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Bhilare KD, Dobariya P, Hanak F, Rothwell PE, More SS. Current understanding of the link between angiotensin-converting enzyme and pain perception. Drug Discov Today 2024; 29:104089. [PMID: 38977123 PMCID: PMC11368640 DOI: 10.1016/j.drudis.2024.104089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/27/2024] [Accepted: 07/03/2024] [Indexed: 07/10/2024]
Abstract
The renin-angiotensin system (RAS) is known to affect diverse physiological processes that affect the functioning of many key organs. Angiotensin-converting enzyme (ACE) modulates a variety of bioactive peptides associated with pain. ACE inhibitors (ACEis) have found applications in the treatment of cardiovascular, kidney, neurological and metabolic disorders. However, ACEis also tend to display undesirable effects, resulting in increased pain sensitization and mechanical allodynia. In this review, we provide comprehensive discussion of preclinical and clinical studies involving the evaluation of various clinically approved ACEis. With the emerging knowledge of additional factors involved in RAS signaling and the indistinct pharmacological role of ACE substrates in pain, extensive studies are still required to elucidate the mechanistic role of ACE in pain perception.
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Affiliation(s)
- Kiran D Bhilare
- Center for Drug Design, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Prakashkumar Dobariya
- Center for Drug Design, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Filip Hanak
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Patrick E Rothwell
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Swati S More
- Center for Drug Design, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA.
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2
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Wang Z, Zhang L, Lu B, Sun H, Zhong S. Causal relationships between circulating inflammatory cytokines and diabetic neuropathy: A Mendelian Randomization study. Cytokine 2024; 177:156548. [PMID: 38395012 DOI: 10.1016/j.cyto.2024.156548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/11/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Emerging evidence suggests systemic inflammation as a critical mechanism underlying diabetic neuropathy. This study aimed to investigate the causal relationship between 41 circulating inflammatory cytokines and diabetic neuropathy. METHODS Summary statistics from previous Genome-Wide Association studies (GWAS) included pooled data on 41 inflammatory cytokines and diabetic neuropathy. A two-sample Mendelian Randomization (MR) design was employed, and the robustness of the results was confirmed through comprehensive sensitivity analyses. RESULTS Our study reveals that the linkage between increased levels of IFN_G (OR = 1.31, 95 %CI: 1.06-1.63; P = 0.014), IP_10 (OR = 1.18, 95 %CI: 1.01-1.36; P = 0.031) and an elevated risk of diabetic neuropathy. Conversely, higher levels of IL_9 (OR = 0.86, 95 %CI: 0.75-1.00; P = 0.048) and SCF (OR = 0.83, 95 %CI: 0.73-0.94; P = 0.003) are genetically determined to protect against diabetic neuropathy. Furthermore, the sensitivity analysis affirmed the results' dependability, revealing no heterogeneity or pleiotropy. CONCLUSION Our MR research identified four upstream inflammatory cytokines implicated in diabetic neuropathy. Overall, these findings suggest the potential for innovative therapeutic strategies. Further large-scale cohort studies are required for validation.
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Affiliation(s)
- Zhaoxiang Wang
- Department of Endocrinology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, China
| | - Li Zhang
- Department of Endocrinology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, China
| | - Bing Lu
- Department of Endocrinology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, China
| | - Heping Sun
- Department of Endocrinology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu 215300, China
| | - Shao Zhong
- Department of Clinical Nutrition, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, 215300, China.
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Zhuang R, Xiong Z, Yan S, Zhang H, Dong Q, Liu W, Miao J, Zhuo Y, Fan X, Zhang W, Wang X, Liu L, Cao J, Zhang T, Hao C, Huang X, Jiang L. Efficacy of electro-acupuncture versus sham acupuncture for diabetic peripheral neuropathy: study protocol for a three-armed randomised controlled trial. BMJ Open 2024; 14:e079354. [PMID: 38569706 PMCID: PMC10989182 DOI: 10.1136/bmjopen-2023-079354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Specific treatment for diabetic peripheral neuropathy (DPN) is still lacking, and acupuncture may relieve the symptoms. We intend to investigate the efficacy and safety of electro-acupuncture (EA) in alleviating symptoms associated with DPN in diabetes. METHODS AND ANALYSIS This multicentre, three-armed, participant- and assessor-blind, randomised, sham-controlled trial will recruit 240 eligible participants from four hospitals in China and will randomly assign (1:1:1) them to EA, sham acupuncture (SA) or usual care (UC) group. Participants in the EA and SA groups willl receive either 24-session EA or SA treatment over 8 weeks, followed by an 8-week follow-up period, while participants in the UC group will be followed up for 16 weeks. The primary outcome of this trial is the change in DPN symptoms from baseline to week 8, as rated by using the Total Symptom Score. The scale assesses four symptoms: pain, burning, paraesthesia and numbness, by evaluating the frequency and severity of each. All results will be analysed with the intention-to-treat population. ETHICS AND DISSEMINATION The protocol has been approved by the Ethics Committee of the Beijing University of Chinese Medicine (Identifier: 2022BZYLL0509). Every participant will be informed of detailed information about the study before signing informed consent. The results of this trial will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ChiCTR2200061408.
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Affiliation(s)
- Rong Zhuang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiyi Xiong
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Shiyan Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Haoran Zhang
- College of Preschool Education, Beijing Youth Politics College, Beijing, China
| | - Qi Dong
- Department of Metabolic Diseases, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Weiai Liu
- Department of Acupuncture and Massage Rehabilitation, The Second Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Jinling Miao
- Acupuncture and Moxibustion Department, Shanxi Provincial Acupuncture and Moxibustion Hospital, Taiyuan, Shanxi, China
| | - Yuanyuan Zhuo
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong, China
| | - Xiaohong Fan
- Department of Metabolic Diseases, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Weiliang Zhang
- Department of Metabolic Diseases, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Xiaomei Wang
- Department of Metabolic Diseases, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Lian Liu
- Department of Acupuncture and Massage Rehabilitation, The Second Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Jianan Cao
- Department of Acupuncture and Massage Rehabilitation, The Second Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Tiansheng Zhang
- Acupuncture and Moxibustion Department, Shanxi Provincial Acupuncture and Moxibustion Hospital, Taiyuan, Shanxi, China
| | - Chongyao Hao
- Acupuncture and Moxibustion Department, Shanxi Provincial Acupuncture and Moxibustion Hospital, Taiyuan, Shanxi, China
| | - Xingxian Huang
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong, China
| | - Lijiao Jiang
- The fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
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Aziz N, Dash B, Wal P, Kumari P, Joshi P, Wal A. New Horizons in Diabetic Neuropathies: An Updated Review on their Pathology, Diagnosis, Mechanism, Screening Techniques, Pharmacological, and Future Approaches. Curr Diabetes Rev 2024; 20:e201023222416. [PMID: 37867268 DOI: 10.2174/0115733998242299231011181615] [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: 02/27/2023] [Revised: 07/16/2023] [Accepted: 08/25/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND One of the largest problems for global public health is diabetes mellitus (DM) and its micro and macrovascular consequences. Although prevention, diagnosis, and treatment have generally improved, its incidence is predicted to keep rising over the coming years. Due to the intricacy of the molecular mechanisms, which include inflammation, oxidative stress, and angiogenesis, among others, discovering treatments to stop or slow the course of diabetic complications is still a current unmet need. METHODS The pathogenesis and development of diabetic neuropathies may be explained by a wide variety of molecular pathways, hexosamine pathways, such as MAPK pathway, PARP pathway, oxidative stress pathway polyol (sorbitol) pathway, cyclooxygenase pathway, and lipoxygenase pathway. Although diabetic neuropathies can be treated symptomatically, there are limited options for treating the underlying cause. RESULT Various pathways and screening models involved in diabetic neuropathies are discussed, along with their possible outcomes. Moreover, both medicinal and non-medical approaches to therapy are also explored. CONCLUSION This study highlights the probable involvement of several processes and pathways in the establishment of diabetic neuropathies and presents in-depth knowledge of new therapeutic approaches intended to stop, delay, or reverse different types of diabetic complications.
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Affiliation(s)
- Namra Aziz
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur 209305, UP, India
| | - Biswajit Dash
- Department of Pharmaceutical Technology, School of Medical Sciences, ADAMAS University, Kolkata 700 126, West Bengal, India
| | - Pranay Wal
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur 209305, UP, India
| | - Prachi Kumari
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur 209305, UP, India
| | - Poonam Joshi
- Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun 248007, Uttarakhand, India
| | - Ankita Wal
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur 209305, UP, India
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Jatuten N, Piyakunmala P, Budkaew J, Chumworathayi B. Effect of topical Zingiber cassumunar on painful diabetic neuropathy: a double-blind randomized-controlled trial. F1000Res 2023; 12:334. [PMID: 39220605 PMCID: PMC11364968 DOI: 10.12688/f1000research.131344.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 09/04/2024] Open
Abstract
Background Plai or Zingiber cassumunar Roxb. was registered into the Thai Traditional Medicine list since 2011. However, there is limited evidence regarding Plai as a treatment in painful diabetic neuropathy (PDN). Therefore, this study aimed to evaluate the efficacy of topical Zingiber cassumunar. Methods A RCT was conducted in patients with PDN during February to March 2019. All participants received oral gabapentin 300 mg before bed as a standard regimen. The intervention group (n=16) received Plai balm 15%w/w 0.5 gram to apply on their feet three times a day and the control group (n=15) received placebo balm to similarly apply. Pain score at baseline, 2 nd and 4 th weeks were assessed and compared. Patients' quality of life, and adverse events, were collected. Mean pain scores before and after treatment in each group and between groups were also analyzed. Results At the end of week two and week four, the Plai group showed statistically significant lesser mean pain scores than the placebo group by -1.47 (95%CI: -1.96 to -1.30, p-value < 0.001), and by -1.51 (95%CI: -1.92 to -0.13, p-value = 0.027), respectively. Moreover, the Plai group had more cases number/ percentages with at least 50% pain score reduction than the placebo group [12/16 (75%) vs 3/15 (20%), p-value = 0.004]. However, there was no statistically significant difference in quality of life between the two groups (overall p-value = 0.366). Adverse event was not found in any groups. Conclusions Zingiber cassumunar balm (Plai) was efficacious for pain reduction in painful diabetic neuropathy. Registration Registered with the Thai Clinical Trials Registry; TCTR20200221001.
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Affiliation(s)
| | | | - Jiratha Budkaew
- Social Medicine, Khon Kaen Hospital, Muang District, Khon Kaen, 40000, Thailand
| | - Bandit Chumworathayi
- Obstetrics and Gynaecology,, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
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Al Amri A, Alshahrani MAA, Asiri MA, Abdulrahman MA, Alshehri AYA, Alqahtani MMM, Oraydan AAA, Summan SI, Alqahtani TS, Al Hunaif AM. Prevalence of Sleep Disorders Among Patients With Type 2 Diabetes Mellitus at Primary Healthcare Centers in the South Region of Abha City. Cureus 2023; 15:e44749. [PMID: 37809270 PMCID: PMC10556360 DOI: 10.7759/cureus.44749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background Type 2 diabetes is a chronic condition that affects the way the body processes blood sugar (glucose). This issue is of considerable importance in the field of public health, as it has a global impact on a substantial number of individuals. The primary emphasis in the management of type 2 diabetes is centered around achieving glycemic control, implementing lifestyle adjustments, and employing pharmaceutical therapies as preventive measures or for the purpose of managing problems that may arise as a result of the disease. Aim This research aimed to investigate the prevalence of sleep-belated issues among individuals diagnosed with type 2 diabetes. Methodology A total of 230 participants with type 2 diabetes patients of primary healthcare in Abha city whose age is ≥18 years were included in the study. The data collection process involved the distribution of a self-administered questionnaire that assessed various aspects of sleep disturbances, including difficulties in falling asleep, waking up during the night, excessive daytime sleepiness, and restless legs or leg muscle cramps. The questionnaire also collected demographic information and data on potential risk factors such as alcohol consumption, caffeine consumption, and smoking/tobacco product use. Data analysis was conducted using chi-square tests and significance levels were set at p < 0.05. Results The findings revealed a prevalence of sleep disturbances among individuals with type 2 diabetes. Difficulties in falling asleep and waking up during the night were reported by a substantial proportion of participants, and a notable number experienced excessive daytime sleepiness. Restless legs or leg muscle cramps that interrupted sleep were experienced occasionally by 16.5% and frequently by 8.7% of the participants. The study also found a significant association between the presence of sleep problems and lower sleep quality ratings. However, no significant associations were found between sleep disturbances and the duration of type 2 diabetes or the examined risk factors. Conclusion The findings from this study emphasize the detrimental effects of sleep disturbances on sleep quality and suggest that improving sleep quality can positively influence the overall health and well-being of individuals with type 2 diabetes.
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Affiliation(s)
- Ali Al Amri
- Family Medicine, Asir Central Hospital, Abha, SAU
| | | | - Mousa A Asiri
- Technician Pharmacy, Primary Care Center Al Mansak, Abha, SAU
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Hazari A, Mishra V, Agouris I. Clinical evaluation of painful diabetes peripheral neuropathy in type 2 diabetes patients: Lessons from expatriates in the United Arab Emirates. Diabetes Metab Syndr 2023; 17:102832. [PMID: 37506409 DOI: 10.1016/j.dsx.2023.102832] [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: 03/08/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The high prevalence of Type 2 Diabetes (T2D) in the United Arab Emirates makes it imperative to screen and manage diabetes peripheral neuropathy (DPN) as a priority. Considering the high number of expats from different ethnicity a more thorough approach is necessary. Unfortunately, there are very few studies addressing this issue. METHODS The study uses the chi-square test to investigate the dependence of the progression of DNP on ethnic origin. The study uses Pearson Correlation to find the association between three prevalent scales used for the measurement of painful diabetes peripheral neuropathy. Student t-test was used further to investigate the significance of the association. RESULTS With a p-value (0.004) and p-value (0.015), the study concludes that DPN risk is dependent on the ethnic origin of the residents. The study further found that there is a significant association between three scales for measuring painful diabetes peripheral neuropathy (pDNP), Douleur Neuropathique en 4 questions (DN4), Neurological Symptoms Score (NSS), and Leeds Assessment of Neuropathic Symptoms and Signs (LANNS). The p-value for all pairwise comparisons for the strength of association between scales was found significant at the level of significance 0.05. CONCLUSION The study concludes that the risk of DNP is high in Arab-origin residents in UAE and the reasons behind the finding need to be empirically tested to customize its management. The study further finds a significant association between the score of the three scales used for measuring pDNP.
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Affiliation(s)
- Animesh Hazari
- College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates.
| | - Vinaytosh Mishra
- College of Healthcare Management and Economics, Gulf Medical University, Ajman, United Arab Emirates.
| | - Ioannis Agouris
- School of Engineering, Robert Gordon University, Scotland, United Kingdom.
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Xin L, Zhu Y, Zhao J, Fang Y, Xie J. Association between short-term exposure to extreme humidity and painful diabetic neuropathy: a case-crossover analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:13174-13184. [PMID: 36125681 DOI: 10.1007/s11356-022-23095-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/14/2022] [Indexed: 06/15/2023]
Abstract
Painful diabetic neuropathy (PDN) is a common complication of diabetes mellitus, which reduces the quality of life. However, the association between PDN and environmental factors, especially ambient humidity, remains unclear. Therefore, this study investigated the impact of extreme humidity events on PDN. Data on PDN-related hospital admissions to two tertiary hospitals in Hefei, China (2014-2019) were obtained. A distributed lag non-linear model with a case-crossover design was used to quantitatively estimate the effects of ambient humidity on PDN, and the results were stratified by sex and age. The 1st, 10th, 90th, and 99th percentiles of relative humidity (RHU) were defined as extreme humidity, and the average relative humidity (74.94%) was set as the reference value. Non-linear exposure-response curves between the RHU and PDN cases were obtained. Extreme humidity (92%) had a significant effect on PDN with a relative risk (RR) of 1.13 (95% confidence interval (CI): 1.01-1.26) on a particular day, which increased with the RHU (RR: 1.21, 95% CI: 1.02-1.45 at 98% extreme humidity). Stratification analysis showed that women (RR: 1.38, 95% CI: 1.07-1.77) and patients aged < 65 years (RR: 1.26, 95% CI: 1.01-1.57) were highly susceptible to this effect on the same day. The results suggest that extreme humidity is a crucial trigger for PDN onset in diabetes patients. Furthermore, the effects vary with sex and age. This study provides detailed evidence of the adverse effects of extreme weather on diabetes patients.
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Affiliation(s)
- Ling Xin
- The First Affiliated Hospital of Anhui University of Chinese Medicine, 117 Mei Shan Road, Shushan District, Hefei, 230031, Anhui, People's Republic of China.
| | - Yongjian Zhu
- School of Management, University of Science and Technology of China, 96 Jin Zhai Road, Bao He District, Hefei, 230026, Anhui, People's Republic of China
| | - Jindong Zhao
- The First Affiliated Hospital of Anhui University of Chinese Medicine, 117 Mei Shan Road, Shushan District, Hefei, 230031, Anhui, People's Republic of China
| | - Yanyan Fang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, 117 Mei Shan Road, Shushan District, Hefei, 230031, Anhui, People's Republic of China
| | - Jingui Xie
- School of Management, Technical University of Munich, Bildungscampus 9, 74076, Heilbronn, Germany
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Sahba K, Berk L, Bussell M, Lohman E, Zamora F, Gharibvand L. Treating peripheral neuropathy in individuals with type 2 diabetes mellitus with intraneural facilitation: a single blind randomized control trial. J Int Med Res 2022; 50:3000605221109390. [PMID: 35922961 PMCID: PMC9358562 DOI: 10.1177/03000605221109390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the effectiveness of intraneural facilitation (INF) for the treatment of diabetic peripheral neuropathy (DPN). Methods This single-blind, randomized clinical trial enrolled patients with type 2 diabetes mellitus and moderate-to-severe DPN symptoms below the ankle. Patients were randomly assigned to receive INF or sham treatment. In the INF group, trained INF physical therapists provided therapy for 50–60 min, three times a week for 3 weeks. Sham treatment consisted of patients believing they received anodyne therapy for 3 weeks. Pre- and post-treatment data were compared between the two groups for quality of life, balance, gait, protective sensory function and pain outcome measures. Results A total of 28 patients (17 males) were enrolled in the study (INF group n = 17; sham group n = 11). There was a significant decrease in the overall pain score in both the INF and sham groups over time, but the decrease was greater in the INF group (1.11 versus 0.82). Between-group comparisons demonstrated significant differences in unpleasant pain and protective sensory function. The INF group showed post-treatment improvements in protective sensory function and composite static balance score. Conclusions INF treatment improved pain perception, the composite static balance score and protective sensations in patients with DPN. Research Registry number: CNCT04025320
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Affiliation(s)
- Kyan Sahba
- Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Lee Berk
- Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA.,Department of Pathology and Human Anatomy, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Mark Bussell
- Neuropathic Therapy Center, Loma Linda University Health, Loma Linda, CA, USA
| | - Everett Lohman
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Francis Zamora
- Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Lida Gharibvand
- Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
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Veloso C, Cardoso C, Vitorino C. Topical Fixed-Dose Combinations: A Way of Progress for Pain Management? J Pharm Sci 2021; 110:3345-3361. [PMID: 34102201 DOI: 10.1016/j.xphs.2021.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 12/17/2022]
Abstract
Pain, a severe public health problem, can affect patient quality of life when inadequately controlled. Considering that pain pathophysiological mechanisms are complex, combining active pharmaceutical ingredients (APIs) with multiple and synergistic mechanisms of action represents a potentially more effective therapeutic approach than conventional monotherapy treatments. In turn, topical drug delivery has clear advantages over other routes of administration, such as high levels of efficacy, better safety profile and great patient compliance. In this context, the combination of two or more APIs in a single dosage form - fixed-dose combination product (FDC) - for topical administration may represent a promising therapeutic option in the field of pain management. Considering the above mentioned, the purpose of this manuscript is to address an overview of some general aspects regarding pain management and FDCs, as well as the regulatory environment that has to be taken into consideration during their development. Special emphasis will be given to fixed-dose combinations for topical administration with analgesic and/or anti-inflammatory activity. Market drivers of the topical FDC currently approved are ultimately pointed out, and new opportunities in pain management highlighted.
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Affiliation(s)
- Cláudia Veloso
- Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; Coimbra Chemistry Center, Department of Chemistry, University of Coimbra, Rua Larga, 3004-535 Coimbra, Portugal
| | - Catarina Cardoso
- Laboratórios Basi, Parque Industrial Manuel Lourenço Ferreira, lote 15, 3450-232 Mortágua, Portugal
| | - Carla Vitorino
- Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; Coimbra Chemistry Center, Department of Chemistry, University of Coimbra, Rua Larga, 3004-535 Coimbra, Portugal; Center for Neurosciences and Cell Biology (CNC), University of Coimbra, Rua Larga, Faculty of Medicine, Pólo I, 1st floor, 3004-504 Coimbra, Portugal.
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Hussain N, Said ASA, Javaid FA, Al Haddad AHI, Anwar M, Khan Z, Abu-Mellal A. The efficacy and safety profile of capsaicin 8% patch versus 5% Lidocaine patch in patients with diabetic peripheral neuropathic pain: a randomized, placebo-controlled study of south Asian male patients. J Diabetes Metab Disord 2021; 20:271-278. [PMID: 34178837 DOI: 10.1007/s40200-021-00741-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/11/2021] [Indexed: 02/06/2023]
Abstract
Aims Diabetic peripheral neuropathy affects up to 60% of individuals and often leads to foot ulceration and eventual amputation. When oral therapy has failed to achieve pain relief, the first line local treatment is the 5% lidocaine-medicated plaster which provides local relief. Capsaicin 8% patch is considered a promising topical treatment for diabetic peripheral neuropathy. The present study investigated the efficacy, safety and tolerability of capsaicin 8% patch vs 5% lidocaine patch treatments over 24 weeks in South Asian male diabetic patients with established peripheral diabetic neuropathy. Methods Analgesic effectiveness was assessed by observing any change in the Numeric Pain Rating Scale (NPRS) score, Brief Pain Inventory (BPI) for painful diabetic peripheral neuropathy (BPI-DPN question 4) and Patient Global Impression of Change (PGIC). All patients received 4% lidocaine gel/cream for 60 min prior to patch application. The trial was probably underpowered, taking into account the smaller than expected number of participants from the calculated 350 sample size required for the whole study. Two hundred ninety-one individuals were divided into three groups based on treatment regimen; Group LL (Lidocaine + Lidocaine), Group LP (Lidocaine + Placebo), Group LC (Lidocaine + Capsaicin). The treatment procedure was conducted once initially and then repeated once at 12 weeks. The patients were followed up on alternate weeks till 24 weeks after the initial treatment. Results Group LC experienced a more significant reduction in the average pain intensity (p < 0.05) during the last twenty-four hours. Group LC showed more significant reduction of pain compared to control (p < 0.01), a baseline score of 5.4 ± 1.2 dropped to 3.2 ± 1.5 by week 24 of treatment. The change in mean daily pain intensity was - 2.2 ± 1.5 [95% CI: -2.45, -1.5]. Group LL and LC experienced a significant overall improvement (slightly, much or very much) in the health status during the study. After the second week of the treatment, patient satisfaction scores were 2.1 ± 1.1 in Group LL which increased to 3.2 ± 1.2 by week 24 of treatment. The capsaicin 8% patch appears to be reasonably well tolerated since there were no discontinuations because of serious drug-related treatment emergent adverse event (TEAEs). Conclusions The aim of the present study was to assess the efficacy, safety and tolerability of the 8% capsaicin patch in patients with established painful diabetic neuropathy. There was a sustained treatment response to the initial and repeat treatment of the capsaicin 8% patch over the 24 weeks. The study population was very specific so further studies are required to investigate the generalizability of the results for patients experiencing painful diabetic neuropathy. The patch could be considered as an effective long-term treatment option in individuals with painful diabetic neuropathy, particularly those experiencing inadequate pain relief or side effects from systemic therapies.
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Affiliation(s)
- Nadia Hussain
- Department of Pharmaceutical Sciences, College of Pharmacy, Al Ain University, P.O.Box: 64141, Al Ain, United Arab Emirates
| | - Amira S A Said
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, P.O.Box: 64141, Al Ain, United Arab Emirates
| | - Farideh A Javaid
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HDI3DH UK
| | | | - Mudassir Anwar
- School of Pharmacy, University of Otago, Dunedin, 9054 New Zealand
| | - Zainab Khan
- Department of Internal Medicine, Punjab Care hospital, Lahore, Punjab Pakistan
| | - Abdallah Abu-Mellal
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern territory 0810 Australia
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Prevalence and associated factors of painful diabetic peripheral neuropathy among diabetic patients on follow up at Jimma University Medical Center. J Diabetes Metab Disord 2020; 19:1407-1413. [PMID: 33520843 DOI: 10.1007/s40200-020-00661-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite having significant impact on the patient's quality of life, painful diabetic peripheral neuropathy (PDPN) is usually underdiagnosed. Screening for PDPN in patients with diabetes is needed in order to get timely identification and management. Hence, the purpose of this study was to assess the prevalence and determinants of PDPN among diabetes patients attending outpatient at Jimma University Medical Center from September 1 November 10, 2019. METHODS Hospital based cross-sectional study was conducted and douleur neuropathique-4 was used to identify the presence of PDPN. Data were collected using pretested structured questionnaire and entered into EPI data 3.1 and exported to SPSS version 20 for analysis. Both bivariate and multivariate binary logistic regression was employed to identify factors associated with PDPN. Variable having a p value of <0.25 in the bivariate model were considered as candidates for multivariable regression. Adjusted odds ratios were calculated at 95%CI and considered significant with a p value of <0.05. RESULTS A total of 366 diabetic patients were enrolled into the study and their mean duration of diabetes was 6.8 ± 5.3 years. The study finding showed that the prevalence of PDPN was 14.5%. According to the multivariate logistic regression analysis smoking [current smoker(AOR = 6.17; 95%CI:2.25,16.86),former smoker(AOR = 3.22;95%CI:1.29,8.03)],diabetes duration[5 to 10 years (AOR = 3.32;95%CI:1.29,8.53), ≥ 10 years (AOR = 8.86;95% CI: 3.49,22.5)] and comorbid hypertension [AOR = 2.54; 95%CI:1.17,5.49] were independent predictors of PDPN among study participants. CONCLUSION The overall prevalence of PDPN in this study was 14.5% and it was significantly associated with smoking, comorbid hypertension and diabetes duration of above 5 years. Early detection and appropriate interventions are important for high risk patients identified in the current study.
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Wei W, Zhang Y, Chen R, Qiu X, Gao Y, Chen Q. The efficacy of vitamin D supplementation on painful diabetic neuropathy: Protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20871. [PMID: 32756079 PMCID: PMC7402721 DOI: 10.1097/md.0000000000020871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Painful diabetic neuropathy (PDN) is one of the main and severe complications of diabetic patients, which not only accelerates the occurrence of ulcers of diabetic foot and amputation of lower extremities but also severely affects the quality of life. It is common that vitamin D deficiency in diabetic patients and especially in these patients diagnosed with diabetic peripheral neuropathy. Previous studies have proved that there is an apparent vitamin D deficiency in PDN patients, and vitamin D supplementation can effectively improve patients' pain symptoms and neurologic function. However, the evidence of these studies is unconvincing. Therefore, our research objective is to explore the effectiveness and security of vitamin D supplements on PDN. METHODS We will include randomized controlled trials on vitamin D supplementation in the treatment of PDN. And we will retrieve 8 electronic databases concerning this theme. The English databases mainly retrieve PubMed, Web of Science, Embase, and the Cochrane Library, while CNKI, VIP, CBM, and Wanfang database will be used to retrieve the Chinese Literature. There is no definite time limit for retrieval literatures, and the languages will be limited to Chinese and English. Besides, some clinical registration tests and gray literatures are also researched by us. The primary outcomes of our study are the amelioration of pain symptoms and assessment of peripheral nerve function. And some changes of biochemical indicators including fasting blood glucose, 2 hours postprandial blood glucose, glycosylated hemoglobin, calcium, and serum vitamin D level from preintervention and postintervention, adverse events will be regarded as secondary outcomes. The Review Manager RevMan5.3 will be used for meta-analysis of studies are included. RESULTS In this systematic review and meta-analysis, higher quality data evidence on vitamin D supplementation for PDN will be provided. CONCLUSION Our study will eventually provide a proof of the efficacy and safety of vitamin D supplementation in patients with PDN, and to add a new option for the prevention and treatment of PDN patients. INPLASY REGISTRATION NUMBER INPLASY202050065.
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Affiliation(s)
| | | | | | | | | | - Qiu Chen
- Department of Endocrinology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, P.R. China
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14
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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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Garoushi S, Johnson MI, Tashani OA. A cross-sectional study to estimate the point prevalence of painful diabetic neuropathy in Eastern Libya. BMC Public Health 2019; 19:78. [PMID: 30654784 PMCID: PMC6335782 DOI: 10.1186/s12889-018-6374-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/27/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Painful Diabetic Neuropathy (PDN) is a complication that affects up to one third of people living with diabetes. There is limited data on the prevalence of PDN from countries in the Middle East and North Africa. The aim of this study was to estimate the point prevalence of PDN in adults in Eastern Libya using the self-report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale. METHODS We invited patients attending the Benghazi Diabetes Centre who had diabetes for ≥ 5 years to take part in the study. Patients provided consent and completed the Arabic S-LANSS. Anthropometrics, marital status, socioeconomic and education information was recoded and fasting plasma glucose concentration determined. RESULTS Four hundred and fifty participants completed the study (age = 19 to 87 years, BMI = 17.6 to 44.2 kg/m2, 224 women). One hundred and ninety five participants (43.3%) reported pain in their lower limbs in the previous 6 months and 190/195 participants (97.4%) reported a S-LANSS score of ≥ 12 suggesting they had neuropathic pain characteristics. Thus, 42.2% (190/450) of participants with diabetes were categorised as experiencing pain with neuropathic characteristics. Mean ± SD duration of diabetes for participants with PDN (20.4 ± 6.5 years) was significantly higher compared with those without PDN (11.1 ± 4.6 years). Participants with PDN smoked tobacco for more years than those without pain (7.9 ± 12.3 years versus 1.1 ± 3.9 years respectively); had significantly higher fasting plasma glucose concentration (143.6 ± 29.3 mg/dl versus 120.0 ± 17.3 mg/dl) and had a significantly higher levels of education and employment status. The most significant predictors of PDN were duration of diabetes (OR = 25.85, 95% CI = 13.56-49.31), followed by smoking for men (OR = 8.28, 95% CI = 3.53-9.42), obesity (OR = 3.96, 95% CI = 2.25-6.96) and high fasting plasma glucose concentration (OR = 3.51, 95% CI = 1.99-6.21). CONCLUSION The prevalence of PDN in people with diabetes in Eastern Libya was 42.2%. Risk factors for developing PDN were high fasting plasma glucose concentration, long duration of diabetes, and higher level of educational and employment status.
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Affiliation(s)
- Sabri Garoushi
- Centre for Pain Research, School of Clinical and Applied Sciences, Portland Way, Leeds Beckett University, Leeds, LS1 3HE UK
- MENA Research Group, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
- Faculty of Medicine, University of Benghazi, Benghazi, Libya
| | - Mark I. Johnson
- Centre for Pain Research, School of Clinical and Applied Sciences, Portland Way, Leeds Beckett University, Leeds, LS1 3HE UK
- MENA Research Group, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
| | - Osama A. Tashani
- Centre for Pain Research, School of Clinical and Applied Sciences, Portland Way, Leeds Beckett University, Leeds, LS1 3HE UK
- MENA Research Group, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
- Faculty of Medicine, University of Benghazi, Benghazi, Libya
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Park JH, Kim DS. Response: The Necessity of the Simple Tests for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients without Neuropathic Symptoms in Clinical Practice ( Diabetes Metab J 2018;42:442-6). Diabetes Metab J 2018; 42:546-547. [PMID: 30565444 PMCID: PMC6300441 DOI: 10.4093/dmj.2018.0248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jung Hwan Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Sun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Kulkantrakorn K, Chomjit A, Sithinamsuwan P, Tharavanij T, Suwankanoknark J, Napunnaphat P. 0.075% capsaicin lotion for the treatment of painful diabetic neuropathy: A randomized, double-blind, crossover, placebo-controlled trial. J Clin Neurosci 2018; 62:174-179. [PMID: 30472337 DOI: 10.1016/j.jocn.2018.11.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/11/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE A randomized, double-blinded, crossover, placebo controlled trial was conducted to evaluate the efficacy and safety of 0.075% capsaicin lotion for treating painful diabetic neuropathy (PDN). PATIENTS AND METHODS PDN subjects were randomized to receive 0.075% capsaicin/placebo for 8 weeks, then crossing over to the other treatment after a 4-weeks washout period. Primary endpoint was the change in visual analog scale score of pain severity. Secondary outcomes were score changes in Neuropathic Pain Scale, short-form McGill Pain Questionnaires, and proportions of patients with pain score reductions of 30% and 50%, and adverse events. RESULTS A total of 42 subjects were enrolled, 27 completed at least an 8-week treatment period. Intention-to-treat analysis showed no significant improvement in pain control with capsaicin lotion compared with placebo for all pain measures and proportion of patients who had 30% or 50% pain relief, respectively. Per protocol analysis were consistent. Capsaicin lotion was well tolerated but local skin reactions were common. CONCLUSION In patients with PDN, the efficacy of 0.075% capsaicin lotion was similar to placebo but was well tolerated. More work is needed to assess different capsaicin formulations.
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Affiliation(s)
- Kongkiat Kulkantrakorn
- Division of Neurology, Department of Internal Medicine, Thammasat University, Pathumthani, Thailand; Center of Excellence for Diabetic Foot Care, Thammasat University Hospital, Pathumthani, Thailand.
| | - Assawin Chomjit
- Division of Neurology, Department of Internal Medicine, Thammasat University, Pathumthani, Thailand
| | - Pasiri Sithinamsuwan
- Division of Neurology, Department of Internal Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Thipaporn Tharavanij
- Center of Excellence for Diabetic Foot Care, Thammasat University Hospital, Pathumthani, Thailand; Division of Endocrinology and Metabolism, Department of Internal Medicine, Thammasat University, Pathumthani, Thailand; Diabetes and Metabolic Syndrome Research Unit, Thammasat University, Pathumthani, Thailand; Center of Excellence in Applied Epidemiology, Thammasat University, Pathumthani, Thailand
| | - Juthamas Suwankanoknark
- Division of Neurology, Department of Internal Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Phunyada Napunnaphat
- Center of Excellence for Diabetic Foot Care, Thammasat University Hospital, Pathumthani, Thailand; Department of Nursing, Thammasat University Hospital, Pathumthani, Thailand
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Chahbi Z, Lahmar B, Hadri SE, Abainou L, Kaddouri S, Qacif H, Baizri H, Zyani M. The prevalence of painful diabetic neuropathy in 300 Moroccan diabetics. Pan Afr Med J 2018; 31:158. [PMID: 31086614 PMCID: PMC6488236 DOI: 10.11604/pamj.2018.31.158.14687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 04/11/2018] [Indexed: 12/18/2022] Open
Abstract
Painful diabetic neuropathy is a frequent complication of diabetes. Its diagnosis is clinical. Our goal is to determine the prevalence of painful diabetic neuropathy in this population. We also analyzed the relationship between this neuropathy and certain parameters, concerning the patient and his diabetes. It is a cross sectional study conducted at the department of endocrinology and internal medicine of Avicenne hospital Marrakech-Morocco, among a cohort of 300 diabetic outpatients. We used the DN4 questionnaire (Douleur Neuropathique en 4 questions), for diagnosis. The results showed a prevalence of 15%. In this study: advanced age, female gender, duration of diabetes greater than 10 years, and the lack of medical follow up were found to be statistically significant risk factors for painful diabetic neuropathy, in addition to some diabetes-related comorbidities such as hypertension, dyslipidemia, sedentary life style and diabetic retinopathy. Painful diabetic neuropathy remains undertreated, in fact 74% of our patients did not receive any specific treatment, knowing that the progress in developing effective and well-tolerated therapies has been disappointing.
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Affiliation(s)
- Zakaria Chahbi
- Internal Medicine Department, Avicenne Military Hospital, Marrakech, Morocco
| | - Bouchra Lahmar
- Internal Medicine Department, Avicenne Military Hospital, Marrakech, Morocco
| | - Sanae El Hadri
- Endocrinology Department, Avicenne Military Hospital, Marrakech, Morocco
| | | | - Said Kaddouri
- Internal Medicine Department, Avicenne Military Hospital, Marrakech, Morocco
| | - Hassan Qacif
- Internal Medicine Department, Avicenne Military Hospital, Marrakech, Morocco
| | - Hicham Baizri
- Endocrinology Department, Avicenne Military Hospital, Marrakech, Morocco
| | - Mohamed Zyani
- Internal Medicine Department, Avicenne Military Hospital, Marrakech, Morocco
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Gaps in Understanding Mechanism and Lack of Treatments: Potential Use of a Nonhuman Primate Model of Oxaliplatin-Induced Neuropathic Pain. Pain Res Manag 2018; 2018:1630709. [PMID: 29854035 PMCID: PMC5954874 DOI: 10.1155/2018/1630709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/03/2018] [Indexed: 12/11/2022]
Abstract
The antineoplastic agent oxaliplatin induces an acute hypersensitivity evoked by cold that has been suggested to be due to sensitized central and peripheral neurons. Rodent-based preclinical studies have suggested numerous treatments for the alleviation of oxaliplatin-induced neuropathic pain, but few have demonstrated robust clinical efficacy. One issue is that current understanding of the pathophysiology of oxaliplatin-induced neuropathic pain is primarily based on rodent models, which might not entirely recapitulate the clinical pathophysiology. In addition, there is currently no objective physiological marker for pain that could be utilized to objectively indicate treatment efficacy. Nonhuman primates are phylogenetically and neuroanatomically similar to humans; thus, disease mechanism in nonhuman primates could reflect that of clinical oxaliplatin-induced neuropathy. Cold-activated pain-related brain areas in oxaliplatin-treated macaques were attenuated with duloxetine, the only drug that has demonstrated clinical efficacy for chemotherapy-induced neuropathic pain. By contrast, drugs that have not demonstrated clinical efficacy in oxaliplatin-induced neuropathic pain did not reduce brain activation. Thus, a nonhuman primate model could greatly enhance understanding of clinical pathophysiology beyond what has been obtained with rodent models and, furthermore, brain activation could serve as an objective marker of pain and therapeutic efficacy.
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Malik RA, Aldinc E, Chan SP, Deerochanawong C, Hwu CM, Rosales RL, Yeung CY, Fujii K, Parsons B. Perceptions of Painful Diabetic Peripheral Neuropathy in South-East Asia: Results from Patient and Physician Surveys. Adv Ther 2017; 34:1426-1437. [PMID: 28502036 PMCID: PMC5487881 DOI: 10.1007/s12325-017-0536-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Indexed: 12/12/2022]
Abstract
There are no data on physician-patient communication in painful diabetic peripheral neuropathy (pDPN) in the Asia-Pacific region. The objective of this study was to examine patient and physician perceptions of pDPN and clinical practice behaviors in five countries in South-East Asia. Primary care physicians and practitioners, endocrinologists, diabetologists, and patients with pDPN completed separate surveys on pDPN diagnosis, impact, management, and physician-patient interactions in Hong Kong, Malaysia, the Philippines, Taiwan, and Thailand. Data were obtained from 100 physicians and 100 patients in each country. The majority of physicians (range across countries, 30-85%) were primary care physicians and practitioners. Patients were mostly aged 18-55 years and had been diagnosed with diabetes for >5 years. Physicians believed pDPN had a greater impact on quality of life than did patients (ranges 83-92% and 39-72%, respectively), but patients believed pDPN had a greater impact on items such as sleep, anxiety, depression, and work than physicians. Physicians considered the diagnosis and treatment of pDPN a low priority, which may be reflected in the generally low incidence of screening (range 12-65%) and a lack of awareness of pDPN. Barriers to treatment included patients' lack of awareness of pDPN. Both physicians and patients agreed that pain scales and local language descriptions were the most useful tools in helping to describe patients' pain. Most patients were monitored upon diagnosis of pDPN (range 55-97%), but patients reported a shorter duration of monitoring compared with physicians. Both physicians and patients agreed that it was patients who initiated conversations on pDPN. Physicians most commonly referred to guidelines from the American Diabetes Association or local guidelines for the management of pDPN. This study highlights important differences between physician and patient perceptions of pDPN, which may impact on its diagnosis and treatment. For a chronic and debilitating complication like pDPN, the physician-patient dialogue is central to maximizing patient outcomes. Strategies, including education of both groups, need to be developed to improve communication. FUNDING Pfizer.
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Affiliation(s)
- Rayaz A Malik
- Weill Cornell Medicine-Qatar, Education City, Doha, Qatar
- Manchester Royal Infirmary, University of Manchester, Manchester, UK
| | | | - Siew-Pheng Chan
- Endocrine Unit, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Chaicharn Deerochanawong
- Diabetes and Endocrinology Unit at Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Chii-Min Hwu
- Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Raymond L Rosales
- Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines
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Actualización en el diagnóstico, tratamiento y prevención de la neuropatía diabética periférica. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bijli AH, Rasool A, Wani AH, Yasir M, Bhat TA, Laway BA. Footboards: Indigenous and Novel Method of Screening for Diabetes Peripheral Neuropathy - A Pilot Study. Indian J Endocrinol Metab 2017; 21:293-296. [PMID: 28459028 PMCID: PMC5367233 DOI: 10.4103/ijem.ijem_549_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To validate the effectiveness of indigenously designed "footboard (FB)" in early diagnosis of diabetic peripheral neuropathy (PNP) by comparing it with Semmes-Weinstein monofilament (SWM) and vibration perception (VP). MATERIALS AND METHODS Two hundred and forty-four patients with diabetes were examined for PNP using SWM and 128 Hz tuning fork. The findings were compared with indigenously designed FBs with 1, 2, and 3 mm elevations. RESULTS Out of 108 patients who did not have protective sensation as per SWM, only 10 (9.2%) felt 1 mm board bearings, and out of 72 patients who did not feel vibration, only 8 (11.1%) felt 1 mm board bearings. Out of 136 patients who had protective sensation, 128 (94.11%) felt 2 mm elevated board bearings, and out of 172 patients who had VP, only 152 patients (88.3%) felt 2 mm board bearings. With SWM as standard, the sensitivities and specificities, respectively, were 63% and 90% (1 mm board), and 94% and 60% (2 mm board). With VP, the sensitivities and specificities, respectively, were 59% and 90% (1 mm board), and 88% and 61% (2 mm board). CONCLUSIONS FB, which simultaneously tests touch and pressure sensation, shows a high level of performance in detecting at-risk feet. FB may be simple, time-efficient, and inexpensive test for detection of neuropathy and needs further validation in a larger study.
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Affiliation(s)
- Akram Hussain Bijli
- Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Altaf Rasool
- Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Adil Hafeez Wani
- Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mir Yasir
- Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Tanveer Ahmad Bhat
- Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Bashir Ahmad Laway
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Xu Z, Zhang P, Long L, He H, Zhang J, Sun S. Diabetes mellitus in classical trigeminal neuralgia: A predisposing factor for its development. Clin Neurol Neurosurg 2016; 151:70-72. [DOI: 10.1016/j.clineuro.2016.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/19/2016] [Accepted: 10/21/2016] [Indexed: 01/19/2023]
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Physical activity and albuminuria were associated with painful diabetic polyneuropathy in type 2 diabetes in an ethnic Chinese population. Clin Chim Acta 2016; 462:55-59. [DOI: 10.1016/j.cca.2016.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/20/2016] [Accepted: 08/30/2016] [Indexed: 02/07/2023]
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Van Acker N, Ragé M, Vermeirsch H, Schrijvers D, Nuydens R, Byttebier G, Timmers M, De Schepper S, Streffer J, Andries L, Plaghki L, Cras P, Meert T. NRP-1 Receptor Expression Mismatch in Skin of Subjects with Experimental and Diabetic Small Fiber Neuropathy. PLoS One 2016; 11:e0161441. [PMID: 27598321 PMCID: PMC5012683 DOI: 10.1371/journal.pone.0161441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/07/2016] [Indexed: 12/27/2022] Open
Abstract
The in vivo cutaneous nerve regeneration model using capsaicin is applied extensively to study the regenerative mechanisms and therapeutic efficacy of disease modifying molecules for small fiber neuropathy (SFN). Since mismatches between functional and morphological nerve fiber recovery are described for this model, we aimed at determining the capability of the capsaicin model to truly mimic the morphological manifestations of SFN in diabetes. As nerve and blood vessel growth and regenerative capacities are defective in diabetes, we focused on studying the key regulator of these processes, the neuropilin-1 (NRP-1)/semaphorin pathway. This led us to the evaluation of NRP-1 receptor expression in epidermis and dermis of subjects presenting experimentally induced small fiber neuropathy, diabetic polyneuropathy and of diabetic subjects without clinical signs of small fiber neuropathy. The NRP-1 receptor was co-stained with CD31 vessel-marker using immunofluorescence and analyzed with Definiens® technology. This study indicates that capsaicin application results in significant loss of epidermal NRP-1 receptor expression, whereas diabetic subjects presenting small fiber neuropathy show full epidermal NRP-1 expression in contrast to the basal expression pattern seen in healthy controls. Capsaicin induced a decrease in dermal non-vascular NRP-1 receptor expression which did not appear in diabetic polyneuropathy. We can conclude that the capsaicin model does not mimic diabetic neuropathy related changes for cutaneous NRP-1 receptor expression. In addition, our data suggest that NRP-1 might play an important role in epidermal nerve fiber loss and/or defective regeneration and that NRP-1 receptor could change the epidermal environment to a nerve fiber repellant bed possibly through Sem3A in diabetes.
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Affiliation(s)
- Nathalie Van Acker
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- HistoGeneX NV, Antwerp, Belgium
- * E-mail:
| | - Michael Ragé
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | | | | | - Rony Nuydens
- Janssen Research and Development, Janssen Pharmaceutics NV, Beerse, Belgium
| | - Geert Byttebier
- Janssen Research and Development, Janssen Pharmaceutics NV, Beerse, Belgium
| | - Maarten Timmers
- Janssen Research and Development, Janssen Pharmaceutics NV, Beerse, Belgium
- Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | | | - Johannes Streffer
- Janssen Research and Development, Janssen Pharmaceutics NV, Beerse, Belgium
- Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | | | - Léon Plaghki
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Patrick Cras
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, Born Bunge Institute, University of Antwerp, Antwerp, Belgium
| | - Theo Meert
- Janssen Research and Development, Janssen Pharmaceutics NV, Beerse, Belgium
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Celik S, Yenidunya G, Temel E, Purisa S, Uzum AK, Gul N, Cinkil G, Dinccag N, Satman I. Utility of DN4 questionnaire in assessment of neuropathic pain and its clinical correlations in Turkish patients with diabetes mellitus. Prim Care Diabetes 2016; 10:259-264. [PMID: 26749091 DOI: 10.1016/j.pcd.2015.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/20/2015] [Accepted: 11/16/2015] [Indexed: 12/21/2022]
Abstract
AIM We aimed to assess the utility of DN4 questionnaire (Douleur Neuropathique en 4 questions) to define the frequency and severity of neuropathic pain (NP) and also its clinical correlation to daily clinical practice. METHODS We included 1357 patients with diabetes (56.5% women, 90.4% type 2 diabetes) who were followed up in our diabetes outpatient clinic. Presence of NP was evaluated by performing simultaneous DN4 questionnaires and physical examination. Those who had a DN4 score ≥4 were considered to have NP. RESULTS The mean age was 58.2±12.1 years, mean duration was 12.5±7.5; (min-max: 1-45) years, mean HbA1c level was 7.8±1.6% (min-max: 5-16.2%), (61.7±6.0mmol/mol; min-max: 31.1-153.6mmol/mol). Three hundred thirteen patients (23%) were diagnosed with NP using the DN4 tool. Male gender (p=0.01), receiving antihypertensive treatment (p=0.01), presence of retinopathy (p<0.001), cardiovascular disease (CVD) (p=0.01) and previously diagnosed neuropathy (p<0.001) were significantly associated with higher NP scores. Those who had increased DN4 scores were more likely to be on oral hypoglycemic agents (OHA)+insulin combinations (p<0.001), had longer diabetes duration (p<0.001) and higher HbA1c levels (p=0.001). Logistic regression model revealed that diabetes duration (OR: 1.02, 95% CI: 1.00-1.04, p=0.007), elevated HbA1c levels (1.11, 1.02-1.21, 0.015), presence of retinopathy (1.41, 1.20-1.64, <0.001), management with at least one OHA (1.47; 1.12-1.92; 0.004) or any insulin regimen (1.62; 1.16-2.27; 0.005) (compared with diet only-regimens) were significantly associated with NP. CONCLUSION Utilization of DN4 questionnaire in daily clinical practice is an effective tool in the identification of pain related with peripheral diabetic polyneuropathy.
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Affiliation(s)
- S Celik
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - G Yenidunya
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - E Temel
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - S Purisa
- Istanbul University, Istanbul Faculty of Medicine, Department of Biostatistics, Istanbul, Turkey.
| | - A Kubat Uzum
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - N Gul
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - G Cinkil
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - N Dinccag
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - I Satman
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
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Sepehri Z, Kiani Z, Nasiri AA, Kohan F. Toll-like receptor 2 and type 2 diabetes. Cell Mol Biol Lett 2016; 21:2. [PMID: 28536605 PMCID: PMC5415836 DOI: 10.1186/s11658-016-0002-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 11/25/2015] [Indexed: 02/08/2023] Open
Abstract
Innate immunity plays a crucial role in the pathogenesis of type 2 diabetes and related complications. Since the toll-like receptors (TLRs) are central to innate immunity, it appears that they are important participants in the development and pathogenesis of the disease. Previous investigations demonstrated that TLR2 homodimers and TLR2 heterodimers with TLR1 or TLR6 activate innate immunity upon recognition of damage-associated molecular patterns (DAMPs). Several DAMPs are released during type 2 diabetes, so it may be hypothesized that TLR2 is significantly involved in its progression. Here, we review recent data on the important roles and status of TLR2 in type 2 diabetes and related complications.
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Affiliation(s)
- Zahra Sepehri
- Department of Internal Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Zohre Kiani
- Zabol Medicinal Plant Research Center, Zabol University of Medical Sciences, Zabol, Iran
- Department of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Nasiri
- Department of Internal Anesthesiology, Zabol University of Medical Sciences, Zabol, Iran
| | - Farhad Kohan
- General Physician, Zabol University of Medical Sciences, Zabol, Iran
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Zhang J, Xiao Z, Chen L, Li L, Yang H, Luo B, Mai L, Yan L, Yang C. Cilostazol Can Increase Skin Oxygen Supply Assessed by Transcutaneous Oxygen Pressure Measurement in Type 2 Diabetes With Lower Limb Ischemic Disease: A Randomized Trial. J Wound Ostomy Continence Nurs 2016; 43:254-9. [PMID: 26938333 DOI: 10.1097/won.0000000000000214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to compare the efficacy and safety of cilostazol versus acetylsalicylic acid (ASA) for amelioration of lower limb ischemia in type 2 diabetes. DESIGN Prospective, randomized positive-controlled open clinical trial. SUBJECTS AND SETTING Eighty-nine patients with type 2 diabetes mellitus and symptoms of lower limb ischemia (perceptions of coldness of the lower limbs, numbness, intermittent claudication, or pain at rest) present for 6 months or more that had not significantly changed within the past 3 months participated in the study. All subjects had an initial transcutaneous oxygen pressure (TcpO2) of less than 40 mm Hg in the foot when measured in the supine position. Subjects included 46 males and 43 females; their ages ranged from 35 to 80 years. METHODS Participants were randomly allocated to 2 groups, one was treated with cilostazol 100 mg taken twice daily (n = 48), and a second group took 100 mg of ASA daily (n = 41) for 8 weeks. Clinical assessment included measurement of transcutaneous oxygenation, and symptoms associated with lower limb ischemia. Blood analyses included a full blood panel, coagulation screen, renal function tests, hepatic function tests, and lipid profiles. All tests were performed at baseline and repeated at 8 weeks. RESULTS Age, duration of diabetes, diabetic complications, lower limb ischemic symptoms, TcpO2, and smoking status did not differ between the 2 groups. In contrast, TcpO2 significantly improved from 37.1 ± 11.9 mm Hg to 42.0 ± 9.7 mm Hg in the cilostazol-treated group (P < .05), whereas no significant change was observed in the ASA-treated group (P > .05). Ischemic symptoms such as intermittent claudication (P = .009), perception of limb coldness (P = .008), and pain at rest (P = .017) showed greater improvement in the cilostazol-treated group when compared to subjects treated with ASA. Approximately 10% of patients treated with cilostazol experienced adverse side effects (palpitations, headache, diarrhea). Cilostazol was not found to have significant detrimental effects in hematologic or biochemical indices, including renal, hepatic, and blood coagulant function tests. CONCLUSIONS We found that 8 weeks of treatment with cilostazol 100 mg daily was safe and well tolerated for the treatment of type 2 diabetes with lower limb ischemic disease.
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Affiliation(s)
- Jinglu Zhang
- Jinglu Zhang, PhD, Institution of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Zidong Xiao, MD, Department of Endocrinology of First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China. Lihong Chen, PhD, Institution of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Li Li, MD, Emergency Department, the Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Haiyun Yang, MD, Department of Ultrasonic of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Baoming Luo, MD, Department of Ultrasonic of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Lifang Mai, MD, Institution of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Li Yan, MD, Institution of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Chuan Yang, PhD, Institution of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Urabe H, Terashima T, Kojima H, Chan L. Ablation of a small subpopulation of diabetes-specific bone marrow-derived cells in mice protects against diabetic neuropathy. Am J Physiol Endocrinol Metab 2016; 310:E269-75. [PMID: 26695138 PMCID: PMC4971812 DOI: 10.1152/ajpendo.00381.2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/14/2015] [Indexed: 12/28/2022]
Abstract
Diabetic peripheral neuropathy (DPN) is a major diabetic complication. Previously, we showed that hyperglycemia induces the appearance of proinsulin (PI)-producing bone marrow-derived cells (PI-BMDCs), which fuse with dorsal root ganglion neurons, causing apoptosis, nerve dysfunction, and DPN. In this study, we have devised a strategy to ablate PI-BMDCs in mice in vivo. The use of this strategy to selectively ablate TNFα-producing PI-BMDCs in diabetic mice protected these animals from developing DPN. The findings provide powerful validation for a pathogenic role of PI-BMDCs and identify PI-BMDCs as an accessible therapeutic target for the treatment and prevention of DPN.
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Affiliation(s)
- Hiroshi Urabe
- Division of Diabetes, Endocrinology, and Metabolism and the Diabetes Research Center, Departments of Medicine, Molecular and Cellular Biology, Biochemistry, and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas; and
| | - Tomoya Terashima
- Department of Stem Cell Biology and Regenerative Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, Japan
| | - Hideto Kojima
- Division of Diabetes, Endocrinology, and Metabolism and the Diabetes Research Center, Departments of Medicine, Molecular and Cellular Biology, Biochemistry, and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas; and Department of Stem Cell Biology and Regenerative Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, Japan
| | - Lawrence Chan
- Division of Diabetes, Endocrinology, and Metabolism and the Diabetes Research Center, Departments of Medicine, Molecular and Cellular Biology, Biochemistry, and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas; and
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YAO HEBIN, CHEN YANING, SHANG JIAN, HAN QIAOJUN. Painful neuropathy in a diabetic patient resulting from lung cancer and not diabetes: A case report. Oncol Lett 2015; 10:3850-3852. [DOI: 10.3892/ol.2015.3808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 09/21/2015] [Indexed: 11/05/2022] Open
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Abd Allah ESH, Gomaa AMS. Effects of curcumin and captopril on the functions of kidney and nerve in streptozotocin-induced diabetic rats: role of angiotensin converting enzyme 1. Appl Physiol Nutr Metab 2015; 40:1061-7. [PMID: 26398443 DOI: 10.1139/apnm-2015-0145] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Oxidative stress and inflammation are involved in the development and progression of diabetes and its complications. The renin-angiotensin system also plays an important role in the pathogenesis of diabetes and its complications. We hypothesized that curcumin and captopril would restore the kidney and nerve functions of diabetic rats through their angiotensin converting enzyme 1 (ACE1) inhibiting activity as well as their antioxidant and anti-inflammatory effects. Diabetes was induced by a single intraperitoneal injection of streptozotocin (100 mg·kg(-1) body weight). One week after induction of diabetes, rats were treated with 100 mg·kg(-1)·day(-1) curcumin or 50 mg·kg(-1)·day(-1) captopril orally for 6 weeks. Compared with diabetic control rats, curcumin- or captopril-treated diabetic rats had significantly improved blood glucose, lipid profile, kidney/body weight ratio, serum creatinine, blood urea nitrogen (BUN), and pain thresholds assessed by Von Frey filaments, hot plate test, and tail-flick test. Diabetic control rats showed increased levels of total peroxide, renal and neural tumor necrosis factor-α and interleukin-10, and renal ACE1 compared with nondiabetic rats. Although treatment with either curcumin or captopril restored the altered variables, captopril was more effective in reducing these variables. ACE1 was positively correlated with BUN and creatinine and negatively correlated with paw withdrawal threshold, hot plate reaction time, and tail-flick latency, suggesting a possible causal relationship. We conclude that curcumin and captopril protect against diabetic nephropathy and neuropathy by inhibiting ACE1 as well as oxidation and inflammation. These findings suggest that curcumin and captopril may have a role in the treatment of diabetic nephropathy and neuropathy.
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Affiliation(s)
- Eman S H Abd Allah
- Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.,Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Asmaa M S Gomaa
- Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.,Medical Physiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Abstract
Distal symmetric polyneuropathy (DSPN), the most common form of diabetic neuropathy, has a complex pathophysiology and can be a major source of physical and psychologic disability. The management of DSPN can be frustrating for both patient and physician. This article provides a general overview of typical patient pathways in DSPN, and highlights variations in diagnosis, management, and referral patterns among different providers. DSPN is managed in several settings by primary care physicians (PCPs), specialists, and nurse practitioners. The initial clinical management of the patient is often dependent on the presenting complaint, the referral pattern of the provider, level of comfort of the PCP in managing diabetic complications, and geographic access to specialists. The primary treatment of DSPN focuses mainly on glycemic control and adjustment of modifiable risk factors, but other causes of neuropathy should also be investigated. Several pharmacologic agents are recommended by treatment guidelines, and as DSPN typically exists with comorbid conditions, a multimodal therapeutic approach should be considered. Barriers to effective management include failure to recognize DSPN, and misdiagnosis. Patient education also remains important. Referral patterns vary widely according to geographic location, access to services, provider preferences, and comfort in managing complex aspects of the disease. The variability in patient pathways affects patient education, satisfaction, and outcomes. Standardized screening tools, a multidisciplinary team approach, and treatment algorithms for diabetic neuropathy should improve future care. To improve patient outcomes, DSPN needs to be diagnosed sooner and interventions made before significant nerve damage occurs.
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Affiliation(s)
- Michelle Kaku
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Sun M, Zhang M, Shen J, Yan J, Zhou B. Critical appraisal of international guidelines for the management of diabetic neuropathy: is there global agreement in the internet era? Int J Endocrinol 2015; 2015:519032. [PMID: 26000014 PMCID: PMC4426819 DOI: 10.1155/2015/519032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/02/2015] [Accepted: 03/18/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose. The management of diabetic neuropathy (DN) can be challenging. There exist many guidelines for DN management, but the quality of these guidelines has not been systematically evaluated or compared. The objective of our study was to assess the quality of these guidelines as a step toward their future optimization, the development of international guidelines, and, ultimately, the improvement of the care process. Methods. Relevant data were selected to identify international guidelines. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool was used to evaluate the quality of the selected guidelines. In addition, the reviewers summarized and compared all of the recommendations from the included guidelines for DN's management. Results. Thirteen guidelines were included after the selection process. According to AGREE II, few guidelines scored well for all three aspects of DN management. Detailed comparisons revealed that these guidelines provide inconsistent recommendations, making it difficult for diabetes clinicians to choose appropriate guideline. Conclusions. The quality of most guidelines for the management of DN should be improved. Further studies should concentrate on developing internationally accepted and evidence-based guidelines that could be used for clinical decision making to improve patient care.
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Affiliation(s)
- Mingfang Sun
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Min Zhang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jing Shen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Juping Yan
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Bo Zhou
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Yoo M, D'Silva LJ, Martin K, Sharma NK, Pasnoor M, LeMaster JW, Kluding PM. Pilot Study of Exercise Therapy on Painful Diabetic Peripheral Neuropathy. PAIN MEDICINE 2015; 16:1482-9. [PMID: 25800666 DOI: 10.1111/pme.12743] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Painful diabetic peripheral neuropathy (DPN) is a common complication of diabetes. While the beneficial effect of exercise on diabetes is well established, its effect specifically on painful DPN has not been thoroughly explored. The objective of this pilot study was to examine the effect of aerobic exercise on pain in people with DPN. METHODS Fourteen sedentary individuals (mean age 57 ± 5.11 years) with painful DPN were enrolled in a 16-week, supervised aerobic exercise program. The Brief Pain Inventory-Diabetic Peripheral Neuropathy was used to assess pain intensity (worst, least, average, now) and pain interference with daily life (activity, mood, walk, normal work, relationship, sleep, enjoyment of life) pre intervention and postintervention. Body mass index (BMI), maximum oxygen uptake (VO2max ), hemoglobin A1c (HbA1c), and blood pressure were also measured preintervention and postintervention as secondary outcomes of interest. RESULTS Significant reductions in pain interference were observed with walking (4.93 ± 3.03 pre to 3.29 ± 2.89 post, P = 0.016), normal work (5.39 ± 3.32 pre to 3.79 ± 3.04 post, P = 0.032), relationship with others (3.96 ± 3.53 pre to 1.29 ± 1.27 post, P = 0.006), sleep (5.11 ± 3.04 pre to 3.5 ± 3.03 post, P = 0.02), and the overall pain interference (4.65 ± 2.70 pre to 2.97 ± 2.22 post, P = 0.013) following the intervention; however, there was no change in pain intensity. VO2max increased significantly postintervention (16.02 ± 3.84 ml/kg/min pre to 17.18 ± 4.19 ml/kg/min, P = 0.028), while BMI, HbA1c, and blood pressure remained unchanged. CONCLUSION These preliminary results suggest that perceived pain interference may be reduced following an aerobic exercise intervention among people with painful DPN, without a change in pain intensity. Further validation by a RCT is needed.
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Affiliation(s)
- Min Yoo
- Departments of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
| | - Linda J D'Silva
- Departments of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
| | - Katherine Martin
- Departments of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
| | - Neena K Sharma
- Departments of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
| | - Mamatha Pasnoor
- Departments of Neurology University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
| | - Joseph W LeMaster
- Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
| | - Patricia M Kluding
- Departments of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3051, Kansas City, Kansas, USA
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Michel-Cherqui M, Ley L, Szekely B, Dreyfus JF, Fischler M. Prevalence and characteristics of pain in patients awaiting lung transplantation. J Pain Symptom Manage 2015; 49:548-54. [PMID: 25150816 DOI: 10.1016/j.jpainsymman.2014.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/08/2014] [Accepted: 07/10/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT Pain in patients awaiting lung transplantation is not well known. OBJECTIVES This study prospectively investigated prevalence and characteristics of pain in these patients. METHODS Assessment, undertaken at the time of registration, comprised an interview, a physical examination by a pain-qualified anesthesiologist, and a questionnaire completed by the patient and investigator. This questionnaire included evaluation of pain (intensity, location, sensory and affective qualifications, and treatment), detection of neuropathic pain, and assessment of anxiety and depression. A patient was considered "with pain" when at least one of the following criteria was met: 1) positive answer to the question "Do you suffer regularly from pain?" and 2) score greater than 3 on at least one of three numeric pain scales (current, maximal, and average during the last eight days) ranging from 0 (no pain) to 10 (most severe pain imaginable). RESULTS One hundred forty-three patients were enrolled. Prevalence of pain was 59%. Three independent variables were correlated to the magnitude of the average pain score for the preceding eight days: female gender (P = 0.003), cystic fibrosis (P = 0.02), and depression score (P = 0.02). Among the pain patients, 39% took analgesic drugs daily and 36% regularly but less than daily; 2% used opioids. Nineteen percent used nonpharmacological strategies (e.g., hypnosis, relaxation). CONCLUSION This study highlights the prevalence of pain in this population and specific problems associated with pain such as anxiety and depression. Appropriate assessment and treatment of pain should be considered a component of pretransplantation management.
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Affiliation(s)
- Mireille Michel-Cherqui
- Department of Anesthesiology, Hôpital Foch, Suresnes, France; Pain Management Unit, Hôpital Foch, Suresnes, France; University Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Léa Ley
- Department of Anesthesiology, Hôpital Foch, Suresnes, France; University Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Barbara Szekely
- Department of Anesthesiology, Hôpital Foch, Suresnes, France; Pain Management Unit, Hôpital Foch, Suresnes, France; University Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | | | - Marc Fischler
- Department of Anesthesiology, Hôpital Foch, Suresnes, France; University Versailles Saint-Quentin-en-Yvelines, Versailles, France.
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Urabe H, Terashima T, Lin F, Kojima H, Chan L. Bone marrow-derived TNF-α causes diabetic neuropathy in mice. Diabetologia 2015; 58:402-10. [PMID: 25399355 PMCID: PMC4289451 DOI: 10.1007/s00125-014-3440-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/14/2014] [Indexed: 12/26/2022]
Abstract
AIMS/HYPOTHESIS Dysregulation of biochemical pathways in response to hyperglycaemia in cells intrinsic to the nervous system (Schwann cells, neurons, vasa nervorum) are thought to underlie diabetic peripheral neuropathy (DPN). TNF-α is a known aetiological factor; Tnf-knockout mice are protected against DPN. We hypothesised that TNF-α produced by a small but specific bone marrow (BM) subpopulation marked by proinsulin production (proinsulin-producing BM-derived cells, PI-BMDCs) is essential for DPN development. METHODS We produced mice deficient in TNF-α, globally in BM and selectively in PI-BMDCs only, by gene targeting and BM transplantation, and induced diabetes by streptozotocin. Motor and sensory nerve conduction velocities were used to gauge nerve dysfunction. Immunocytochemistry, fluorescence in situ hybridisation (FISH) and PCR analysis of dorsal root ganglia (DRG) were employed to monitor outcome. RESULTS We found that loss of TNF-α in BM only protected mice from DPN. We developed a strategy to delete TNF-α specifically in PI-BMDCs, and found that PI-BMDC-specific loss of TNF-α protected against DPN as robustly as loss of total BM TNF-α. Selective loss of PI-BMDC-derived TNF-α downregulated TUNEL-positive DRG neurons. FISH revealed PI-BMDC-neuron fusion cells in the DRG in mice with DPN; fusion cells were undetectable in non-diabetic mice or diabetic mice that had lost TNF-α expression selectively in the PI-BMDC subpopulation. CONCLUSIONS/INTERPRETATION BMDC-specific TNF-α is essential for DPN development; its selective removal from a small PI-BMDC subpopulation protects against DPN. The pathogenicity of PI-BMDC-derived TNF-α may have important therapeutic implications.
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Affiliation(s)
- Hiroshi Urabe
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza (MS: BCM185), Houston, TX, 77030, USA
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Abstract
Diabetes is the leading cause of end-stage renal disease, blindness, and nontraumatic lower-limb amputation. The largest reductions in cardiovascular events are seen when multiple risk factors are addressed simultaneously. The benefit of aspirin as secondary prevention in patients with previous stroke or myocardial infarction has been well established. Regular, dilated eye examinations are effective in detecting sight-threatening diabetic retinopathy and have been shown to prevent blindness. The use of appropriate tools and clinical examination/inspection provides greater than 87% specificity in detecting diabetic peripheral neuropathy. Early treatment of risk factors, including hypertension, hyperglycemia, and dyslipidemia can delay or prevent diabetic nephropathy.
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Affiliation(s)
- Matthew P Gilbert
- Division of Endocrinology and Diabetes, Department of Medicine, College of Medicine, The University of Vermont, 62 Tilley Drive, South Burlington, VT 05403, USA.
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Liu P, Guo WY, Zhao XN, Bai HP, Wang Q, Wang XL, Zhang YZ. Intrathecal baclofen, a GABAB receptor agonist, inhibits the expression of p-CREB and NR2B in the spinal dorsal horn in rats with diabetic neuropathic pain. Can J Physiol Pharmacol 2014; 92:655-60. [PMID: 24988216 DOI: 10.1139/cjpp-2013-0463] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study aimed to investigate the effect of baclofen, a γ-aminobutyric acid B (GABAB) receptor agonist, on the expression of p-CREB and NR2B in the spinal dorsal horn of rats with diabetic neuropathic pain (DNP). The DNP rats, which were successfully induced with streptozocin, were distributed among 3 groups that were treated with saline (D1 group), baclofen (D2 group), or CGP55845 + baclofen (D3 group) continuously for 4 days. The rats induced with saline and subsequently treated with saline were used as controls (C group). The times for the paw withdrawal threshold and thermal withdrawal latency of the D1 group were lower than those for the C group, and were significantly increased after baclofen treatment, but not when GABA receptor was pre-blocked with CGP55845 (D3 group). Increased protein expression levels of NR2B and p-CREB and mRNA levels of NR2B were found in the D1 group when compared with the controls. Baclofen treatment significantly suppressed their expression, bringing it close to the levels of controls. However, in the D3 group, the expression of p-CREB and NR2B were still significantly higher than that of the controls. Activation of GABAB receptor by baclofen attenuates diabetic neuropathic pain, which may partly be accomplished via down-regulating the expression of p-CREB and NR2B.
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Affiliation(s)
- Peng Liu
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang 050051, Hebei Province, China
| | - Wen-Ya Guo
- Hebei Medical University, Shijiazhuang 050051, China
| | - Xiao-Nan Zhao
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang 050051, Hebei Province, China
| | - Hui-Ping Bai
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang 050051, Hebei Province, China
| | - Qian Wang
- Department of Library, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Xiu-Li Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang 050051, Hebei Province, China
| | - Ying-Ze Zhang
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
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Uçeyler N, Sommer C. Cytokine-related and histological biomarkers for neuropathic pain assessment. Pain Manag 2014; 2:391-8. [PMID: 24654725 DOI: 10.2217/pmt.12.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
SUMMARY Neuropathic pain (NP) is a disabling condition that may occur following a disease or a lesion of the somatosensory nervous system. With an estimated prevalence of up to 8.2% in the general population, NP is common, and robust and objective diagnostic tools are warranted for pain assessment and follow-up. In the last years research has focused on defining biochemical and histological markers for this purpose, and possible systemic (blood, cerebrospinal fluid) and local (skin and nerve) targets have been investigated in a number of different NP disorders. This article focuses on an update giving an overview over some potential biomarkers for the diagnosis of NP, and will discuss their clinical relevance.
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Affiliation(s)
- Nurcan Uçeyler
- Department of Neurology, University of Würzburg, Josef-Schneider Str. 11, 97080 Würzburg, Germany
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Rajanandh MG, Kosey S, Prathiksha G. Assessment of antioxidant supplementation on the neuropathic pain score and quality of life in diabetic neuropathy patients – A randomized controlled study. Pharmacol Rep 2014; 66:44-8. [DOI: 10.1016/j.pharep.2013.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 06/25/2013] [Accepted: 08/02/2013] [Indexed: 01/31/2023]
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Herbert MS, Varley AL, Andreae SJ, Goodin BR, Bradley LA, Safford MM. Association of pain with HbA1c in a predominantly black population of community-dwelling adults with diabetes: a cross-sectional analysis. Diabet Med 2013; 30:1466-71. [PMID: 23796252 PMCID: PMC3935766 DOI: 10.1111/dme.12264] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2013] [Indexed: 11/29/2022]
Abstract
AIMS To assess the relationship between pain and HbA(1c) levels in a predominantly black population with diabetes, and to determine whether self-management behaviours (exercise and diet) and symptoms of depression mediate this relationship. METHODS We analysed cross-sectional data from 417 community-dwelling individuals with diabetes in rural Alabama, USA. Binary logistic regression was used to analyse the relationship between pain and HbA(1c) levels, defined as relatively good [≤ 64 mmol/mol (≤ 8.0%)] and relatively poor [> 64 mmol/mol (> 8.0%)], after adjusting for sociodemographics, insulin use, medication count, cigarette smoking history and body mass index (BMI). We examined the mediating roles of exercise, diet, and symptoms of depression using bootstrapping. RESULTS Participants were primarily black (86.6%), female (76.1%) and reported an annual income of ≤$20,000 (52.7%). Their mean (sd) age was 59.6 (12.8) years. The majority of the participants reported moderate to extreme pain (71.5%). Participants reporting pain were more than twice as likely to have HbA(1c) levels > 64 mmol/mol (8.0%) in the fully adjusted model (odds ratio 2.33 [95% CI 1.28-4.24]; P < 0.05). Diet significantly mediated the relationship between pain and HbA(1c) control (β = 0.06; 95% CI: 0.01-0.17), but only in the unadjusted model. Exercise and symptoms of depression were not significant mediators. CONCLUSIONS A significant independent relationship between pain and HbA(1c) control was found in this mainly black population, which was not explained by self-management behaviours or symptoms of depression. Future research is needed to delineate the mechanism by which pain influences HbA(1c) control, especially among black people with diabetes on low incomes.
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Affiliation(s)
- M S Herbert
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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Bouhassira D, Letanoux M, Hartemann A. Chronic pain with neuropathic characteristics in diabetic patients: a French cross-sectional study. PLoS One 2013; 8:e74195. [PMID: 24058527 PMCID: PMC3772849 DOI: 10.1371/journal.pone.0074195] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/29/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Our aim was to estimate the prevalence of distal chronic pain with neuropathic characteristics in patients with type 1 and type 2 diabetes mellitus and its impact on quality of life, mood, anxiety, sleep and healthcare utilization. METHODS In total, 885 patients were screened and 766 diabetic patients (38.7% with type 1 diabetes mellitus, 44.8% women, mean age: 57.2 ± 14.9 years) were enrolled consecutively over a three-month period in this observational study by 85 diabetes specialists working in a hospital department or in private practice. All the patients completed a series of questionnaires for the detection of chronic pain (i.e. daily pain for more than three months) in the lower limbs and assessment of health-related quality of life (Medical Outcomes Short Form 12 scale), sleep disturbances (MOS sleep scale), depression and anxiety (Hospital Anxiety and Depression scale). Patients with chronic pain were also assessed with the 7-item DN4-interview questionnaire, the monofilament test and the Michigan Neuropathy Screening Instrument (MNSI). RESULTS The overall prevalence of chronic pain with neuropathic characteristics was 20.3% [95% CI 17.4-23.1]. The MNSI examination score suggested that pain was related to polyneuropathy, in 80.1% of these patients (89.5% of those with bilateral pain). Patients with chronic pain had a poorer quality of life and more sleep disturbances, anxiety and depression than patients without pain and the presence of neuropathic characteristics was predictive of such impairments. Only 38.6% of the patients had received appropriate treatment for neuropathic pain. CONCLUSIONS Chronic pain with neuropathic characteristics concerns one in five diabetic patients, has a significant impact on quality of life and is not adequately managed. The close correlation between the DN4 questionnaire and MNSI results suggests that screening tools for neuropathic pain could be used in daily practice for the identification of painful diabetic polyneuropathy.
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Affiliation(s)
- Didier Bouhassira
- INSERM U-987, Centre d’Evaluation et Traitement de la Douleur, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
- Université Versailles-Saint-Quentin, Versailles, France
- * E-mail:
| | | | - Agnès Hartemann
- Service de Diabétologie, CHU Pitié-Salpétrière, Paris, France
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Tahrani AA, Altaf Q, Stevens MJ. Advances in Pharmaceutical Options and Current Clinical Trials for the Treatment of Painful Diabetic Polyneuropathy. PAINFUL DIABETIC POLYNEUROPATHY 2013:121-138. [DOI: 10.1007/978-1-4614-6299-6_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Yoo M, Sharma N, Pasnoor M, Kluding PM. Painful Diabetic Peripheral Neuropathy: Presentations, Mechanisms, and Exercise Therapy. ACTA ACUST UNITED AC 2013; Suppl 10. [PMID: 25360348 PMCID: PMC4211105 DOI: 10.4172/2155-6156.s10-005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Diabetic peripheral neuropathy (DPN) is a frequent complication of diabetes and a major cause of morbidity and increased mortality. It is typically characterized by significant deficits in tactile sensitivity, vibration sense, lower-limb proprioception, and kinesthesia. Painful diabetic neuropathy (P-DPN) is a common phenotype of DPN that affects up to one-third of the general diabetic population. P-DPN has been shown to be associated with significant reductions in overall quality of life, increased levels of anxiety and depression, sleep impairment, and greater gait variability. The purpose of this review is to examine proposed mechanisms of P-DPN, summarize current treatment regimen, and assess exercise as a potential therapy for P-PDN. Although exercise has been shown to be an effective therapeutic modality for diabetes, its specific effects on DPN and especially the painful phenotype have not been sufficiently investigated in current literature. Several rodent models and clinical trials have presented promising results in this area, and warrant further investigations examining the effect of exercise on P-DPN.
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Affiliation(s)
- Min Yoo
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, USA
| | - Neena Sharma
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, USA
| | - Mamatha Pasnoor
- Department of Neurology, University of Kansas Medical Center, USA
| | - Patricia M Kluding
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, USA
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Deli G, Bosnyak E, Pusch G, Komoly S, Feher G. Diabetic neuropathies: diagnosis and management. Neuroendocrinology 2013; 98:267-80. [PMID: 24458095 DOI: 10.1159/000358728] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 01/14/2014] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Changes in human behaviour and lifestyle over the last century have resulted in a dramatic increase in the incidence of diabetes worldwide. Neuropathy is a common and costly complication of both type 1 and type 2 diabetes. The prevalence of neuropathy is estimated to be about 8% in newly diagnosed patients and greater than 50% in patients with long-standing disease. There are two main types of diabetic neuropathies, named as sensorimotor and autonomic neuropathies. Sensorimotor neuropathy is marked by pain, paraesthesia and sensory loss, and autonomic neuropathy may contribute to myocardial infarction, malignant arrhythmia and sudden death. METHODS In this article we reviewed the pathogenesis, clinical manifestations diagnosis and treatment of diabetic neuropathies. CONCLUSION Sensorimotor and autonomic neuropathies (cardiovascular, gastrointestinal and genitourinary autonomic neuropathies) are common in diabetic patients. Apart from strict glycaemic control, no further therapeutic approach exists in the prevention of this phenomenon. Intensive diabetes therapy, intensive multifactorial cardiovascular risk reduction and lifestyle intervention are recommended in patients with cardiovascular autonomic neuropathy. Gastroparesis is the most debilitating complication of gastrointestinal autonomic neuropathy and genitourinary autonomic neuropathy can cause sexual dysfunction and neurogenic bladder; these conditions are hard to manage. The symptomatic treatment of sensory symptoms includes tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, gabapentin, pregabalin and opioids. Other treatment strategies are not so effective.
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Affiliation(s)
- Gabriella Deli
- Department of Neurology, University of Pécs, Pécs, Hungary
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Abstract
Diabetes is the most common cause of peripheral neuropathy in the world. Both type 1 (insulin-dependent) and type 2 diabetes are commonly complicated by peripheral nerve disorders. Two main types of neuropathy are observed: the most common is a nerve fiber length-dependent, distal symmetrical sensory polyneuropathy with little motor involvement but frequent, and potentially life threatening, autonomic dysfunction. Alteration of temperature and pain sensations in the feet is an early manifestation of diabetic polyneuropathy. The second pattern is a focal neuropathy, which more commonly complicates or reveals type 2 diabetes. Poor diabetic control increases the risk of neuropathy with subsequent neuropathic pains and trophic changes in the feet, which can be prevented by education of patients.
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Affiliation(s)
- Gérard Said
- Department of Neurology, Hôpital de la Salpêtrière, Paris, France.
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Textor LH, Hedrick J. The Lived Experience of Peripheral Neuropathy after Solid Organ Transplant. Prog Transplant 2012; 22:271-9. [DOI: 10.7182/pit2012703] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background The immunosuppressants required after transplant cause peripheral neuropathy with an incidence of 10% to 60%. Peripheral neuropathy adversely affects health-related quality of life in other populations. Objective To describe the lived experience of peripheral neuropathy after solid organ transplant. Design A qualitative phenomenological study with semistructured interviews. A purposive sample of 7 solid organ transplant recipients with peripheral neuropathy was recruited from 2 transplant clinics at a large Midwest tertiary care center. Interviews were audio taped and transcribed verbatim. Data were analyzed line-byline and coded by using HyperResearch 2.0. Results Although participants' experiences were similar to those reported by others with peripheral neuropathy, there were also unique differences. Unique to this population was unexpected onset, rapid escalation of symptoms, lack of provider monitoring, and poor provider response to reported symptoms. Their experience demonstrated that peripheral neuropathy diminished health-related quality of life. Four themes emerged from the data: (1) nothing is supposed to happen after transplant; (2) neuropathy causes me more problems than my heart; (3) maybe there is something that could help; and (4) I've learned to live with certain limitations. Conclusion Development of or worsening of peripheral neuropathy after solid organ transplant may decrease health-related quality of life. Follow-up care should include vigilant monitoring for signs of peripheral neuropathy. Providers need to provide early treatment, education, support, empathy, and understanding.
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Affiliation(s)
- Laura Hanssen Textor
- Midwest Neuroscience Institute, Center for the Relief of Pain (LHT), Saint Luke's College of Health Sciences (JH), Kansas City, Missouri
| | - Jane Hedrick
- Midwest Neuroscience Institute, Center for the Relief of Pain (LHT), Saint Luke's College of Health Sciences (JH), Kansas City, Missouri
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Abstract
The treatment of painful diabetic polyneuropathy (PDPN) remains a major challenge. A number of reasons have made the guidelines on PDPN management of particular interest, including its high prevalence, health and socioeconomic impact, interdisciplinary nature and the need for updated evidence-based information to refine patient-tailored treatment by weighing up the risks of each treatment against its proven benefits, as well as optimizing the use of all available resources. The various guidelines on the management of neuropathic pain developed so far contain some differences in their work methodology and results. Some variations in the recommendations are to be expected but could be disorienting and confusing for stakeholders. In this review, a critical evaluation of the more recent guidelines on the management of PDPN is provided together with highlights on points of agreement and disagreement as well as insights into their clinical aspects.
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Affiliation(s)
- Vincenza Spallone
- Endocrinology, Department of Internal Medicine, Tor Vergata University, Rome, Italy.
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