty, Adana 33170, Turkey
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Badrah MH, Abdelaaty TA, Imbaby SAE, Abdel-Fattah YH, Silim WM, El Feky AY. The relationship between vascular endothelial growth factor-A serum level and the severity of diabetic peripheral neuropathy. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00164-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background and aims
Diabetic peripheral neuropathy (DPN) is a common microvascular complication in type 2 diabetes mellitus (T2DM). The nerve fibers injury is caused by the interaction between metabolic and vascular factors. Vascular endothelial growth factor (VEGF) is an essential growth factor for vascular endothelial cells. We aimed to investigate the relation between VEGF-A serum level and the degree of DPN.
Results
This cross-sectional study was conducted on 81 patients with T2DM. Based on the combined clinical and electrophysiological assessment, 67 patients (82.7%) were diagnosed with peripheral neuropathy of which 32 patients (39.5%) had subclinical neuropathy, whereas 35 patients (43.2%) were confirmed cases of DPN. Patients with DPN had longer duration of DM and higher values of glycosylated hemoglobin (HbA1c). Although the mean serum VEGF-A level in diabetic patients without neuropathy was higher than that in diabetic patients with DPN, this difference did not reach statistical significance (P = 0.07). However, patients with subclinical DPN had significantly higher serum VEGF-A level compared to patients with confirmed DPN (P < 0.001).
Conclusion
DPN was found to be a common finding in the studied sample of T2DM patients. Longer duration of DM and poor glycemic control may be risk factors for development of severe DPN. Low VEGF-A serum levels may lead to more severe DPN in patients with T2DM.
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Qiu L, Li Y, Yang C, Mao X, Mai L, Zhu L, Xie W. Influence of Foot Ulceration on All-Cause and Cardiovascular Mortality in Diabetic Patients: A Case-Control Study. J Wound Ostomy Continence Nurs 2022; 49:175-179. [PMID: 35255070 DOI: 10.1097/won.0000000000000856] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to analyze the influence of a diabetic foot ulcer on all-cause and cardiovascular disease (CVD) mortality. DESIGN Retrospective case-control study. SUBJECTS AND SETTING OUTPATIENTS Eighty-eight patients with new-onset diabetic foot ulceration (DFU) were paired with 176 patients without DFU (controls). The study setting was the Department of Endocrinology, Sun Yat-sen Memorial Hospital, located in Guangzhou, China. METHODS Cause-specific mortality was recorded during a median follow-up duration of 6.20 years up to 1 March 2016. Records review dates were from January 1, 2004, to December 31, 2010. RESULTS The all-cause mortality rate for the DFU group and the control group was 48.9% and 22.7%, respectively. The risk of all-cause death in the DFU group was 3.126 times higher than that in the control group (risk ratio [RR]= 3.126; 95% CI, 1.998-4.891; P = .000). The CVD mortality rate of the DFU group and the control group was 12.5% and 6.8%, respectively. The risk of CVD death in the DFU group was 3.277 times higher than that in the control group (RR = 3.277; 95% CI, 1.392-7.715; P = .007). CONCLUSIONS Development of a diabetic foot ulcer was associated with a significantly higher all-cause and CVD-related death risk than that in a control group of persons with diabetes mellitus without DFU.
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Affiliation(s)
- Liangzhi Qiu
- Liangzhi Qiu, MSN, Chronic Wound and Ostomy Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Yongjie Li, MSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Chuan Yang, MD, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Xiaoqun Mao, MSN, Nursing Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lifang Mai, BSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lisi Zhu, MSN, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Wen Xie, MSN, Nursing Department, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yongjie Li
- Liangzhi Qiu, MSN, Chronic Wound and Ostomy Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Yongjie Li, MSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Chuan Yang, MD, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Xiaoqun Mao, MSN, Nursing Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lifang Mai, BSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lisi Zhu, MSN, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Wen Xie, MSN, Nursing Department, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuan Yang
- Liangzhi Qiu, MSN, Chronic Wound and Ostomy Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Yongjie Li, MSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Chuan Yang, MD, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Xiaoqun Mao, MSN, Nursing Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lifang Mai, BSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lisi Zhu, MSN, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Wen Xie, MSN, Nursing Department, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoqun Mao
- Liangzhi Qiu, MSN, Chronic Wound and Ostomy Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Yongjie Li, MSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Chuan Yang, MD, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Xiaoqun Mao, MSN, Nursing Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lifang Mai, BSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lisi Zhu, MSN, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Wen Xie, MSN, Nursing Department, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lifang Mai
- Liangzhi Qiu, MSN, Chronic Wound and Ostomy Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Yongjie Li, MSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Chuan Yang, MD, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Xiaoqun Mao, MSN, Nursing Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lifang Mai, BSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lisi Zhu, MSN, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Wen Xie, MSN, Nursing Department, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lisi Zhu
- Liangzhi Qiu, MSN, Chronic Wound and Ostomy Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Yongjie Li, MSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Chuan Yang, MD, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Xiaoqun Mao, MSN, Nursing Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lifang Mai, BSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lisi Zhu, MSN, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Wen Xie, MSN, Nursing Department, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wen Xie
- Liangzhi Qiu, MSN, Chronic Wound and Ostomy Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Yongjie Li, MSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Chuan Yang, MD, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Xiaoqun Mao, MSN, Nursing Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lifang Mai, BSN, Endocrinology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Lisi Zhu, MSN, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Wen Xie, MSN, Nursing Department, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Lasschuit JWJ, Greenfield JR, Tonks KTT. Contribution of peripheral neuropathy to poor bone health in the feet of people with type 2 diabetes mellitus. Acta Diabetol 2022; 59:217-224. [PMID: 34568958 PMCID: PMC8475816 DOI: 10.1007/s00592-021-01803-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023]
Abstract
AIMS To evaluate the impact of peripheral neuropathy on bone health in people with type 2 diabetes mellitus (T2DM). METHODS Participants with T2DM were grouped according to the presence of peripheral neuropathy as assessed by vibration perception threshold (VPT). Recruitment ensured groups were balanced for age, sex and body mass index (BMI). Bone health was measured by calcaneal quantitative ultrasound (QUS) and compared between groups. Calcaneal QUS parameters were correlated across the cohort with VPT and other prespecified variables. RESULTS Thirty-four participants (17 per group) were included with mean age 68 ± 12 years, 47% male, with median BMI 29.9 (IQR 26.9-32.7) kg/m2. The peripheral neuropathy group had significantly lower mean Stiffness Index (87 ± 12 versus 101 ± 16, p = 0.01), Speed of Sound (1542 ± 28 versus 1574 ± 34 m/s, p < 0.01), and a trend towards lower Broadband Ultrasound Attenuation (113 ± 10 versus 120 ± 12 dB/MHz, p = 0.07). Pedal bone health asymmetry was not a significant feature in those with peripheral neuropathy. All calcaneal QUS parameters correlated negatively with VPT, although significance of the relationship with Broadband Ultrasound Attenuation was nullified if controlled for diabetes duration or time on insulin. Broadband Ultrasound Attenuation showed independent negative correlation with diabetes duration. CONCLUSIONS People with T2DM and peripheral neuropathy have poorer bone health as measured by calcaneal QUS than those without peripheral neuropathy, independent of age, sex and BMI.
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Affiliation(s)
- Joel Willem Johan Lasschuit
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, NSW, Australia.
- Healthy Ageing, Garvan Institute of Medical Research, Sydney, NSW, Australia.
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Jerry Richard Greenfield
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, NSW, Australia
- Healthy Ageing, Garvan Institute of Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Katherine Thuy Trang Tonks
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, NSW, Australia
- Healthy Ageing, Garvan Institute of Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
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10
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Liu M, Gao Y, Chen D, Lin S, Wang C, Chen L, Ran X. Quantitative vibration perception threshold in assessing diabetic polyneuropathy: Should the cut-off value be adjusted for Chinese individuals with type 2 diabetes? J Diabetes Investig 2021; 12:1663-1670. [PMID: 33512757 PMCID: PMC8409819 DOI: 10.1111/jdi.13515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/15/2021] [Accepted: 01/25/2021] [Indexed: 02/05/2023] Open
Abstract
AIMS/INTRODUCTION To examine the performance and identify the optimal threshold of vibration perception threshold (VPT) for diagnosing diabetic polyneuropathy (DPN) in a Chinese population according to multiple definitions of DPN as gold standards. MATERIALS AND METHODS VPT was determined in 421 Chinese individuals with type 2 diabetes, who simultaneously completed a questionnaire of neuropathic symptoms, and underwent the assessment of signs of peripheral neuropathy and electromyography tests. Three definitions of DPN (i.e., clinician-diagnosed DPN, abnormal nerve conduction and confirmed DPN) were taken as reference gold standards. RESULTS Vibration perception threshold was a specific measure for all three groups of DPN outcomes, with the highest specificity noted for clinician-diagnosed DPN (85.1%). The specificity for abnormal nerve conduction and confirmed DPN was 77.0 and 76.6%, respectively. The sensitivity of VPT was 67.0% for clinician-diagnosed DPN, 66.5% for abnormal nerve conduction and 67.2% for confirmed DPN. The optimal cut-off threshold for abnormal nerve conduction, as well as confirmed DPN, was VPT >14.9 V. The specificity and sensitivity of VPT >14.9 V as the cut-off value for clinician-diagnosed DPN were 85.6 and 66.2%, respectively. When taking clinician-diagnosed DPN as the gold standard, the performance of VPT for diagnosing DPN was best with an area under the curve value of 0.804. CONCLUSIONS VPT measured using the neurothesiometer had relatively high specificity and best performance for diagnosing DPN when clinician-diagnosed DPN rather than abnormal nerve conduction was taken as the gold standard in a Chinese population. A VPT value of ≥15 V might be equally applicable for diagnosing DPN in a Chinese population.
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Affiliation(s)
- Min Liu
- Department of Endocrinology and MetabolismDiabetic Foot Care CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Yun Gao
- Department of Endocrinology and MetabolismDiabetic Foot Care CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Da‐Wei Chen
- Department of Endocrinology and MetabolismDiabetic Foot Care CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Shuang Lin
- Department of Endocrinology and MetabolismDiabetic Foot Care CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Chun Wang
- Department of Endocrinology and MetabolismDiabetic Foot Care CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Li‐Hong Chen
- Department of Endocrinology and MetabolismDiabetic Foot Care CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Xing‐Wu Ran
- Department of Endocrinology and MetabolismDiabetic Foot Care CenterWest China HospitalSichuan UniversityChengduSichuanChina
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11
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Cho E, Kim W. Effect of Acupuncture on Diabetic Neuropathy: A Narrative Review. Int J Mol Sci 2021; 22:ijms22168575. [PMID: 34445280 PMCID: PMC8395323 DOI: 10.3390/ijms22168575] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 12/17/2022] Open
Abstract
Diabetic neuropathy, a major complication of diabetes mellitus, refers to a collection of clinically diverse disorders affecting the nervous system that may present with pain. Although the number of patients suffering from severe neuropathy is increasing, no optimal treatment method has been developed yet. Acupuncture is well known for its ability to reduce various kinds of pain, and a number of studies have also reported its effect on diabetes mellitus; however, its effect and underlying mechanism against diabetic neuropathy are not yet clearly understood. In this review, ten and five studies performed in humans and animals, respectively, were analyzed. All studies reported that acupuncture significantly relieved diabetic neuropathy. ST36, BL13, BL20, SP6, and SP9 were the most widely used acupoints. Five studies used electro-acupuncture, whereas other studies used manual acupuncture. Furthermore, the effect of acupuncture was shown to be mediated through the various molecules present in the peripheral nerves and spinal cord, such as P65, GPR78, and TRPV1. Five studies reported side effects, such as swelling, numbness, and nausea, but none were reported to be serious. Based on these results, we suggest that acupuncture should be considered as a treatment option for diabetic neuropathy.
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12
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Vibration Perception Thresholds of Skin Mechanoreceptors Are Influenced by Different Contact Forces. J Clin Med 2021; 10:jcm10143083. [PMID: 34300249 PMCID: PMC8307596 DOI: 10.3390/jcm10143083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 12/02/2022] Open
Abstract
Determining vibration perception thresholds (VPT) is a central concern of clinical research and science to assess the somatosensory capacity of humans. The response of different mechanoreceptors to an increasing contact force has rarely been studied. We hypothesize that increasing contact force leads to a decrease in VPTs of fast-adapting mechanoreceptors in the sole of the human foot. VPTs of 10 healthy subjects were measured at 30 Hz and 200 Hz at the heel of the right foot using a vibration exciter. Contact forces were adjusted precisely between 0.3 N–9.6 N through an integrated force sensor. Significant main effects were found for frequency and contact force. Furthermore, there was a significant interaction for frequency and contact force, meaning that the influence of an increasing contact force was more obvious for the 30 Hz condition. We presume that the principles of contrast enhancement and spatial summation are valid in Meissner and Pacinian corpuscles, respectively. In addition to spatial summation, we presume an effect on Pacinian corpuscles due to their presence in the periosteum or interosseous membrane.
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Drechsel TJ, Monteiro RL, Zippenfennig C, Ferreira JSSP, Milani TL, Sacco ICN. Low and High Frequency Vibration Perception Thresholds Can Improve the Diagnosis of Diabetic Neuropathy. J Clin Med 2021; 10:3073. [PMID: 34300239 PMCID: PMC8304943 DOI: 10.3390/jcm10143073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 12/20/2022] Open
Abstract
Recent studies demonstrate neuropathic changes with respect to vibration sensitivity for different measurement frequencies. This study investigates the relationship between vibration perception thresholds (VPTs) at low and high frequencies at two plantar locations and diabetic peripheral neuropathy (DPN) severity in diabetes mellitus (DM) subjects with DPN. We examine differences of VPTs between participants with DM, with DPN, as well as healthy controls. The influence of anthropometric, demographic parameters, and DM duration on VPTs is studied. Thirty-three healthy control group subjects (CG: 56.3 ± 9.9 years) and 33 with DM are studied. DM participants are subdivided into DM group (DM without DPN, n = 20, 53.3 ± 15.1 years), and DPN group (DM with DPN, n = 13, 61.0 ± 14.5 years). VPTs are measured at the first metatarsal head (MTH1) and heel (30 Hz, 200 Hz), using a customized vibration exciter. Spearman and Pearson correlations are used to identify relationships between VPTs and clinical parameters. ANOVAs are calculated to compare VPTs among groups. Significant correlations are observed between DPN severity (by fuzzy scores) and VPTs at both locations and frequencies (MTH1_30 Hz vs. fuzzy: r = 0.68, p = 0.011; Heel_30 Hz vs. fuzzy: r = 0.66, p = 0.014; MTH1_200 Hz vs. fuzzy: r = 0.73, p = 0.005; Heel_200 Hz vs. fuzzy: r = 0.60, p = 0.032). VPTs in CG and DM groups are significantly smaller than the DPN group, showing higher contrasts for the 30 Hz compared to the 200 Hz measurement. The correlations between fuzzy scores and VPTs confirm the relevance of using low and high frequencies to assess a comprehensive foot sensitivity status in people with DM.
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Affiliation(s)
- Tina J. Drechsel
- Department of Human Locomotion, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, 09107 Chemnitz, Germany; (C.Z.); (T.L.M.)
| | - Renan L. Monteiro
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universdade de São Paulo, São Paulo 05360-160, Brazil; (R.L.M.); (J.S.S.P.F.); (I.C.N.S.)
| | - Claudio Zippenfennig
- Department of Human Locomotion, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, 09107 Chemnitz, Germany; (C.Z.); (T.L.M.)
| | - Jane S. S. P. Ferreira
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universdade de São Paulo, São Paulo 05360-160, Brazil; (R.L.M.); (J.S.S.P.F.); (I.C.N.S.)
| | - Thomas L. Milani
- Department of Human Locomotion, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, 09107 Chemnitz, Germany; (C.Z.); (T.L.M.)
| | - Isabel C. N. Sacco
- Department of Physical Therapy, Speech, and Occupational Therapy, Faculdade de Medicina, Universdade de São Paulo, São Paulo 05360-160, Brazil; (R.L.M.); (J.S.S.P.F.); (I.C.N.S.)
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14
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Jung J, Kim MG, Kang YJ, Min K, Han KA, Choi H. Vibration Perception Threshold and Related Factors for Balance Assessment in Patients with Type 2 Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116046. [PMID: 34199765 PMCID: PMC8200021 DOI: 10.3390/ijerph18116046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 12/16/2022]
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (DM). DPN causes a decrease in proprioception, which could reduce balance ability. We investigated the association of impaired vibration sense, based on vibration perception threshold (VPT), with assessments of balance and other factors affecting balance impairment and fear of falling in patients with type 2 DM. Sixty-three patients with DM aged >50 years were categorized as having normal vibration sense (NVS; n = 34) or impaired vibration sense (IVS; n = 29) according to a VPT value of 8.9 μm. The following parameters were evaluated for all patients: postural steadiness through the fall index using posturography, functional balance through the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and fear of falling through the Falls Efficacy Scale-International (FES-I). The IVS group showed a significantly greater balance impairment in fall index, BBS, and TUG, as well as greater fear of falling on the FES-I than the NVS group. The linear regression analysis showed that the fall index was associated only with the VPT, whereas BBS, TUG, and FES-I were associated with the VPT, age, and/or lower extremity muscle strength. VPT, age, and/or muscle strength were identified as predictors of balance and fear of falling in patients with type 2 DM. Therefore, along with age and lower extremity strength, the VPT can be useful for balance assessment in patients with type 2 DM.
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Affiliation(s)
- Jisang Jung
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea; (J.J.); (M.-G.K.); (Y.-J.K.)
| | - Min-Gyu Kim
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea; (J.J.); (M.-G.K.); (Y.-J.K.)
| | - Youn-Joo Kang
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea; (J.J.); (M.-G.K.); (Y.-J.K.)
| | - Kyungwan Min
- Diabetes Center, Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea; (K.M.); (K.-A.H.)
| | - Kyung-Ah Han
- Diabetes Center, Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea; (K.M.); (K.-A.H.)
| | - Hyoseon Choi
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea; (J.J.); (M.-G.K.); (Y.-J.K.)
- Correspondence: ; Tel.: +82-2-970-8315
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15
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Hu G, Wu H, Kuang L, Zee BCY, Huang Y, Huang Z, He L, Zeng Y, Gao Y, Wang H. Clinical study of diabetic peripheral neuropathy screening by retinal vascular geometric parameters. Sci Rep 2021; 11:6784. [PMID: 33762602 PMCID: PMC7990935 DOI: 10.1038/s41598-021-85831-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 03/02/2021] [Indexed: 11/09/2022] Open
Abstract
To investigate the relationship between geometrical changes of retinal vessels and diabetic peripheral neuropathy (DPN), and to determine the effectiveness of retinal vascular geometry analysis and vibration perception threshold (VPT) for DPN assessment. Type 2 diabetes patients (n = 242) were categorized by stage of DPN. VPT and fundus photography was performed to obtain retinal vascular geometry parameters. The risk factors for DPN and the correlation between DPN stages were analyzed. The efficiency of the retinal vascular geometric parameters obtained with VPT as a diagnostic tool for DPN was examined. Stages of DPN showed a linear correlation with VPT (r = 0.818), central retinal vein equivalent (CRVE) (r = 0.716), and fractal dimension arterioles (DFa) (r = - 0.769). VPT, CRVE, DFa, and fractal dimension veins (DFv) showed high sensitivity (80%, 55%, 82%, and 67%, respectively) and specificity (92%, 93%, 82%, and 80%, respectively) for DPN diagnosis. Good agreement was observed between combined use of geometric parameters (CRVE, DFa and DFv) and VPT (Kappa value 0.430). The detection rate of DPN with combined use of geometric parameters of retinal vessels (64.88%) was significantly higher than that with use of VPT (47.52%). Retinal vascular geometry changes demonstrated significant correlation with DPN severity. VPT, CRVE, DFa, and DFv may provide insights for understanding DPN.
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Affiliation(s)
- Guotao Hu
- Department of Endocrinology, Longgang Central Hospital, Shenzhen 1228 Longgang Road, Shenzhen, 518116, Guangdong, China
| | - Hongmei Wu
- Department of Endocrinology, Longgang Central Hospital, Shenzhen 1228 Longgang Road, Shenzhen, 518116, Guangdong, China
| | - Lei Kuang
- Department of Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Benny Chung-Ying Zee
- Department of Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Ying Huang
- Department of Endocrinology, Longgang Central Hospital, Shenzhen 1228 Longgang Road, Shenzhen, 518116, Guangdong, China
| | - Zhen Huang
- Department of Laboratory, Longgang Central Hospital, Shenzhen, 518116, Guangdong, China
| | - Li He
- Department of Nursing, Longgang Central Hospital, Shenzhen, 518116, Guangdong, China
| | - Yuanhong Zeng
- Department of Ophthalmology, Longgang Central Hospital, Shenzhen, 518116, Guangdong, China
| | - Yongbo Gao
- Department of Stomatology, Longgang Central Hospital, Shenzhen, 518116, Guangdong, China
| | - Hailan Wang
- Department of Endocrinology, Longgang Central Hospital, Shenzhen 1228 Longgang Road, Shenzhen, 518116, Guangdong, China.
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Wilcoxon A, Kober KM, Viele C, Topp K, Smoot B, Abrams G, Chesney M, Paul SM, Conley YP, Levine JD, Miaskowski C. Association Between Physical Activity Levels and Chemotherapy-Induced Peripheral Neuropathy Severity in Cancer Survivors. Oncol Nurs Forum 2020; 47:703-719. [PMID: 33063789 DOI: 10.1188/20.onf.703-719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate for differences in demographic and clinical characteristics, as well as subjective and objective measures of chemotherapy-induced peripheral neuropathy (CIPN), among different exercise groups. SAMPLE & SETTING Cancer survivors (N = 290) were recruited from throughout the San Francisco Bay Area. METHODS & VARIABLES Based on the recommended 150 minutes or more of exercise per week, survivors were classified into the no exercise (NoEx), less exercise (LessEx), or recommended exercise (RecEx) group. Survivors completed self-report questionnaires and underwent sensory and balance testing. RESULTS Compared to the RecEx group, survivors in the NoEx group had less education, were less likely to be married/partnered, had a lower household income, had a higher level of comorbidity, and had poorer functional status. No differences were found among the groups in CIPN duration; pain intensity scores; or changes in light touch, cold, and pain sensations. IMPLICATIONS FOR NURSING Clinicians can recommend walking as a therapeutic option for survivors with CIPN and refer them to physical therapy.
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17
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Syngle A, Chahal S, Vohra K. Efficacy and tolerability of DPP4 inhibitor, teneligliptin, on autonomic and peripheral neuropathy in type 2 diabetes: an open label, pilot study. Neurol Sci 2020; 42:1429-1436. [PMID: 32803534 DOI: 10.1007/s10072-020-04681-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 08/08/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Diabetic neuropathy increases risk of cardiovascular disease, peripheral artery disease, foot amputation and overall mortality. Not only hyperglycaemia induced nerve damage is harder to repair using currently approved medications, but also, the use of these agents is often limited by the extent of pain relief provided and side effects. METHODOLOGY In this prospective, open-label, pilot study, 20 type-2 diabetes mellitus patients (male/female=13/7, mean age- 56.1±8.04 years), meeting inclusion/exclusion criteria, were treated with dipeptidyl peptidase-4 (DPP-4) inhibitor, Teneligliptin, 20mg once a day for three months. Efficacy parameters: Sudomotor function (Sudoscan score); parasympathetic dysfunction assessed using Ewing's criteria i.e. heart rate response to -standing (HRS), -valsalva (HRV) and -deep breath (HRD); sympathetic dysfunction assessed as blood pressure response to -standing (BPS) and -handgrip (BPH); ankle brachial index (ABI), vibration perception threshold (VPT), C-reactive protein, glycemic profile and health related quality of life (HRQoL); and, tolerability parameters: complete blood count, liver function tests, serum creatinine, thyroid stimulating hormone, QT- interval and serum vitamin B12 levels, were measured. RESULTS There was no statistical difference in BMI, SBP, DBP, HRD, BPH and all safety parameters. After 12 weeks treatment, there was improvement in HRS (p<0.01) and HRV (p<0.01), but not in HRD (p=0.12). BPS was significantly lowered (p <0.01), but not the BPH (p =0.06). Sudoscan score was increased, while VPT was significantly decreased (both p<0.01). CONCLUSION Teneligliptin not only improves the glycemic status but also improves sudomotor function, peripheral and autonomic neuropathy, and reduces vascular inflammation in type 2 diabetes.
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Affiliation(s)
- Ashit Syngle
- Healing Touch City Clinic, # 547, Sector 16-D, Chandigarh, India.,Fortis Multi Specialty Hospital, Mohali, Punjab, India
| | - Simran Chahal
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India
| | - Kanchan Vohra
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, India.
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Djouhri L, Zeidan A, Abd El-Aleem SA, Smith T. Cutaneous Aβ-Non-nociceptive, but Not C-Nociceptive, Dorsal Root Ganglion Neurons Exhibit Spontaneous Activity in the Streptozotocin Rat Model of Painful Diabetic Neuropathy in vivo. Front Neurosci 2020; 14:530. [PMID: 32528247 PMCID: PMC7263321 DOI: 10.3389/fnins.2020.00530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/29/2020] [Indexed: 12/30/2022] Open
Abstract
Diabetic peripheral neuropathic pain (DPNP) is the most devastating complication of diabetes mellitus. Unfortunately, successful therapy for DPNP remains a challenge because its pathogenesis is still elusive. However, DPNP is believed to be due partly to abnormal hyperexcitability of dorsal root ganglion (DRG) neurons, but the relative contributions of specific functional subtypes remain largely unknown. Here, using the strepotozotocin (STZ) rat model of DPNP induced by a STZ injection (60 mg/kg, i.p), and intracellular recordings of action potentials (APs) from DRG neurons in anesthetized rats, we examined electrophysiological changes in C-and Aβ-nociceptive and Aβ-low threshold mechanoreceptive (LTM) neurons that may contribute to DPNP. Compared with control, we found in STZ-rats with established pain hypersensitivity (5 weeks post-STZ) several significant changes including: (a) A 23% increase in the incidence of spontaneous activity (SA) in Aβ-LTMs (but not C-mechanosensitive nociceptors) that may cause dysesthesias/paresthesia suffered by DPNP patients, (b) membrane hyperpolarization and a ∼85% reduction in SA rate in Aβ-LTMs by Kv7 channel activation with retigabine (6 mg/kg, i.v.) suggesting that Kv7/M channels may be involved in mechanisms of SA generation in Aβ-LTMs, (c) decreases in AP duration and in duration and amplitude of afterhyperpolarization (AHP) in C-and/or Aβ-nociceptors. These faster AP and AHP kinetics may lead to repetitive firing and an increase in afferent input to the CNS and thereby contribute to DPNP development, and (d) a decrease in the electrical thresholds of Aβ-nociceptors that may contribute to their sensitization, and thus to the resulting hypersensitivity associated with DPNP.
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Affiliation(s)
- Laiche Djouhri
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Asad Zeidan
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Seham A. Abd El-Aleem
- Department of Histology and Cell Biology, University of Manchester, Manchester, United Kingdom
- Department of Pathology, Faculty of Medicine, Minia University, Minya, Egypt
| | - Trevor Smith
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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19
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Schmidt D, Schlee G, Germano AMC, Milani TL. Larger contactor area increases low-frequency vibratory sensitivity in hairy skin. PeerJ 2020; 8:e8479. [PMID: 32117615 PMCID: PMC7003686 DOI: 10.7717/peerj.8479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/27/2019] [Indexed: 12/16/2022] Open
Abstract
Background In research, assessing vibratory cutaneous sensitivity is an important research branch to quantify various diseases or to develop devices for pattern recognition. The measured vibration perception thresholds (VPTs), however, are subjective and usually result in a large data variability. This might induce difficulties to detect differences, for example, when comparing different anatomical locations. Hence, a higher ability to detect changes is desirable. Another feature of VPTs is spatial summation, but in the literature it is controversially discussed whether or not this phenomenon is also present in the lower frequency range. For these reasons, the present study aimed to investigate whether an enlarged matrix contactor area (measured at the hairy skin) induces improvements in subjective sensitivity using high and low frequencies, and whether a large contactor area is better able to identify changes of VPTs than a small contactor area of a single contactor. For each frequency, we hypothesized an increased sensitivity for the matrix compared to the single contactor. We also hypothesized that changes can be better-detected between the anatomical locations when using the matrix than the single contactor. Methods Twenty healthy and young participants voluntarily took part in this study. Three anatomical locations at the torso were measured at the middle aspect of the lower back, middle lateral aspect of the upper arm, and the region just below the armpit. At each location, two frequencies (30, 200 Hz) and two contactor conditions (single contactor: 0.48 cm2 , contactor matrix: 9 × 0.48 cm2 = 4.32 cm2) were tested in a randomized order. Results Supporting our hypothesis, we found that improved cutaneous sensitivity after increasing the contactor size occurs not only at high, but also at low frequencies at all anatomical locations. Large contactor sizes resulted in higher sensitivity and in a superior ability to detect changes. The superior behavior of the matrix to exhibit a lower variability could not always be proven. This work may be relevant for future studies aiming to identify changes of VPTs in various patient groups, for example.
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Affiliation(s)
- Daniel Schmidt
- Department of Human Locomotion, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Guenther Schlee
- Biophysics and Human Performance Lab, W.L. Gore and Associates, Putzbrunn, Germany
| | - Andresa M C Germano
- Department of Human Locomotion, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Thomas L Milani
- Department of Human Locomotion, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
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20
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Raymond B, Steriovski J, Gillyard K, Yang C, Wu SC, Crews RT. Choosing a Vibratory Test to Pair With Semmes Weinstein Monofilament Testing for Evaluating Lower Extremity Sensation in Patients With Diabetes: A Comparison of Three Vibratory Methodologies. J Diabetes Sci Technol 2020; 14:8-15. [PMID: 31113243 PMCID: PMC7189163 DOI: 10.1177/1932296819849478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Numerous guidelines recommend pairing Semmes-Weinstein monofilament (SWM) testing with a secondary clinical test when screening for diabetic peripheral neuropathy, yet time is very limited in clinical practice. This study compared the time to complete and the diagnostic agreement of three vibratory sensation tests. METHODS Sixty-five individuals (42% male; aged: 61 ± 12 years) were recruited. A single investigator administered the following tests bilaterally: 10-site SWM, traditional tuning fork (TTF), electronic tuning fork (ETF), and vibration perception threshold (VPT) via biothesiometer. Times to physically administer the tests were compared with a one-way repeated measures ANOVA. Cochran's Q test was used to compare the varied tests' diagnostic agreement. RESULTS The ANOVA indicated there were significant (P < .001, partial eta squared = .442) differences in time to complete the varied tests. Sidak post hoc comparisons indicated the VPT (21.2 ± 14.3) testing took an intermediate time to complete, while the ETF (9.7 ± 6.5) and TTF (10.1 ± 7.5) tests took the least amount of time, and the SWM (28.6 ± 8.4) test took the longest time. There were also numerous significant differences (P ≤ .001) between the different tests in regards to neuropathy diagnoses. CONCLUSIONS Tuning fork methods required 11 seconds less to administer than VPT testing. Although that may seem trivial, it is worth noting peripheral neuropathy screening often fails to occur in the precious few minutes clinicians are allotted per patient. Considering ETF's intrinsic control of stimulus amplitude and its ease of use with an embedded timer, the ETF is recommended over the TTF. Clinicians should also be mindful that different tests yield different diagnostic conclusions.
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Affiliation(s)
- Bryan Raymond
- Dr William M. Scholl College of
Podiatric Medicine’s Center for Lower Extremity Ambulatory Research (CLEAR) at
Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - KaNesha Gillyard
- Dr William M. Scholl College of
Podiatric Medicine’s Center for Lower Extremity Ambulatory Research (CLEAR) at
Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Atlanta VA Medical Center, Decatur, GA,
USA
| | - Chalen Yang
- Dr William M. Scholl College of
Podiatric Medicine’s Center for Lower Extremity Ambulatory Research (CLEAR) at
Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Stephanie C. Wu
- Dr William M. Scholl College of
Podiatric Medicine’s Center for Lower Extremity Ambulatory Research (CLEAR) at
Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Ryan T. Crews
- Dr William M. Scholl College of
Podiatric Medicine’s Center for Lower Extremity Ambulatory Research (CLEAR) at
Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Ryan T. Crews, MS, Rosalind Franklin
University of Medicine & Science, 3333 Green Bay Rd, North Chicago, IL
60064, USA.
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Ekman L, Persson Löfgren J, Dahlin LB. Examining practice effects in repeated measurements of vibration perception thresholds on finger pulps of healthy individuals - Is it possible to improve your results over a clinically relevant test interval? PLoS One 2019; 14:e0226371. [PMID: 31846492 PMCID: PMC6917284 DOI: 10.1371/journal.pone.0226371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 11/25/2019] [Indexed: 11/20/2022] Open
Abstract
Aims To investigate practice effects in a test-retest situation, where vibration perception thresholds (VPT) were measured in healthy subjects using a multi-frequency test method. Methods In eight consecutive tests, VPTs were tested in the pulps of the index and little fingers at seven frequencies (8, 16, 32, 64, 125, 250 and 500 Hz). Subjects were twenty healthy adults aged 26 to 65 years (mean 46.0 ± 11.1 years; 10 male and 10 female). The subjects were examined at six tests with intervals of one month (mean 33 ± 6; time 0 to month 5) and at two additional tests with prolonged intervals (month 12 and 18). Linear mixed model analysis was performed to investigate differences over the subsequent test occasions. To examine where potential practice effects occurred, a pairwise comparison with Bonferroni correction was made. Results Small decreases in VPTs were found in 8 out of the 14 frequencies (index finger: 8, 16, 32, 250 and 500 Hz; little finger: 16, 250 and 500 Hz) within the test period from time 0 to month 5. In tests at 12 and 18 months, VPTs were increased compared to month 5, but lowered in comparison with time 0. Hence, minor significant decreases were found in three frequencies for the index finger (125, 250 and 500 Hz) and one frequency for the little finger (250 Hz) when examining VPTs with prolonged time intervals. Conclusions When evaluating vibration perception thresholds in a clinically relevant time period of once or twice a year, no consideration of practice effects is necessary when interpreting the results.
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Affiliation(s)
- Linnéa Ekman
- Department of Translational Medicine-Hand Surgery, Lund University, Malmö, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Jin Persson Löfgren
- Department of Translational Medicine-Hand Surgery, Lund University, Malmö, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine-Hand Surgery, Lund University, Malmö, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
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22
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Ponirakis G, Elhadd T, Chinnaiyan S, Dabbous Z, Siddiqui M, Al‐muhannadi H, Petropoulos I, Khan A, Ashawesh KAE, Dukhan KMO, Mahfoud ZR, Murgatroyd C, Slevin M, Malik RA. Prevalence and risk factors for painful diabetic neuropathy in secondary healthcare in Qatar. J Diabetes Investig 2019; 10:1558-1564. [PMID: 30860314 PMCID: PMC6825939 DOI: 10.1111/jdi.13037] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/23/2019] [Accepted: 03/03/2019] [Indexed: 01/16/2023] Open
Abstract
AIMS/INTRODUCTION Painful diabetic peripheral neuropathy (PDPN) has a significant impact on the patient's quality of life. The prevalence of PDPN in the Middle East and North Africa region has been reported to be almost double that of populations in the UK. We sought to determine the prevalence of PDPN and its associated factors in type 2 diabetes mellitus patients attending secondary care in Qatar. MATERIALS AND METHODS This was a cross-sectional study of 1,095 participants with type 2 diabetes mellitus attending Qatar's two national diabetes centers. PDPN and impaired vibration perception on the pulp of the large toes were assessed using the Douleur Neuropathique en 4 questionnaire with a cut-off ≥4 and the neurothesiometer with a cut-off ≥15 V, respectively. RESULTS The prevalence of PDPN was 34.5% (95% confidence interval [CI] 31.7-37.3), but 80% of these patients had not previously been diagnosed or treated for this condition. Arabs had a higher prevalence of PDPN compared with South Asians (P < 0.05). PDPN was associated with impaired vibration perception adjusted odds ratio (AOR) 4.42 (95% CI 2.92-6.70), smoking AOR 2.43 (95% CI 1.43-4.15), obesity AOR 1.74 (95% CI 1.13-2.66), being female AOR 1.65 (95% CI: 1.03-2.64) and duration of diabetes AOR 1.08 (95% CI 1.05-1.11). Age, poor glycemic control, hypertension, physical activity and proteinuria showed no association with PDPN. CONCLUSIONS PDPN occurs in one-third of type 2 diabetes mellitus patients attending secondary care in Qatar, but the majority have not been diagnosed. Arabs are at higher risk for PDPN. Impaired vibration perception, obesity and smoking are associated with PDPN in Qatar.
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Affiliation(s)
- Georgios Ponirakis
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
- Faculty of Science and EngineeringManchester Metropolitan UniversityManchesterUK
| | - Tarik Elhadd
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
- National Diabetes and Endocrine CentreHamad Medical CorporationAl‐Wakra HospitalDohaQatar
| | - Subitha Chinnaiyan
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
| | - Zeinab Dabbous
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
| | - Mashhood Siddiqui
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
| | | | | | - Adnan Khan
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | - Khaled AE Ashawesh
- National Diabetes and Endocrine CentreHamad Medical CorporationAl‐Wakra HospitalDohaQatar
| | - Khaled MO Dukhan
- National Diabetes and Endocrine CentreHamad Medical CorporationAl‐Wakra HospitalDohaQatar
| | - Ziyad R Mahfoud
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | | | - Mark Slevin
- Faculty of Science and EngineeringManchester Metropolitan UniversityManchesterUK
| | - Rayaz A Malik
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
- Faculty of Science and EngineeringManchester Metropolitan UniversityManchesterUK
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
- Institute of Cardiovascular ScienceUniversity of ManchesterManchesterUK
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Kang GE, Zahiri M, Lepow B, Saleem N, Najafi B. The Effect of Daily Use of Plantar Mechanical Stimulation Through Micro-Mobile Foot Compression Device Installed in Shoe Insoles on Vibration Perception, Gait, and Balance in People With Diabetic Peripheral Neuropathy. J Diabetes Sci Technol 2019; 13:847-856. [PMID: 30943782 PMCID: PMC6955449 DOI: 10.1177/1932296819839703] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE People with diabetic peripheral neuropathy (DPN) have impaired gait and balance performance. The aim of this study is to investigate therapeutic effectiveness of mechanical stimulation through a wearable foot compression device equipped in a shoe insole on vibration perception, balance control and gait performance in people with DPN. METHODS Using a single-arm 4-week intervention study design, we examined effectiveness of daily use of shoes equipped with the foot compression device (Footbeat™, AVEX, Grand Junction, CO, USA) on improving vibration perception threshold (VPTmax), skin perfusion pressure (SPP), ankle brachial index (ABI), lower extremities edema (circumferences in the calf and ankle), and motor performance (postural sway with eyes open and closed conditions, and gait performance during normal, dual-task and fast walking). Thirty people with type 2 diabetes and symptoms of PN completed the experimental protocol. RESULTS Improvements in VPTmax (before = 27.4 V, after = 23.3 V, P = .007, d = 0.33, where d denotes effect size), center-of-mass sway in the mediolateral direction with both eyes open and closed conditions (before = 0.94 cm, after = 0.76 cm, P = .020, d = 0.47; before = 1.10 cm, after = 0.83 cm, P = .033, d = 0.66, respectively), and stride velocity for normal walking, dual-task walking and fast walking tasks (before = 0.87 m/s, after = 0.96 m/s, P = .017, d = 0.41; before = 0.75 m/s, after = 0.91 m/s, P = .001, d = 0.77; before = 1.10 m/s, after = 1.20 m/s, P = .043, d = 0.33, respectively) were found post treatment. There was no significant improvement in SPP, ABI, and circumferences in the calf and ankle. CONCLUSIONS Our findings suggest the wearable foot compression device may be effective for reducing neuropathic symptoms and enhancing motor performances in people with DPN.
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Affiliation(s)
- Gu Eon Kang
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Mohsen Zahiri
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Brian Lepow
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Nimrah Saleem
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Bijan Najafi, PhD, iCAMP, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, Houston, TX 77030, USA.Emails: ;
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Petrovchich I, Kober KM, Wagner L, Paul SM, Abrams G, Chesney MA, Topp K, Smoot B, Schumacher M, Conley YP, Hammer M, Levine JD, Miaskowski C. Deleterious Effects of Higher Body Mass Index on Subjective and Objective Measures of Chemotherapy-Induced Peripheral Neuropathy in Cancer Survivors. J Pain Symptom Manage 2019; 58:252-263. [PMID: 31047960 PMCID: PMC6679783 DOI: 10.1016/j.jpainsymman.2019.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 12/28/2022]
Abstract
CONTEXT Recent, albeit, limited evidence suggests that body mass index (BMI) may be a modifiable risk factor to reduce the deleterious effects of chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors. OBJECTIVES To evaluate for differences in demographic, clinical, pain, sensation, and balance characteristics among three BMI groups. We hypothesized that as BMI increased, survivors would report higher pain intensity scores and have significant decrements in measures of sensation and balance. METHODS A total of 416 survivors with CIPN were evaluated using subjective and objective measures of CIPN. Survivors were divided into three BMI groups (i.e., normal weight, overweight, and obese). Differences among the BMI groups were evaluated using parametric and nonparametric statistics. RESULTS Of the 416 survivors, 45.4% were normal weight, 32.5% were overweight, and 22.1% were obese. Compared with the normal-weight group, survivors in the other two groups had lower functional status scores, a higher comorbidity burden, higher pain intensity scores, and higher interference scores. In addition, compared with the normal-weight group, survivors in the other two BMI groups had significantly worse balance scores. CONCLUSION Our findings support the hypothesis that as BMI increased, pain sensation and balance characteristics worsened. Our findings suggest that nutritional counseling as well as exercise and weight management programs in survivors with CIPN may improve these clinically important problems.
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Affiliation(s)
- Iva Petrovchich
- School of Nursing, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Laura Wagner
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, California, USA
| | - Margaret A Chesney
- School of Medicine, University of California, San Francisco, California, USA
| | - Kimberly Topp
- School of Medicine, University of California, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California, San Francisco, California, USA
| | - Mark Schumacher
- School of Medicine, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
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25
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Nash J, Armour M, Penkala S. Acupuncture for the treatment of lower limb diabetic peripheral neuropathy: a systematic review. Acupunct Med 2019; 37:3-15. [PMID: 30900484 DOI: 10.1136/acupmed-2018-011666] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine evidence for acupuncture interventions in the management of diabetes-related peripheral neuropathy (DPN) symptoms. METHODS Five electronic databases were searched up to June 2017 for studies that included participants with symptoms of DPN, used an acupuncture intervention, and reported before-and-after DPN-related outcome measures. Two reviewers independently performed the data extraction. The level of homogeneity was assessed, and studies were appraised using the Cochrane Risk of Bias tool, the STRICTA guidelines for acupuncture reporting and the NICMAN scale for acupuncture quality. RESULTS Ten studies with 432 participants were included: three randomised controlled trials (RCTs), two pilot RCTs, three uncontrolled clinical trials, one quasi-RCT and one prospective case series. Improvements in DPN pain symptoms were reported by all studies. Heterogeneity of outcome measures prevented a meta-analysis. Variations were found in needle retention time and point selection, as well as total number and frequency of treatments. Common acupuncture point selections were ST36 and SP6. Half of the studies used local point selection. Studies conducted outside China had better acupuncture reporting and quality according to the STRICTA checklist and NICMAN scales, respectively. Risk of bias was high or unclear in the majority of studies for all domains except attrition bias. CONCLUSIONS Acupuncture for DPN appears to improve symptoms. However, the application of acupuncture varies greatly, and the quality of included studies was generally low. Available studies have varying methodologies and different outcome measures. Further, suitably powered studies using appropriate DPN outcome measures are required.
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Affiliation(s)
- Jane Nash
- 1 Department of Podiatric Medicine, School of Science and Health, University of Western Sydney, Penrith, New South Wales, Australia
| | - Mike Armour
- 2 NICM Health Research Institute, University of Western Sydney, Penrith, New South Wales, Australia
| | - Stefania Penkala
- 1 Department of Podiatric Medicine, School of Science and Health, University of Western Sydney, Penrith, New South Wales, Australia
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26
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Sensitivity and specificity of the Neuropad for distal sensory peripheral neuropathy (DSPN) in subjects with HIV-Infection: A case controlled observational study. INT J OSTEOPATH MED 2019. [DOI: 10.1016/j.ijosm.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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27
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Megallaa MH, Ismail AA, Zeitoun MH, Khalifa MS. Association of diabetic foot ulcers with chronic vascular diabetic complications in patients with type 2 diabetes. Diabetes Metab Syndr 2019; 13:1287-1292. [PMID: 31336479 DOI: 10.1016/j.dsx.2019.01.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/23/2019] [Indexed: 12/11/2022]
Abstract
CONTEXT Diabetes mellitus is a common disease which is prevalent globally, presenting with chronic complications and constitutes a major risk to the patient. Diabetic foot ulcers are the single biggest risk factor for non-traumatic lower limb amputations in persons with diabetes. We aimed to screen for the chronic vascular diabetic complications in patients with diabetic foot ulcers (DFUs) and to assess the association of diabetic foot ulcers with these complications in the study group. SUBJECTS AND METHODS This cross-sectional study included 180 type 2 diabetic patients (aged 30-70 years) with diabetic foot ulcers who attended the Outpatient Clinic of Diabetes in Alexandria Main University Hospital. Full diabetic foot examination was done to all study subjects. DFUs were assessed using University of Texas Diabetic Wound Classification System. HbA1c, LDL-C, serum creatinine, and urinary albumin creatinine ratio (ACR) were measured for all study subjects. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Fundus examination was done for all study subjects. RESULTS The prevalence of diabetic kidney disease (DKD) and diabetic retinopathy (DR) was 86.1% and 90% respectively among the study group. 86.7% of patients had neuropathic DFUs, 11.1% of them had ischemic DFUs and 2.2% had neuro-ischemic DFUs. Regarding diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD) as risk factors for developing DFU, the prevalence of both of them respectively was 82% and 20% among the study group. There was statistically significant association between both DKD, DR and peripheral neuropathy. There was also statistically significant association between both DKD, DR and peripheral arterial disease (PAD). CONCLUSION Chronic vascular diabetic complications are common among type 2 diabetic patients with diabetic foot ulcers. There is statistically significant association between these complications and diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD).
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Affiliation(s)
- Magdy H Megallaa
- Unit of Diabetes and Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Azza A Ismail
- Unit of Diabetes and Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohammed H Zeitoun
- Unit of Diabetes and Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mai S Khalifa
- Unit of Diabetes and Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
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28
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Zahiri M, Chen KM, Zhou H, Nguyen H, Workeneh BT, Yellapragada SV, Sada YH, Schwenk M, Najafi B. Using wearables to screen motor performance deterioration because of cancer and chemotherapy-induced peripheral neuropathy (CIPN) in adults - Toward an early diagnosis of CIPN. J Geriatr Oncol 2019; 10:960-967. [PMID: 30665876 DOI: 10.1016/j.jgo.2019.01.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/30/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE An essential component for optimizing quality of life in adults with cancer is determining the degree to which therapy may negatively impact motor-performance, so that patients can maintain their quality of life and independence. This study examined whether instrumented gait and balance could determine the magnitude of deterioration in motor-performance from chemotherapy-induced peripheral neuropathy (CIPN). METHODS We recruited 84 adults with cancer (age = 71.1 ± 9.7 years old, BMI = 26.8 ± 6.2 kg/m2, gender = 56%female) and 57 age-matched non-cancer patients (age = 69.5 ± 9.8 years old, BMI = 27.1 ± 6.0 kg/m2, gender = 79%female). Based on clinical screening, the group with cancer was classified into two groups: participants with CIPN (CIPN+) and without CIPN (CIPN-). Gait and balance were quantified using validated wearables. The Vibration Perception Threshold (VPT) test was used to stratify the CIPN+ group into mild (Mild-CIPN) and severe (Severe-CIPN) subgroups. RESULTS All gait and balance parameters were deteriorated in the group with cancer compared to non-cancer group with the largest effects observed for stride-time (11%, Cohen's effect size d = 1.00, p < 0.001) and eyes-closed ankle sway (94%, d = 0.49, p = 0.001). The same trend was observed when the Severe-CIPN subgroup was compared to the Mild-CIPN. VPT correlates significantly with motor deterioration, with the largest correlation found in stride-time (Rho = 0.37, p = 0.007). Severe-CIPN subjects were significantly older and overall had more deterioration in the majority of motor-performance parameters after adjusting for age (p < 0.050). CONCLUSION These results confirmed the negative impact of CIPN on motor-performance with the largest effects on ankle stability and stride-time. VPT is a predictor of motor deterioration and may be used to determine the severity of CIPN symptom.
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Affiliation(s)
- Mohsen Zahiri
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Kevin M Chen
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - He Zhou
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Hung Nguyen
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Biruh T Workeneh
- Department of Nephrology, Division of Internal Medicine, MD Anderson, Houston, TX, USA
| | - Sarvari V Yellapragada
- Department of Medicine, Section of Hematology and Oncology, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Hematology and Oncology, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Yvonne H Sada
- Department of Medicine, Section of Hematology and Oncology, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Hematology and Oncology, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Michael Schwenk
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany; Department of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Schmidt D, Germano AM, Milani TL. Effects of water immersion on sensitivity and plantar skin properties. Neurosci Lett 2018; 686:41-46. [DOI: 10.1016/j.neulet.2018.08.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 12/31/2022]
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30
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Lindberg K, Møller BS, Kirketerp-Møller K, Kristensen MT. An exercise program for people with severe peripheral neuropathy and diabetic foot ulcers – a case series on feasibility and safety. Disabil Rehabil 2018; 42:183-189. [DOI: 10.1080/09638288.2018.1494212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Kajsa Lindberg
- Health and Rehabilitation Centre Vanløse, Copenhagen Municipality, Copenhagen, Denmark
| | | | | | - Morten Tange Kristensen
- Departments of Physiotherapy and Orthopaedic Surgery, Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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Van Eetvelde BLM, Cambier D, Vanden Wyngaert K, Celie B, Calders P. The Influence of Clinically Diagnosed Neuropathy on Respiratory Muscle Strength in Type 2 Diabetes Mellitus. J Diabetes Res 2018; 2018:8065938. [PMID: 30622971 PMCID: PMC6304822 DOI: 10.1155/2018/8065938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/11/2018] [Accepted: 10/29/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES This cross-sectional study investigated the influence of clinically diagnosed neuropathy (cdNP) on respiratory muscle strength in patients with type 2 diabetes mellitus (T2DM). METHODS 110 T2DM patients and 35 nondiabetic healthy controls (≥60 years) were allocated to one of three groups depending on the presence of cdNP: T2DM without cdNP (D-; n = 28), T2DM with cdNP (D+; n = 82), and controls without cdNP (C; n = 35). Clinical neurological diagnostic examination consisted of Vibration Perception Threshold and Diabetic Neuropathy Symptom score. Respiratory muscle strength was registered by maximal Inspiratory and Expiratory Pressures (PImax and PEmax), and respiratory function by Peak Expiratory Flow (PEF). Isometric Handgrip Strength and Short Physical Performance Battery were used to evaluate peripheral skeletal muscle strength and physical performance. Univariate analysis of covariance was used with age, level of physical activity, and body mass index as covariates. RESULTS PImax, PEmax, and PEF were higher in C compared to D- and D+. Exploring more in detail, PImax, PEmax, and PEF were significantly lower in D+ compared to C. PEmax and PEF were also significantly lower in D- versus C. Measures of peripheral muscle strength and physical performance showed less associations with cdNP and T2DM. CONCLUSIONS The presence of cdNP affects respiratory muscle strength in T2DM patients compared to healthy controls. Both cdNP and diabetes in themselves showed a distinctive impact on respiratory muscle strength and function; however, an accumulating effect could not be ascertained in this study. As commonly used measures of peripheral muscle strength and physical performance seemed to be less affected at the given time, the integration of PImax, PEmax, and PEF measurements in the assessment of respiratory muscle weakness could be of added value in the (early) screening for neuropathy in patients with T2DM.
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Affiliation(s)
| | - Dirk Cambier
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | | | - Bert Celie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Yeboah K, Agyekum JA, Owusu Mensah RNA, Affrim PK, Adu-Gyamfi L, Doughan RO, Adjei AB. Arterial Stiffness Is Associated with Peripheral Sensory Neuropathy in Diabetes Patients in Ghana. J Diabetes Res 2018; 2018:2320737. [PMID: 29629375 PMCID: PMC5830981 DOI: 10.1155/2018/2320737] [Citation(s) in RCA: 8] [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: 07/24/2017] [Revised: 11/30/2017] [Accepted: 12/12/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Peripheral sensory neuropathy (PSN) is among microvascular complications of diabetes that make patients prone to ulceration and amputation. Arterial stiffness is a predictor of cardiovascular diseases and microvascular complications associated with diabetes. We investigated the association between PSN and arterial stiffness, measured as aortic pulse wave velocity (PWVao) and cardio-ankle vascular index (CAVI). METHOD In a case-control design, arterial stiffness was measured in 240 diabetes patients and 110 nondiabetic control. Large-fibre nerve function was assessed by vibration perception threshold (VPT) using a neurothesiometer. PSN was defined as the VPT > 97.5th percentile from age- and gender-adjusted models in nondiabetic controls. RESULTS The overall prevalence of PSN was 16.6% in the entire study participants. Compared to non-PSN participants, PSN patients had higher levels of PWVao (9.5 ± 1.7 versus 8.7 ± 1.2 m/s, p = 0.016) and CAVI (8.4 ± 1.3 versus 7.6 ± 1.1, p = 0.001). In multiple regression models, VPT was associated with PWVao (β = 0.14, p = 0.025) and CAVI (β = 0.12, p = 0.04). PSN patients had increased odds of CAVI (OR = 1.51 (1.02-2.4), p = 0.043), but not PWVao (OR = 1.25 (0.91-1.71), p = 0.173). CONCLUSION PWVao and CAVI were associated with VPT and PSN in diabetes patients in Ghana. Patients having PSN have increased odds of CAVI, independent of other conventional risk factors.
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Affiliation(s)
- Kwame Yeboah
- Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Jennifer A. Agyekum
- Department of Medical Laboratory Sciences, School of Biomedical & Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Richard N. A. Owusu Mensah
- Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Patrick K. Affrim
- Department of Chemical Pathology, School of Biomedical & Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Linda Adu-Gyamfi
- Department of Medical Biochemistry, School of Biomedical & Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Rita O. Doughan
- Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Afua B. Adjei
- Department of Chemical Pathology, School of Biomedical & Allied Health Sciences, University of Ghana, Accra, Ghana
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Kuppens K, Hans G, Roussel N, Struyf F, Fransen E, Cras P, Van Wilgen CP, Nijs J. Sensory processing and central pain modulation in patients with chronic shoulder pain: A case-control study. Scand J Med Sci Sports 2017; 28:1183-1192. [DOI: 10.1111/sms.12982] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- K. Kuppens
- Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Departments of Human Physiology and Physiotherapy; Faculty of Physical Education and Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Pain in Motion Research Group
| | - G. Hans
- Pain Center; University Hospital Antwerp; Antwerp Belgium
| | - N. Roussel
- Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
| | - F. Struyf
- Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
| | - E. Fransen
- StatUa Center for Statistics; University of Antwerp; Antwerp Belgium
| | - P. Cras
- Department of Neurology; University Hospital Antwerp; Antwerp Belgium
| | - C. P. Van Wilgen
- Departments of Human Physiology and Physiotherapy; Faculty of Physical Education and Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Pain in Motion Research Group
- Transcare, Transdisciplinairy Painmanagement Centre; Groningen The Netherlands
| | - J. Nijs
- Departments of Human Physiology and Physiotherapy; Faculty of Physical Education and Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Pain in Motion Research Group
- Department of Physiotherapy and Rehabilitation; University Hospital Brussels; Brussels Belgium
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Hu G, Zhai F, Mo F, He L, Shen W, Wang H. Effectiveness and feasibility of nailfold microcirculation test to screen for diabetic peripheral neuropathy. Diabetes Res Clin Pract 2017; 131:42-48. [PMID: 28683299 DOI: 10.1016/j.diabres.2017.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/19/2017] [Accepted: 06/09/2017] [Indexed: 01/06/2023]
Abstract
AIMS The nailfold microcirculation index (MI) is a non-invasive, objective, and highly sensitive blood capillary detection method. This study evaluated the diagnostic efficiency of the nailfold MI relative to the more subjective vibration perception threshold (VPT) examination for early diagnostic screening of diabetic peripheral neuropathy (DPN). METHODS From February 2015 to February 2016, 227 diabetes mellitus patients and 39 healthy individuals were enrolled. Each subject underwent the MI test and the VPT examination. RESULTS MI was more closely associated with DPN than age, diabetic duration, smoking, drinking, systolic pressure, serum creatinine, 24-h urinary protein, hypoxia-inducible factor-1α (HIF1A), vascular endothelial growth factor (VEGF), the VEGF receptors Flt-1 and Flt-4, ankle branchial index (ABI), DPN, or DPN stage (OR=11.819). Both the MI and VPT closely correlated with age, diabetic duration, serum creatinine, 24-h urinary protein, HIF1A, VEGF, Flt-1, Flt-4, ABI, DPN, and DPN stage. By the receiver operating characteristic (ROC) curve, the MI diagnostic cutoff point was 2.56, where the corresponding Youden's index was maximum and the area under ROC curve was 0.943. The diagnostic efficiency of MI and VPT were similar. MI and VPT indicated similar percentages of diabetic patients with DPN at the most severe stage, while MI achieved a higher diagnostic rate for the earliest stages. CONCLUSIONS The nailfold MI is a feasible method for clinical early diagnostic screening of DPN in diabetic patients, and is more objective and reliable than VPT.
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Affiliation(s)
- Guotao Hu
- Department of Endocrinology, Zunyi Medical College Affiliated Shenzhen Longgang Central Hospital, Shenzhen 518116, Guangdong, China
| | - Fanglong Zhai
- Department of Endocrinology, Zunyi Medical College Affiliated Shenzhen Longgang Central Hospital, Shenzhen 518116, Guangdong, China
| | - Feifei Mo
- Department of Endocrinology, Zunyi Medical College Affiliated Shenzhen Longgang Central Hospital, Shenzhen 518116, Guangdong, China
| | - Li He
- Department of Nursing, Zunyi Medical College Affiliated Shenzhen Longgang Central Hospital, Shenzhen 518116, Guangdong, China
| | - Weiya Shen
- Department of Endocrinology, Zunyi Medical College Affiliated Shenzhen Longgang Central Hospital, Shenzhen 518116, Guangdong, China
| | - Hailan Wang
- Department of Endocrinology, Zunyi Medical College Affiliated Shenzhen Longgang Central Hospital, Shenzhen 518116, Guangdong, China.
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Boyd BS, Nee RJ, Smoot B. Safety of lower extremity neurodynamic exercises in adults with diabetes mellitus: a feasibility study. J Man Manip Ther 2017; 25:30-38. [PMID: 28855790 PMCID: PMC5539576 DOI: 10.1080/10669817.2016.1180772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Neurodynamic exercises aim to improve neural mechanosensitivity in order to promote pain-free movement and function. People with diabetes mellitus (DM) may be candidates for neurodynamic exercises to address common DM-related impairments such as reduced lower extremity range of motion (ROM) and altered neural mechanosensitivity. However, no studies have examined the safety and immediate effects of neurodynamic exercise in people with DM. This study aims to determine the feasibility of applying neurodynamic exercises in adults with DM by evaluating the rate of adverse events and quantifying immediate changes in straight leg raise (SLR) ROM. METHODS This quasi-experimental study included 20 people with DM who performed a series of neurodynamic exercises on their right leg. Their left leg was used as an internal control. SLR testing was performed before and immediately after these exercises. Adverse events were monitored, including provocation of their neuropathy symptoms or discomfort or pain. RESULTS All participants completed the neurodynamic exercises without provocation of their neuropathy symptoms. No pain was reported and only one participant had minor discomfort with one exercise; a <30-s calf cramp. The right SLR ROM increased by an average of 5.2°-5.3° (p < 0.01) with no change on the left. DISCUSSION This study demonstrated that lower extremity neurodynamic exercises are safe in adults with DM and may create small immediate improvements in SLR testing. Further research is indicated to investigate the safety and efficacy of neurodynamic exercises performed over multiple sessions. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Benjamin S. Boyd
- Department of Physical Therapy, Samuel Merritt University, Oakland, CA, USA
| | - Robert J. Nee
- School of Physical Therapy, Pacific University, Forest Grove, OR, USA
| | - Betty Smoot
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
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Yang J, Yan PJ, Wan Q, Li H. Association between Hemoglobin Levels and Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes: A Cross-Sectional Study Using Electronic Health Records. J Diabetes Res 2017; 2017:2835981. [PMID: 28713833 PMCID: PMC5497611 DOI: 10.1155/2017/2835981] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/06/2017] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To investigate the relationship between hemoglobin levels and diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM). METHODS 1511 patients with T2DM were included in the study. DPN was diagnosed based on symptoms, signs, and laboratory tests. Hemoglobin was defined as both a continuous variable and a quartile category variable. We compared patient characteristics between the no diabetic peripheral neuropathy (NDPN) and DPN groups. Logistic regression was conducted to investigate the association of DPN with hemoglobin in all T2DM patients. Linear regression was also performed to investigate the impact of hemoglobin on the vibrating perception threshold (VPT). RESULTS Compared with the NDPN group, hemoglobin level in the DPN group was significantly lower (118.54 ± 16.91 versus 131.62 ± 18.32 g/L, P < 0.01). The prevalence of DPN increased by 50.1% (95% CI: 42.2-57.0%; P < 0.001) per standard deviation decrease in hemoglobin. Compared to the highest quartile of hemoglobin, the lower quartiles were associated with a significantly increased risk of DPN in the entire T2DM population (all P < 0.01). A per unit decrease in hemoglobin leads to a 0.12 (95% CI: 0.07-0.168) unit increase in VPT after adjustment for possible confounders (P < 0.001). CONCLUSIONS Lower hemoglobin levels were associated with increased prevalence of DPN and higher VPT.
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Affiliation(s)
- Jun Yang
- Department of Endocrinology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- *Jun Yang:
| | - Pi-jun Yan
- Department of Endocrinology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Qin Wan
- Department of Endocrinology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Hua Li
- Department of Endocrinology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Zhu X, Mao F, Liu S, Zheng H, Lu B, Li Y. Association of SUDOSCAN Values with Vibration Perception Threshold in Chinese Patients with Type 2 Diabetes Mellitus. Int J Endocrinol 2017; 2017:8435252. [PMID: 28808444 PMCID: PMC5541789 DOI: 10.1155/2017/8435252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 11/18/2022] Open
Abstract
AIMS/INTRODUCTION SUDOSCAN has been proved to be an efficient method in detecting diabetic microvascular complications. In this study, we determine to detect the possible relationship between vibration perception threshold (VPT) and cardiac autonomic neuropathy (CAN) values produced by SUDOSCAN. MATERIALS AND METHODS A total of 920 Chinese patients with T2DM were enrolled in the study. Spearman correlation analysis and multivariate regression analysis were performed to determine the relation between CAN and VPT values. Mean VPT values across the CAN value tertiles were analyzed stratified by HbA1c status. RESULTS In the study, we discovered a relatively high correlation between CAN value and both VPT values from dorsal feet and toes. Multivariate regression analyses also showed a significant relation between VPT and CAN values after adjusting all covariates. The mean value of VPT decreased across the SUDOSCAN-CAN value quartiles in both groups, and it was higher in patients with HbA1C > 9% than in patients with HbA1C < 9% across all quartiles of the SUDOSCAN-CAN except for the VPT mean in the low quartile of the SUDOSCAN-CAN value. CONCLUSIONS All these results suggested that SUDOSCAN-CAN result was associated with VPT value which indicated a probable link between VPT value and cardiovascular autonomic dysfunction.
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Affiliation(s)
- Xiaoming Zhu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Fei Mao
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Siying Liu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Hangping Zheng
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Lu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
- *Bin Lu: and
| | - Yiming Li
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
- Department of Endocrinology and Metabolism, Jing'an District Center Hospital of Shanghai, Shanghai, China
- *Yiming Li:
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Mao F, Liu S, Qiao X, Zheng H, Xiong Q, Wen J, Liu L, Tang M, Zhang S, Zhang Z, Ye H, Lu B, Li Y. Sudoscan is an effective screening method for asymptomatic diabetic neuropathy in Chinese type 2 diabetes mellitus patients. J Diabetes Investig 2016; 8:363-368. [PMID: 27607763 PMCID: PMC5415453 DOI: 10.1111/jdi.12575] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/26/2016] [Accepted: 09/05/2016] [Indexed: 01/19/2023] Open
Abstract
Aims/Introduction The aim of the present study was to use the sudomotor function test, Sudoscan, as a screening method for the evaluation of asymptomatic diabetic distal symmetric polyneuropathy in Chinese type 2 diabetes patients. As a result, more attention could be paid to those asymptomatic patients who could be easily neglected and underdiagnosed in everyday clinic. Materials and Methods A total of 394 Chinese type 2 diabetes patients were enrolled and tested for symptoms and clinical signs of neuropathy using the Neurological Symptom Score, Neuropathy Disability Score, and vibration perception threshold. Sudoscan was carried out, and the results were collected as the measurement of the electrochemical skin conductance of both hands and feet. Results In the present study, we found that the abnormal rate of Sudoscan results in patients with asymptomatic neuropathy was higher than those without neuropathy and those with symptomatic neuropathy. This study also showed that lower electrochemical skin conductance at the feet was significantly associated with increasing symptoms, Neurological Symptom Score (r = −0.124, P < 0.05), Neuropathy Disability Score (r = −0.3, P < 0.01) and vibration perception threshold value (r = −0.18, P < 0.05). Logistic analysis showed that age (odds ratio 1.042, 95% confidence interval 1.014−1.071, P < 0.05) and feet electrochemical skin conductance levels (odds ratio 0.98, 95% confidence interval 0.962–0.993, P < 0.01) were independently associated with diabetic distal symmetric polyneuropathy. Conclusions Sudoscan might be a promising tool to screen asymptomatic diabetic distal symmetric polyneuropathy in Chinese patients with type 2 diabetes mellitus.
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Affiliation(s)
- Fei Mao
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Siying Liu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaona Qiao
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Hangping Zheng
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Qian Xiong
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.,Department of Endocrinology and Metabolism, Jing'an District Center Hospital of Shanghai, Shanghai, China
| | - Jie Wen
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.,Department of Endocrinology and Metabolism, Jing'an District Center Hospital of Shanghai, Shanghai, China
| | - Lianyong Liu
- Department of Endocrinology and Metabolism, Punan Hospital, Shanghai, China
| | - Mingming Tang
- Department of Endocrinology and Metabolism, Jiading District Center Hospital of Shanghai, Shanghai, China
| | - Shuo Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhaoyun Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongying Ye
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Lu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiming Li
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.,Department of Endocrinology and Metabolism, Jing'an District Center Hospital of Shanghai, Shanghai, China
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Zou SY, Zhao Y, Shen YP, Shi YF, Zhou HJ, Zou JY, Shi BM. Identifying at-risk foot among hospitalized patients with type 2 diabetes: A cross-sectional study in one Chinese tertiary hospital. Chronic Dis Transl Med 2016; 1:210-216. [PMID: 29063009 PMCID: PMC5643747 DOI: 10.1016/j.cdtm.2015.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of diabetic at-risk foot and its associated factors. METHODS A total of 838 hospitalized patients with type 2 diabetes were screened for at-risk foot. Neural and vascular disorders were evaluated by assessing vibration perception thresholds and ankle brachial indexes (ABIs). After excluding 12 patients with abnormally high ABIs, remaining individuals with neural and/or vascular disorder were identified as at-risk patients and further classified into three subtypes: isolated neural disorder, isolated vascular disorder and mixed disorder. Potential associated factors were examined using Logistic regression models. RESULTS In the final sample of 826 individuals, the prevalence of diabetic at-risk foot was 30.6%. Among all at-risk patients, isolated neural disorders (69.6%) were more common than mixed (16.2%) or isolated vascular disorders (14.2%). Isolated neural and vascular disorders shared specific risk factors, including age per 20-year increment (odds ratio [95% CI], 3.73 [2.59-5.37] and 4.01 [1.98-8.11]), diabetic duration ≥10 years (1.69 [1.13-2.54] and 3.29 [1.49-7.24]) and systolic blood pressure ≥140 mmHg (1.96 [1.31-2.93] and 2.90 [1.38-6.10]) respectively. In addition, isolated neural disorders were associated with a heavy smoking history (95%CI 2.69 [1.15-6.31]), increased high-sensitivity C-reactive protein levels (95%CI 1.30 [1.04-1.62]) and mild obesity (95%CI 0.49 [0.20-1.24]). Isolated vascular disorders were linked with decreased high density lipoprotein (HDL) cholesterol levels (95%CI 3.42 [1.31-8.96]) and increased triglycerides levels (95%CI 2.74 [1.26-5.97]). CONCLUSIONS Diabetic at-risk foot is epidemic among hospitalized patients with type 2 diabetes. Aging, long-term diabetes, hypertension, smoking, inflammatory response and dyslipidemia may be associated with the prevalence of diabetic at-risk foot.
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Affiliation(s)
- Sheng-Yi Zou
- Department of Endocrinology and Metabolic Disease, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Yuan Zhao
- Department of Endocrinology and Metabolic Disease, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Yue-Ping Shen
- Department of Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215123, China
| | - Yao-Fang Shi
- Department of Endocrinology and Metabolic Disease, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Hui-Juan Zhou
- Department of Endocrinology and Metabolic Disease, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Jian-Ying Zou
- Department of Endocrinology and Metabolic Disease, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Bi-Min Shi
- Department of Endocrinology and Metabolic Disease, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
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Schwenk M, Grewal GS, Holloway D, Muchna A, Garland L, Najafi B. Interactive Sensor-Based Balance Training in Older Cancer Patients with Chemotherapy-Induced Peripheral Neuropathy: A Randomized Controlled Trial. Gerontology 2015; 62:553-63. [PMID: 26678611 DOI: 10.1159/000442253] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/07/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cancer patients with chemotherapy-induced peripheral neuropathy (CIPN) have deficits in sensory and motor skills leading to inappropriate proprioceptive feedback, impaired postural control, and fall risk. Balance training programs specifically developed for CIPN patients are lacking. OBJECTIVE This pilot study investigated the effect of an interactive motor adaptation balance training program based on wearable sensors for improving balance in older cancer patients with CIPN. METHODS Twenty-two patients (age: 70.3 ± 8.7 years) with objectively confirmed CIPN [vibration perception threshold (VPT) >25 V] were randomized to either an intervention (IG) or a control (CG) group. The IG received interactive game-based balance training including repetitive weight shifting and virtual obstacle crossing tasks. Wearable sensors provided real-time visual/auditory feedback from the lower limb trajectory and allowed the perception of motor errors during each motor action. The CG received no exercise intervention and continued their normal activity. Outcome measures were changes in sway of ankle, hip, and center of mass (CoM) in both mediolateral and anteroposterior (AP) directions during 30-second balance tests with increasing task difficulty [i.e. standing in feet-closed position with eyes open (EO) and eyes closed (EC), and in semi-tandem position with EO] at baseline and after the intervention. Additionally, gait performance (speed, variability) and fear of falling [Falls Efficacy Scale-International (FES-I)] were measured. RESULTS Training was safe despite the participants' impaired health status, great severity of CIPN (VPT 49.6 ± 26.7 V), and great fear of falling (FES-I score 31.37 ± 11.20). After the intervention, sway of hip, ankle, and CoM was significantly reduced in the IG compared to the CG while standing in feet-closed position with EO (p = 0.010-0.022, except AP CoM sway) and in semi-tandem position (p = 0.008-0.035, except ankle sway). No significant effects were found for balance with EC, gait speed, and FES-I score (p > 0.05). CONCLUSIONS This proof-of-concept study demonstrates that older cancer patients with CIPN can significantly improve their postural balance with specifically tailored, sensor-based exercise training. The training approach has potential as a therapy for improving CIPN-related postural control deficits. However, future studies comparing the proposed technology-based training with traditional balance training are required to evaluate the benefit of the interactive joint movement feedback.
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Affiliation(s)
- Michael Schwenk
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, College of Medicine, Arizona Center on Aging, University of Arizona, Tucson, Ariz., USA
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Kaminski MR, Raspovic A, McMahon LP, Erbas B, Landorf KB. Risk factors for foot ulceration in adults with end-stage renal disease on dialysis: study protocol for a prospective observational cohort study. J Foot Ankle Res 2015; 8:53. [PMID: 26388946 PMCID: PMC4575467 DOI: 10.1186/s13047-015-0110-9] [Citation(s) in RCA: 9] [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: 01/21/2015] [Accepted: 09/10/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Adults with end-stage renal disease treated with dialysis experience a high burden of foot ulceration and lower extremity amputation. However, the risk factors for foot ulceration in the dialysis population are incompletely understood due to the lack of high-quality prospective evidence. This article outlines the design of a prospective observational cohort study, which aims to investigate the risk factors for foot ulceration in adults on dialysis. METHODS/DESIGN This study will recruit 430 participants with end-stage renal disease on dialysis from satellite and home-therapy dialysis units across multiple health organisations in Melbourne, Victoria, Australia. Data collection at baseline will include a participant interview, medical record review, completion of a health-status questionnaire and a non-invasive foot assessment. Twenty participants will also be recruited to a reliability study to evaluate the reproducibility of testing procedures. Primary outcome data includes: new foot ulcer(s). Secondary outcome data includes: number of new foot ulcers, time to onset of new foot ulcer(s), new lower extremity amputation(s), episodes of infection of the foot or lower extremity, episodes of osteomyelitis, foot-related hospitalisations, revascularisation procedure(s) of the lower extremity, new podiatry interventions, kidney transplantation, and mortality. Participants will be assessed at baseline, and at 12 months they will be evaluated for the primary and secondary outcomes. Multivariate Cox proportional hazards models will be used to assess predictors of new foot ulceration and time to event secondary outcomes. Logistic regression will be used for binary outcomes including prevalence of foot ulcerations. DISCUSSION This is the first multi-centre prospective observational cohort study to investigate risk factors for foot ulceration in adults with end-stage renal disease on dialysis. This study will improve on prior studies by using prospective methods, multi-centre recruitment, statistical methods to control for confounding variables, and a pre-specified sample size estimation. The findings can inform the design of future trials evaluating the effectiveness of clinical interventions, which may lead to improved patient outcomes in the dialysis setting.
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Affiliation(s)
- Michelle R Kaminski
- Discipline of Podiatry and Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Melbourne, VIC 3086 Australia ; Department of Podiatry, Eastern Health, Melbourne, VIC 3156 Australia
| | - Anita Raspovic
- Discipline of Podiatry and Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Melbourne, VIC 3086 Australia
| | - Lawrence P McMahon
- Departments of Renal Medicine and Obstetric Medicine, Eastern Health Clinical School, Monash University, Melbourne, VIC 3128 Australia
| | - Bircan Erbas
- Department of Public Health, College of Science, Health and Engineering, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086 Australia
| | - Karl B Landorf
- Discipline of Podiatry and Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Melbourne, VIC 3086 Australia
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Jia Y, Tong Y, Min L. Significance of functional GRP78 polymorphisms in predicting the onset of type 2 diabetic peripheral neuropathy in Chinese population. Neurol Res 2015; 37:683-7. [PMID: 26005757 DOI: 10.1179/1743132815y.0000000054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The objective of this study is to investigate the significance of functional GRP78 polymorphisms in predicting the risk of type 2 diabetic peripheral neuropathy in Chinese population. METHODS Between the years of 2006 and 2010, a total of 295 definitely diagnosed type 2 diabetes mellitus (T2DM) patients were included into our study cohort and followed for 3 years. At baseline and annual re-examinations, the patients underwent physical examinations, laboratory tests and evaluation of Michigan diabetic neuropathy score (MDNS). Age, gender, disease course, waist-hip circumference ratio (WHR), body mass index (BMI), triglycerine (TG), total cholesterol (Tch), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), glycosylated haemoglobin (HbA1c), uric acid elimination rate (UAER) and uric acid (UA) were recorded and GRP78 polymorphisms were tested by direct sequencing. The prognostic significance of GRP78 polymorphisms were analysed using monovariate and multivariate logistic regression. RESULTS Three years after baseline, 32.9% (97/295) of the T2DM patients had suffered the development of diabetic peripheral neuropathy and GRP78 rs391957 promoter polymorphism is a significant risk factor for the onset of type 2 diabetic peripheral neuropathy. In monovariate regression model, the OR values of GRP78 rs391957 promoter polymorphism were 2.233 (C/T) and 2.734 (T/T). As for the model calibrated with demographic and laboratory indexes, the OR values were, respectively, 2.124 (C/T) and 2.423 (T/T). CONCLUSION Our study suggested that the GRP78 rs391957 promoter polymorphism is a potential risk factor for type 2 diabetic peripheral neuropathy.
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Prevention of lower-limb lesions and reduction of morbidity in diabetic patients. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2014; 49:482-7. [PMID: 26229849 PMCID: PMC4487491 DOI: 10.1016/j.rboe.2014.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/23/2013] [Indexed: 11/22/2022]
Abstract
Objective Methods Results Conclusions
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do Amaral Júnior AH, do Amaral LAH, Bastos MG, do Nascimento LC, Alves MJM, de Andrade MAP. Prevenção de lesões de membros inferiores e redução da morbidade em pacientes diabéticos. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Xiao W, Huang Y, Dong J, Zhang X, Hu J. Relationship between platelet volume indices with macrovascular and peripheral neuropathy complications in type 2 diabetic patients. J Diabetes 2014; 6:298-303. [PMID: 24171761 DOI: 10.1111/1753-0407.12104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 10/21/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The relationship of platelet volume indices including mean platelet volume (MPV) and platelet distribution width (PDW) with carotid intima-media thickness (IMT) as well as vibration perception threshold (VPT) was investigated in type 2 diabetic patients. METHODS A total of 500 type 2 diabetic patients (298 male, 202 female) were enrolled. Clinical and laboratory data were collected from hospital records. RESULTS Both MPV and PDW were significantly associated with carotid IMT, after adjustment for confounding factors including age, systolic blood pressure, total cholesterol and creatinine (0.833 ± 0.029 mm vs. 0.955 ± 0.030 mm; 0.839 ± 0.029 mm vs. 0.955 ± 0.030 mm; P = 0.0015 and P = 0.022, respectively). Agreed with carotid IMT analysis results, significant association was found between PDW and VPT as tertiles (15.760 ± 1.091V vs 20.187 ± 1.094V, P = 0.016). In multivariable analysis, both MPV and PDW were significantly associated with VPT (P = 0.021 and P = 0.007, respectively). However, only PDW, but not MPV, was significantly associated with carotid IMT (P = 0.002). CONCLUSIONS These findings implied the predictive value of platelets volume indices in vascular and peripheral neuropathy complications in type 2 diabetes.
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Affiliation(s)
- Wenjin Xiao
- Department of Endocrinology, the Second Affiliated Hospital of Soochow University, Suzhou, China
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Boyd BS, Dilley A. Altered tibial nerve biomechanics in patients with diabetes mellitus. Muscle Nerve 2014; 50:216-23. [PMID: 24375463 DOI: 10.1002/mus.24155] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 12/17/2013] [Accepted: 12/23/2013] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Hyperglycemia associated with diabetes mellitus (DM) has adverse impacts on peripheral nerve connective tissue structure, and there is preliminary evidence that nerve biomechanics may be altered. METHODS Ultrasound imaging was utilized to quantify the magnitude and timing of tibial nerve excursion during ankle dorsiflexion in patients with DM and matched healthy controls. RESULTS Tibial nerve longitudinal excursion at the ankle and knee was reduced, and timing was delayed at the ankle in the DM group. Severity of neuropathy was correlated with larger reductions in longitudinal excursion. Nerve cross-sectional area was increased at the ankle in the DM group. CONCLUSIONS Larger tibial nerve size within the tarsal tunnel in patients with DM may restrict longitudinal excursion, which was most evident with more severe neuropathy. It is hypothesized that these alterations may be related to painful symptoms during functional activities that utilize similar physiological motions through various biomechanical and physiological mechanisms.
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Affiliation(s)
- Benjamin S Boyd
- Department of Physical Therapy, Samuel Merritt University, 450 30th Street, Oakland, California, 94609, USA
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Garrow AP, Xing M, Vere J, Verrall B, Wang L, Jude EB. Role of acupuncture in the management of diabetic painful neuropathy (DPN): a pilot RCT. Acupunct Med 2014; 32:242-9. [PMID: 24657491 DOI: 10.1136/acupmed-2013-010495] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To examine the role of acupuncture in the treatment of diabetic painful neuropathy (DPN) using a single-blind, placebo-controlled RCT and to collect data that would be required in a future definitive study of the efficacy of acupuncture in DPN. METHODS 45 patients were allocated to receive a 10-week course either of real (53%) or sham (47%) acupuncture. Five standardised acupuncture points on the lower limb of each leg were used in the study: LR3, KI3, SP6, SP10 and ST36. Outcome measures included the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, lower limb pain (Visual Analogue Scale, VAS); Sleep Problem Scale (SPS); Measure Yourself Medical Outcome Profile (MYMOP); 36-item Short Form 36 Health Survey and resting blood pressure (BP). RESULTS Over the 10-week treatment period, small improvements were seen in VAS -15 (-26 to -3.5), MYMOP -0.89 (-1.4 to -0.3), SPS -2.5 (-4.2 to -0.82) and resting diastolic BP -5.2 (-10.4 to -0.14) in the true acupuncture group. In contrast, there was little change in those receiving sham acupuncture. A moderate treatment effect in favour of active acupuncture was detected in MYMOP scores -0.66 (-0.96 to -0.35) but non-significant effect sizes in LANSS Pain Scale -0.37 (-2.2 to 1.4), resting diastolic BP -0.50 (-3.0 to 1.99) and the SPS -0.51 (-2.2 to 1.16). CONCLUSIONS We have demonstrated the practicality and feasibility of acupuncture as an additional treatment for people with DPN. The treatment was well tolerated with no appreciable side effects. Larger randomised trials are needed to confirm the clinical and cost-effectiveness of acupuncture in the treatment of DPN. TRIAL REGISTRATION NUMBER ISRCTN number: 39740785.
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Affiliation(s)
- Adam P Garrow
- Tameside Hospital NHS Foundation Trust, Diabetes Centre, Tameside General Hospital, Ashton-Under-Lyne, Greater Manchester, UK The University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, Greater Manchester, UK
| | - Mei Xing
- Tameside Hospital NHS Foundation Trust, Diabetes Centre, Tameside General Hospital, Ashton-Under-Lyne, Greater Manchester, UK The University of Salford, School of Health Sciences, Salford, UK
| | - Joanne Vere
- Tameside Hospital NHS Foundation Trust, Diabetes Centre, Tameside General Hospital, Ashton-Under-Lyne, Greater Manchester, UK
| | - Barbara Verrall
- Tameside Hospital NHS Foundation Trust, Diabetes Centre, Tameside General Hospital, Ashton-Under-Lyne, Greater Manchester, UK
| | - LiFen Wang
- Tameside Hospital NHS Foundation Trust, Diabetes Centre, Tameside General Hospital, Ashton-Under-Lyne, Greater Manchester, UK Christie Hospital NHS Trust, Manchester, Greater Manchester, UK
| | - Edward B Jude
- Tameside Hospital NHS Foundation Trust, Diabetes Centre, Tameside General Hospital, Ashton-Under-Lyne, Greater Manchester, UK School of Clinical and Laboratory Sciences, The University of Manchester, Manchester, Greater Manchester, UK
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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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Hurley L, Kelly L, Garrow AP, Glynn LG, McIntosh C, Alvarez-Iglesias A, Avalos G, Dinneen SF. A prospective study of risk factors for foot ulceration: the West of Ireland Diabetes Foot Study. QJM 2013; 106:1103-10. [PMID: 24072752 DOI: 10.1093/qjmed/hct182] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND This is the first study to examine risk factors for diabetic foot ulceration in Irish general practice. AIM To determine the prevalence of established risk factors for foot ulceration in a community-based cohort, and to explore the potential for estimated glomerular filtration rate (eGFR) to act as a novel risk factor. DESIGN A prospective observational study. METHODS Patients with diabetes attending 12 (of 17) invited general practices were invited for foot screening. Validated clinical tests were carried out at baseline to assess for vascular and sensory impairment and foot deformity. Ulcer incidence was ascertained by patient self-report and medical record. Patients were re-assessed 18 months later. RESULTS Of 828 invitees, 563 (68%) attended screening. On examination 23-25% had sensory dysfunction and 18-39% had evidence of vascular impairment. Using the Scottish Intercollegiate Guidelines Network risk stratification system we found the proportion at moderate and high risk of future ulceration to be 25% and 11%, respectively. At follow-up 16/383 patients (4.2%) developed a new foot ulcer (annual incidence rate of 2.6%). We observed an increasing probability of abnormal vascular and sensory test results (pedal pulse palpation, doppler waveform assessment, 10 g monofilament, vibration perception and neuropathy disability score) with declining eGFR levels. We were unable to show an independent association between new ulceration and reduced eGFR [Odds ratio 1.01; P = 0.64]. CONCLUSION Our data show the extent of foot complications in a representative sample of diabetes patients in Ireland. Use of eGFR did not improve identification of patients at risk of foot ulceration.
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Affiliation(s)
- L Hurley
- Diabetes Centre, University Hospital Galway, Newcastle Road, Galway.
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