1
|
Çakici R, Saldiran TÇ, Kara İ, Açik H. Plantar fascia stiffness in patients with type 2 diabetes mellitus: Stiffness effect on fall risk and gait speed. Foot (Edinb) 2023; 56:102020. [PMID: 36990015 DOI: 10.1016/j.foot.2023.102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023]
Abstract
AIMS The primary objective was to compare patients with type 2 diabetes mellitus (T2DM) and healthy peers in terms of plantar fascia (PF) stiffness, fall risk, and gait speed. The second objective was to examine the relationship between stiffness of PF and fall risk, gait speed. METHODS Fifty patients diagnosed with T2DM (mean duration = 10.74 ± 7.07 years) were included. Myotonometer was used to evaluate the stiffness of PF. To assess the risk of falling, and gait speed, the International Fall Efficiency Scale (FES-I) and the 4-Meter Gait Speed Test (4mGST) were used, respectively. RESULTS Compared to healthy controls, PF stiffness (right foot mean difference = 148.99 N/m, left foot mean difference = 113.13 N/m p < .001) was higher in the T2DM group. The FES-I and 4mGST scores were worse in the group with T2DM (p < .05). 12.8 % of FES-I and 23.4 % of 4mGST variance were explained by stiffness of PF. CONCLUSIONS The results of the study showed that the stiffness of PF changed in patients with T2DM. There was a decrease in gait speed and an increase in the risk of falling as PF stiffness increased.
Collapse
Affiliation(s)
- Rumeysa Çakici
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul Okan University, Istanbul, Turkey
| | - Tülay Çevik Saldiran
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bitlis Eren University, Bitlis, Turkey.
| | - İlke Kara
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bitlis Eren University, Bitlis, Turkey; Department of Physical Therapy and Rehabilitation, Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Hasan Açik
- Department of Internal Medicine, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| |
Collapse
|
2
|
Chen T, Xing X, Huang L, Tu M, Lai X, Wen S, Cai J, Lin S, Zheng Y, Lin Y, Xu L, Qiu Y, Qiu L, Xu Y, Wu P. Efficacy and safety of high-dose intramuscular vitamin D 2 injection in type 2 diabetes mellitus with distal symmetric polyneuropathy combined with vitamin D insufficiency: study protocol for a multicenter, randomized, double-blinded, and placebo-controlled trial. Front Endocrinol (Lausanne) 2023; 14:1202917. [PMID: 37484958 PMCID: PMC10361572 DOI: 10.3389/fendo.2023.1202917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background Distal symmetric polyneuropathy (DSPN) is the most common chronic complication of type 2 diabetes mellitus (T2DM). DSPN may lead to more serious complications, such as diabetic foot ulcer, amputation, and reduced life expectancy. Observational studies have suggested that vitamin D deficiency may be associated with the development of DSPN in T2DM. However, interventional studies have found that low-dose vitamin D supplementation does not significantly improve neuropathy in DSPN. This study aims to evaluate the efficacy and safety of intramuscular injection of high-dose vitamin D (HDVD) in T2DM with DSPN combined with vitamin D insufficiency. Methods and analysis We will conduct a multicenter, randomized, double-blinded, and placebo-controlled trial in four large hospitals. All eligible participants will be randomly assigned to either the vitamin D2 supplement or placebo control group and injected intramuscularly monthly for 3 months. Additionally, anthropometric measurements and clinical data will be collected at baseline and 3 months. Adverse events will be collected at 1, 2, and 3 months. The primary outcome measure is the change in the mean Michigan Neuropathy Screening Instrument (MNSI) score at baseline and 3 months post-intervention. We will use the gold-standard liquid chromatography-tandem mass spectrometry method to distinguish between 25(OH)D2 and 25(OH)D3 levels. The MNSN score before the intervention will be used as a covariate to compare the changes between both groups before and after the intervention, and the analysis of covariance will be used to analyze the change in the MNSI score after HDVD supplementation. Discussion Glycemic control alone does not prevent the progression of DSPN in T2DM. Some studies have suggested that vitamin D may improve DSPN; however, the exact dose, method, and duration of vitamin D supplementation are unknown. Additionally, neuropathy repair requires HDVD supplementation to sustain adequate vitamin D levels. This once-a-month intramuscular method avoids daily medication; therefore, compliance is high. This study will be the first randomized controlled trial in China to analyze the efficacy and safety of HDVD supplementation for patients with T2DM and DSPN and will provide new ideas for pharmacological research and clinical treatment of diabetic neuropathy. Clinical trial registration https://www.chictr.org.cn/, identifier ChiCTR2200062266.
Collapse
Affiliation(s)
- Tao Chen
- Department of Endocrinology, Clinical Research Center for Metabolic Diseases of Fujian Province, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Endocrinology and Metabolism, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Xiaoyan Xing
- Department of Endocrinology and Metabolism, China-Japan Friendship Hospital, Beijing, China
| | - Lihua Huang
- Department of Tumor Radiotherapy, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Mei Tu
- Department of Endocrinology and Metabolism, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Xiaoli Lai
- Department of Endocrinology and Metabolism, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Shidi Wen
- Department of Endocrinology and Metabolism, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Jin Cai
- Department of Endocrinology and Metabolism, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Shenglong Lin
- Department of Severe Liver Disease, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Youping Zheng
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Yuehui Lin
- Department of Endocrinology and Metabolism, Longyan Traditional Chinese Medicine Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Longyan, China
| | - Lijuan Xu
- Department of Endocrinology and Metabolism, Longyan Traditional Chinese Medicine Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Longyan, China
| | - Yuwen Qiu
- Department of Endocrinology and Metabolism, Longyan Shanghang County Hospital, Longyan, China
| | - Lumin Qiu
- Department of Endocrinology and Metabolism, Longyan Shanghang County Hospital, Longyan, China
| | - Yuebo Xu
- Department of Diabetes, Longyan Boai Hospital, Longyan, China
| | - Peiwen Wu
- Department of Endocrinology, Clinical Research Center for Metabolic Diseases of Fujian Province, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| |
Collapse
|
3
|
Sutkowska E, Marciniak D, Koszewicz M, Dziadkowiak E, Budrewicz S, Biernat K, Kuciel N, Mazurek J, Hap K. Validity and reliability of the Polish version of the Michigan Neuropathy Screening Instrument. World J Diabetes 2023; 14:435-446. [PMID: 37122429 PMCID: PMC10130898 DOI: 10.4239/wjd.v14.i4.435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/11/2022] [Accepted: 01/10/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation. Thus, patients with diabetes should be screened for this disorder according to local guidelines. An obstacle to the diagnosis of this disease may be the lack of unified diagnostic criteria due to the lack of properly validated scales used for assessment.
AIM To validate both sections (A and B) of the Michigan Neuropathy Screening Instrument (MNSI) in Polish (PL) patients with diabetes.
METHODS A cross-sectional study using a test (A1, B1) and re-test (A2, B2) formula was performed in 80 patients with diabetes. The gold standard used for neuropathy detection was a nerve conduction study (NCS) which was performed in all participants. Reliability of the MNSI-PL was assessed using the Cronbach’s alpha, Kuder-Richardson formula 20 (KR-20), split-half reliability, the Gottman split-half tests, and correlation between first and second half was accessed. Stability was assessed using an intraclass correlation coefficient (ICC). For external validation, we used simple linear correlation, binomial regression, and agreement between two different tools using a Bland-Altman plot analysis.
RESULTS The scale was internally consistent (Cronbach’s alpha for the full scale: 0.81 for A and 0.87 for B). MNSI-PL scores in test/retest showed high stability (ICC = 0.73 for A and ICC = 0.97 for B). The statistically important correlations between MNSI-PL and NCS were found for B1, B2, and A1 (P < 0.005). The cut-off points of ≥ 3 for section A (sensitivity of 90%-100%; specificity of 33%-40%) and ≥ 2 for section B (sensitivity of 81%-84%; specificity of 60%-70%) were obtained during neuropathy detection.
CONCLUSION The MNSI-PL is a reliable and valid instrument in screening for diabetic neuropathy.
Collapse
Affiliation(s)
- Edyta Sutkowska
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Dominik Marciniak
- Department of Drugs Form Technology, Wroclaw Medical University, Wroclaw 50-556, Poland
| | | | - Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Karolina Biernat
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Natalia Kuciel
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Justyna Mazurek
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Katarzyna Hap
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
| |
Collapse
|
4
|
Viswanathan V, Ahmed Khan B, Nachimuthu S, Kumpatla S. Precision of Michigan Neuropathy Screening Instrument (MNSI) Tool for the Diagnosis of Diabetic Peripheral Neuropathy Among People with Type 2 Diabetes-A Study from South India. INT J LOW EXTR WOUND 2023:15347346231163209. [PMID: 36924005 DOI: 10.1177/15347346231163209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Diabetic peripheral neuropathy (DPN) is one of the risk factors for foot-related complications among people with type 2 diabetes mellitus (T2DM). Hence, we aimed to validate the Michigan Neuropathy Screening Instrument (MNSI) tool against biothesiometer with a cut-off value of ≥25 V and also to determine the cut-off point of MNSI score for the diagnosis of diabetic neuropathy among people with T2DM in India. A cross-sectional study was conducted among 357 people with T2DM in a tertiary care centre for diabetes in Chennai, South India. The eligible study participants underwent testing with a biothesiometer and the MNSI tool was administered. The patient version tool of MNSI was translated to the local language, Tamil. The MNSI scores (1, 1.5, 2, and 2.5) were compared with biothesiometer value. For the MNSI scores of less than 1, 1.5, 2, and 2.5, sensitivities were 97.6%, 97.6%, 96.8%, and 77.8% and specificities were 76.6%, 77.9%, 85.7%, and 88.3% respectively. The cut-off value of MNSI score was derived as two with AUC of 0.934. The sensitivity was 96.8% and the specificity was 85.7% with 89.6% accuracy. The high sensitivity indicates the positive cases are diagnosed correctly. There is no validated tool available for detection of DPN in Indian population. The Indian version of MNSI tool was found to be effective for screening diabetic neuropathy among people with T2DM. The MNSI tool was found to be reliable, convenient, and non-invasive for diagnosis of DPN and can be used in routine clinical settings.
Collapse
Affiliation(s)
- Vijay Viswanathan
- 58896MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Chennai, India
| | - Balkhiwala Ahmed Khan
- 58896MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Chennai, India
| | - Sukanya Nachimuthu
- Department of Epidemiology, 58896Prof M Viswanathan Diabetes Research Centre, Chennai, India
| | - Satyavani Kumpatla
- 58896MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Chennai, India
| |
Collapse
|
5
|
Abuzinadah AR, Alkully HS, Alanazy MH, Alrawaili MS, Milyani HA, AlAmri B, AlShareef AA, Bamaga AK. Translation, validation, and diagnostic accuracy of the Arabic version of the Michigan neuropathy screening instrument. Medicine (Baltimore) 2021; 100:e27627. [PMID: 34871227 PMCID: PMC8568465 DOI: 10.1097/md.0000000000027627] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/07/2021] [Indexed: 01/05/2023] Open
Abstract
The Michigan Neuropathy Screening Instrument (MNSI) is used to screen patients for diabetic neuropathy (DNP). We aimed to translate the MNSI questionnaire into Arabic (MNSIq-Ar) and to assess the validity and diagnostic performance of the MNSI Arabic version (MNSI-Ar).Cronbach alpha α and the interclass correlation coefficient were used to measure the reliability and reproducibility of the MNSIq-Ar. The instrument's validity was assessed by Spearman correlation with the Utah Early Neuropathy Scale (UENS), the Modified Toronto Neuropathy Score (mTCNS), diabetic neuropathy symptoms (DNS), and sural nerve amplitude (SNA). The construct validity of the MNSI-Ar was assessed by its ability to differentiate the severity of DNP (using the Kruskal-Wallis test). The diagnostic performance was assessed through the receiver operator curve area.We recruited 89 participants (mean [SD] age, 50.8 [12.3] years; 48% men). The MNSIq-Ar showed an α of 0.81 and intraclass correlation coefficient = 0.94, and the correlation coefficients with UENS, mTCNS, DNS, and sural nerve amplitude were 0.67, 0.83, 0.73, and -0.49, respectively (all P < .0001). The MNSI-Ar was able to differentiate the different severities of DNP. The receiver operator curve area was 0.93 with a high sensitivity of 95.9% and 100% for probable and confirmed DNP, respectively.MNSI-Ar is a reliable and valid tool to screen for diabetic neuropathy in the Arabic language with a good diagnostic performance and high sensitivity.
Collapse
Affiliation(s)
- Ahmad R. Abuzinadah
- King Abdulaziz University, Faculty of Medicine and King Abdulaziz University Hospital, Internal Medicine Department, Neurology Division, Neuroscience Unit, Jeddah, Saudi Arabia
- King Abdulaziz University, King Fahad Medical Research Center and King Abdulaziz University Hospital, Neuromuscular Medicine Unit, Jeddah, Saudi Arabia
| | - Hussien S. Alkully
- King Abdulaziz University, King Abdulaziz University Hospital, Internal Medicine Department, Neurology Division, Jeddah, Saudi Arabia
| | - Mohammed H. Alanazy
- Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Moafaq S. Alrawaili
- King Abdulaziz University, King Abdulaziz University Hospital, Internal Medicine Department, Neurology Division, Jeddah, Saudi Arabia
| | - Haneen A. Milyani
- King Abdulaziz University, King Abdulaziz University Hospital, Internal Medicine Department, Neurology Division, Jeddah, Saudi Arabia
| | - Bashayr AlAmri
- King Abdulaziz University, King Abdulaziz University Hospital, Internal Medicine Department, Neurology Division, Jeddah, Saudi Arabia
| | - Aysha A. AlShareef
- King Abdulaziz University, Faculty of Medicine and King Abdulaziz University Hospital, Internal Medicine Department, Neurology Division, Neuroscience Unit, Jeddah, Saudi Arabia
- King Abdulaziz University, King Fahad Medical Research Center and King Abdulaziz University Hospital, Neuromuscular Medicine Unit, Jeddah, Saudi Arabia
| | - Ahmed K. Bamaga
- King Abdulaziz University, Faculty of Medicine and King Abdulaziz University Hospital, Pediatric Department, Pediatric Neurology Division, Jeddah, Saudi Arabia
| |
Collapse
|