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Chen AC, Shah HA, Vilaysom S, Ryan C, Kruse A, D'Amico RS, Silverstein JW. Influence of Preoperative Motor Score and Patient Comorbidities on Transcranial Motor-Evoked Potential Acquisition in Intracranial Surgery: A Retrospective Cohort Study. Neurosurgery 2024; 95:842-848. [PMID: 38639495 DOI: 10.1227/neu.0000000000002943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/12/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Intraoperative neurophysiological monitoring plays a pivotal role in modern neurosurgery, aiding in real-time assessment of eloquent neural structures to mitigate iatrogenic neural injury. This study represents the largest retrospective series to date in monitoring corticospinal tract integrity during intracranial surgery with transcranial motor-evoked potentials (TCMEPs), focusing on the influence of demographic factors, comorbidities, and preoperative motor deficits on the reliability of intraoperative neurophysiological monitoring. While the impact of patient-specific factors affecting TCMEP monitoring in spine surgery is well-documented, similar insights for intracranial surgery are lacking. METHODS A total of 420 craniotomy patients were retrospectively analyzed from electronic medical records from December 2017 to February 2023, excluding patients without preoperative Medical Research Council scores or medical histories. Using intrinsic hand muscles as a robust data set, 840 hand TCMEPs acquired during intracranial surgery were assessed. Demographic and clinical factors, including preoperative motor scores, were analyzed to identify associations with TCMEP acquisition and amplitude. Nonparametric statistics and multivariate regression analysis were employed. RESULTS TCMEPs were successfully acquired in 734 (87.7%) patient hands, even in the presence of preoperative motor deficits in 13.9% of total patient hands. Preoperative motor scores did not predict the ability to acquire baseline TCMEPs ( P = .6). Notably, older age ( P < .001) and hypertension ( P = .01) were independent predictors of lower TCMEP acquisition rates. Preoperative motor scores significantly influenced TCMEP amplitudes, with higher scores correlating with higher amplitudes (1771 [SD = 1550] eve vs 882 [SD = 856] μV, P < .0001). Older age ( P < .001) and chronic kidney disease ( P = .04) were also associated with reduced TCMEP amplitudes. CONCLUSION Our investigation into TCMEPs during intracranial surgery demonstrated a notably high acquisition rate in hand muscles, irrespective of preoperative motor deficits. Preoperative motor scores reliably correlated with TCMEP amplitudes in a linear fashion while advanced age and renal disease emerged as independent predictors of lower TCMEP amplitudes.
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Affiliation(s)
- Adrian C Chen
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset , New York , USA
| | - Harshal A Shah
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset , New York , USA
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York , New York , USA
| | | | - Casey Ryan
- Neuro Protective Solutions, New York , New York , USA
| | - Aaron Kruse
- Neuro Protective Solutions, New York , New York , USA
| | - Randy S D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York , New York , USA
| | - Justin W Silverstein
- Neuro Protective Solutions, New York , New York , USA
- Department of Neurology, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York , New York , USA
- Department of Neurology, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York , New York , USA
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Ponirakis G, Al-Janahi I, Elgassim E, Homssi M, Petropoulos IN, Gad H, Khan A, Zaghloul HB, Ali H, Siddique MA, Mohamed FFS, Ahmed LHM, Dakroury Y, El Shewehy AMM, Saeid R, Mahjoub F, Al-Thani SN, Ahmed F, Hussein R, Mahmoud S, Hadid NH, Al Obaidan A, Salivon I, Mahfoud ZR, Zirie MA, Al-Ansari Y, Atkin SL, Malik RA. Sustained corneal nerve loss predicts the development of diabetic neuropathy in type 2 diabetes. Front Neurosci 2024; 18:1393105. [PMID: 39015377 PMCID: PMC11249546 DOI: 10.3389/fnins.2024.1393105] [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: 02/28/2024] [Accepted: 06/05/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction This study was undertaken to investigate whether sustained rather than a single measure of corneal nerve loss was associated with the onset of diabetic peripheral neuropathy (DPN) and the progression of neuropathic symptoms and deficits in individuals with type 2 diabetes (T2D). Methods Participants underwent clinical, metabolic testing and assessment of neuropathic symptoms, vibration perception threshold (VPT), sudomotor function, and corneal confocal microscopy (CCM) at baseline, 1, 2, and 4-7 years. Sustained corneal nerve loss was defined as abnormal corneal nerve fiber density (CNFD, <24 fibers/mm2), corneal nerve branch density (CNBD, <21 branches/mm2), and corneal nerve fiber length (CNFL, <16 mm/mm2) persisting for ≥50% of the study duration. Results A total of 107 participants with a mean duration of T2D of 13.3 ± 7.3 years, aged 54.8 ± 8.5 years, underwent baseline and follow-up assessments over a median duration of 4 years, ranging from 1 to 7 years. The DPN prevalence at baseline was 18/107 (16.8%), and of the 89 participants without DPN at baseline, 13 (14.6%) developed DPN during follow-up. Approximately half of the cohort had sustained corneal nerve damage, and corneal nerve measures were significantly lower in this group than those without sustained damage (p < 0.0001). Sustained corneal nerve damage was associated with the development of DPN (p < 0.0001), a progressive loss of vibration perception (p ≤ 0.05), an increased incidence of burning pain, numbness, or a combination of both (p = 0.01-0.001), and a borderline association with progressive sudomotor dysfunction (p = 0.07). Sustained abnormal CNFL effectively distinguished between participants who developed DPN and those who did not (AUC: 76.3, 95% CI: 65.9-86.8%, p < 0.0001), while baseline and other sustained measures did not predict DPN onset. Conclusion Sustained abnormal CCM is associated with more severe corneal nerve damage, DPN development, and the progression of neuropathic symptoms and deficits. Regular CCM monitoring may enable the identification of those at greater risk of developing and worsening DPN who may benefit from more aggressive risk factor reduction.
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Affiliation(s)
- Georgios Ponirakis
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Ibrahim Al-Janahi
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Einas Elgassim
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Moayad Homssi
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | - Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Hadeel B. Zaghloul
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Hamda Ali
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mashhood A. Siddique
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fatima F. S. Mohamed
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Lina H. M. Ahmed
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Youssra Dakroury
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | - Ruba Saeid
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Fadwa Mahjoub
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Shaikha N. Al-Thani
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Farheen Ahmed
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Rawan Hussein
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Salah Mahmoud
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Nebras H. Hadid
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Aisha Al Obaidan
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Iuliia Salivon
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad R. Mahfoud
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Mahmoud A. Zirie
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Yousuf Al-Ansari
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Rayaz A. Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
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Anastasiou G, Liberopoulos E, Tentolouris N, Papanas N. Diabetic Sensorimotor Polyneuropathy: An Overview on Epidemiology, Risk Factors, Classification, Diagnosis, and Treatment. INT J LOW EXTR WOUND 2024:15347346241240513. [PMID: 38533581 DOI: 10.1177/15347346241240513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Diabetic distal symmetric sensorimotor polyneuropathy (DSPN) is a common complication of diabetes with devastating consequences. Hyperglycaemia is the major aetiological factor, while emerging data demonstrate that cardiometabolic risk factors also contribute to its development. Diagnosis of DSPN involves interview of medical and neurological history, foot inspection, and sensory and motor function examination with specific tests such as temperature and pinprick perception for small nerve fibers, and vibration and light touch assessments for large nerve fibers. Management includes optimised glycaemic control, treatment of cardiovascular risk factors, and symptomatic treatment aiming at improving life quality. This article provides an overview on epidemiology, risk factors, classification, diagnosis and current treatment of DSPN.
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Affiliation(s)
- Georgia Anastasiou
- Department of Internal Medicine, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Evangelos Liberopoulos
- First Propedeutic Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Tentolouris
- First Propedeutic Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Wang PW, Chung MH, Hueng DY, Hsia CC. Case Report: Acute common peroneal nerve injury after posterior lumbar decompression surgery. Front Surg 2024; 11:1329860. [PMID: 38410409 PMCID: PMC10894923 DOI: 10.3389/fsurg.2024.1329860] [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: 10/30/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
Spine surgery is a prevalently performed procedure. Some authors have proposed an age-related surge in surgical and general complications. During spine surgery, patients are placed in positions that are not physiologic, would not be tolerated for prolonged periods by the patient in the awake state, and may lead to complications. Understanding these uncommon complications and their etiology is pivotal to prevention and necessary. The patient is a 76-year-old woman referred to the outpatient department of neurosurgery in February 2022 by her physiatrist with a chief complaint of chronic low back pain and numbness over the left leg. Lumbar spine magnetic resonance imaging revealed degenerative disc disease and posterior disc bulging at the levels of L2/3∼L5/S1 with compression of the thecal sac. After receiving anti-inflammatory medication, nerve block and caudal block, her symptoms persisted. She was referred to a neurosurgeon for surgical intervention. We diagnosed spinal stenosis with left L3 and L4 radiculopathy, and elective decompression surgery was scheduled a few days later. We performed discectomies at L2/3 and L3/4 and left unilateral laminectomy at L2 and L3 for bilateral decompression. Following an uneventful surgery, the patient was extubated, and her left leg pain improved, but pain over the right outer calf with drop foot developed. A second lumbar MRI the next day revealed no evidence of recurrent disc herniation or epidural hematoma. Then, she received nerve conduction velocity and needle electromyogram on postoperative day 2, and the studies indicated right common peroneal nerve entrapment neuropathy. After medication with steroids and foot splint use, right leg pain improved. However, weak dorsiflexion of the right ankle persisted. We referred this patient to a physiatrist and OPD for follow-up after discharge. Perioperative peripheral nerve injury (PPNI) is most commonly caused by peripheral nerve ischemia due to abnormal nerve lengthening or pressure and can be exacerbated by systemic hypotension. Any diseases affecting microvasculature and anatomical differences may contribute to nerve injury or render patients more susceptible to nerve injury. Prevention, early detection and intervention are paramount to reducing PPNI and associated adverse outcomes. The use of intraoperative neuromonitoring theoretically allows the surgical team to detect and intervene in impending PPNI during surgery.
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Affiliation(s)
- Peng Wei Wang
- Department of Surgery, Taoyuan Armed Forced General Hospital, Taoyuan, Taiwan
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Ming Hsuan Chung
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Dueng Yuan Hueng
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Chung Ching Hsia
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
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Iwane S, Nemoto W, Miyamoto T, Hayashi T, Tanaka M, Uchitani K, Muranaka T, Fujitani M, Koizumi Y, Hirata A, Tsubota M, Sekiguchi F, Tan-No K, Kawabata A. Clinical and preclinical evidence that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prevent diabetic peripheral neuropathy. Sci Rep 2024; 14:1039. [PMID: 38200077 PMCID: PMC10781693 DOI: 10.1038/s41598-024-51572-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/06/2024] [Indexed: 01/12/2024] Open
Abstract
Given possible involvement of the central and peripheral angiotensin system in pain processing, we conducted clinical and preclinical studies to test whether pharmacological inhibition of the angiotensin system would prevent diabetic peripheral neuropathy (DPN) accompanying type 2 diabetes mellitus (T2DM). In the preclinical study, the nociceptive sensitivity was determined in leptin-deficient ob/ob mice, a T2DM model. A clinical retrospective cohort study was conducted, using the medical records of T2DM patients receiving antihypertensives at three hospitals for nearly a decade. In the ob/ob mice, daily treatment with perindopril, an angiotensin-converting enzyme inhibitor (ACEI), or telmisartan, an angiotensin receptor blocker (ARB), but not amlodipine, an L-type calcium channel blocker (CaB), significantly inhibited DPN development without affecting the hyperglycemia. In the clinical study, the enrolled 7464 patients were divided into three groups receiving ACEIs, ARBs and the others (non-ACEI, non-ARB antihypertensives). Bonferroni's test indicated significantly later DPN development in the ARB and ACEI groups than the others group. The multivariate Cox proportional analysis detected significant negative association of the prescription of ACEIs or ARBs and β-blockers, but not CaBs or diuretics, with DPN development. Thus, our study suggests that pharmacological inhibition of the angiotensin system is beneficial to prevent DPN accompanying T2DM.
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Affiliation(s)
- Shiori Iwane
- Laboratory of Pharmacology and Pathophysiology, Faculty of Pharmacy, Kindai University, Higashi-Osaka, 577-8502, Japan
- Department of Pharmacy, Kansai Medical University Hospital, Hirakata, 573-1191, Japan
| | - Wataru Nemoto
- Division of Pharmacology, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, 981-8558, Japan
| | - Tomoyoshi Miyamoto
- Laboratory of Pharmacology and Pathophysiology, Faculty of Pharmacy, Kindai University, Higashi-Osaka, 577-8502, Japan
- School of Pharmacy, Hyogo Medical University, Kobe, 650-8530, Japan
| | - Tomonori Hayashi
- Department of Pharmacy, Kindai University Nara Hospital, Ikoma, 630-0293, Japan
| | - Masayuki Tanaka
- Department of Pharmacy, Kansai Medical University Hospital, Hirakata, 573-1191, Japan
| | - Kazuki Uchitani
- Department of Pharmacy, Kansai Medical University Hospital, Hirakata, 573-1191, Japan
| | - Tatsuya Muranaka
- Department of Pharmacy, Kansai Medical University Hospital, Hirakata, 573-1191, Japan
| | - Masanori Fujitani
- Department of Pharmacy, Seichokai Fuchu Hospital, Izumi, 594-0076, Japan
| | - Yuichi Koizumi
- Department of Pharmacy, Seichokai Fuchu Hospital, Izumi, 594-0076, Japan
| | - Atsushi Hirata
- Department of Pharmacy, Kindai University Nara Hospital, Ikoma, 630-0293, Japan
| | - Maho Tsubota
- Laboratory of Pharmacology and Pathophysiology, Faculty of Pharmacy, Kindai University, Higashi-Osaka, 577-8502, Japan
| | - Fumiko Sekiguchi
- Laboratory of Pharmacology and Pathophysiology, Faculty of Pharmacy, Kindai University, Higashi-Osaka, 577-8502, Japan
| | - Koichi Tan-No
- Division of Pharmacology, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, 981-8558, Japan
| | - Atsufumi Kawabata
- Laboratory of Pharmacology and Pathophysiology, Faculty of Pharmacy, Kindai University, Higashi-Osaka, 577-8502, Japan.
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Ponirakis G, Odriozola A, Ortega L, Martinez L, Odriozola S, Torrens A, Coroleu D, Martínez S, Sanz X, Ponce M, Meije Y, Clemente M, Duarte A, Odriozola MB, Malik RA. Quantitative sensory testing defines the trajectory of sensory neuropathy after severe COVID-19. Diabetes Res Clin Pract 2024; 207:111029. [PMID: 38007044 DOI: 10.1016/j.diabres.2023.111029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/01/2023] [Accepted: 11/22/2023] [Indexed: 11/27/2023]
Abstract
AIMS To assess sensory neuropathy development after severe COVID-19. METHODS Patients with severe COVID-19 underwent assessment of neuropathic symptoms, tendon reflexes, and quantitative sensory testing to evaluate vibration (VPT), cold (CPT), warm (WPT) and heat perception thresholds (HPT) within 1-3 weeks of admission and after 1-year. RESULTS 32 participants with severe COVID-19 aged 68.6 ± 12.4 (18.8 % diabetes) were assessed. At baseline, numbness and neuropathic pain were present in 56.3 % and 43.8 % of participants, respectively. On the feet, VPT, WPT, and HPT were abnormal in 81.3 %, CPT was abnormal in 50.0 % and HPT on the face was abnormal in 12.5 % of patients. At 1-year follow-up, the prevalence of abnormal VPT (81.3 % vs 50.0 %, P < 0.01), WPT (81.3 % vs 43.8 %, P < 0.01), and HPT (81.3 % vs 50.0 %, P < 0.01) decreased, with no change in CPT (P = 0.21) on the feet or HPT on the face (P = 1.0). Only participants without diabetes recovered from an abnormal VPT, CPT, and WPT. Patients with long-COVID (37.5 %) had comparable baseline VPT, WPT and CPT with those without long-COVID (P = 0.07-0.69). CONCLUSIONS Severe COVID-19 is associated with abnormal vibration and thermal thresholds which are sustained for up to 1 year in patients with diabetes. Abnormal sensory thresholds have no association with long-COVID development.
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Affiliation(s)
- Georgios Ponirakis
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | | | | | | | | | | | | | - Xavier Sanz
- Hospital of Barcelona SCIAS, Barcelona, Spain
| | | | | | | | | | | | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
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Gaur A, Varatharajan S, Katta R, Taranikanti M, John NA, Umesh M, Ganji V, Medala K. Assessment of Neuropathy by Temperature Threshold Testing in Type 2 Diabetes Mellitus. Int J Appl Basic Med Res 2024; 14:54-59. [PMID: 38504834 PMCID: PMC10947757 DOI: 10.4103/ijabmr.ijabmr_397_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/05/2024] [Accepted: 01/19/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Diagnosing diabetic neuropathy is a challenge at times as it is asymptomatic. Diagnosing diabetic neuropathy involves the use of quantitative sensory testing, nerve conduction study, and autonomic testing. Tempearture threshold testing (TTT) can aid in diagnosing small fiber neuropathy at early stages. This study aimed to assess the small fiber neuropathy using TTT in diabetes mellitus (DM) and correlate with age, duration of diabetes, and lipid profile. Materials and Methods The study was commenced after obtaining ethics approval from the institute ethics committee. The study participants included 100 patients with type 2 DM of both genders between the ages of 40 and 65 years. The glycemic status and lipid profile were noted along with physical examination. Neuropathy assessment was done using Michigan Neuropathy Screening Instrument (MNSI) and TTT. Results The prevalence of small fiber neuropathy based on TTT was 63%. The lipid profile was similar in both the groups. The MNSI B scale had significantly higher scores in the neuropathy group. In the neuropathy group, the thresholds for hot were significantly greater in all four limbs and cold were significantly lower. Age and years of DM were positively correlated with the neuropathy. Hot threshold in the lower limb had shown a strong positive correlation. Conclusion The age and duration of diabetes are independent risk factors for diabetic peripheral neuropathy. Small fiber neuropathy is a prequel to the motor neuropathy. Hot threshold testing in the lower limb is more sensitive than cold threshold testing for diagnosing small fiber neuropathy.
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Affiliation(s)
- Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Roja Katta
- Department of Physiology, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | - Madhuri Taranikanti
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Nitin Ashok John
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Madhusudhan Umesh
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vidya Ganji
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Kalpana Medala
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
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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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Guldiken YC, Malik A, Petropoulos IN, Gad H, Elgassim E, Salivon I, Ponirakis G, Alam U, Malik RA. Where Art Thou O treatment for diabetic neuropathy: the sequel. Expert Rev Neurother 2023; 23:845-851. [PMID: 37602687 DOI: 10.1080/14737175.2023.2247163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Having lived through a pandemic and witnessed how regulatory approval processes can evolve rapidly; it is lamentable how we continue to rely on symptoms/signs and nerve conduction as primary endpoints for clinical trials in DPN. AREAS COVERED Small (Aδ and C) fibers are key to the genesis of pain, regulate skin blood flow, and play an integral role in the development of diabetic foot ulceration but continue to be ignored. This article challenges the rationale for the FDA insisting on symptoms/signs and nerve conduction as primary endpoints for clinical trials in DPN. EXPERT OPINION Quantitative sensory testing, intraepidermal nerve fiber density, and especially corneal confocal microscopy remain an after-thought, demoted at best to exploratory secondary endpoints in clinical trials of diabetic neuropathy. If pharma are to be given a fighting chance to secure approval for a new therapy for diabetic neuropathy, the FDA needs to reassess the evidence rather than rely on 'opinion' for the most suitable endpoint(s) in clinical trials of diabetic neuropathy.
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Affiliation(s)
- Yigit Can Guldiken
- Department of Neurology, Kocaeli University Research and Application Hospital, İzmit/Kocaeli, Turkey
| | - Ayesha Malik
- Barts and The London School of Medicine and Dentistry - Medicine, London, UK
| | | | - Hoda Gad
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Einas Elgassim
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Iuliia Salivon
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
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Garutti L, Tamborini F, Fagetti A, Baroni T, Bascialla E, Minini A, Cherubino M, Valdatta L. Sensitive peripheral nerve repair during COVID-19 emergency: does the outpatient surgical setting work as well as the operating theater? EUROPEAN JOURNAL OF PLASTIC SURGERY 2023:1-5. [PMID: 37363689 PMCID: PMC10250169 DOI: 10.1007/s00238-023-02085-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/21/2023] [Indexed: 06/28/2023]
Abstract
Background Nerve injuries are a common occurrence among hand injuries, which at the time of the COVID-19 emergency, did not appear to have reduced their incidence. The treatment of these injuries is urgent, but the pandemic has led to a reduction in the availability of resources and a consequent reorganization of activities. Principles about Wide-Awake Local Anesthesia No Tourniquet (WALANT) in hand surgery expressed by LaLonde helped hand surgeons to adapt to this new condition by demonstrating a possible outpatient pathway for the treatment of hand traumatic conditions. In the present study, we bring our experience in nerve repair at time of COVID-19 emergency. Methods We retrospectively enrolled in this study all patients surgically treated for a peripheral nerve injury (PNI) during the COVID-19 emergency period from March 2020 to March 2022. Demographical, anamnestic, surgical, and postoperative data were recorded and analyzed. Persisting Tinel was set as the primary outcome, while hypoesthesia and other complications as secondary outcomes. Results Thirty-six patients have been enrolled. Despite some difference in group homogeneity in term of hypertension and multi-digital involvement, we registered no difference in term of outcomes (P > 0.05) between patient operated in surgical theater and in outpatient clinic and between the various techniques of nerve repair employed (P > 0.05). Conclusions Nerve repair on an outpatient facility is technically feasible and was found in this study to be safe and effective. Compared to hospitalization, the outpatient setting has a more "agile" organization and lower costs, making it preferable in selected cases.Level of evidence: Level IV, Therapeutic.
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Affiliation(s)
- Leonardo Garutti
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Ravasi 2, 21100 Varese, Italy
| | - Federico Tamborini
- Division of Plastic Surgery, Ospedale Di Circolo Fondazione Macchi Varese, Varese, Italy
- Microsurgery and Hand Surgery Unit, ASST Settelaghi, Ospedale Di Circolo Fondazione Macchi Varese, Varese, Italy
| | - Alessandro Fagetti
- Microsurgery and Hand Surgery Unit, ASST Settelaghi, Ospedale Di Circolo Fondazione Macchi Varese, Varese, Italy
| | - Tommaso Baroni
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Ravasi 2, 21100 Varese, Italy
| | - Elisa Bascialla
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Ravasi 2, 21100 Varese, Italy
| | - Andrea Minini
- Microsurgery and Hand Surgery Unit, ASST Settelaghi, Ospedale Di Circolo Fondazione Macchi Varese, Varese, Italy
| | - Mario Cherubino
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Ravasi 2, 21100 Varese, Italy
- Division of Plastic Surgery, Ospedale Di Circolo Fondazione Macchi Varese, Varese, Italy
- Microsurgery and Hand Surgery Unit, ASST Settelaghi, Ospedale Di Circolo Fondazione Macchi Varese, Varese, Italy
| | - Luigi Valdatta
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Ravasi 2, 21100 Varese, Italy
- Division of Plastic Surgery, Ospedale Di Circolo Fondazione Macchi Varese, Varese, Italy
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11
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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: 5] [Impact Index Per Article: 5.0] [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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12
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Sabaghan M, Ataee S, Ataee M, Tebyanian M, Afrashteh S, Daneshi N. Diabetic peripheral neuropathy screening and the related risk factors to its prevalence in people with type 2 diabetes. Int J Diabetes Dev Ctries 2023. [DOI: 10.1007/s13410-022-01165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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13
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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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14
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Corneal subbasal nerve analysis in patients with primary Sjogren's syndrome: a novel objective grading method and clinical correlations. Int Ophthalmol 2022; 43:779-793. [PMID: 36056289 DOI: 10.1007/s10792-022-02478-0] [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: 01/11/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate corneal sub-basal nerve morphology changes in primary Sjogren's syndrome (SS) dry eye (SSDE) patients and determine the association with disease severity at microstructural level. METHODS Twenty-eight eyes of 17 SSDE and 82 eyes of 47 age- and sex-matched non-SS dry eye (NSSDE) patients were included. The Ocular Surface Disease Index questionnaire (OSDI), Schirmer's test (ST), tear meniscus height (TMH), non-invasive breakup time (NIBUT), meibomian gland (MG) morphology, and ocular staining score (OSS) were assessed. In vivo confocal microscopy was performed to observe corneal sub-basal nerve morphology (length, reflectivity, width, and tortuosity). Associations between clinical features and nerve parameters were analysed. RESULTS SSDE patients more frequently had increased nerve reflectivity (151.12 ± 17.07 vs. 139.37 ± 14.31 grey value), width (4.45 ± 0.87 vs. 3.92 ± 0.81 μm), tortuosity (132.90 ± 8.04 vs. 129.50 ± 7.33 degree), and higher reflectivity, width, and total nerve grades than NSSDE individuals (all P < 0.05). Significant associations were found between nerve reflectivity/width and anti-SSA [OR = 1.139 (1.013-1.281)/1.802 (1.013-4.465)]/labial gland biopsy [OR = 1.046 (1.002-1.161)/1.616 (1.020-3.243)]. Higher nerve width was associated with increased OSDI [β = 0.284 (0.187-0.455)], MG score [β = 0.185 (0.109-0.300)] and OSS [β = 0.163 (0.020-0.345)], but decreased NIBUT [β = - 0.247 (- 0.548 ~ - 0.154)]. Higher nerve total grade was associated with increased OSDI [β = 0.418 (0.157-0.793)] and OSS [β = 0.287 (0.027-0.547)], but decreased ST [β = - 0.410 (-0.857 ~ - 0.138)]. CONCLUSIONS Corneal nerve morphology changes associated with clinical features in SS patients. These changes may facilitate severity evaluation and management of the disease.
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15
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Jin CY, Yu SW, Yin JT, Yuan XY, Wang XG. Corresponding risk factors between cognitive impairment and type 1 diabetes mellitus: a narrative review. Heliyon 2022; 8:e10073. [PMID: 35991978 PMCID: PMC9389196 DOI: 10.1016/j.heliyon.2022.e10073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/24/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Type 1 diabetes mellitus (T1DM) is a type of diabetes caused by the destruction of pancreatic β cells and the absolute lack of insulin secretion. T1DM usually starts in adolescence or develops directly as a severe disease state of ketoacidosis. T1DM and its complications make many people suffer and have psychological problems, which make us have to pay more attention to the prevention and early control of T1DM. Cognitive impairment (CI) is one of the major complications of T1DM. It can further develop into Alzheimer's disease, which can seriously affect the quality of life of the elderly. Furthermore, the relationship between T1DM and CI is unclear. Hence, we conducted a narrative review of the existing literature through a PubMed search. We summarized some risk factors that may be associated with the cognitive changes in T1DM patients, including onset age and duration, education and gender, glycemic states, microvascular complications, glycemic control, neuropsychology and emotion, intestinal flora, dyslipidemia, sleep quality. We aimed to provide some content related to CI in T1DM, and hoped that it could play a role in early prediction and treatment to reduce the prevalence. Corresponding risk factors between cognitive impairment and type 1 diabetes mellitus. Duration and age; Education and gender and Glycemic states. Diabetic ketoacidosis; Microvascular complications and Glycemic control–HbA1c. Neuropsychology and emotion; Intestinal flora; Dyslipidemia and Sleep Quality.
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Affiliation(s)
- Chen-Yang Jin
- The First Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian 116011, PR China
| | - Shi-Wen Yu
- The First Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian 116011, PR China
| | - Jun-Ting Yin
- The Second Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian 116027, PR China
| | - Xiao-Ying Yuan
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian 116044, PR China
- Department of Surgery, The Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, PR China
- Corresponding author.
| | - Xu-Gang Wang
- Department of Neurology, The Second Affiliated Hospital of Dalian Medical University, Dalian 116027, PR China
- Corresponding author.
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16
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Hao R, Ding Y, Li X. Alterations in corneal epithelial dendritic cell in Sjogren's syndrome dry eye and clinical correlations. Sci Rep 2022; 12:11167. [PMID: 35778532 PMCID: PMC9249752 DOI: 10.1038/s41598-022-15537-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/24/2022] [Indexed: 11/23/2022] Open
Abstract
We aimed to investigate the density and morphology of corneal dendritic cells (DCs) in dry eye (DE) patients with or without Sjogren’s syndrome (SS). This study included 28 patients with Sjogren’s syndrome dry eye (SSDE), 33 patients with non-Sjogren’s syndrome dry eye (NSSDE), and 30 age and sex matched healthy volunteers. In vivo confocal microscopy (IVCM) was used to investigate density and morphology (size, dendrites, and field) of DC. Compared with NSSDE and healthy group, SSDE showed significantly higher DC density, larger DC size, more DC dendrites with larger DC field (all P < 0.001). Comparison between NSSDE and healthy group demonstrated that DC density, dendrites and field were significantly higher in NSSDE. However, there was no significant difference in DC size (P = 0.076). DC density and morphological parameters showed significant associations with the systemic severity (salivary gland biopsy and serum antibodies) and ocular surface damage. The corneal epithelium DC density and morphological alterations were obvious in SSDE, which reflected higher level of immune activation and inflammatory response in SS. Marked correlations were found between DC density/morphology and systemic/ocular severity. Dynamic assessment of corneal DC may facilitate to clarify pathogenesis, stratify patient, and tailor treatment in SS patients.
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Affiliation(s)
- Ran Hao
- Department of Ophthalmology, Peking University Third Hospital, No. 49, North Garden Street, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, China
| | - Yi Ding
- Capital Medical University, No.10, Xi Toutiao, Youanmen Wai Street, Beijing, China
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, No. 49, North Garden Street, Beijing, China. .,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, China.
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17
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Ponirakis G, Al-Janahi I, Elgassim E, Gad H, Petropoulos IN, Khan A, Ali H, Siddique MA, Gul W, Ferdousi M, Kalteniece A, Mohamed FF, Ahmed LH, Dakroury Y, El Shewehy AM, Al-Mohamedi A, AlMarri F, Homssi M, Qazi M, Hadid NH, Al-Khayat F, Mahfoud ZR, Azmi S, Alam U, Zirie MA, Al-Ansari Y, Jayyousi A, Rigby AS, Kilpatrick ES, Atkin SL, Malik RA. Progressive loss of corneal nerve fibers is associated with physical inactivity and glucose lowering medication associated with weight gain in type 2 diabetes. J Diabetes Investig 2022; 13:1703-1710. [PMID: 35652859 PMCID: PMC9533053 DOI: 10.1111/jdi.13864] [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: 02/14/2022] [Revised: 04/03/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Aims/Introduction Limited studies have identified risk factors linked to the progression of diabetic peripheral neuropathy (DPN) in type 2 diabetes. This study examined the association of risk factors with change in neuropathy measures over 2 years. Materials and Methods Participants with type 2 diabetes (n = 78) and controls (n = 26) underwent assessment of clinical and metabolic parameters and neuropathy using corneal confocal microscopy (CCM), vibration perception threshold (VPT), and the DN4 questionnaire at baseline and 2 year follow‐up. Results Participants with type 2 diabetes had a lower corneal nerve fiber density (CNFD), branch density (CNBD), and fiber length (CNFL) (P ≤ 0.0001) and a higher VPT (P ≤ 0.01) compared with controls. Over 2 years, despite a modest reduction in HbA1c (P ≤ 0.001), body weight (P ≤ 0.05), and LDL (P ≤ 0.05) the prevalence of DPN (P = 0.28) and painful DPN (P = 0.21) did not change, but there was a significant further reduction in CNBD (P ≤ 0.0001) and CNFL (P ≤ 0.05). CNFD, CNBD, and CNFL decreased significantly in physically inactive subjects (P < 0.05–0.0001), whilst there was no change in CNFD (P = 0.07) or CNFL (P = 0.85) in physically active subjects. Furthermore, there was no change in CNFD (P = 0.82), CNBD (P = 0.08), or CNFL (P = 0.66) in patients treated with glucose lowering medication associated with weight loss, whilst CNBD (P = 0.001) decreased in patients on glucose lowering medication associated with weight gain. Conclusions In participants with type 2 diabetes, despite a modest improvement in HbA1c, body weight, and LDL there was a progressive loss of corneal nerve fibers; except in those who were physically active or on glucose lowering medication associated with weight loss.
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Affiliation(s)
- Georgios Ponirakis
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Ibrahim Al-Janahi
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Einas Elgassim
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Hamda Ali
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mashhood A Siddique
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Wajiha Gul
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maryam Ferdousi
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alise Kalteniece
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Fatima Fs Mohamed
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Lina Hm Ahmed
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Youssra Dakroury
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Abeer Mm El Shewehy
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | - Fatema AlMarri
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Moayad Homssi
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Murtaza Qazi
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Nebras H Hadid
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Fatima Al-Khayat
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Ziyad R Mahfoud
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Shazli Azmi
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, UK
| | - Uazman Alam
- Department of Cardiovascular & 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
| | - Mahmoud A Zirie
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Yousuf Al-Ansari
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amin Jayyousi
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Alan S Rigby
- Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, UK.,Hull York Medical School, University of Hull, Kingston Upon Hull, UK
| | - Eric S Kilpatrick
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, UK.,Hull York Medical School, University of Hull, Kingston Upon Hull, UK
| | - Stephen L Atkin
- Royal College of Surgeons in Ireland Bahrain, Adliya, Kingdom of Bahrain
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar.,Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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18
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Circulating Growth Differentiation Factor 15 Is Associated with Diabetic Neuropathy. J Clin Med 2022; 11:jcm11113033. [PMID: 35683420 PMCID: PMC9180959 DOI: 10.3390/jcm11113033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Growth differentiation factor (GDF15) is a superfamily of transforming growth factor-beta which has been suggested to be correlated with various pathological conditions. The current study aimed to investigate the predicted role of circulating GDF15 in diabetic metabolism characteristics and diabetic neuropathy. Methods: 241 diabetic patients and 42 non-diabetic subjects were included to participate in the study. The plasma GDF15 levels were measured using ELISA. Chronic kidney disease and albuminuria were defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline. The nerve conductive study (NCS) was performed with measurement of distal latency, amplitude, nerve conduction velocity (NCV), H-reflex, and F-wave studies. Results: The diabetic group had a significantly higher prevalence of chronic kidney disease and higher plasma GDF15 level. After adjusting for age and BMI, GDF15 was significantly positively correlated with waist circumference (r = 0.332, p = <0.001), hip circumference (r = 0.339, p < 0.001), HbA1c (r = 0.302, p < 0.001), serum creatine (r = 0.146, p = 0.017), urine albumin/creatinine ratio (r = 0.126, p = 0.040), and HOMA-IR (r = 0.166, p = 0.007). As to NCS, GDF15 was significantly correlated with all latency and amplitude of sensory and motor nerves, as well as F-wave and H-reflex latencies. The area under the curve (AUC) in predicting tibial motor nerve neuropathy (MNCV) in all subjects and in the diabetic group for GDF15 was 0.646 (p = 0.001) and 0.610 (p = 0.012), respectively; for HbA1c was 0.639 (p = 0.001) and 0.604 (p = 0.018), respectively. Predicting ulnar sensory nerve neuropathy for GDF15 was 0.639 (p = 0.001) and 0.658 (p = 0.001), respectively; for HbA1c was 0.545 (p = 0.307) and 0.545 (p = 0.335), respectively. Predicting median sensory nerve neuropathy for GDF15 was 0.633 (p = 0.007) and 0.611 (p = 0.032), respectively; for HbA1c was 0.631 (p = 0.008) and 0.607 (p = 0.038), respectively. Predicting CKD for GDF15 was 0.709 (95% CI, 0.648−0.771), p < 0.001) and 0.676 (95% CI, 0.605−0.746), p < 0.001), respectively; for HbA1c was 0.560 (95% CI, 0.493−0.627); p = 0.080) and 0.515 (95% CI, 0.441−0.588); p = 0.697), respectively. Conclusions: We suggest that there is a significant association between the increased serum GDF-15 level and metabolic parameters and diabetic neuropathy. Plasma GDF15 may be an independent predictor of diabetic neuropathy.
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19
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Frachet S, Danigo A, Labriffe M, Bessaguet F, Quinchard B, Deny N, Baffert KA, Deluche E, Sturtz F, Demiot C, Magy L. Renin-Angiotensin-System Inhibitors for the Prevention of Chemotherapy-Induced Peripheral Neuropathy: OncoToxSRA, a Preliminary Cohort Study. J Clin Med 2022; 11:jcm11102939. [PMID: 35629066 PMCID: PMC9144468 DOI: 10.3390/jcm11102939] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent and dose-limiting adverse side effect of treatment. CIPN affects the oncological prognosis of patients, as well as their quality of life. To date, no specific pharmacological therapy has demonstrated effectiveness in preventing CIPN. Accumulating preclinical evidence suggests that renin-angiotensin system (RAS) inhibitors may have neuroprotective effects. One hundred and twenty patients were included in this observational study and were followed from the beginning of their neurotoxic chemotherapy schedule until their final assessment, at least one month after its cessation. The National Cancer Institute's common toxicity criteria 4.0 (NCI-CTC 4.0) were used to grade the severity of adverse events. Follow-ups also included electrochemical skin conductance and scales for pain, quality of life and disability. Among patients receiving a platinum-based regimen, the mean grade of sensory neuropathy (NCI-CTC 4.0) was significantly lower in the RAS inhibitor group after the end of their anticancer treatment schedule. Because of the observational design of the study, patients in the RAS inhibitor group cumulated comorbidities at risk of developing CIPN. Randomized controlled trials in platinum-based regimens would be worth conducting in the future to confirm the neuroprotective potential of RAS inhibitors during chemotherapy.
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Affiliation(s)
- Simon Frachet
- Department of Neurology, Reference Center for Rare Peripheral Neuropathies, University Hospital of Limoges, 87000 Limoges, France;
- UR 20218-NeurIT, Faculties of Medicine and Pharmacy, University of Limoges, 87025 Limoges, France; (A.D.); (B.Q.); (F.S.); (C.D.)
- Correspondence: ; Tel.: +33-5550-56568
| | - Aurore Danigo
- UR 20218-NeurIT, Faculties of Medicine and Pharmacy, University of Limoges, 87025 Limoges, France; (A.D.); (B.Q.); (F.S.); (C.D.)
| | - Marc Labriffe
- Department of Pharmacology, Toxicology and Pharmacovigilance, University Hospital of Limoges, 87000 Limoges, France;
- Pharmacology & Transplantation, INSERM U1248, University of Limoges, 87025 Limoges, France
| | - Flavien Bessaguet
- INSERM 1083 CNRS UMR 6015 Mitovasc Laboratory, CarMe Team, University of Angers, 49045 Angers, France;
| | - Bianca Quinchard
- UR 20218-NeurIT, Faculties of Medicine and Pharmacy, University of Limoges, 87025 Limoges, France; (A.D.); (B.Q.); (F.S.); (C.D.)
| | - Nicolas Deny
- Department of Medical Oncology, University Hospital of Limoges, 87000 Limoges, France; (N.D.); (K.-A.B.); (E.D.)
| | - Kim-Arthur Baffert
- Department of Medical Oncology, University Hospital of Limoges, 87000 Limoges, France; (N.D.); (K.-A.B.); (E.D.)
| | - Elise Deluche
- Department of Medical Oncology, University Hospital of Limoges, 87000 Limoges, France; (N.D.); (K.-A.B.); (E.D.)
| | - Franck Sturtz
- UR 20218-NeurIT, Faculties of Medicine and Pharmacy, University of Limoges, 87025 Limoges, France; (A.D.); (B.Q.); (F.S.); (C.D.)
- Department of Biochemistry and Molecular Genetics, University Hospital of Limoges, 87000 Limoges, France
| | - Claire Demiot
- UR 20218-NeurIT, Faculties of Medicine and Pharmacy, University of Limoges, 87025 Limoges, France; (A.D.); (B.Q.); (F.S.); (C.D.)
| | - Laurent Magy
- Department of Neurology, Reference Center for Rare Peripheral Neuropathies, University Hospital of Limoges, 87000 Limoges, France;
- UR 20218-NeurIT, Faculties of Medicine and Pharmacy, University of Limoges, 87025 Limoges, France; (A.D.); (B.Q.); (F.S.); (C.D.)
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20
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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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21
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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: 10] [Impact Index Per Article: 5.0] [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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22
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Dinh Le T, Phi Thi Nguyen N, Thanh Thi Tran H, Luong Cong T, Ho Thi Nguyen L, Do Nhu B, Tien Nguyen S, Van Ngo M, Trung Dinh H, Thi Nguyen H, Trung Nguyen K, Le DC. Diabetic Peripheral Neuropathy Associated with Cardiovascular Risk Factors and Glucagon-Like Peptide-1 Concentrations Among Newly Diagnosed Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:35-44. [PMID: 35023938 PMCID: PMC8747623 DOI: 10.2147/dmso.s344532] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/10/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This study was aimed at the prevalence, cardiovascular risk factors of diabetic peripheral neuropathy (DPN), and the relationship between DPN and fasting glucagon-like peptide-1 (fGLP-1) concentrations in newly diagnosed patients with type 2 diabetes mellitus (nT2D). METHODS A cross-sectional descriptive study was conducted from 2015 to 2020 with a population of 473 nT2D. Screening for DPN was based on the United Kingdom screening test. fGLP-1 was measured by enzyme-linked immunosorbent assay. RESULTS The prevalence of DPN was 26.6%, in which mild grade was 17.3%, moderate grade was 8.2% and severe grade was 1.1% in total. Age (OR = 1.73, 95% CI 1.12-2.67, p = 0.012), smoking (OR = 1.64, 95% CI 1.03-2.62, p = 0.037), poor control HbA1c (OR = 2.66, 95% CI 1.23-5.76, p = 0.01), 24-h urinary albumin (24hUA) (OR = 2.49, 95% CI 1.26-4.94, p = 0.007), and diabetic retinopathy (OR = 3.17, 95% CI 1.46-6.89, p = 0.002) significantly increased the risk for DPN. In multivariate logistic regression analysis, hypertension (OR = 2.96, 95% CI 1.16-7.55, p = 0.023), triglyceride (OR = 1.50, 95% CI 1.11-2.03, p = 0.009), albumin (OR = 0.85, 95% CI 0.75-0.95, p = 0.005), and fGLP-1 (OR = 0.79, 95% CI 0.67-0.93, p = 0.005) correlated with DPN. The fGLP-1 concentrations were reduced significantly in DPN (p < 0.001). In particular, male patients with DPN had a significantly lower fGLP-1 levels than those without DPN (p < 0.001). CONCLUSION The prevalence of DPN among nT2D was 26.6%. Age, smoking, hypertension, HbA1c control, triglyceride, albumin, 24hUA, diabetic retinopathy were the associated risk factors of DPN, and fGLP-1 was negatively correlated with DPN (OR = 0.79, 95% CI 0.67-0.93, p = 0.005).
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Affiliation(s)
- Tuan Dinh Le
- Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, Ha Noi, Vietnam
- Department of Rheumatology and Endocrinology, Military Hospital 103, Vietnam Military Medical University, Ha Noi, Vietnam
- Correspondence: Tuan Dinh Le Center of Emergency, Critical Care Medicine and Clinical Toxicology, Department of Rheumatology and Endocrinology, Military Hospital 103, Vietnam Military Medical University, 261 Phung Hung Street, Phuc La Ward, Ha Dong District, Ha Noi, VietnamTel +840388166078 Email
| | - Nga Phi Thi Nguyen
- Department of Rheumatology and Endocrinology, Military Hospital 103, Vietnam Military Medical University, Ha Noi, Vietnam
| | | | - Thuc Luong Cong
- Department of Cardiology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Lan Ho Thi Nguyen
- Department of General Internal Medicine, National Hospital of Endocrinology, Ha Noi, Vietnam
| | - Binh Do Nhu
- Division of Military Science, Military Hospital 103, Vietnam Military Medical University, Ha Noi, Vietnam
| | - Son Tien Nguyen
- Department of Rheumatology and Endocrinology, Military Hospital 103, Vietnam Military Medical University, Ha Noi, Vietnam
| | - Manh Van Ngo
- Postgraduate Training Management Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Hoa Trung Dinh
- Department of Requested Treatment, National Hospital of Endocrinology, Ha Noi, Vietnam
| | - Hien Thi Nguyen
- Department of Physiology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Kien Trung Nguyen
- Department of Science Management, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Duc-Cuong Le
- Postgraduate Training Management Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
- Epidemiology-Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
- Duc-Cuong Le Postgraduate Training Management Department; Epidemiology-Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Ky Ba Ward, Thai Binh, VietnamTel +84 93 8042 668 Email
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23
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Gad H, Petropoulos IN, Khan A, Ponirakis G, MacDonald R, Alam U, Malik RA. Corneal confocal microscopy for the diagnosis of diabetic peripheral neuropathy: A systematic review and meta-analysis. J Diabetes Investig 2022; 13:134-147. [PMID: 34351711 PMCID: PMC8756328 DOI: 10.1111/jdi.13643] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/12/2021] [Accepted: 07/15/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Corneal confocal microscopy (CCM) is a rapid non-invasive ophthalmic imaging technique that identifies corneal nerve fiber damage. Small studies suggest that CCM could be used to assess patients with diabetic peripheral neuropathy (DPN). AIM To undertake a systematic review and meta-analysis assessing the diagnostic utility of CCM for sub-clinical DPN (DPN- ) and established DPN (DPN+ ). DATA SOURCES Databases (PubMed, Embase, Central, ProQuest) were searched for studies using CCM in patients with diabetes up to April 2020. STUDY SELECTION Studies were included if they reported on at least one CCM parameter in patients with diabetes. DATA EXTRACTION Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), and inferior whorl length (IWL) were compared between patients with diabetes with and without DPN and controls. Meta-analysis was undertaken using RevMan V.5.3. DATA SYNTHESIS Thirty-eight studies including ~4,000 participants were included in this meta-analysis. There were significant reductions in CNFD, CNBD, CNFL, and IWL in DPN- vs controls (P < 0.00001), DPN+ vs controls (P < 0.00001), and DPN+ vs DPN- (P < 0.00001). CONCLUSION This systematic review and meta-analysis shows that CCM detects small nerve fiber loss in subclinical and clinical DPN and concludes that CCM has good diagnostic utility in DPN.
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Affiliation(s)
- Hoda Gad
- Department of MedicineWeill Cornell Medicine‐QatarDohaQatar
| | | | - Adnan Khan
- Department of MedicineWeill Cornell Medicine‐QatarDohaQatar
| | | | | | - Uazman Alam
- Diabetes and Neuropathy ResearchDepartment of Eye and Vision Sciences and Pain Research InstituteInstitute of Ageing and Chronic DiseaseUniversity of Liverpool and Aintree University Hospital NHS Foundation TrustLiverpoolUK
- Department of Diabetes and EndocrinologyRoyal Liverpool and Broadgreen University NHS Hospital TrustLiverpoolUK
- Division of Endocrinology, Diabetes and GastroenterologyUniversity of ManchesterManchesterUK
| | - Rayaz A Malik
- Department of MedicineWeill Cornell Medicine‐QatarDohaQatar
- Institute of Cardiovascular MedicineUniversity of ManchesterManchesterUK
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24
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Galosi E, Hu X, Michael N, Nyengaard JR, Truini A, Karlsson P. Redefining distal symmetrical polyneuropathy features in type 1 diabetes: a systematic review. Acta Diabetol 2022; 59:1-19. [PMID: 34213655 PMCID: PMC8758619 DOI: 10.1007/s00592-021-01767-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
Diabetic neuropathy is among the most frequent complications of both type 1 (T1DM) and type 2 diabetes (T2DM) and commonly manifests as a distal symmetrical polyneuropathy (DSPN). Despite evidence that T1DM- and T2DM-related DSPN are separate entities, most of our knowledge on diabetic DSPN derives from studies focused on type 2 diabetes. This systematic review provides an overview of current evidence on DSPN in T1DM, including its epidemiological, pathophysiological and clinical features, along with principal diagnostic tests findings. This review included 182 clinical and preclinical studies. The results indicate that DSPN is a less frequent complication in T1DM compared with T2DM and that distinctive pathophysiological mechanisms underlie T1DM-related DSPN development, with hyperglycemia as a major determinant. T1DM-related DSPN more frequently manifests with non-painful than painful symptoms, with lower neuropathic pain prevalence compared with T2DM-associated DSPN. The overt clinical picture seems characterized by a higher prevalence of large fiber-related clinical signs (e.g., ankle reflexes reduction and vibration hypoesthesia) and to a lesser extent small fiber damage (e.g., thermal or pinprick hypoesthesia). These findings as a whole suggest that large fibers impairment plays a dominant role in the clinical picture of symptomatic T1DM-related DSPN. Nevertheless, small fiber diagnostic testing shows high diagnostic accuracy in detecting early nerve damage and may be an appropriate diagnostic tool for disease monitoring and screening.
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Affiliation(s)
- Eleonora Galosi
- Department of Human Neuroscience, Sapienza University, Rome, Italy.
| | - Xiaoli Hu
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
| | - Nivatha Michael
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Randel Nyengaard
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Páll Karlsson
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
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25
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Burgess J, Petropoulos I, Gad H, Nevitt SJ, Ponirakis G, Ferdousi M, Kalteniece A, Azmi S, Kaye S, Malik RA, Alam U. Corneal confocal microscopy for the diagnosis of diabetic sensorimotor polyneuropathy in people with type 1 and 2 diabetes mellitus. Hippokratia 2021. [DOI: 10.1002/14651858.cd014675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jamie Burgess
- Department of Cardiovascular & Metabolic Medicine and the Pain Research Institute, Institute of Life Course and Medical Sciences; University of Liverpool and Liverpool University Hospital NHS Trust; Liverpool UK
| | - Ioannis Petropoulos
- Weill Cornell Medicine-Qatar, Research Division; Qatar Foundation, Education City; Doha Qatar
| | - Hoda Gad
- Weill Cornell Medicine-Qatar, Research Division; Qatar Foundation, Education City; Doha Qatar
| | - Sarah J Nevitt
- Department of Health Data Science; University of Liverpool; Liverpool UK
| | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Research Division; Qatar Foundation, Education City; Doha Qatar
| | - Maryam Ferdousi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health; The University of Manchester; Manchester UK
| | - Alise Kalteniece
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health; The University of Manchester; Manchester UK
| | - Shazli Azmi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health; The University of Manchester; Manchester UK
| | - Stephen Kaye
- Department of Ophthalmology; Royal Liverpool University Hospital Trust and University of Liverpool; Liverpool UK
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Research Division; Qatar Foundation, Education City; Doha Qatar
- Institute of Cardiovascular Sciences; University of Manchester; Manchester UK
| | - Uazman Alam
- Department of Ophthalmology; Royal Liverpool University Hospital Trust and University of Liverpool; Liverpool UK
- Division of Endocrinology, Diabetes and Gastroenterology; University of Manchester; Manchester UK
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26
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Tsang P, Larocerie-Salgado J, MacDermid JC, Miller TA, Doherty C, Ross DC. Postoperative management and rehabilitation after the supercharged end-to-side anterior interosseous nerve to ulnar motor nerve transfer: A report of 3 cases. J Hand Ther 2021; 34:469-478. [PMID: 32571598 DOI: 10.1016/j.jht.2020.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Compressive ulnar neuropathy at the elbow is the second most common compressive neuropathy. Nerve transfers are used for severe ulnar neuropathies as a means of facilitating recovery. Hand therapy and rehabilitation after nerve transfers have not been extensively explored. PURPOSE OF THE STUDY The aim of this repeated case study was to describe the responses, functional outcome, and neuromuscular health of three participants after the supercharged end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar motor nerve transfer do describe the hand therapy and recovery of 3 cases reflecting different recovery potential mediators, trajectories, and outcomes. STUDY DESIGN Repeated case study. METHODS Three participants of similar age (76-80 years) that had severe ulnar neuropathy who underwent surgical treatment including a SETS AIN to ulnar motor nerve surgery were purposively selected from an ongoing clinical trial, based on their response to the surgical and the rehabilitation intervention (large, moderate, and small improvements). Clinical evaluations included measuring range of motion, strength testing, and clinical tests (ie, Egawa's sign) and, subjective assessment of rehabilitation adherence., Quick Disability of Arm, Shoulder and Hand and decomposition-based quantitative electromyography were performed at >23 months to evaluate patients. RESULTS All the three participants completed the surgical and hand therapy interventions, demonstrating a variable course of recovery and functional outcomes. The Quick Disability of Arm, Shoulder and Hand scores (>23 months) for participants A, B, and C were 68, 30, and 18, respectively. The person with the least improvement had idiopathic Parkinson's disease, dyslipidemia, history of depression, and gout. Comparison across cases suggested that the comorbidities, longer time from neuropathy to the surgical intervention, and psychosocial barriers to exercise and rehabilitation adherence influenced the recovery process. The participants with the best outcomes demonstrated improvements in his lower motor neurons or motor unit counts (109 and 18 motor units in the abductor digiti minimi (ADM) and first dorsal interosseous, respectively) and motor unit stability (39.5% and 37.6% near-fiber jiggle in the ADM and first dorsal interosseous, respectively). The participant with moderate response to the interventions had a motor unit count of 93 for the ADM muscle. We were unable to determine motor unit counts and measurements from the participant with the poorest outcomes due to his physical limitations. CONCLUSIONS SETS AIN to ulnar motor nerve followed by multimodal hand therapy provides measurable improvements in neurophysiology and function, although engagement in hand therapy and outcomes appear to be mediated by comorbid physical and psychosocial health.
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Affiliation(s)
- Philemon Tsang
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; Hand and Upper Limb Centre Clinical Research Lab, St. Joseph's Health Centre, London, Ontario, Canada.
| | | | - Joy C MacDermid
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; Hand and Upper Limb Centre Clinical Research Lab, St. Joseph's Health Centre, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Thomas A Miller
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Christopher Doherty
- Division of Plastic Surgery, University of British Columbia, London, Ontario, Canada
| | - Douglas C Ross
- Division of Plastic Surgery, Department of Surgery, Roth-McFarlane Hand & Upper Limb Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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27
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Tran PMH, Kim E, Tran LKH, Khaled BS, Hopkins D, Gardiner M, Bryant J, Bernard R, Morgan J, Bode B, Reed JC, She JX, Purohit S. T1DMicro: A Clinical Risk Calculator for Type 1 Diabetes Related Microvascular Complications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111094. [PMID: 34769614 PMCID: PMC8583376 DOI: 10.3390/ijerph182111094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/04/2021] [Accepted: 10/15/2021] [Indexed: 01/11/2023]
Abstract
Development of complications in type 1 diabetes patients can be reduced by modifying risk factors. We used a cross-sectional cohort of 1646 patients diagnosed with type 1 diabetes (T1D) to develop a clinical risk score for diabetic peripheral neuropathy (DPN), autonomic neuropathy (AN), retinopathy (DR), and nephropathy (DN). Of these patients, 199 (12.1%) had DPN, 63 (3.8%) had AN, 244 (14.9%) had DR, and 88 (5.4%) had DN. We selected five variables to include in each of the four microvascular complications risk models: age, age of T1D diagnosis, duration of T1D, and average systolic blood pressure and HbA1C over the last three clinic visits. These variables were selected for their strong evidence of association with diabetic complications in the literature and because they are modifiable risk factors. We found the optimism-corrected R2 and Harrell’s C statistic were 0.39 and 0.87 for DPN, 0.24 and 0.86 for AN, 0.49 and 0.91 for DR, and 0.22 and 0.83 for DN, respectively. This tool was built to help inform patients of their current risk of microvascular complications and to motivate patients to control their HbA1c and systolic blood pressure in order to reduce their risk of these complications.
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Affiliation(s)
- Paul Minh Huy Tran
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Eileen Kim
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Lynn Kim Hoang Tran
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Bin Satter Khaled
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Diane Hopkins
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Melissa Gardiner
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Jennifer Bryant
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - Risa Bernard
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
| | - John Morgan
- Department of Neurology, Medical College of Georgia, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA;
| | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, GA 30318, USA;
| | - John Chip Reed
- Southeastern Endocrine and Diabetes, Atlanta, GA 30076, USA;
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
- Department of Obstetrics and Gynecology, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA
| | - Sharad Purohit
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA; (P.M.H.T.); (E.K.); (L.K.H.T.); (B.S.K.); (D.H.); (M.G.); (J.B.); (R.B.); (J.-X.S.)
- Department of Obstetrics and Gynecology, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA
- Department of Undergraduate Health Professionals, Augusta University, 1120, 15th Str., Augusta, GA 30912, USA
- Correspondence:
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Fang Y, Luo L, Li R. Application of traditional Chinese medicine syndrome differentiation in identification of body constitution of hypertensive and diabetic patients. Am J Transl Res 2021; 13:12034-12042. [PMID: 34786139 PMCID: PMC8581866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the application of traditional Chinese medicine (TCM) syndrome differentiation in identification of body constitution of hypertensive and diabetic patients. METHODS A total of 110 hypertensive patients with diabetes treated in our hospital were enrolled in this study, and were divided into a study group (SG, n=60) and a control group (CG, n=50) according to different intervention methods. Patients in the CG received conventional western medical intervention for hypertension and diabetes, while patients in the SG received body constitution-identified TCM syndrome differentiation intervention additionally. The changes of blood pressure and plasma glucose during the intervention were compared between the two groups, the clinical effect and quality of life of the two groups were evaluated, and multivariate stepwise Logistic regression analysis on influencing factor of TCM body constitution was conducted. RESULTS Compared with that before intervention, the proportion of gentleness constitution in the SG showed a significant increase (P<0.05) after intervention. Dynamic analysis during the intervention showed that patients in the SG had lower systolic blood pressure (SBP), diastolic blood pressure (DBP), lower level of fasting plasma glucose (GLU) and 2-h postprandial plasma glucose (2hPG) than the CG from 1 to 12 months after intervention (P<0.05). Patients in the SG scored higher than the CG on all SF-36 dimensions after intervention (P<0.05). Multivariate stepwise Logistic regression analysis showed that dampness-heat constitution, blood-stasis constitution, Yin-deficiency constitution and phlegm-dampness constitution were the main risk factors for hypertension with diabetes (P<0.05). CONCLUSION Body constitution-identified TCM syndrome differentiation treatment for hypertensive patients with diabetes is effective, which can significantly improve the plasma glucose and blood pressure indices of patients. Dampness-heat constitution, blood-stasis constitution, Yin-deficiency constitution and phlegm-dampness constitution are the risk factors for hypertension with diabetes.
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Affiliation(s)
- Yuxi Fang
- Basic Medical College, Zhejiang Chinese Medical UniversityHangzhou City, Zhejiang Province, China
| | - Le Luo
- Beijing University of Chinese MedicineBeijing, China
| | - Ruhui Li
- Basic Medical College, Zhejiang Chinese Medical UniversityHangzhou City, Zhejiang Province, China
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29
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Corneal nerve loss as a surrogate marker for poor pial collaterals in patients with acute ischemic stroke. Sci Rep 2021; 11:19718. [PMID: 34611233 PMCID: PMC8492683 DOI: 10.1038/s41598-021-99131-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/17/2021] [Indexed: 01/01/2023] Open
Abstract
In patients with acute ischemic stroke, pial collaterals play a key role in limiting neurological disability by maintaining blood flow to ischemic penumbra. We hypothesized that patient with poor pial collaterals will have greater corneal nerve and endothelial cell abnormalities. In a cross-sectional study, 35 patients with acute ischemic stroke secondary to middle cerebral artery (MCA) occlusion with poor (n = 12) and moderate-good (n = 23) pial collaterals and 35 healthy controls underwent corneal confocal microscopy and quantification of corneal nerve and endothelial cell morphology. In patients with MCA stroke, corneal nerve fibre length (CNFL) (P < 0.001), corneal nerve fibre density (CNFD) (P = 0.025) and corneal nerve branch density (CNBD) (P = 0.002) were lower compared to controls. Age, BMI, cholesterol, triglycerides, HDL, LDL, systolic blood pressure, NIHSS and endothelial cell parameters did not differ but mRS was higher (p = 0.023) and CNFL (p = 0.026) and CNBD (p = 0.044) were lower in patients with poor compared to moderate-good collaterals. CNFL and CNBD distinguished subjects with poor from moderate-good pial collaterals with an AUC of 72% (95% CI 53–92%) and 71% (95% CI 53–90%), respectively. Corneal nerve loss is greater in patients with poor compared to moderate-good pial collaterals and may act as a surrogate marker for pial collateral status in patients with ischemic stroke.
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30
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Ponirakis G, Elsotouhy A, Al Hamad H, Vattoth S, Petropoulos IN, Khan A, Gad H, Al-Khayat F, Chandran M, Ramadan M, Elorrabi M, Gadelseed M, Tosino R, Gawhale PV, Alobaidi M, Khan S, Manikoth P, Abdelrahim YHM, Thodi N, Almuhannadi H, Al-Mohannadi S, AlMarri F, Qazi M, Own A, Mahfoud ZR, Shuaib A, Malik RA. Association of Cerebral Ischemia With Corneal Nerve Loss and Brain Atrophy in MCI and Dementia. Front Neurosci 2021; 15:690896. [PMID: 34234643 PMCID: PMC8257078 DOI: 10.3389/fnins.2021.690896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction This study assessed the association of cerebral ischemia with neurodegeneration in mild cognitive impairment (MCI) and dementia. Methods Subjects with MCI, dementia and controls underwent assessment of cognitive function, severity of brain ischemia, MRI brain volumetry and corneal confocal microscopy. Results Of 63 subjects with MCI (n = 44) and dementia (n = 19), 11 had no ischemia, 32 had subcortical ischemia and 20 had both subcortical and cortical ischemia. Brain volume and corneal nerve measures were comparable between subjects with subcortical ischemia and no ischemia. However, subjects with subcortical and cortical ischemia had a lower hippocampal volume (P < 0.01), corneal nerve fiber length (P < 0.05) and larger ventricular volume (P < 0.05) compared to those with subcortical ischemia and lower corneal nerve fiber density (P < 0.05) compared to those without ischemia. Discussion Cerebral ischemia was associated with cognitive impairment, brain atrophy and corneal nerve loss in MCI and dementia.
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Affiliation(s)
- Georgios Ponirakis
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar.,Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
| | - Ahmed Elsotouhy
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar.,Neuroradiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hanadi Al Hamad
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Surjith Vattoth
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | | | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Fatima Al-Khayat
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Mani Chandran
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Marwan Ramadan
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Marwa Elorrabi
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Masharig Gadelseed
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rhia Tosino
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Priya V Gawhale
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maryam Alobaidi
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shafi Khan
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Pravija Manikoth
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Yasmin H M Abdelrahim
- Geriatric and Memory Clinic, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Noushad Thodi
- Magnetic Resonance Imaging Unit, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hamad Almuhannadi
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Salma Al-Mohannadi
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Fatema AlMarri
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Murtaza Qazi
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Ahmed Own
- Neuroradiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad R Mahfoud
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar.,Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom.,Institute of Cardiovascular Science, University of Manchester, Manchester, United Kingdom
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Gad H, Al-Jarrah B, Saraswathi S, Mohamed S, Kalteniece A, Petropoulos IN, Khan A, Ponirakis G, Singh P, Khodor SA, Elawad M, Almasri W, Hendaus MA, Akobeng AK, Hussain K, Malik RA. Corneal confocal microscopy identifies a reduction in corneal keratocyte density and sub-basal nerves in children with type 1 diabetes mellitus. Br J Ophthalmol 2021; 106:1368-1372. [PMID: 33931390 DOI: 10.1136/bjophthalmol-2021-319057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/10/2021] [Accepted: 04/20/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE To assess whether alterations in stromal keratocyte density are related to loss of corneal nerve fibres in children with type 1 diabetes mellitus (T1DM). METHODS Twenty participants with T1DM and 20 age-matched healthy controls underwent corneal confocal microscopy. Corneal sub-basal nerve morphology and corneal keratocyte density (KD) were quantified. RESULTS Corneal nerve fibre density (CNFD) (p<0.001), corneal nerve branch density (p<0.001), corneal nerve fibre length (CNFL) (p<0.001) and inferior whorl length (IWL) (p<0.001) were lower in children with T1DM compared with healthy controls. Anterior (p<0.03) and mid (p=0.03) stromal KDs were lower with no difference in posterior KD (PKD) in children with T1DM compared with controls. Age, duration of diabetes, height, weight and body mass index did not correlate with anterior (AKD), mid (MKD) or PKD. Inverse correlations were found between glycated haemoglobin and PKD (r=-0.539, p=0.026), bilirubin with MKD (r=-0.540, p=0.025) and PKD (r=-0.531, p=0.028) and 25-hydroxycholecalciferol with MKD (r=-0.583, p=0.018). CNFD, CNFL and IWL did not correlate with AKD, MKD or PKD. CONCLUSION This study demonstrates a reduction in corneal nerves and anterior and mid stromal KD in children with T1DM, but no correlation between corneal nerve and keratocyte cell loss.
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Affiliation(s)
- Hoda Gad
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | | | | | - Sara Mohamed
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Alise Kalteniece
- Cardiovascular Medicine, University of Manchester, Manchester, UK
| | | | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | | | | | | | | | | | | | | | | | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar .,Cardiovascular Medicine, University of Manchester, Manchester, UK
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Lambourg E, Colvin L, Guthrie G, Murugan K, Lim M, Walker H, Boon G, Bell S. The prevalence of pain among patients with chronic kidney disease using systematic review and meta-analysis. Kidney Int 2021; 100:636-649. [PMID: 33940112 DOI: 10.1016/j.kint.2021.03.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023]
Abstract
Pain is a common but often undertreated symptom in patients with chronic kidney disease (CKD) with a much higher prevalence than in the general population. The aim of this systematic review was to synthesize all available quantitative evidence, in order to gain a better understanding of pain prevalence and pain types in patients with CKD. Four databases and the grey literature were searched until 15th January 2021. Random-effect meta-analyses were conducted with multiple subgroup analyses and meta-regressions to further explore the between-study heterogeneity. The quality of studies included was assessed using the Newcastle-Ottawa scale and the level of evidence was determined using the GRADE approach. One hundred sixteen studies reported data on 40,678 individuals. Results from meta-analyses yielded an overall prevalence of 60% (95% confidence interval 56-64) for pain, 48% (42-55) for chronic pain and 10% (6-15) for neuropathic pain. The prevalence of pain was lower among kidney transplant recipients 46% (37-56) compared with patients undergoing dialysis 63% (57-68) and those with non-dialysis CKD 63% (55-70). Musculoskeletal pain appeared to be the most common pain symptom among patients with CKD managed conservatively 42% (28-56) or receiving dialysis 45% (36-55) whilst abdominal pain was most prevalent in kidney transplant recipients 41% (7-86). Thus, all subgroups of patients with CKD suffer from a high burden of pain. Hence, greater awareness and recognition of this issue is vital to inform policy and service provision in this area.
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Affiliation(s)
- Emilie Lambourg
- Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, UK
| | - Lesley Colvin
- Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, UK
| | | | | | - Michelle Lim
- Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, UK
| | - Heather Walker
- Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, UK; Renal Unit, Ninewells Hospital, Dundee, UK
| | | | - Samira Bell
- Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, UK; Renal Unit, Ninewells Hospital, Dundee, UK.
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Sabuncu T, Sonmez A, Eren MA, Sahin I, Çorapçioğlu D, Üçler R, Akin Ş, Haymana C, Demirci İ, Atmaca A, Ersöz HÖ, Satman I, Bayram F. Characteristics of patients with hypertension in a population with type 2 diabetes mellitus. Results from the Turkish Nationwide SurvEy of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Hypertension Study). Prim Care Diabetes 2021; 15:332-339. [PMID: 33277201 DOI: 10.1016/j.pcd.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/05/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The present survey aimed to find out the demographical and clinical characteristics of patients with hypertension in a population with type 2 diabetes mellitus (T2DM) in Turkey. METHODS Patients with T2DM who were followed-up in tertiary endocrine units for at least last one year were recruited. Demographic, clinical and biochemical data of the patients were collected. Hypertension was defined as taking anti-hypertensive medications or having office arterial blood pressure (ABP) ≥140/90 mmHg or home ABP ≥ 130/80 mmHg. RESULTS A total of 4756 (58.9% women) diabetic patients were evaluated. The percentage of patients with hypertension was 67.5% (n = 3212). Although 87.4% (n = 2808) of hypertensive patients were under treatment, blood pressure was on target in 52.7% (n = 1479) of patients. Hypertension proportions were higher in woman (p = 0.001), older, more obese, and those who had longer diabetes duration, lower education levels, higher frequency of hypoglycemic events (all p < 0.001) and higher triglyceride levels (p = 0.003). LDL cholesterol level and the percentage of smokers were lower in hypertensive group than in non-hypertensive group (both p < 0.001). The percentage of macro and microvascular complications was higher in the hypertensive group than in the normotensive one (both p < 0.001). In multivariate logistic regression analysis, being a woman (OR: 1.26, 95% CI: 1.04-1.51, p = 0.016), smoking (OR: 1.38, 95% CI: 1.05-1.80, p = 0.020), regular physical activity (OR: 1.24, 95% CI: 1.01-1.53, p = 0.039) and the presence of macrovascular complications (OR: 1.38 95% CI: 1.15-1.65, p = 0.001) were the significant predictors of good ABP regulation. The ratios of masked and white coat hypertension were 41.2% and 5.7%, respectively. CONCLUSION Our findings indicate that two-thirds (67.5%) of adult patients with T2DM have hypertension. Co-existence of hypertension increases the frequency of macro and microvascular diabetic complications in these patients. Despite the critical role of hypertension in morbidity and mortality, only half of the patients have favorable ABP levels. Masked hypertension seems to be another important issue in this population.
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Affiliation(s)
- Tevfik Sabuncu
- Harran University, Faculty of Medicine, Department of Endocrinology and Metabolism, Sanliurfa, Turkey
| | - Alper Sonmez
- Health Sciences University, Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Mehmet Ali Eren
- Harran University, Faculty of Medicine, Department of Endocrinology and Metabolism, Sanliurfa, Turkey.
| | - Ibrahim Sahin
- Inonu University, Faculty of Medicine, Department of Endocrinology and Metabolism, Malatya, Turkey
| | - Demet Çorapçioğlu
- Ankara University, Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Rıfkı Üçler
- Van Yüzüncü Yıl University, Faculty of Medicine, Department of Endocrinology and Metabolism, Van, Turkey
| | - Şafak Akin
- Ankara Memorial Hospital, Ankara, Turkey
| | - Cem Haymana
- Health Sciences University, Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - İbrahim Demirci
- Health Sciences University, Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Ayşegül Atmaca
- On Dokuz Mayıs University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey
| | - Halil Önder Ersöz
- Karadeniz Teknik University, Faculty of Medicine, Department of Endocrinology and Metabolism, Trabzon, Turkey
| | - Ilhan Satman
- Istanbul University, Faculty of Medicine, Department of Endocrinology and Metabolism, Istanbul, Turkey
| | - Fahri Bayram
- Erciyes University, Faculty of Medicine, Department of Endocrinology and Metabolism, Kayseri, Turkey
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Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres. Diagnostics (Basel) 2021; 11:diagnostics11020165. [PMID: 33498918 PMCID: PMC7911433 DOI: 10.3390/diagnostics11020165] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the most common complication of both type 1 and 2 diabetes. As a result, neuropathic pain, diabetic foot ulcers and lower-limb amputations impact drastically on quality of life, contributing to the individual, societal, financial and healthcare burden of diabetes. DPN is diagnosed at a late, often pre-ulcerative stage due to a lack of early systematic screening and the endorsement of monofilament testing which identifies advanced neuropathy only. Compared to the success of the diabetic eye and kidney screening programmes there is clearly an unmet need for an objective reliable biomarker for the detection of early DPN. This article critically appraises research and clinical methods for the diagnosis or screening of early DPN. In brief, functional measures are subjective and are difficult to implement due to technical complexity. Moreover, skin biopsy is invasive, expensive and lacks diagnostic laboratory capacity. Indeed, point-of-care nerve conduction tests are convenient and easy to implement however questions are raised regarding their suitability for use in screening due to the lack of small nerve fibre evaluation. Corneal confocal microscopy (CCM) is a rapid, non-invasive, and reproducible technique to quantify small nerve fibre damage and repair which can be conducted alongside retinopathy screening. CCM identifies early sub-clinical DPN, predicts the development and allows staging of DPN severity. Automated quantification of CCM with AI has enabled enhanced unbiased quantification of small nerve fibres and potentially early diagnosis of DPN. Improved screening tools will prevent and reduce the burden of foot ulceration and amputations with the primary aim of reducing the prevalence of this common microvascular complication.
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Fang WC, Chou KM, Sun CY, Lee CC, Wu IW, Chen YC, Pan HC. Thermal Perception Abnormalities Can Predict Diabetic Kidney Disease in Type 2 Diabetes Mellitus Patients. Kidney Blood Press Res 2020; 45:926-938. [PMID: 33053551 DOI: 10.1159/000510479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/26/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous studies have illustrated clinical associations between diabetic peripheral neuropathy (DPN) and diabetic kidney disease (DKD). Quantitative sensory testing (QST) can accurately detect thermal perception abnormalities and aid in the early diagnosis of asymptomatic small-fiber DPN in patients with type 2 diabetes. The aim of this study was to determine the predictive value of thermal perception abnormalities by QST to detect DKD. METHODS We prospectively enrolled 432 patients with type 2 diabetes (50.2% male, mean age 57.2 years, and average duration of diabetes 9.9 years) at our hospital between 2016 and 2017. Demographic and clinical data of the patients were recorded and analyzed. Diagnosis and staging of DKD were determined by urinary albumin excretion rate and estimated glomerular filtration rate. The presence of thermal perception abnormalities was determined by QST. Multiple logistic regression and receiver operating characteristic (ROC) analyses were performed to investigate the relationships between thermal perception abnormalities and DKD in these patients. RESULTS In multiple regression analysis, abnormal cold perception in the lower limbs was associated with an increased risk of advanced DKD. Area under the ROC curve analysis revealed that four-limb cold perception abnormalities had the best discriminatory power (0.741 ± 0.053) to predict advanced DKD. CONCLUSIONS Our results demonstrate the value of using thermal perception abnormalities to identify patients with type 2 diabetes also at risk of DKD.
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Affiliation(s)
- Wei-Ching Fang
- Department of Family Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuei-Mei Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chiao-Yin Sun
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chin-Chan Lee
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - I-Wen Wu
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yung-Chang Chen
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Heng-Chih Pan
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan, .,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan,
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Okdahl T, Brock C, Fløyel T, Wegeberg AML, Jakobsen PE, Ejskjaer N, Pociot F, Brock B, Størling J. Increased levels of inflammatory factors are associated with severity of polyneuropathy in type 1 diabetes. Clin Endocrinol (Oxf) 2020; 93:419-428. [PMID: 32497255 DOI: 10.1111/cen.14261] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/01/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Distal symmetrical polyneuropathy (DSPN) is a severe common long-term complication of type 1 diabetes caused by impaired sensory-motor nerve function. As chronic low-grade inflammation may be involved in the pathogenesis of DSPN, we investigated the circulating levels of inflammatory markers in individuals with type 1 diabetes with and without DSPN. Furthermore, we determined to what extent these factors correlated with different peripheral sensory nerve functions. DESIGN Cross-sectional study. PATIENTS The study included 103 individuals with type 1 diabetes with (n = 50) and without DSPN (n = 53) as well as a cohort of healthy controls (n = 21). MEASUREMENTS Circulating levels of various inflammatory markers (cytokines, chemokines and soluble adhesion molecules) were determined in serum samples by Luminex multiplexing technology. Peripheral sensory nerve testing, for example vibration, tactile and thermal perception, was assessed by standardized procedures. RESULTS The cytokines IL-1α, IL-4, IL-12p70, IL-13, IL-17A and TNF-α; the chemokine MCP-1; and the adhesion molecule E-selectin were significantly increased in individuals with type 1 diabetes with DSPN compared to those without DSPN (P < .001). These observations were independent of age, sex, BMI, disease duration and blood pressure. Additionally, higher serum concentrations of cytokines and chemokines were associated with higher vibration and tactile perception thresholds, but not with heat tolerance threshold. CONCLUSIONS Individuals with type 1 diabetes and concomitant DSPN display higher serum levels of several inflammatory markers. These findings support that systemic low-grade inflammation may play a role in the pathogenesis of DSPN.
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Affiliation(s)
- Tina Okdahl
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tina Fløyel
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Anne-Marie L Wegeberg
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Poul Erik Jakobsen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Ejskjaer
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Flemming Pociot
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Joachim Størling
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ponirakis G, Abdul-Ghani MA, Jayyousi A, Almuhannadi H, Petropoulos IN, Khan A, Gad H, Migahid O, Megahed A, DeFronzo R, Mahfoud Z, Hassan M, Al Hamad H, Ramadan M, Alam U, Malik RA. Effect of treatment with exenatide and pioglitazone or basal-bolus insulin on diabetic neuropathy: a substudy of the Qatar Study. BMJ Open Diabetes Res Care 2020; 8:8/1/e001420. [PMID: 32576561 PMCID: PMC7312325 DOI: 10.1136/bmjdrc-2020-001420] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/28/2020] [Accepted: 05/13/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION To assess the effect of exenatide and pioglitazone or basal-bolus insulin on diabetic peripheral neuropathy (DPN) in patients with poorly controlled type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS This is a substudy of the Qatar Study, an open-label, randomized controlled trial. 38 subjects with poorly controlled T2D were studied at baseline and 1-year follow-up and 18 control subjects were assessed at baseline only. A combination of exenatide (2 mg/week) and pioglitazone (30 mg/day) or glargine with aspart insulin were randomly assigned to patients to achieve an HbA1c <53 mmol/mol (<7%). DPN was assessed with corneal confocal microscopy (CCM), DN4, vibration perception and sudomotor function. RESULTS Subjects with T2D had reduced corneal nerves, but other DPN measures were comparable with the control group. In the combination treatment arm (n=21), HbA1c decreased by 35.2 mmol/mol (3.8 %) (p<0.0001), body weight increased by 5.6 kg (p<0.0001), corneal nerve branch density increased (p<0.05), vibration perception worsened (p<0.05), and DN4 and sudomotor function showed no change. In the insulin treatment arm, HbA1c decreased by 28.7 mmol/mol (2.7 %) (p<0.0001), body weight increased by 4.6 kg (p<0.01), corneal nerve branch density and fiber length increased (p≤0.01), vibration perception improved (p<0.01), and DN4 and sudomotor function showed no change. There was no association between the change in CCM measures with change in HbA1c, weight or lipids. CONCLUSIONS Treatment with exenatide and pioglitazone or basal-bolus insulin results in corneal nerve regeneration, but no change in neuropathic symptoms or sudomotor function over 1 year.
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Affiliation(s)
- Georgios Ponirakis
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
- Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | | | - Amin Jayyousi
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
| | | | | | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Hoda Gad
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Osama Migahid
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
| | - Ayman Megahed
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
| | - Ralph DeFronzo
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ziyad Mahfoud
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Mona Hassan
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
| | - Hanadi Al Hamad
- Department of Geriatrics and Long Term Care, Qatar Rehabilitation Institute, Doha, Qatar
| | - Marwan Ramadan
- Department of Geriatrics and Long Term Care, Qatar Rehabilitation Institute, Doha, Qatar
| | - Uazman Alam
- Aintree University Hospitals NHS Foundation Trust, Liverpool, Liverpool, UK
| | - Rayaz A Malik
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
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Ponirakis G, Elhadd T, Chinnaiyan S, Dabbous Z, Siddiqui M, Al-Muhannadi H, Petropoulos IN, Khan A, Ashawesh KAE, Dukhan KMO, Mahfoud ZR, Murgatroyd C, Slevin M, Malik RA. Prevalence and management of diabetic neuropathy in secondary care in Qatar. Diabetes Metab Res Rev 2020; 36:e3286. [PMID: 31913560 DOI: 10.1002/dmrr.3286] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/12/2019] [Accepted: 12/30/2019] [Indexed: 12/24/2022]
Abstract
AIMS Diabetic neuropathy (DN) is a "Cinderella" complication, particularly in the Middle East. A high prevalence of undiagnosed DN and those at risk of diabetic foot ulceration (DFU) is a major concern. We have determined the prevalence of DN and its risk factors, DFU, and those at risk of DFU in patients with type 2 diabetes mellitus (T2DM) in secondary care in Qatar. MATERIALS AND METHODS Adults with T2DM were randomly selected from the two National Diabetes Centers in Qatar. DN was defined by the presence of neuropathic symptoms and a vibration perception threshold (VPT) ≥ 15 V. Participants with a VPT ≥ 25 V were categorized as high risk for DFU. Painful DN was defined by a DN4 score ≥4. Logistic regression analysis was used to identify predictors of DN. RESULTS In 1082 adults with T2DM (age 54 ± 11 years, duration of diabetes 10.0 ± 7.7 years, 60.6% males), the prevalence of DN was 23.0% (95% CI, 20.5%-25.5%) of whom 33.7% (95% CI, 27.9%-39.6%) were at high risk of DFU, and 6.3% had DFU; 82.0% of the patients with DN were previously undiagnosed. The prevalence of DN increased with age and duration of diabetes and was associated with poor glycaemic control (HbA1c ≥ 9%) AOR = 2.1 (95% CI, 1.3-3.2), hyperlipidaemia AOR = 2.7 (95% CI, 1.5-5.0), and hypertension AOR = 2.0 (95% CI, 1.2-3.4). CONCLUSIONS Despite DN affecting 23% of adults with T2DM, 82% had not been previously diagnosed with one-third at high risk for DFU. This argues for annual screening and identification of patients with DN. Furthermore, we identify hyperglycaemia, hyperlipidaemia, and hypertension as predictors of DN.
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Affiliation(s)
- Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Tarik Elhadd
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- National Diabetes Center, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Subitha Chinnaiyan
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zeinab Dabbous
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mashhood Siddiqui
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hamad Al-Muhannadi
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Adnan Khan
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Khaled A E Ashawesh
- National Diabetes Center, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khaled M O Dukhan
- National Diabetes Center, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad R Mahfoud
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Mark Slevin
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
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Khan A, Akhtar N, Kamran S, Almuhannadi H, Ponirakis G, Petropoulos IN, Babu B, Jose NR, Ibrahim RG, Gad H, Bourke P, Saqqur M, Shuaib A, Malik RA. Corneal confocal microscopy identifies greater corneal nerve damage in patients with a recurrent compared to first ischemic stroke. PLoS One 2020; 15:e0231987. [PMID: 32320450 PMCID: PMC7176137 DOI: 10.1371/journal.pone.0231987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/03/2020] [Indexed: 01/01/2023] Open
Abstract
Objectives Corneal nerve damage may be a surrogate marker for the risk of ischemic stroke. This study was undertaken to determine if there is greater corneal nerve damage in patients with recurrent ischemic stroke. Methods Corneal confocal microscopy (CCM) was used to quantify corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL) and corneal nerve fiber tortuosity (CNFT) in 31 patients with recurrent ischemic stroke, 165 patients with a first acute ischemic stroke and 23 healthy control subjects. Results Triglycerides (P = 0.004, P = 0.017), systolic BP (P = 0.000, P = 0.000), diastolic BP (P = 0.000, P = 0.000) and HbA1c (P = 0.000, P = 0.000) were significantly higher in patients with first and recurrent stroke compared to controls. There was no difference in age, BMI, HbA1c, total cholesterol, triglycerides, LDL, HDL, systolic and diastolic BP between patients with a first and recurrent ischemic stroke. However, CNFD was significantly lower (24.98±7.31 vs 29.07±7.58 vs 37.91±7.13, P<0.05) and CNFT was significantly higher (0.085±0.042 vs 0.064±0.037 vs 0.039±0.022, P<0.05) in patients with recurrent stroke compared to first stroke and healthy controls. CNBD (42.21±24.65 vs 50.46±27.68 vs 87.24±45.85, P<0.001) and CNFL (15.66±5.70, P<0.001 vs 17.38±5.06, P = 0.003) were equally reduced in patients with first and recurrent stroke compared to controls (22.72±5.14). Conclusions Corneal confocal microscopy identified greater corneal nerve fibre loss in patients with recurrent stroke compared to patients with first stroke, despite comparable risk factors. Longitudinal studies are required to determine the prognostic utility of corneal nerve fiber loss in identifying patients at risk of recurrent ischemic stroke.
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Affiliation(s)
- Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Naveed Akhtar
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Blessy Babu
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Namitha R. Jose
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Rumissa G. Ibrahim
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Paula Bourke
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- Department of Neurology and Institute of Neurosciences, Hamad Medical Corporation, Doha, Qatar
- Department of Neurology, Stroke Program, University of Alberta, Alberta, Canada
| | - Ashfaq Shuaib
- Department of Neurology, Stroke Program, University of Alberta, Alberta, Canada
| | - Rayaz A. Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- * E-mail:
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40
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Javed S, Hayat T, Menon L, Alam U, Malik RA. Diabetic peripheral neuropathy in people with type 2 diabetes: too little too late. Diabet Med 2020; 37:573-579. [PMID: 31797434 DOI: 10.1111/dme.14194] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2019] [Indexed: 12/12/2022]
Abstract
Diabetic peripheral neuropathy in people with type 2 diabetes is poorly managed because of its insidious onset, delayed diagnosis and more complex aetiology resulting from the contribution of not only hyperglycaemia, but also ageing, hyperlipidaemia, hypertension and obesity. Because there is no US Food and Drug Adminstration-approved disease-modifying therapy for diabetic peripheral neuropathy, the key to ameliorating it in type 2 diabetes has to be through earlier diagnosis and timely multi-factorial risk factor reduction. The management of painful diabetic peripheral neuropathy also requires a detailed appraisal of the choice of therapy, taking into account efficacy, patient wishes, comorbidities, side effect profile and potential for abuse.
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Affiliation(s)
- S Javed
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| | - T Hayat
- Primary Health Care Corporation, Doha, Qatar
| | - L Menon
- Department of Medicine, Weill-Cornell Medicine-Qatar, Doha, Qatar
| | - U Alam
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - R A Malik
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
- Department of Medicine, Weill-Cornell Medicine-Qatar, Doha, Qatar
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41
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Corneal nerve fiber loss in diabetes with chronic kidney disease. Ocul Surf 2019; 18:178-185. [PMID: 31770601 DOI: 10.1016/j.jtos.2019.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 12/19/2022]
Abstract
AIMS Patients with chronic kidney disease (CKD) in type 2 diabetes typically manifest with severe peripheral neuropathy. Corneal confocal microscopy is a novel technique that may serve as a marker of nerve injury in peripheral neuropathy. This study examines the changes that occur in corneal nerve morphology as a result of peripheral neuropathy due to renal dysfunction in people with type 2 diabetes. METHODS Sixty-two participants (mean age, 62 ± 12 years) with type 2 diabetes and 25 age-matched healthy controls underwent a comprehensive assessment of neuropathy using the total neuropathy score (TNS). The corneal sub-basal nerve plexus was imaged using corneal confocal microscopy. Corneal nerve fiber length, fiber density, branch density, total branch density, nerve fractal dimension, inferior whorl length and inferior whorl nerve fractal dimension were quantified. Based on the eGFR, participants were classified into those with diabetic CKD (eGFR < 60; n = 22) and those without CKD (eGFR ≥ 60; n = 40). RESULTS Participants with diabetic CKD had significantly lower corneal nerve fiber density (P = 0.037), length (P = 0.036) and nerve fractal dimension (P = 0.036) compared to those without CKD. Multiple linear regression analysis revealed that reduced corneal nerve fiber density (ß coefficient = 0.098, P = 0.017), length (ß coefficient = 0.006, P = 0.008) and nerve fractal dimension (ß coefficient = 0.001, P = 0.007) was associated with low eGFR levels when adjusted for age, duration of diabetes and severity of neuropathy. CONCLUSION Corneal confocal microscopy detects corneal nerve loss in patients with diabetic CKD and reduction in corneal nerve parameters is associated with the decline of kidney function.
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