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Ding J, Shi Q, Dong L, Su H, Du Y, Pan T, Zhong X. Association of HbA1c Variability with Vibrating Perception Threshold in Middle-Aged and Elderly Patients with Type 2 Diabetes Mellitus: A Retrospective Cohort Study. Diabetes Metab Syndr Obes 2024; 17:193-202. [PMID: 38225978 PMCID: PMC10788684 DOI: 10.2147/dmso.s443917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/07/2024] [Indexed: 01/17/2024] Open
Abstract
Purpose To investigate the relationship between HbA1c variability and vibrating perception threshold (VPT) in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM). Patients and Methods A total of 367 middle-aged and elderly patients with T2DM were enrolled. All patients were categorized into the control and vibration sensation deficiency group (VSD) based on VPT. Clinical data were collected. The coefficient of variation of glycated hemoglobin A1c (HbA1c-CV) and the mean glycated hemoglobin A1c(HbA1c-Mean) are considered as indexes of HbA1c variability. Multivariate logistic regression analysis, the generalized linear model and ROC curve correlation analysis were used to analyze the correlation of various factors and VPT. Results The multivariate logistic regression analysis revealed that age, systolic blood pressure (SBP), and HbA1c-CV were identified as risk factors for vibration sensation deficiency in middle-aged and elderly patients with T2DM, while estimated glomerular filtration rate (eGFR), triiodothyronine (T3), and alanine aminotransferase (ALT) were considered as protective factors. In the unadjusted generalized linear model, a significant association was observed between HbA1c-CV and VPT values. After adjusting for age, diabetic duration, SBP, homeostatic model assessment for beta-cell function (HOMA-β), ALT, eGFR, T3, 24-hour urinary protein excretion levels, and HbA1c-Mean, HbA1c-CV remained significantly correlated with VPT values on both sides. (left side, B=2.560, 95% CI 1.298~3.823; P<0.001; right side, B=2.608, 95% CI 1.498~3.718, P<0.001). The area under the curve (AUC) for HbA1c-CV and VSD prevalence was 0.723, with a sensitivity of 79.85%, specificity of 56.22%. Conclusion The risk of developing VSD increases proportionally with higher HbA1c-CV levels in middle-aged and elderly patients with T2DM. Reaching and maintaining blood glucose stability is essential to the mitigation of diabetes peripheral neuropathy occurrence.
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Affiliation(s)
- Jingcheng Ding
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
| | - Qian Shi
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
| | - Ling Dong
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
| | - Hong Su
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
| | - Yijun Du
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
| | - Tianrong Pan
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
| | - Xing Zhong
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
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Zaino B, Goel R, Devaragudi S, Prakash A, Vaghamashi Y, Sethi Y, Patel N, Kaka N. Diabetic neuropathy: Pathogenesis and evolving principles of management. Dis Mon 2023; 69:101582. [PMID: 37164794 DOI: 10.1016/j.disamonth.2023.101582] [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] [Indexed: 05/12/2023]
Abstract
The global rise of prediabetes and diabetes has spawned an epidemic of complications associated with these conditions. Neuropathy is the most common consequence, with distal symmetric polyneuropathy (DSP) being the most prevalent. Diabetic neuropathy (DN) is a debilitating consequence of diabetes mellitus resulting in the highest morbidity and death, besides imposing a substantial financial burden on the patient. Loss of sensory function commencing distally in the lower limbs, accompanied by discomfort and considerable morbidity, characterizes diabetic neuropathy. The clinical evaluation and therapeutic options for diabetic peripheral neuropathy are multifaceted. At least fifty percent of people with diabetes acquire diabetic neuropathy over time. Good glycemic control halts the evolution in individuals with Type 1 diabetes mellitus. These results have prompted fresh attempts to comprehend the origin and develop new guidelines for prevention and treatment. New recommendations have also been established for the treatment of painful DN using separate classes of medications, with an emphasis on avoiding the use of opioids. Although our comprehension of the intricacies of diabetic neuropathy has progressed significantly over the past decade, the unique processes driving the neuropathy in type 1 and type 2 diabetes remain unexplained. Currently, glycemic control and pain management are the only effective therapies. While glucose management significantly reduces neuropathy development in type 1 diabetics, the effect is considerably lower in type 2 diabetics. Evidence supports the use of anticonvulsants and antidepressants for diabetic peripheral neuropathy pain treatment. However, the absence of disease-modifying medications for diabetic DSP necessitates the identification of unrecognized modifiable risk factors. It is imperative to identify the 'missed' risk factors and targets, allowing comprehensive, individualized care for patients.
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Affiliation(s)
- Basem Zaino
- Tishreen University, Syria; PearResearch, India
| | - Rashika Goel
- Punjab Institute of Medical Sciences, India; PearResearch, India
| | - Sanjana Devaragudi
- Apollo Institute of Medical Sciences and Research, Hyderabad, India; PearResearch, India
| | - Ananya Prakash
- Narayana Institute of Cardiac Sciences, Bangalore, India; PearResearch, India
| | - Yogeshkumar Vaghamashi
- Bicol Christian College of Medicine, Legazpi city, Philippines; Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Yashendra Sethi
- PearResearch, India; Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Neil Patel
- PearResearch, India; GMERS Medical College Himmatnagar, India.
| | - Nirja Kaka
- PearResearch, India; GMERS Medical College Himmatnagar, India
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Pan Q, Fei S, Zhang L, Chen H, Luo J, Wang W, Xiao F, Guo L. How does diabetic peripheral neuropathy impact patients' burden of illness and the economy? A retrospective study in Beijing, China. Front Public Health 2023; 11:1164536. [PMID: 37250086 PMCID: PMC10213523 DOI: 10.3389/fpubh.2023.1164536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Diabetic peripheral neuropathy (DPN) causes significant illness in patients and has a negative impact on the economy. The objective of this study is to evaluate the cost and quantity of anti-diabetic drugs needed by patients with or without DPN, as well as their variation trends in Beijing between 2016 and 2018. Methods This observational cross-sectional study used data on diabetic patients with outpatient medication records obtained from Beijing Medical Insurance from 2016 to 2018. The medications, comorbidities, diabetes-related complications, treatment strategies, and costs of drug treatment were compared between DPN patients and non-DPN patients. Results Of the 28,53,036 diabetic patients included in the study, 3,75,216 (13.15%) had DPN and 1,87,710 (50.03%) of the DPN patients were women. Compared with non-DPN patients, DPN patients used more mediations (4.7 ± 2.47 vs. 3.77 ± 2.32, p < 0.0001, in 2018) to treat related complications and comorbidities (2.03 ± 1.2 vs. 1.71 ± 1.05; 2.68 ± 1.93 vs. 2.06 ± 1.86, p < 0.0001, respectively, in 2018). The total annual costs of drug treatment were higher in DPN patients than in non-DPN patients (¥12583.25 ± 10671.48 vs. ¥9810.91 ± 9234.14, p < 0.0001, in 2018). The usage of DDP4i increased from 2.55 to 6.63% in non-DPN patients and from 4.45 to 10.09% in DPN patients from 2017 to 2018. Conclusions The number of comorbidities, diabetic complications, medications, and annual drug treatment costs were greater in DPN patients than in non-DPN patients.
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Affiliation(s)
- Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Sijia Fei
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Lina Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Huan Chen
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Jingyi Luo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Fei Xiao
- The Key Laboratory of Geriatrics, Beijing Institution of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Sethi Y, Uniyal N, Vora V, Agarwal P, Murli H, Joshi A, Patel N, Chopra H, Hasabo EA, Kaka N. Hypertension the 'Missed Modifiable Risk Factor' for Diabetic Neuropathy: a Systematic Review. Curr Probl Cardiol 2023; 48:101581. [PMID: 36584725 DOI: 10.1016/j.cpcardiol.2022.101581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
Diabetes and hypertension stand as the major non-infectious diseases affecting 34.2 million and 1.28 billion people respectively. The literature on the impact of diabetes on hypertension and vice versa is evolving. The major objectives of this review were to compile the evolving literature establishing the role of hypertension in diabetic neuropathy, derive the exact mechanisms for its pathogenesis, and describe evidence-based precise individualized management of diabetic neuropathy in patients having diabetes complicated by hypertension. A systematic review was conducted by searching databases of PubMed, Embase, and Scopus covering the literature from inception to 2022. We included all observational and experimental studies, including both human and animal studies looking into the correlation between diabetic neuropathy and hypertension. Hypertension poses to be the leading modifiable risk factor for the development of diabetic neuropathy, especially distal symmetrical polyneuropathy, producing abnormal nerve conduction parameters and increased vibration perception threshold in patients with diabetes mellitus. Thus, we advocate that good glycemic control in patients with diabetes needs to be supported with strict blood pressure control for preventing and delaying the onset of diabetic neuropathy.
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Affiliation(s)
- Yashendra Sethi
- PearResearch, Dehradun, Uttarakhand, India; Department of Medicine, Government Doon Medical College, Dehradun, Uttarakhand, India.
| | - Nidhi Uniyal
- PearResearch, Dehradun, Uttarakhand, India; Department of Medicine, Gautam Buddha Chikitsa Mahavidyalaya, Ras Bihari Bose Subharti University, Dehradun, Uttarakhand, India
| | - Vidhi Vora
- PearResearch, Dehradun, Uttarakhand, India; Department of Medicine, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India
| | - Pratik Agarwal
- PearResearch, Dehradun, Uttarakhand, India; Department of Medicine, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India
| | - Hamsa Murli
- PearResearch, Dehradun, Uttarakhand, India; Department of Medicine, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India
| | - Archi Joshi
- PearResearch, Dehradun, Uttarakhand, India; Department of Medicine, Government Medical College, Haldwani, Uttarakhand, India
| | - Neil Patel
- PearResearch, Dehradun, Uttarakhand, India; Department of Medicine, GMERS Medical College, Himmatnagar, Gujarat, India
| | - Hitesh Chopra
- Department of Pharmaceutics, Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India
| | - Elfatih A Hasabo
- Faculty of Medicine, University of Khartoum, Khartoum, Khartoum State, Sudan
| | - Nirja Kaka
- PearResearch, Dehradun, Uttarakhand, India; Department of Medicine, GMERS Medical College, Himmatnagar, Gujarat, India
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Hossain MJ, Kendig MD, Letton ME, Morris MJ, Arnold R. Peripheral Neuropathy Phenotyping in Rat Models of Type 2 Diabetes Mellitus: Evaluating Uptake of the Neurodiab Guidelines and Identifying Future Directions. Diabetes Metab J 2022; 46:198-221. [PMID: 35385634 PMCID: PMC8987683 DOI: 10.4093/dmj.2021.0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/25/2022] [Indexed: 11/08/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) affects over half of type 2 diabetes mellitus (T2DM) patients, with an urgent need for effective pharmacotherapies. While many rat and mouse models of T2DM exist, the phenotyping of DPN has been challenging with inconsistencies across laboratories. To better characterize DPN in rodents, a consensus guideline was published in 2014 to accelerate the translation of preclinical findings. Here we review DPN phenotyping in rat models of T2DM against the 'Neurodiab' criteria to identify uptake of the guidelines and discuss how DPN phenotypes differ between models and according to diabetes duration and sex. A search of PubMed, Scopus and Web of Science databases identified 125 studies, categorised as either diet and/or chemically induced models or transgenic/spontaneous models of T2DM. The use of diet and chemically induced T2DM models has exceeded that of transgenic models in recent years, and the introduction of the Neurodiab guidelines has not appreciably increased the number of studies assessing all key DPN endpoints. Combined high-fat diet and low dose streptozotocin rat models are the most frequently used and well characterised. Overall, we recommend adherence to Neurodiab guidelines for creating better animal models of DPN to accelerate translation and drug development.
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Affiliation(s)
- Md Jakir Hossain
- Department of Pharmacology, School of Medical Sciences, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Michael D. Kendig
- Department of Pharmacology, School of Medical Sciences, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Meg E. Letton
- Department of Exercise Physiology, School of Medical Sciences, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Margaret J. Morris
- Department of Pharmacology, School of Medical Sciences, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Ria Arnold
- Department of Pharmacology, School of Medical Sciences, University of New South Wales (UNSW) Sydney, Sydney, Australia
- Department of Exercise Physiology, School of Medical Sciences, University of New South Wales (UNSW) Sydney, Sydney, Australia
- Department of Exercise and Rehabilitation, School of Medical, Indigenous and Health Science, University of Wollongong, Wollongong, Australia
- Corresponding author: Ria Arnold https://orcid.org/0000-0002-7469-6587 Department of Exercise Physiology, School of Health Sciences, UNSW Sydney, Sydney, NSW 2052, Australia E-mail:
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6
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Esmat A, Elshamy MI, Mohamed Zakaria D, Shady Z, Roshdy Mohamed E, El-Khouly N, Hassan MM, El-Senosy FM. Median Nerve Affection in Hypertensive Patients with and without Diabetes High-Resolution Ultrasound Assessment. Diabetes Metab Syndr Obes 2022; 15:183-188. [PMID: 35068936 PMCID: PMC8769048 DOI: 10.2147/dmso.s340111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/13/2021] [Indexed: 12/07/2022] Open
Abstract
PURPOSE Diabetes is a documented risk factor for peripheral neuropathy. It was reported that associated hypertension could increase this risk. The present study aimed to assess the effect of hypertension and diabetes on median nerve using high-resolution ultrasound. METHODS The study includes 50 hypertensive patients (HTN group), 50 diabetic patients (DM group), 50 patients with coexisting diabetes and hypertension (HTN + DM group) and 50 healthy controls. Median nerve affection in the studied groups was studied by vibration perception thresholds (VPT). The median nerve cross-sectional area was determined at the nerve cross-sectional area of the median nerve at the carpal tunnel by high-resolution ultrasound. Clinical symptoms were assessed using Toronto Clinical Severity Score (TCSS). RESULTS There was significantly higher median nerve CSA in all patient groups in comparison to controls. HTN + DM group had significantly higher median nerve CSA when compared with DM group. Patients with peripheral neuropathy in HTN + DM and DM groups had significantly higher median nerve CSA than patients without. Using ROC curve analysis, it was shown that median CSA could successfully distinguish patients with peripheral neuropathy from patients without in HTN + DM group [AUC (95% CI): 0.71 (0.54-0.89)] and in DM group [AUC (95% CI): 0.86 (0.72-0.99)]. CONCLUSION Hypertensive patients with and without diabetes have significantly higher median nerve CSA when compared with controls.
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Affiliation(s)
- Ahmed Esmat
- Department of Neurology, Al-Azhar University, Faculty of Medicine, Cairo, Egypt
| | - Mahmoud I Elshamy
- Department of Radiology, Al-Azhar University, Faculty of Medicine, Cairo, Egypt
| | - Doaa Mohamed Zakaria
- Department of Internal Medicine, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
| | - Zakarya Shady
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Eman Roshdy Mohamed
- Department of Internal Medicine, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
| | - Nashwa El-Khouly
- Department of Internal Medicine, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
| | - Marwa M Hassan
- Department of Internal Medicine, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
| | - Fatma M El-Senosy
- Department of Internal Medicine, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt
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Cheng Y, Cao W, Zhang J, Wang J, Liu X, Wu Q, Lin Q. Determinants of Diabetic Peripheral Neuropathy and Their Clinical Significance: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2022; 13:934020. [PMID: 35957831 PMCID: PMC9360478 DOI: 10.3389/fendo.2022.934020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In this study, we investigated the epidemiological characteristics and predictors of diabetic peripheral neuropathy (DPN) in adult patients with type 2 diabetes mellitus (DM). METHODS The study was designed as a retrospective cohort trial at the First Affiliated Hospital of Wenzhou Medical University. From January 2017 to December 2020, a total of 1,262 patients with DM were enrolled to assess the risk factors for DPN. The patients were divided into two groups (DPN group and non-DPN group). The Mann-Whitney U test or t-test, receiver operating characteristic (ROC) analyses, univariate chi-square analyses, and multiple logistic regression analyses were used to analyze the adjusted predictors of DPN. RESULTS The overall prevalence of DPN in DM patients was 72.7% (n = 793/1,091). Multivariate analysis revealed that age > 66 years (odds ratio [OR], 2.647; 95% confidence interval [CI] 1.469-4.770; p = 0.002), history of hypertension (OR, 1.829; 95% CI 1.146-2.920; p = 0.011), neutrophil (NE) levels exceeding 4.0 × 109/L (OR 0.256; 95% CI 0.162-0.405; p = 0.001), lymphocyte (LY) levels over 3.0 × 109/L (OR 7.173; 95% CI 4.258-12.086; p = 0.000), HbA1c > 7.7% (OR 3.151; 95% CI 1.959-5.068; p = 0.000), and FT3 > 4.4 pmol/L (OR 0.417; 95% CI 0.263-0.662; p = 0.000) were six significant predictive factors for the prevalence of DPN. CONCLUSIONS High levels of LY, HbA1c, history of hypertension, and > 66 years of age increase the risk of DPN in adult patients with DM, while high levels of NE and FT3 were protective factors of DPN. Thus, the prediction of DPN can significantly be improved by identifying older patients over the age of 66 and history of hypertension, as well as establishing the biochemical cutoff values of NE, LY, HbA1c, and FT3.
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Affiliation(s)
- Yifan Cheng
- Department of Neurology, Center for Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Wen Cao
- Department of Neurology, The Third Hospital of Peking University, Beijing, China
| | - Junzhe Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiabin Wang
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
| | - Xiang Liu
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
| | - Qianqian Wu
- Department of Geriatrics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Qingxia Lin
- Department of Psychiatry, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Qingxia Lin,
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Lee KA, Park TS, Jin HY. Non-glucose risk factors in the pathogenesis of diabetic peripheral neuropathy. Endocrine 2020; 70:465-478. [PMID: 32895875 DOI: 10.1007/s12020-020-02473-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/23/2020] [Indexed: 11/29/2022]
Abstract
In this review, we consider the diverse risk factors in diabetes patients beyond hyperglycemia that are being recognized as contributors to diabetic peripheral neuropathy (DPN). Interest in such alternative mechanisms has been encouraged by the recognition that neuropathy occurs in subjects with metabolic syndrome and pre-diabetes and by the reporting of several large clinical studies that failed to show reduced prevalence of neuropathy after intensive glucose control in patients with type 2 diabetes. Animal models of obesity, dyslipidemia, hypertension, and other disorders common to both pre-diabetes and diabetes have been used to highlight a number of plausible pathogenic mechanisms that may either damage the nerve independent of hyperglycemia or augment the toxic potential of hyperglycemia. While pathogenic mechanisms stemming from hyperglycemia are likely to be significant contributors to DPN, future therapeutic strategies will require a more nuanced approach that considers a range of concurrent insults derived from the complex pathophysiology of diabetes beyond direct hyperglycemia.
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Affiliation(s)
- Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Jeonbuk National University Hospital, Jeonbuk National University, Medical School, Jeonju, South Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Jeonbuk National University Hospital, Jeonbuk National University, Medical School, Jeonju, South Korea
| | - Heung Yong Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Jeonbuk National University Hospital, Jeonbuk National University, Medical School, Jeonju, South Korea.
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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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Ozaki K, Matsuura T. Superimposition of hypertension on diabetic peripheral neuropathy affects small unmyelinated sensory nerves in the skin and myelinated tibial and sural nerves in rats with alloxan-induced type 1 diabetes. J Toxicol Pathol 2020; 33:161-169. [PMID: 32764841 PMCID: PMC7396736 DOI: 10.1293/tox.2020-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/19/2020] [Indexed: 11/19/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) is a major complication of diabetes mellitus, and hypertension is considered to be a risk factor for DPN in patients with type 1 diabetes (T1DM). However, the morphological effects of hypertension on DPN are unclear. In this study, we investigated the effect of hypertension on DPN by investigating the changes in unmyelinated and myelinated nerve fibers in hypertensive rats with alloxan (AL)-induced T1DM. Thirteen-week-old WBN/Kob rats with AL-induced diabetes were allocated to receive tap water only (AL group), tap water containing 0.5% saline (0.5AN group), or tap water containing 0.75% saline (0.75AN group) for 15 weeks. Hyperglycemia was maintained for 15 weeks, and the animals were euthanized at 28 weeks. By 23 weeks of age, the systolic blood pressure was significantly higher in the 0.75AN and 0.5AN groups than in the AL group and was unchanged in all groups at 28 weeks. The number of intraepidermal sensory unmyelinated nerve fibers was significantly smaller in the 0.75AN and 0.5AN groups than in the AL group. The axonal size in the myelinated tibial and sural nerve fibers was significantly smaller in the 0.75AN group than in the AL group. Furthermore, luminal narrowing and endothelial hypertrophy were observed in the endoneurial tibial nerve vessels in the 0.75AN group. These findings suggest that superimposing hypertension on hyperglycemia may accelerate a reduction in the number of small unmyelinated sensory nerve fibers in the skin and induce mild axonal atrophy in myelinated tibial and sural nerve fibers in rats with AL-induced T1DM.
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Affiliation(s)
- Kiyokazu Ozaki
- Laboratory of Pathology, Faculty of Pharmaceutical Science, Setsunan University, 45-1 Nagaotohge-cho, Hirakata, Osaka 573-0101, Japan
| | - Tetsuro Matsuura
- Laboratory of Pathology, Faculty of Pharmaceutical Science, Setsunan University, 45-1 Nagaotohge-cho, Hirakata, Osaka 573-0101, Japan
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Yokoyama H, Tsuji T, Hayashi S, Kabata D, Shintani A. Factors associated with diabetic polyneuropathy-related sensory symptoms and signs in patients with polyneuropathy: A cross-sectional Japanese study (JDDM 52) using a non-linear model. J Diabetes Investig 2020; 11:450-457. [PMID: 31314173 PMCID: PMC7078109 DOI: 10.1111/jdi.13117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 02/06/2023] Open
Abstract
AIMS/INTRODUCTION To assess the prevalence of diabetic polyneuropathy (DPN)-related sensory symptoms/signs and associated factors in patients with polyneuropathy, considering non-linear effects for numerical variables. MATERIALS AND METHODS A cross-sectional survey of patients with type 2 diabetes mellitus from 17 primary care clinics across Japan was carried out. DPN and DPN-related sensory symptoms/signs were diagnosed according to the Diabetic Neuropathy Study Group in Japan criteria. RESULTS Of the 9,914 patients with type 2 diabetes mellitus in this study, 2,745 had DPN and 1,689 had DPN-related sensory symptoms/signs (61.5% of patients with DPN). There were significant correlations between DPN-related sensory symptoms/signs and smoking status (odds ratio 2.04 for current and 1.64 for former; P < 0.001 and P = 0.002, respectively), sex (odds ratio 0.56 for male/female; P < 0.001) and alcohol consumption (odds ratio 2.02 for former/never; P = 0.004). Based on the non-linear logistic regression model, significant correlations were observed between the presence of DPN-related sensory symptoms/signs and higher systolic blood pressure (SBP), longer diabetes duration, and decreasing age. The logarithm of odds for SBP increased until reaching approximately 130 mmHg, then it plateaued. CONCLUSIONS Some modifiable factors assessed in the large survey database might be associated with DPN-related sensory symptoms/signs, namely smoking, alcohol consumption and SBP. Maintaining SBP <130 mmHg was associated with lower odds of DPN-related sensory symptoms/signs in patients with DPN.
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Affiliation(s)
- Hiroki Yokoyama
- Department of Internal MedicineJiyugaoka Medical ClinicObihiroJapan
| | | | | | - Daijiro Kabata
- Department of Medical StatisticsOsaka City University Graduate School of MedicineOsakaJapan
| | - Ayumi Shintani
- Department of Medical StatisticsOsaka City University Graduate School of MedicineOsakaJapan
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Ponirakis G, Petropoulos IN, Alam U, Ferdousi M, Asghar O, Marshall A, Azmi S, Jeziorska M, Mahfoud ZR, Boulton AJM, Efron N, Nukada H, Malik RA. Hypertension Contributes to Neuropathy in Patients With Type 1 Diabetes. Am J Hypertens 2019; 32:796-803. [PMID: 31013342 PMCID: PMC6636691 DOI: 10.1093/ajh/hpz058] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) can lead to foot ulceration and amputation. There are currently no disease-modifying therapies for DPN. The aim of this study was to determine if hypertension contributes to DPN in patients with type 1 diabetes mellitus (T1DM). METHODS Subjects with T1DM (n = 70) and controls (n = 78) underwent a comprehensive assessment of DPN. RESULTS Hypertension was present in 40 of 70 T1DM subjects and 20 of 78 controls. Hypertension was associated with abnormal nerve conduction parameters (P = 0.03 to <0.001), increased vibration perception threshold (P = 0.01) and reduced corneal nerve fiber density and length (P = 0.02) in subjects with T1DM. However, after adjusting for confounding factors only tibial compound motor action potential and nerve conduction velocity were associated with hypertension (P = 0.03) and systolic blood pressure (P < 0.01 to <0.0001). Hypertension had no effect on neuropathy in subjects without diabetes. CONCLUSIONS This study shows that hypertension is associated with impaired nerve conduction in T1DM. It supports previous small trials showing that angiotensin-converting enzyme inhibitors improve nerve conduction and advocates the need for larger clinical trials with blood pressure lowering agents in DPN.
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Affiliation(s)
- Georgios Ponirakis
- Weill Cornell Medicine–Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Uazman Alam
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
- Eye and Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool, UK
| | - Maryam Ferdousi
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Omar Asghar
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Andrew Marshall
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Shazli Azmi
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Maria Jeziorska
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Ziyad R Mahfoud
- Weill Cornell Medicine–Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Andrew J M Boulton
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Hitoshi Nukada
- Nukada Institute for Medical and Biological Research, Chiba, Japan
| | - Rayaz A Malik
- Weill Cornell Medicine–Qatar, Qatar Foundation, Education City, Doha, Qatar
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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13
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Najafi MT, Khaloo P, Alemi H, Jaafarinia A, Blaha MJ, Mirbolouk M, Mansournia MA, Afarideh M, Esteghamati S, Nakhjavani M, Esteghamati A. Ambulatory blood pressure monitoring and diabetes complications: Targeting morning blood pressure surge and nocturnal dipping. Medicine (Baltimore) 2018; 97:e12185. [PMID: 30235664 PMCID: PMC6160188 DOI: 10.1097/md.0000000000012185] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Ambulatory blood pressure monitoring (ABPM) correlates more closely to organ damages than clinic blood pressure (BP). In the current study we aimed to investigate the association between micro- and macrovascular complications of diabetes and both diurnal and nocturnal variability in BP.A total of 192 patients with type 2 diabetes (T2DM) who had complete data on ABPM were selected. BP categories were defined based on 2017 ACC/American Heart Association BP guideline. The cross-sectional association between different BP phenotypes and diabetes complications including cardiovascular disease (CVD), nephropathy, retinopathy, and neuropathy was assessed using multiple logistic regression models adjusted for age, sex, body mass index, hypertension (HTN), hemoglobin A1c, fasting blood glucose (FBG), triglyceride (TG), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol.Approximately 48.9% of participants with T2DM had 24-hour HTN. The prevalence of daytime, nighttime, and clinic HTN were 35.9%, 96.3%, and 53.1%, respectively. Approximately 54.2% of participants had nondipping nocturnal pattern and 28.6% were risers. Nondipping nocturnal BP was associated with CVD, neuropathy, and retinopathy (P = .05, .05, and .014, respectively). Sleep trough morning blood pressure surge (MBPS) was associated with neuropathy (P = .023). Neuropathy was also associated with other components of MBPS (P < .05).We demonstrated that diabetic neuropathy was associated with all the components of MBPS and abnormal dipping status. Our results indicated loss of nocturnal BP dipping but not MBPS as a risk factor for CVD and retinopathy in patients with T2DM. Our findings once again highlighted the importance of ambulatory BP monitoring and targeted antihypertensive therapy directed toward to restore normal circadian BP in patients with T2DM.
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Affiliation(s)
| | - Pegah Khaloo
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran
| | - Hamid Alemi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran
| | - Asma Jaafarinia
- Department of Nephrology, Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Baltimore, MD
| | - Mohammadhassan Mirbolouk
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Baltimore, MD
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Afarideh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran
| | - Sadaf Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran
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Association of single nucleotide polymorphisms in CACNA 1A/CACNA 1C/CACNA 1H calcium channel genes with diabetic peripheral neuropathy in Chinese population. Biosci Rep 2018; 38:BSR20171670. [PMID: 29581247 PMCID: PMC6435562 DOI: 10.1042/bsr20171670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/20/2018] [Accepted: 03/26/2018] [Indexed: 12/22/2022] Open
Abstract
The present study was conducted to explore the correlations between single nucleotide polymorphisms (SNPs) in the calcium channel CACNA 1A, CACNA 1C, and CACNA 1H genes and diabetic peripheral neuropathy (DPN) amongst the Chinese population. In total, 281 patients diagnosed with type 2 diabetes participated in the present study. These patients were divided into the case group, which was subdivided into the DPN (143 cases) and the non-DPN groups (138 cases). Subsequently, 180 healthy individuals that had undergone routine health examinations were also recruited and assigned to the control group. PCR-restriction fragment length polymorphism (PCR-RFLP) was used to detect the genotype and allele frequencies of CACNA 1A, CACNA 1C, and CACNA 1H genes; logistic regression analysis to investigate the association of gene polymorphisms with DNP. Gene–gene interactions were then detected by generalized multifactor dimensionality reduction (GMDR). The results revealed that CACNA 1A rs2248069 and rsl6030, CACNA 1C rs216008 and rs2239050, and CACNA 1H rs3794619, and rs7191246 SNPs were all associated with DPN, while rs2248069, rsl6030, rs2239050, and rs7191246 polymorphisms were attributed to the susceptibility to DPN. It was also observed that the optimal models were three-, four- and five-dimensional models with a prediction accuracy of 61.05% and the greatest consistency of cross-validation was 10/10. In summary, these findings demonstrated that the SNPs in the CACNA 1A, CACNA 1C, and CACNA 1H genes were involved in the pathophysiology of DPN. In addition, polymorphisms in the CACNA 1A, CACNA 1C, and CACNA 1H genes and their interactions also had effects on DPN.
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15
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Ozaki K, Terayama Y, Matsuura T, Narama I. Effect of combined dyslipidemia and hyperglycemia on diabetic peripheral neuropathy in alloxan-induced diabetic WBN/Kob rats. J Toxicol Pathol 2018; 31:125-133. [PMID: 29750001 PMCID: PMC5938213 DOI: 10.1293/tox.2017-0063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/21/2018] [Indexed: 01/08/2023] Open
Abstract
Clinical and experimental research have suggested that dyslipidemia aggravates diabetic peripheral neuropathy (DPN). However, whether dyslipidemia is a risk factor for DPN remains unclear. To investigate the effect of dyslipidemia on DPN, morphological features of peripheral nerves were analyzed in diabetic rats treated with a high-fat diet (HFD). Male rats were divided into four groups: nondiabetic rats (N), alloxan-induced diabetic rats (AL), diabetic rats treated with an HFD (AH), and nondiabetic rats treated with an HFD (HF). Combined hyperglycemia and dyslipidemia (AH group) induced a significant increase in plasma triglyceride and cholesterol levels. In addition, the combined effects contributed to a reduction in myelin size and a reduction in myelin thickness as indicated on sensory sural nerve histograms. There was also a reduction in the size of motor nerve axons when compared with the effects of hyperglycemia or dyslipidemia alone. However, the sensory nerve conduction velocity in the AH group was slightly but not significantly lower than those in the HF and AL groups. These results suggest that combined hyperglycemia and dyslipidemia induced mild peripheral motor and sensory nerve lesions, without significantly affecting sensory nerve conduction velocity.
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Affiliation(s)
- Kiyokazu Ozaki
- Laboratory of Pathology, Faculty of Pharmaceutical Science, Setsunan University, 45-1 Nagaotohge-cho, Hirakata, Osaka 573-0101, Japan
| | - Yui Terayama
- Laboratory of Pathology, Faculty of Pharmaceutical Science, Setsunan University, 45-1 Nagaotohge-cho, Hirakata, Osaka 573-0101, Japan
| | - Tetsuro Matsuura
- Laboratory of Pathology, Faculty of Pharmaceutical Science, Setsunan University, 45-1 Nagaotohge-cho, Hirakata, Osaka 573-0101, Japan
| | - Isao Narama
- Laboratory of Pathology, Faculty of Pharmaceutical Science, Setsunan University, 45-1 Nagaotohge-cho, Hirakata, Osaka 573-0101, Japan
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16
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Daulatzai MA. Dysfunctional Sensory Modalities, Locus Coeruleus, and Basal Forebrain: Early Determinants that Promote Neuropathogenesis of Cognitive and Memory Decline and Alzheimer’s Disease. Neurotox Res 2016; 30:295-337. [DOI: 10.1007/s12640-016-9643-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 12/22/2022]
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17
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Nukada H, Baba M, Ogasawara S, McMorran D, Yagihashi S. Neuropathy in the spontaneously hypertensive rat: An electrophysiological and histological study. Muscle Nerve 2016; 54:756-62. [PMID: 26970072 DOI: 10.1002/mus.25098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Hypertension is identified as a risk factor for development of polyneuropathy. In this study we examined nerve conduction and morphological alteration of peripheral nerves in spontaneously hypertensive rats (SHR). METHODS Motor nerve conduction velocity (MNCV) in the sciatic-tibial nerve and sensory nerve conduction velocity (SNCV) in the sural nerve were measured. Pathological investigations included spinal cord, dorsal root ganglion, and hindlimb nerves in SHR and Wistar-Kyoto rats (WKY) aged 4-64 weeks. RESULTS Blood pressure was significantly higher in SHR than WKY animals at 4 weeks and elevated further with aging. MNCV and SNCV were significantly slower in SHR compared with WKY after age 24 weeks. Prominent morphological changes in SHR nerves included axonal atrophy and myelin splitting. SHR also had endoneurial microangiopathy with reduplication of basement membrane. CONCLUSIONS SHR showed slowed nerve conduction velocity and pathological abnormalities of hindlimb nerves. Sustained severe hypertension may cause axonal atrophy and endoneurial microangiopathy. Muscle Nerve 54: 756-762, 2016.
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Affiliation(s)
- Hitoshi Nukada
- The Nukada Institute for Medical & Biological Research, 5-18 Inage-machi, Inage-ku, Chiba, 263-0035, Japan. .,Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Masayuki Baba
- Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Saori Ogasawara
- Department of Pathology and Molecular Medicine, Hirosaki University, Hirosaki, Japan
| | - Denise McMorran
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Soroku Yagihashi
- Department of Pathology and Molecular Medicine, Hirosaki University, Hirosaki, Japan
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18
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Study on the use of quantitative ultrasound evaluation of diabetic neuropathy in the rat sciatic nerve. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2016; 39:997-1005. [DOI: 10.1007/s13246-016-0448-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/26/2016] [Indexed: 01/19/2023]
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Ozaki K, Hamano H, Matsuura T, Narama I. Effect of deoxycorticosterone acetate-salt-induced hypertension on diabetic peripheral neuropathy in alloxan-induced diabetic WBN/Kob rats. J Toxicol Pathol 2015; 29:1-6. [PMID: 26989296 PMCID: PMC4766525 DOI: 10.1293/tox.2015-0033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 08/18/2015] [Indexed: 11/19/2022] Open
Abstract
The relationship between hypertension and diabetic peripheral neuropathy (DPN) has recently been reported in clinical research, but it remains unclear whether hypertension is a risk factor for DPN. To investigate the effects of hypertension on DPN, we analyzed morphological features of peripheral nerves in diabetic rats with hypertension. Male WBN/Kob rats were divided into 2 groups: alloxan-induced diabetic rats with deoxycorticosterone acetate-salt (DOCA-salt) treatment (ADN group) and nondiabetic rats with DOCA-salt treatment (DN group). Sciatic, tibial (motor) and sural (sensory) nerves were subjected to qualitative and quantitative histomorphological analysis. Systolic blood pressure in the two groups exhibited a higher value (>140 mmHg), but there was no significant difference between the two groups. Endoneurial blood vessels in both groups presented endothelial hypertrophy and narrowing of the vascular lumen. Electron microscopically, duplication of basal lamina surrounding the endothelium and pericyte of the endoneurial vessels was observed, and this lesion appeared to be more frequent and severe in the ADN group than the DN group. Many nerve fibers of the ADN and DN groups showed an almost normal appearance, whereas morphometrical analysis of the tibial nerve showed a significant shift to smaller fiber and myelin sizes in the ADN group compared with DN group. In sural nerve, the fiber and axon-size significantly shifted to a smaller size in ADN group compared with the DN group. These results suggest that combined diabetes and hypertension could induce mild peripheral nerve lesions with vascular changes.
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Affiliation(s)
- Kiyokazu Ozaki
- Laboratory of Pathology, Faculty of Pharmaceutical Science, Setsunan University, 45-1 Nagaotohge-cho, Hirakata, Osaka 573-0101, Japan
| | - Hiroko Hamano
- Laboratory of Pathology, Faculty of Pharmaceutical Science, Setsunan University, 45-1 Nagaotohge-cho, Hirakata, Osaka 573-0101, Japan
| | - Tetsuro Matsuura
- Laboratory of Pathology, Faculty of Pharmaceutical Science, Setsunan University, 45-1 Nagaotohge-cho, Hirakata, Osaka 573-0101, Japan
| | - Isao Narama
- Laboratory of Pathology, Faculty of Pharmaceutical Science, Setsunan University, 45-1 Nagaotohge-cho, Hirakata, Osaka 573-0101, Japan
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Sanada LS, Tavares MR, Sato KL, Ferreira RDS, Neubern MCM, Castania JA, Salgado HC, Fazan VPS. Association of chronic diabetes and hypertension in sural nerve morphometry: an experimental study. Diabetol Metab Syndr 2015; 7:9. [PMID: 25717348 PMCID: PMC4339238 DOI: 10.1186/s13098-015-0005-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prospective studies have shown incidence rates of hypertension in diabetes mellitus to be three times that of subjects without diabetes mellitus. The reverse also applies, with the incidence of diabetes two to three times higher in patients with hypertension. Despite this common clinical association, the contribution of each isolated entity in the development of a neuropathy is still not well understood. The aims of the present study were to investigate the presence of peripheral neuropathy in spontaneously hypertensive rats (SHR) and SHR with chronically induced diabetes, using a morphological and morphometric study of the sural nerves. METHODS Female SHR and normotensive Wistar rats (WR), 8 weeks old, received a single intravenous injection of streptozotocin (STZ) through the tail vein. Controls from both strains received vehicle. Twelve weeks after the injection, sural nerves were dissected and prepared for light microscopy. Morphometry of sural nerve fascicles and myelinated fibers was performed with the aid of computer software. RESULTS The sural nerve myelinated fibers were highly affected by experimental diabetes in normotensive rats, causing mainly the reduction of the fiber size. Hypertensive rats showed characteristics of small fiber neuropathy and a severe reduction of the number and density or Schwann cells. The association between diabetes and hypertension caused an increase on the average size of the myelinated fibers, pointing to a small fiber loss, associated to axonal atrophy. CONCLUSIONS Our study gives morphological support to the existence of a neuropathy due to hypertension, which is among one of the most common risk factors for diabetic neuropathy. The association between the two neuropathies showed to be a complex alteration, involving and including both, large and small fibers neuropathy. Hypertension caused, indeed, an exacerbation of the alterations already observed in experimental models of diabetic neuropathy.
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Affiliation(s)
- Luciana Sayuri Sanada
- />Department of Neuroscience and Behavioral Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
| | | | - Karina Laurenti Sato
- />Departament of Physical Therapy, Federal University of Sergipe, Aracaju, SE Brazil
| | - Renata da Silva Ferreira
- />Department of Neuroscience and Behavioral Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Milena Cardoso Maia Neubern
- />Department of Neuroscience and Behavioral Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Jaci Ayrton Castania
- />Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Helio Cesar Salgado
- />Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Valéria Paula Sassoli Fazan
- />Department of Neuroscience and Behavioral Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil
- />Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto, USP, Av. Bandeirantes 3900, Ribeirão Preto, SP Brazil
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