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Atmaca A, Ketenci A, Sahin I, Sengun IS, Oner RI, Erdem Tilki H, Adas M, Soyleli H, Demir T. Expert opinion on screening, diagnosis and management of diabetic peripheral neuropathy: a multidisciplinary approach. Front Endocrinol (Lausanne) 2024; 15:1380929. [PMID: 38952393 PMCID: PMC11215140 DOI: 10.3389/fendo.2024.1380929] [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] [Received: 02/02/2024] [Accepted: 05/15/2024] [Indexed: 07/03/2024] Open
Abstract
The proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of the disease by clinicians as a key factor in early recognition and diagnosis, emphasizing an improved awareness of the disease by the first-admission or referring physicians. The proposed "screening and diagnostic" algorithm involves the consideration of DPN in a patient with prediabetes or diabetes who presents with neuropathic symptoms and/or signs of neuropathy in the presence of DPN risk factors, with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction in atypical cases. Although, the first-line interventions for DPN are currently represented by optimized glycemic control (mainly for type 1 diabetes) and multifactorial intervention (mainly for type 2 diabetes), there is a need for individualized pathogenesis-directed treatment approaches for DPN. Alpha-lipoic acid (ALA) seems to be an important first-line pathogenesis-directed agent, given that it is a direct and indirect antioxidant that works with a strategy targeted directly against reactive oxygen species and indirectly in favor of endogenous antioxidant capacity for improving DPN conditions. There is still a gap in existing research in the field, necessitating well-designed, robust, multicenter clinical trials with sensitive endpoints and standardized protocols to facilitate the diagnosis of DPN via a simple and effective algorithm and to track progression of disease and treatment response. Identification of biomarkers/predictors that would allow an individualized approach from a potentially disease-modifying perspective may provide opportunities for novel treatments that would be efficacious in early stages of DPN, and may modify the natural course of the disease. This expert opinion document is expected to increase awareness among physicians about conceptual, clinical, and therapeutic aspects of DPN and to assist them in timely recognition of DPN and translating this information into their clinical practice for best practice in the management of patients with DPN.
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Affiliation(s)
- Aysegul Atmaca
- Department of Endocrinology and Metabolism, Ondokuz Mayis University Faculty of Medicine, Samsun, Türkiye
| | - Aysegul Ketenci
- Department of Physical Medicine and Rehabilitation, Koc University Faculty of Medicine, Istanbul, Türkiye
| | - Ibrahim Sahin
- Department of Endocrinology and Metabolism, Inonu University Faculty of Medicine, Malatya, Türkiye
| | - Ihsan Sukru Sengun
- Department of Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Türkiye
| | - Ramazan Ilyas Oner
- Department of Internal Medicine, Adiyaman University Faculty of Medicine, Adiyaman, Türkiye
| | - Hacer Erdem Tilki
- Department of Neurology, Ondokuz Mayis University Faculty of Medicine, Samsun, Türkiye
| | - Mine Adas
- Department of Endocrinology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
| | - Hatice Soyleli
- Department of Medical Affairs, Abdi Ibrahim Pharmaceuticals, Istanbul, Türkiye
| | - Tevfik Demir
- Department of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, Izmir, Türkiye
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Xu R, Fang Z, Wang H, Gu Y, Yu L, Zhang B, Xu J. Molecular mechanism and intervention measures of microvascular complications in diabetes. Open Med (Wars) 2024; 19:20230894. [PMID: 38645437 PMCID: PMC11032097 DOI: 10.1515/med-2023-0894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/23/2023] [Accepted: 01/05/2024] [Indexed: 04/23/2024] Open
Abstract
Objective In this article, the epidemiology, molecular mechanism of occurrence and development, risk factors, and treatment of diabetic microvascular complications such as diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy were discussed, providing the theoretical basis for more accurate elucidation of the pathogenesis and treatment of diabetic microvascular complications. Methods The electronic database of PubMed was searched, and retrieved papers were screened for eligibility by two independent reviewers. Data were extracted using a standardized data extraction form and the quality of included papers was assessed. Results Thirty-eight articles were included. Diabetes nephropathy, diabetes peripheral neuropathy, and diabetes retinopathy are the most common and serious microvascular complications of diabetes in clinical patients. Renin-angiotensin system blockers, beta drugs, statins, antivascular endothelial growth factor drugs, and antioxidants can inhibit the occurrence of microvascular complications in diabetes. Conclusions However, there has been no breakthrough in the treatment of diabetic microvascular complications. Therefore, prevention of diabetic microvascular complications is more important than treatment.
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Affiliation(s)
- Rui Xu
- Hanan Branch of the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Ziming Fang
- The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Hongyu Wang
- Dongning Maternal and Child Care Service Center, Mudanjiang, China
| | - Ye Gu
- Heilongjiang University Of Chinese Medicine, Harbin, China
| | - Liying Yu
- Daqing Traditional Chinese Medicine Hospital, Daqing, China
| | - Boyang Zhang
- Wuxi Traditional Chinese Medicine Hospital, Wuxi, China
| | - Jingyu Xu
- Department of Cardiology, The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
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Huang HY, Lin YP, Wei H, Fu Y, Zhou YH, Fang ZH, Qiu XT, Wang M, Li QB, Li SS, Wang SD, Dai F, Liu ZJ, Zhao L, Wen JX, Wu LY, Zeng HY, Zhang JM, Lu QY, He L, Song W, Sun L, Luo LL, He JL, Xie WW, Liang QS, Huang Y, Zhu SL, Long JE, Gao ZJ, Wen ZH, Li CJ, Ouyang WW, Li G, Wu MH, Li AX, Huang JZ, Paul SK, Tang XY, Fan GJ. Effect and Safety of Herbal Medicine Foot Baths in Patients with Diabetic Peripheral Neuropathy: A Multicenter Double-Blind Randomized Controlled Trial. Chin J Integr Med 2024; 30:195-202. [PMID: 38374490 DOI: 10.1007/s11655-024-3900-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To evaluate the effect and safety of foot baths with Tangbi Waixi Decoction (TW) in treating patients with diabetic peripheral neuropathy (DPN). METHODS It is a multicenter double-blinded randomized controlled trial. Participants with DPN were recruited between November 18, 2016 and May 30, 2018 from 8 hospitals in China. All patients received basic treatments for glycemic management. Patients received foot baths with TW herbal granules either 66.9 g (intervention group) or 6.69 g (control group) for 30 min once a day for 2 weeks and followed by a 2-week rest, as a therapeutic course. If the Toronto Clinical Scoring System total score (TCSS-TS) ⩾6 points, the patients received a total of 3 therapeutic courses (for 12 weeks) and were followed up for 12 weeks. The primary outcome was change in TCSS-TS score at 12 and 24 weeks. Secondary outcomes included changes in bilateral motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of the median and common peroneal nerve. Safety was also assessed. RESULTS Totally 632 patients were enrolled, and 317 and 315 were randomized to the intervention and control groups, respectively. After the 12-week intervention, patients in both groups showed significant declines in TCSSTS scores, and significant increases in MNCV and SNCV of the median and common peroneal nerves compared with pre-treatment (P<0.05). The reduction of TCSS-TS score at 12 weeks and the increase of SNCV of median nerve at 24 weeks in the control group were greater than those in the intervention group (P<0.05). The number of adverse events did not differ significantly between groups (P>0.05), and no serious adverse event was related with treatment. CONCLUSION Treatment of TW foot baths was safe and significantly benefitted patients with DPN. A low dose of TW appeared to be more effective than a high dose. (Registry No. ChiCTR-IOR-16009331).
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Affiliation(s)
- Hao-Yue Huang
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Yu-Ping Lin
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Hua Wei
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Yu Fu
- Department of Endocrinology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, China
| | - Yue-Hong Zhou
- Department of Endocrinology, Liuyang Hospital of Chinese Medicine, Changsha, 410000, China
| | - Zhao-Hui Fang
- Department of Endocrinology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230000, China
| | - Xiao-Tang Qiu
- Department of Endocrinology, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou, 570100, China
| | - Mei Wang
- Department of Endocrinology, The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, 110000, China
| | - Qing-Bo Li
- Department of Geriatric, Luoyang No.1 Hospital of Traditional Chinese Medicine, Luoyang, Henan Province, 471000, China
| | - Shan-Shan Li
- Department of Endocrinology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, 550000, China
| | - Shi-Dong Wang
- Department of Endocrinology, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, 100000, China
| | - Fang Dai
- Department of Endocrinology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, 550000, China
| | - Zhen-Jie Liu
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Ling Zhao
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Jian-Xuan Wen
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Li-Yan Wu
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Hui-Yan Zeng
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Jin-Ming Zhang
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Qi-Yun Lu
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Liu He
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Wei Song
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Lu Sun
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Lu-Lu Luo
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Jia-Li He
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Wen-Wen Xie
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Qing-Shun Liang
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Yuan Huang
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Sheng-Ling Zhu
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Jie-Er Long
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Zhi-Juan Gao
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Ze-Huai Wen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Chun-Ji Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Wen-Wei Ouyang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Geng Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Ming-Hui Wu
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - An-Xiang Li
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China
| | - Jin-Zhu Huang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Sanjoy K Paul
- Melbourne EpiCentre, The University of Melbourne and Melbourne Health, Melbourne, 3013, Australia
| | - Xian-Yu Tang
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China.
| | - Guan-Jie Fan
- Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120, China.
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Abd-Elsayed AA, Marcondes LP, Loris ZB, Reilly D. Painful Diabetic Peripheral Neuropathy - A Survey of Patient Experiences. J Pain Res 2023; 16:2269-2285. [PMID: 37425223 PMCID: PMC10329444 DOI: 10.2147/jpr.s409876] [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] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose An online survey was conducted in the USA to obtain information about the knowledge and experiences of patients with painful diabetic peripheral neuropathy (pDPN). Patients and Methods 506 adults with diabetes and pDPN affecting the feet for ≥6 months, for which pain medication had been prescribed for ≥6 months, completed an online survey questionnaire in March 2021. Results 79% of respondents had type 2 diabetes, 60% were male, 82% were Caucasian and 87% had comorbidities. Pain was significant to severe in 49% of respondents, and 66% had disability due to nerve pain. Anticonvulsants, over-the-counter pills and supplements were the most commonly used medications. Topical creams/patches were prescribed in 23% of respondents. 70% had tried multiple medications for their pain. 61% of respondents had to see ≥2 doctors before receiving a correct diagnosis of pDPN. 85% of respondents felt that the doctor understood their pain and its impact on their life. 70% had no difficulty finding the information they wanted. 34% felt insufficiently informed about their condition. A medical professional was the primary, and most trusted, source of information. Frustration, worry, anxiety and uncertainty were the most commonly reported emotions. Respondents were generally eager to find new medications for pain relief and desperate for a cure. Lifestyle changes because of nerve pain were most commonly associated with physical disabilities and sleep disturbance. Better treatments and freedom from pain were the overriding perspectives when considering the future. Conclusion Patients with pDPN are generally well informed about their pain and trust their doctor but remain unsatisfied with their current treatment and struggle to find a lasting solution for their pain. Early identification and diagnosis of pain in diabetics, and education about treatments, is important to minimize the impact of pain on quality of life and emotional well-being.
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Affiliation(s)
- Alaa A Abd-Elsayed
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Kender Z, von Rauchhaupt E, Schwarz D, Tsilingiris D, Schimpfle L, Bartl H, Longo VD, Bendszus M, Kopf S, Herzig S, Heiland S, Szendroedi J, Sulaj A. Six-month periodic fasting does not affect somatosensory nerve function in type 2 diabetes patients. Front Endocrinol (Lausanne) 2023; 14:1143799. [PMID: 37251671 PMCID: PMC10213657 DOI: 10.3389/fendo.2023.1143799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/20/2023] [Indexed: 05/31/2023] Open
Abstract
Background and aim Current strategies for preventing diabetic sensorimotor polyneuropathy (DSPN) are limited mainly to glucose control but rapid decrease of glycemia can lead to acute onset or worsening of DSPN. The aim of this study was to examine the effects of periodic fasting on somatosensory nerve function in patients with type 2 diabetes (T2D). Study design and methods Somatosensory nerve function was assessed in thirty-one patients with T2D (HbA1c 7.8 ± 1.3% [61.4 ± 14.3 mmol/mol]) before and after a six-month fasting-mimicking diet (FMD; n=14) or a control Mediterranean diet (M-diet; n=17). Neuropathy disability score (NDS), neuropathy symptoms score (NSS), nerve conduction velocity and quantitative sensory testing (QST) were analyzed. 6 participants of the M-Diet group and 7 of the FMD group underwent diffusion-weighted high-resolution magnetic resonance neurography (MRN) of the right leg before and after the diet intervention. Results Clinical neuropathy scores did not differ between study groups at baseline (64% in the M-Diet group and 47% in the FMD group had DSPN) and no change was found after intervention. The differences in sensory NCV and sensory nerve action potential (SNAP) of sural nerve were comparable between study groups. Motor NCV of tibial nerve decreased by 12% in the M-Diet group (P=0.04), but did not change in the FMD group (P=0.39). Compound motor action potential (CMAP) of tibial nerve did not change in M-Diet group (P=0.8) and increased in the FMD group by 18% (P=0.02). Motor NCV and CMAP of peroneal nerve remained unchanged in both groups. In QST M-diet-group showed a decrease by 45% in heat pain threshold (P=0.02), FMD group showed no change (P=0.50). Changes in thermal detection, mechanical detection and mechanical pain did not differ between groups. MRN analysis showed stable fascicular nerve lesions irrespective of the degree of structural pathology. Fractional anisotropy and T2-time did not change in both study groups, while a correlation with the clinical degree of DSPN could be confirmed for both. Conclusions Our study shows that six-month periodic fasting was safe in preserving nerve function and had no detrimental effects on somatosensory nerve function in T2D patients. Clinical trial registration https://drks.de/search/en/trial/DRKS00014287, identifier DRKS00014287.
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Affiliation(s)
- Zoltan Kender
- Clinic for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research (DZD), Neuherberg, Germany
| | - Ekaterina von Rauchhaupt
- Clinic for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research (DZD), Neuherberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dimitrios Tsilingiris
- Clinic for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research (DZD), Neuherberg, Germany
| | - Lukas Schimpfle
- Clinic for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research (DZD), Neuherberg, Germany
| | - Hannelore Bartl
- Clinic for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Valter D. Longo
- Longevity Institute, School of Gerontology, and Department of Biological Sciences, University of Southern California, Los Angeles, CA, United States
- FIRC Institute of Molecular Oncology, Italian Foundation for Cancer Research Institute of Molecular Oncology, Milan, Italy
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Kopf
- Clinic for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research (DZD), Neuherberg, Germany
| | - Stephan Herzig
- German Center of Diabetes Research (DZD), Neuherberg, Germany
- Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Internal Medicine 1, Heidelberg University Hospital, Heidelberg, Germany
- Chair Molecular Metabolic Control, Technical University Munich, Munich, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Julia Szendroedi
- Clinic for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research (DZD), Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Helmholtz Center Munich, Neuherberg, Germany
| | - Alba Sulaj
- Clinic for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research (DZD), Neuherberg, Germany
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Jett S, Thompson MR, Awasthi S, Cuccia DJ, Tan TW, Armstrong DG, Mazhar A, Weinkauf CC. Stratification of Microvascular Disease Severity in the Foot Using Spatial Frequency Domain Imaging. J Diabetes Sci Technol 2023; 17:25-34. [PMID: 34218713 PMCID: PMC9846398 DOI: 10.1177/19322968211024666] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Microvascular disease (MVD) describes systemic changes in the small vessels (~100 um diameter) that impair tissue oxygenation and perfusion. MVD is a common but poorly monitored complication of diabetes. Recent studies have demonstrated that MVD: (i) is an independent risk factor for ulceration and amputation and (ii) increases risk of adverse limb outcomes synergistically with PAD. Despite the clinical relevance of MVD, microvascular evaluation is not standard in a vascular assessment. METHODS We evaluated 299 limbs from 153 patients seen clinically for possible lower extremity PAD. The patients were assessed by ankle brachial index (ABI), toe brachial index (TBI), and spatial frequency domain imaging (SFDI). These measurements were evaluated and compared to patient MVD status, defined by clinical diagnoses of (in ascending order of severity) no diabetes; diabetes; diabetes + neuropathy; diabetes + neuropathy + retinopathy. RESULTS SFDI-derived parameters HbT1 and StO2 were significantly different across the MVD groups (P < .001). A logistic regression model based on HbT1 and StO2 differentiated limbs with severe MVD (diabetes+neuropathy+retinopathy) from the larger group of limbs from patients with only diabetes (P = .001, area under the curve = 0.844). Neither ABI nor TBI significantly differentiated these populations. CONCLUSIONS Standard assessment of PAD using ABI and TBI are inadequate for detecting MVD in at-risk populations. SFDI-defined HbT1 and StO2 are promising tools for evaluating MVD. Prospective studies with wound-based outcomes would be useful to further evaluate the role MVD assessment could play in routine clinical evaluation of patients at risk for lower extremity complications.
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Affiliation(s)
| | | | - Shubhangi Awasthi
- The Division of Vascular Surgery,
University of Arizona, Tucson, AZ, USA
| | | | - Tze-Woei Tan
- The Division of Vascular Surgery,
University of Arizona, Tucson, AZ, USA
| | - David G. Armstrong
- Department of Surgery, Southwestern
Academic Limb Salvage Alliance, Keck School of Medicine of University of Southern
California, Los Angeles, CA, USA
| | | | - Craig C. Weinkauf
- The Division of Vascular Surgery,
University of Arizona, Tucson, AZ, USA
- Craig C. Weinkauf, MD, PhD, Vascular
Surgery, University of Arizona, 1501 N Campbell Ave, Rm 4402, Tucson, AZ 85724,
USA.
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7
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Liu YP, Tian MY, Yang YD, Li H, Zhao TT, Zhu J, Mou FF, Cui GH, Guo HD, Shao SJ. Schwann cells-derived exosomal miR-21 participates in high glucose regulation of neurite outgrowth. iScience 2022; 25:105141. [PMID: 36204278 PMCID: PMC9529988 DOI: 10.1016/j.isci.2022.105141] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/06/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022] Open
Abstract
As a common complication of diabetes, the pathogenesis of diabetic peripheral neuropathy (DPN) is closely related to high glucose but has not been clarified. Exosomes can mediate crosstalk between Schwann cells (SC) and neurons in the peripheral nerve. Herein, we found that miR-21 in serum exosomes from DPN rats was decreased. SC proliferation was inhibited, cell apoptosis was increased, and the expression of miR-21 in cells and exosomes was downregulated when cultured in high glucose. Increasing miR-21 expression reversed these changes, while knockdown of miR-21 led to the opposite results. When co-cultured with exosomes derived from SC exposed to high glucose, neurite outgrowth was inhibited. On the contrary, neurite outgrowth was accelerated when incubated with exosomes rich in miR-21. We further demonstrated that the SC-derived exosomal miR-21 participates in neurite outgrowth probably through the AKT signaling pathway. Thus, SC-derived exosomal miR-21 contributes to high glucose regulation of neurite outgrowth. The miR-21 was decreased in serum exosomes and sciatic nerve of DPN rats High glucose inhibited SC viability and downregulated the expression of miR-21 Exosomes derived from SC cultured in high glucose inhibited the neurite outgrowth SC-derived exosomes rich in miR-21 accelerated the neurite outgrowth of neuron
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Affiliation(s)
- Yu-pu Liu
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China
| | - Ming-yue Tian
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yi-duo Yang
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Han Li
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Tian-tian Zhao
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jing Zhu
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Fang-fang Mou
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Guo-hong Cui
- Department of Neurology, Shanghai No. 9 People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
- Corresponding author
| | - Hai-dong Guo
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Corresponding author
| | - Shui-jin Shao
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Corresponding author
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8
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Hansen CS, Suvitaival T, Theilade S, Mattila I, Lajer M, Trošt K, Ahonen L, Hansen TW, Legido-Quigley C, Rossing P, Ahluwalia TS. Cardiovascular Autonomic Neuropathy in Type 1 Diabetes Is Associated With Disturbances in TCA, Lipid, and Glucose Metabolism. Front Endocrinol (Lausanne) 2022; 13:831793. [PMID: 35498422 PMCID: PMC9046722 DOI: 10.3389/fendo.2022.831793] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/11/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Diabetic cardiovascular autonomic neuropathy (CAN) is associated with increased mortality and morbidity. To explore metabolic mechanisms associated with CAN we investigated associations between serum metabolites and CAN in persons with type 1 diabetes (T1D). MATERIALS AND METHODS Cardiovascular reflex tests (CARTs) (heart rate response to: deep breathing; lying-to-standing test; and the Valsalva maneuver) were used to diagnose CAN in 302 persons with T1D. More than one pathological CARTs defined the CAN diagnosis. Serum metabolomics and lipidomic profiles were analyzed with two complementary non-targeted mass-spectrometry methods. Cross-sectional associations between metabolites and CAN were assessed by linear regression models adjusted for relevant confounders. RESULTS Participants were median (IQR) aged 55(49, 63) years, 48% males with diabetes duration 39(32, 47) years, HbA1c 63(55,69) mmol/mol and 34% had CAN. A total of 75 metabolites and 106 lipids were analyzed. In crude models, the CAN diagnosis was associated with higher levels of hydroxy fatty acids (2,4- and 3,4-dihydroxybutanoic acids, 4-deoxytetronic acid), creatinine, sugar derivates (ribitol, ribonic acid, myo-inositol), citric acid, glycerol, phenols, phosphatidylcholines and lower levels of free fatty acids and the amino acid methionine (p<0.05). Upon adjustment, positive associations with the CAN diagnoses were retained for hydroxy fatty acids, tricarboxylic acid (TCA) cycle-based sugar derivates, citric acid, and phenols (P<0.05). CONCLUSION Metabolic pathways, including the TCA cycle, hydroxy fatty acids, phosphatidylcholines and sugar derivatives are associated with the CAN diagnosis in T1D. These pathway may be part of the pathogeneses leading to CAN and may be modifiable risk factors for the complication.
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Affiliation(s)
- Christian S. Hansen
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- *Correspondence: Christian S. Hansen,
| | - Tommi Suvitaival
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Simone Theilade
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Department of Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Ismo Mattila
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Maria Lajer
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kajetan Trošt
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Linda Ahonen
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Tine W. Hansen
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Peter Rossing
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tarunveer S. Ahluwalia
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- The Bioinformatics Center, Department of Biology, University of Copenhagen, Copenhagen, Denmark
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9
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Sloan G, Alam U, Selvarajah D, Tesfaye S. The Treatment of Painful Diabetic Neuropathy. Curr Diabetes Rev 2022; 18:e070721194556. [PMID: 34238163 DOI: 10.2174/1573399817666210707112413] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 11/22/2022]
Abstract
Painful diabetic peripheral neuropathy (painful-DPN) is a highly prevalent and disabling condition, affecting up to one-third of patients with diabetes. This condition can have a profound impact resulting in a poor quality of life, disruption of employment, impaired sleep, and poor mental health with an excess of depression and anxiety. The management of painful-DPN poses a great challenge. Unfortunately, currently there are no Food and Drug Administration (USA) approved disease-modifying treatments for diabetic peripheral neuropathy (DPN) as trials of putative pathogenetic treatments have failed at phase 3 clinical trial stage. Therefore, the focus of managing painful- DPN other than improving glycaemic control and cardiovascular risk factor modification is treating symptoms. The recommended treatments based on expert international consensus for painful- DPN have remained essentially unchanged for the last decade. Both the serotonin re-uptake inhibitor (SNRI) duloxetine and α2δ ligand pregabalin have the most robust evidence for treating painful-DPN. The weak opioids (e.g. tapentadol and tramadol, both of which have an SNRI effect), tricyclic antidepressants such as amitriptyline and α2δ ligand gabapentin are also widely recommended and prescribed agents. Opioids (except tramadol and tapentadol), should be prescribed with caution in view of the lack of definitive data surrounding efficacy, concerns surrounding addiction and adverse events. Recently, emerging therapies have gained local licenses, including the α2δ ligand mirogabalin (Japan) and the high dose 8% capsaicin patch (FDA and Europe). The management of refractory painful-DPN is difficult; specialist pain services may offer off-label therapies (e.g. botulinum toxin, intravenous lidocaine and spinal cord stimulation), although there is limited clinical trial evidence supporting their use. Additionally, despite combination therapy being commonly used clinically, there is little evidence supporting this practise. There is a need for further clinical trials to assess novel therapeutic agents, optimal combination therapy and existing agents to determine which are the most effective for the treatment of painful-DPN. This article reviews the evidence for the treatment of painful-DPN, including emerging treatment strategies such as novel compounds and stratification of patients according to individual characteristics (e.g. pain phenotype, neuroimaging and genotype) to improve treatment responses.
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Affiliation(s)
- Gordon Sloan
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine and the Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, and Liverpool University Hospital, NHS Foundation Trust, Liverpool, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester, Manchester, UK
| | - Dinesh Selvarajah
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK
| | - Solomon Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
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10
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Menon D, Lewis EJH, Perkins BA, Bril V. Omega-3 Nutrition Therapy for the Treatment of Diabetic Sensorimotor Polyneuropathy. Curr Diabetes Rev 2022; 18:e010921196028. [PMID: 34488588 DOI: 10.2174/1573399817666210901121111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/06/2021] [Accepted: 05/06/2021] [Indexed: 11/22/2022]
Abstract
Despite advances in clinical and translational research, an effective therapeutic option for diabetic sensorimotor polyneuropathy (DSP) has remained elusive. The pathomechanisms of DSP are diverse, and along with hyperglycemia, the roles of inflammatory mediators and lipotoxicity in the development of microangiopathy have been well elucidated. Omega-3 (n-3) polyunsaturated fatty acids (PUFA) are essential fatty acids with a vital role in a number of physiological processes, including neural health, membrane structure integrity, anti-inflammatory processes, and lipid metabolism. Identification of n-3 PUFA derived specialised proresolving mediators (SPM), namely resolvins, neuroprotectin, and maresins which also favour nerve regeneration, have positioned n-3 PUFA as potential treatment options in DSP. Studies in n-3 PUFA treated animal models of DSP showed positive nerve benefits in functional, electrophysiological, and pathological indices. Clinical trials in humans are limited, but recent proof-of-concept evidence suggests n-3 PUFA has a positive effect on small nerve fibre regeneration with an increase in the small nerve fiber measure of corneal nerve fibre length (CNFL). Further randomized control trials with a longer duration of treatment, higher n-3 PUFA doses, and more rigorous neuropathy measures are needed to provide a definitive understanding of the benefits of n-3 PUFA supplementation in DSP.
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Affiliation(s)
- Deepak Menon
- Ellen and Martin Prosserman Centre for Neuromuscular Disorders. Division of Neurology, University Health Network, University of Toronto, Toronto, Canada
| | - Evan J H Lewis
- Lunenfeld-Tanenbaum Research Institute, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - Bruce A Perkins
- Lunenfeld-Tanenbaum Research Institute, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Disorders. Division of Neurology, University Health Network, University of Toronto, Toronto, Canada
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11
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Onikanni AS, Lawal B, Olusola AO, Olugbodi JO, Sani S, Ajiboye BO, Ilesanmi OB, Alqarni M, Mostafa-Hedeab G, Obaidullah AJ, Batiha GES, Wu ATH. Sterculia tragacantha Lindl Leaf Extract Ameliorates STZ-Induced Diabetes, Oxidative Stress, Inflammation and Neuronal Impairment. J Inflamm Res 2021; 14:6749-6764. [PMID: 34916823 PMCID: PMC8668250 DOI: 10.2147/jir.s319673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/17/2021] [Indexed: 12/13/2022] Open
Abstract
Background Sterculia tragacantha is a medicinal plant commonly used in the western part of Nigeria, for managing diabetes mellitus. However, there is a dearth of scientific information on the antidiabetic and neuroprotective properties of the plant. Methods The in silico, in vitro and in vivo models were used to evaluate the antioxidants, antidiabetic, anti-inflammatory and neuroprotective potential of aqueous extract of Sterculia tragacantha leaf (AESTL) in streptozotocin (STZ)-induced diabetic rats. Thirty (30) male albino rats (155.34±6.33 g) were intraperitoneal injected with 40 mg/kg of freshly prepared streptozotocin and were divided into 5 groups (A-E) of 6 animals each. Groups A–D were treated with 0, 150 and 300 mg/kg of AESTL, and 200 mg/kg body weight of metformin respectively, while group E serve as the normal control. Results The results of in vitro analysis revealed dose-dependent antioxidant activities; ABTS (IC50 = 63.03±2.57 μg/mL), DPPH (117.49±2.35 μg/mL), FRAP (15.19±0.98 mmol/100g), TAC (43.38±0.96 mg/100g), hypoglycaemic effect; α-amylase (IC50 = 77.21±4.35 μg/mL) and α-glucosidase (IC50 = 443.25±12.35), and anti-cholinesterase; AChE (IC50 = 113.07±3.42 μg/mL) and BChE (IC50 = 87.50±4.32 μg/mL) activities of AESTL. In vivo study revealed dose-dependent hypoglycemic effect and body weight improvement in rats treated with the AESTL. In addition, AESTL improved the antioxidant status and attenuated STZ-induced dysregulations of Na+-K+-ATPase, cholinesterases and neurotransmitters in the brain tissue of experimental rats. The results also demonstrated that AESTL could regulate anti-inflammatory response via inhibition of COX-2/NO signaling axis in the brain of diabetic rats. Molecular docking analysis revealed that epicatechin and procyanidin B2, the bioactive compounds from AESTL, docked well to the binding cavities of acetylcholinesterase, butyrylcholinesterase, α-amylase and α-glucosidase with binding affinities ranges between –8.0 and –11.4 kcal/mol, suggesting that these compounds are the bioactive component that could be responsible for the antidiabetic and neuroprotective activities of AESTL. Conclusion The results of the present study strongly suggested that the AESTL extract could be very useful for halting diabetes progression and its associated neuroinflammation complications.
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Affiliation(s)
- Amos Sunday Onikanni
- Toxicology and Environmental Laboratory, Department of Biochemistry, Faculty of Science, Adekunle Ajasin University, Akungba-Akoko, Ondo State, Nigeria.,Biochemistry Unit, Department of Chemical Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria.,Graduate Institute of Biomedical Science, College of Medicine, China Medical University, Taipei, Taiwan
| | - Bashir Lawal
- PhD Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei, 11031, Taiwan.,Graduate Institute of Cancer Biology & Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, 11031, Taiwan
| | - Augustine O Olusola
- Toxicology and Environmental Laboratory, Department of Biochemistry, Faculty of Science, Adekunle Ajasin University, Akungba-Akoko, Ondo State, Nigeria
| | | | - Saidu Sani
- Department of Biochemistry, Faculty of Biological Science, Alex Ekwueme Federal University Ndufu Alike IkwoD, Abakaliki, Ebonyi State, Nigeria
| | - Basiru Olaitan Ajiboye
- Phytomedicine and Molecular Toxicology Research Laboratory, Department of Biochemistry, Faculty of Science, Federal University, Oye-Ekiti, Ekiti State, Nigeria
| | - Omotayo B Ilesanmi
- Department of Biochemistry, Faculty of Science, Federal University Otuoke, Ogbia, Bayelsa State, 23401, Nigeria
| | - Mohammed Alqarni
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, Taif, 21944, Saudi Arabia
| | - Gomaa Mostafa-Hedeab
- Pharmacology Department & Health Research Unit, Medical College, Jouf University, Sakakah, Saudi Arabia.,Pharmacology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ahmad J Obaidullah
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia.,Drug Exploration and Development Chair (DEDC), Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, 22511, AlBeheira, Egypt
| | - Alexander T H Wu
- The PhD Program of Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, 11031, Taiwan.,International Ph.D. Program for Translational Science, College of Medical Science and Technology, Taipei Medical University, Taipei, 11031, Taiwan.,TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, 11031, Taiwan.,Clinical Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, 11031, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, 11031, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, 11490, Taiwan
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12
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Abstract
Diabetic neuropathy is a neurodegenerative disorder that may alter both the somatic and autonomic peripheral nervous systems in the context of diabetes mellitus (DM). It is a prevalent and burdensome chronic complication of DM, that requires timely management. Optimized glycemic control (mainly for type 1 DM), multifactorial intervention (mainly for type 2 DM), with lifestyle intervention/physical exercise, and weight loss represent the basis of management for diabetic distal symmetrical polyneuropathy, and should be implemented early in the disease course. Despite better understanding of the pathogenetic mechanisms of diabetic peripheral neuropathy, there is still a stringent need for more pathogenetic-based agents that would significantly modify the natural history of the disease. The paper reviews the available drugs and current recommendations for the management of distal symmetrical polyneuropathy, including pain management, and for diabetic autonomic neuropathy. Evaluation of drug combinations that would perhaps be more efficient in slowing the progression of the disease or even reversing it, and that would provide a better pain management is still needed.
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Affiliation(s)
- Simona Cernea
- Department M3/Internal Medicine I, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Târgu Mureş, Romania; Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, Târgu Mureş, Romania.
| | - Itamar Raz
- Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
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13
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Alam U. To Be, or Not To Be … a Biomarker? A Question to the FDA. Clin Ther 2021; 43:1438-1440. [PMID: 34535276 DOI: 10.1016/j.clinthera.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Uazman Alam
- Department of Diabetes and Endocrinology Research, Institute of Life Course and Medical Sciences and the Pain Research Institute, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom
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14
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Olmsted ZT, Hadanny A, Marchese AM, DiMarzio M, Khazen O, Argoff C, Sukul V, Pilitsis JG. Recommendations for Neuromodulation in Diabetic Neuropathic Pain. FRONTIERS IN PAIN RESEARCH 2021; 2:726308. [PMID: 35295414 PMCID: PMC8915647 DOI: 10.3389/fpain.2021.726308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/27/2021] [Indexed: 01/25/2023] Open
Abstract
Over 50% of the 34 million people who suffer from diabetes mellitus (DM) are affected by diabetic neuropathy. Painful diabetic neuropathy (PDN) impacts 40–50% of that group (8.5 million patients) and is associated with a significant source of disability and economic burden. Though new neuromodulation options have been successful in recent clinical trials (NCT03228420), still there are many barriers that restrict patients from access to these therapies. We seek to examine our tertiary care center (Albany Medical Center, NY, USA) experience with PDN management by leveraging our clinical database to assess patient referral patterns and utilization of neuromodulation. We identified all patients with a diagnosis of diabetes type 1 (CODE: E10.xx) or diabetes type 2 (CODE: E11.xx) AND neuralgia/neuropathic pain (CODE: M79.2) or neuropathy (CODE: G90.09) or chronic pain (CODE: G89.4) or limb pain (CODE: M79.6) OR diabetic neuropathy (CODE: E11.4) who saw endocrinology, neurology, and/or neurosurgery from January 1, 2019, to December 31, 2019. We then determined which patients had received pain medications and/or neuromodulation to divide the cohort into three groups: no treatment, conservative treatment, and neuromodulation treatment. The cohorts were compared with chi-square or one-way ANOVA with multiple comparisons to analyze the differences. A total of 2,635 PDN patients were identified, of which 700 received no treatment for PDN, 1,906 received medication(s), and 29 received neuromodulation (intrathecal therapy, spinal cord stimulation, or dorsal root ganglion stimulation). The patients who received pain medications for PDN visited neurology more often than the pain specialists. Of the patients that received neuromodulation, 24 had seen neurology, 6 neurology pain, and 3 anesthesia pain. They averaged 2.78 pain medications prior to implant. Approximately 41% of the patients in the conservative management group were prescribed three or more medications. Of the 1,935 treated patients, only 1.5% of the patients received neuromodulation. The patients on three or more pain medications without symptomatic relief may be potential candidates for neuromodulation. An opportunity, therefore, exists to educate providers on the benefits of neuromodulation procedures.
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Affiliation(s)
- Zachary T. Olmsted
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Amir Hadanny
- Department of Neurosurgery, Albany Medical College, Albany, NY, United States
| | - Anthony M. Marchese
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Charles Argoff
- Department of Neurology, Albany Medical College, Albany, NY, United States
| | - Vishad Sukul
- Department of Neurosurgery, Albany Medical College, Albany, NY, United States
| | - Julie G. Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
- Department of Neurosurgery, Albany Medical College, Albany, NY, United States
- *Correspondence: Julie G. Pilitsis
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15
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Chukhlovina ML. [Polyneuropathies during COVID-19 epidemics]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:138-143. [PMID: 34184490 DOI: 10.17116/jnevro2021121051138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Our review article aimed for analysis of pathogenesis, diagnostyics and treatment of polyneuropathies manifesting in the course of COVID-19. The reasons for hyposmia and taste disturbances are considered in the subjects with this coronavirus infection as well as relationship between these clinical manifestations and severity of the viral infection. Special attention is given to description of autoimmune mechanisms of Guillain-Barré syndrome and polyneuropathies of critical conditions associated with COVID-19. Some data report about clinical deterioration of diabetic and alcoholic neuropathy during the SARS-CoV-2 infection. Inclusion of group B vitamins, together with C and D vitamins, is recommended to the schedules of combined treatment for polyneuropathies in these patients. Early diagnostics of polyneuropathies, especially, Guillain-Barré syndrome, is required during COVID-19 pandemics, thus helping to administer rational therapy and promoting better quality of life in the patients.
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Affiliation(s)
- M L Chukhlovina
- Almazov National Medical Research Center, St. Petersburg, Russia
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16
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Wang F, Wang F, Pan T, Wu Z, Wang Y, Liu P, Yu Z, Shang R, Song B. Tuina for diabetic peripheral neuropathy: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26222. [PMID: 34115007 PMCID: PMC8202603 DOI: 10.1097/md.0000000000026222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of diabetes mellitus, with an incidence ranging from 60% to 90%. With the change in modern dietary structure, the incidence of diabetes is increasing year by year, and DPN is also on the rise. Tuina therapy has been widely used in the treatment of DPN, but there is no systematic review on the treatment of DPN. Therefore, this study aimed to conduct a meta-analysis of Tuina in the treatment of DPN to clarify its efficacy. METHODS The following electronic databases will be searched: PubMed, the Cochrane Library, Embase, Web of Science, Medline, CNKI, Chinese Biomedical Literature Database, VIP, and Wan Fang databases. We will consider articles published between database initiation and May 2021. We will use Review Manager 5.4, provided by the Cochrane Collaborative Network for statistical analysis. Clinical randomized controlled trials related to Tuina for diabetic peripheral neuropathy were included in this study. Language is limited to both Chinese and English. Research selection, data extraction, and research quality assessments were independently completed by two researchers. We then assessed the quality and risk of the included studies and observed the outcome measures. RESULTS This study provides a high-quality synthesis to assess the effectiveness and safety of Tuina for treating diabetic peripheral neuropathy. CONCLUSION This systematic review will provide evidence to determine whether Tuina is an effective and safe intervention for patients with diabetic peripheral neuropathy. ETHICS AND DISSEMINATION The protocol of the systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences. REGISTRATION NUMBER INPLASY202150027.
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Affiliation(s)
- Fengyang Wang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine
| | - Fengjuan Wang
- Anesthesia professional, Traditional Chinese Medicine Hospital of Jilin Province
| | - Ting Pan
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine
| | | | - Yufeng Wang
- Department of Tuina, Traditional Chinese Medicine Hospital of Jilin Province
| | - Peng Liu
- Department of Tuina, Traditional Chinese Medicine Hospital of Jilin Province
| | - Ziyang Yu
- Endocrinology of Traditional Chinese Medicine, Changchun University of Chinese Medicine
| | - Rui Shang
- Department of Acupuncture and Tuina, Jilin Provincial Cancer Hospital
| | - Bailin Song
- Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
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