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Wang CS, Pai YW, Lin CH, Lee IT, Chen HH, Chang MH. Diabetic peripheral neuropathy: age-stratified glycemic control. Front Endocrinol (Lausanne) 2024; 15:1377923. [PMID: 38694945 PMCID: PMC11061506 DOI: 10.3389/fendo.2024.1377923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/05/2024] [Indexed: 05/04/2024] Open
Abstract
Background We explore the effect of suboptimal glycemic control on the incidence of diabetic peripheral neuropathy (DPN) in both non-elderly and elderly patients with type 2 diabetes mellitus (T2DM). Methods A 6-year follow-up study (2013-2019) enrolled T2DM patients aged >20 without DPN. Participants were classified into two groups: those below 65 years (non-elderly) and those 65 years or older (elderly). Biochemical measurements, including glycated hemoglobin (HbA1C), were recorded regularly. DPN was diagnosed using the Michigan Neuropathy Screening Instrument examination. The outcome was DPN occurrence in 2019. Results In 552 enrollments (69% non-elderly), DPN occurred in 8.4% non-elderly and 24.0% elderly patients. A higher initial HbA1C level was significantly linked with a higher risk of future DPN in the non-elderly group (adjusted odds ratio [AOR] 1.46, 95% CI 1.13-1.89, p=0.004). In comparison, HbA1c at the end of the study period was not associated with DPN in the non-elderly group (AOR 1.17, 95% CI 0.72-1.90, p=0.526). In the elderly group, no statistical relationship was found between HbA1C levels and DPN, either in 2013 or in 2019. Conclusion Suboptimal glycemic control at baseline, rather than at the end of the study period, predicts an increased risk of future DPN in individuals with T2DM under age 65. This correlation is not seen in elderly patients. Therefore, we recommend implementing enhanced glycemic control early in middle-aged T2DM patients and propose individualized therapeutic strategies for diabetes in different age groups.
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Affiliation(s)
- Chi-Sheng Wang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yen-Wei Pai
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine and Brain and Neuroscience Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsiao-Hui Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Hong Chang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine and Brain and Neuroscience Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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Mekuria Negussie Y, Tilahun Bekele N. Diabetic peripheral neuropathy among adult type 2 diabetes patients in Adama, Ethiopia: health facility-based study. Sci Rep 2024; 14:3844. [PMID: 38361024 PMCID: PMC10869338 DOI: 10.1038/s41598-024-53951-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024] Open
Abstract
Diabetic peripheral neuropathy is the most prominent microvascular complication of diabetes mellitus and the leading cause of ulceration, amputation, and extended hospitalization. Evidence regarding the magnitude and factors associated with diabetic peripheral neuropathy is not well documented in Ethiopia, particularly in the study area. A facility-based cross-sectional study was conducted among 293 adult type 2 diabetic patients who were on treatment and follow-up from May to June 31, 2023. To select participants in the study, a systematic random sampling method was utilized. Data were collected using semi-structured questionnaires and medical record reviews. The Michigan Neuropathy Screening Instrument (MNSI) was employed to assess diabetic peripheral neuropathy. To model the association between diabetic peripheral neuropathy and independent variables, binary logistic regression model was used. An adjusted odds ratio with a 95% confidence interval was used to estimate the association and statistical significance was proclaimed at a p-value < 0.05. The magnitude of diabetic peripheral neuropathy was 14.3% (95% CI 10.4-18.0). It was 13.4% (95% CI 8.4-19.1) among males and 15.4% (95% CI 10.1-22.2) among females. Age above 60 years (AOR = 5.06, 95% CI 1.60-15.96), being rural resident (AOR = 2.41; 95% CI 1.15-5.06), duration of diabetes above 5 years (AOR = 2.48, 95% CI 1.16-5.27) and having comorbid hypertension (AOR = 2.56, 95% CI 1.24-5.28) were independently associated with diabetic peripheral neuropathy. One in seven adult type 2 diabetes patients in the study area had diabetic peripheral neuropathy. Factors such as age, place of residence, duration of diabetes, and comorbid hypertension showed positive associations with diabetic peripheral neuropathy. Thus, it is imperative to give special consideration to diabetic patients who are elderly, living in rural areas, experiencing a prolonged duration of diabetes, or dealing with comorbid hypertension.
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Kim J, Noh W, Kim A, Choi Y, Kim YS. The Effect of Fenugreek in Type 2 Diabetes and Prediabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Mol Sci 2023; 24:13999. [PMID: 37762302 PMCID: PMC10531284 DOI: 10.3390/ijms241813999] [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: 08/17/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Fenugreek is a widely used herbal medicine as a complementary therapy for diabetes mellitus. Lots of clinical trials have proved its beneficial effect on glycemic control parameters and lipid profiles. Thus, we conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of fenugreek as a treatment for type 2 diabetes mellitus. We searched PubMed, Embase, Cochrane, China Knowledge Resource Integrated Database (CNKI), Korean studies Information Service System (KISS), Research Information Sharing Service (RISS), and ScienceON to select RCTs which used fenugreek targeting hyperglycemia with a control group. We used either a random effect model or a fixed model in a meta-analysis of Fasting blood glucose (FBG), 2 h plasma glucose during a 75 g oral glucose tolerance test (OGTT) (2-hPG), homeostatic model assessment for insulin resistance (HOMA-IR), glycosylated hemoglobin (HbA1c)/total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), body mass index (BMI). After screening, a total of 10 studies (706 participants) remained. Fenugreek significantly reduced FBG, 2-hPG, and HbA1c, but it did not significantly decrease HOMA-IR. Moreover, it significantly improved TC, TG, and HDL-C, while there were no significant differences in LDL-C and BMI. Hepatic or renal toxicity was not observed, and there were no severe adverse events associated with fenugreek despite mild gastrointestinal side effects in some studies. In conclusion, fenugreek improves overall glycemic control parameters and lipid profile safely.
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Affiliation(s)
- Jiwon Kim
- College of Korean Medicine, Woosuk University, Jeonju 54986, Republic of Korea; (J.K.); (W.N.); (A.K.)
| | - Woojeong Noh
- College of Korean Medicine, Woosuk University, Jeonju 54986, Republic of Korea; (J.K.); (W.N.); (A.K.)
| | - Ahrim Kim
- College of Korean Medicine, Woosuk University, Jeonju 54986, Republic of Korea; (J.K.); (W.N.); (A.K.)
| | - Yoomin Choi
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Woosuk University, Jeonju 54986, Republic of Korea;
| | - Young-Sik Kim
- Department of Herbology, College of Korean Medicine, Woosuk University, Jeonju 54986, Republic of Korea
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He Q, Zeng Z, Zhao M, Ruan B, Chen P. Association between thyroid function and diabetes peripheral neuropathy in euthyroid type 2 diabetes mellitus patients. Sci Rep 2023; 13:13499. [PMID: 37596396 PMCID: PMC10439138 DOI: 10.1038/s41598-023-40752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 08/16/2023] [Indexed: 08/20/2023] Open
Abstract
Previous studies disclosed that a high thyroid stimulating hormone level is an independent risk factor for diabetes peripheral neuropathy (DPN) in subclinical hypothyroidism (SCH) patients with type 2 diabetes mellitus (T2DM). However, whether thyroid metabolism has an effect on DPN in euthyroid T2DM patients remains unknown. The aim of this study was to identify the association between thyroid function and DPN in euthyroid T2DM patients. A set of 580 euthyroid T2DM patients was enrolled in the current study and stratified into DPN and Non-DPN groups. Mann-Whitney U test was performed to analyze the continuous variables of biochemical and thyroid metabolism indicators, and the Chi-square test was used to compare the categorical variables. Spearman correlation analysis was performed to analyze the relationship between clinical indicators and free thyroxine (FT4). By using the logistic regression analysis, the prevalence of DPN in different thyroid function indicators were evaluated. T2DM patients with DPN had obviously lower levels of aspartate aminotransferase (AST), alpha-hydroxybutyric dehydrogenase (α-HBDH), superoxide dismutase (SOD), calcium (Ca), creatinine (Cr), uric acid (UA), retinol binding protein (RBP), total protein (TP), albumin (ALB), alanine aminotransferase (ALT) and FT4 than the T2DM patients without DPN (P < 0.05). FT4 was associated with TP, prealbumin (PA), ALB, SOD, anion gap (AG), Ca, chlorine (Cl), UA, RBP, apoprotein A (Apo A), apoprotein B (Apo B), apoprotein E (Apo E), and total cholesterol (TC). According to the FT4 quartile, participants were sequentially divided into four groups to compare the prevalence of DPN between each group. The data suggested that the prevalence of DPN in these four groups was 53.79%, 53.28%, 54.97%, 38.10%, respectively. Moreover, compared with quartile 4, patients in quartile 1, 2, 3 all had a significantly higher risk of DPN (P = 0.007, P = 0.011, P = 0.004). The level of FT4 was negatively correlated with the prevalence of DPN in euthyroid T2DM patients.
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Affiliation(s)
- Qingyuan He
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Zekun Zeng
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Man Zhao
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
- Clinical Laboratory, Xi'an NO. 1 Hospital, Xi'an, 710002, Shaanxi, People's Republic of China
| | - Banjun Ruan
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Pu Chen
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China.
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Chang KC, Pai YW, Lin CH, Lee IT, Chang MH. The association between hyperlipidemia, lipid-lowering drugs and diabetic peripheral neuropathy in patients with type 2 diabetes mellitus. PLoS One 2023; 18:e0287373. [PMID: 37319238 PMCID: PMC10270586 DOI: 10.1371/journal.pone.0287373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 06/04/2023] [Indexed: 06/17/2023] Open
Abstract
AIMS Previous studies showed conflicting relationship between hyperlipidemia, lipid-lowering therapy and diabetic peripheral neuropathy (DPN). As most of these works emerges from the Western and Australian countries, our study aims to investigate whether hyperlipidemia or lipid-lowering therapy (LLT) is associated with DPN in Taiwanese patients with type 2 diabetes (T2D). METHODS A cross-sectional, hospital-based observation study in adults with T2D was conducted from January to October 2013. DPN was screened using the Michigan Neuropathy Screening Instrument. Data were obtained at the time of enrollment, including medication usage, anthropometric measurements and laboratory examinations. RESULTS 2,448 participants were enrolled, 524 (21.4%) of whom had DPN. Patients with DPN had significantly lower plasma total cholesterol (185.6 ± 38.6 vs 193.4 ± 42.3 mg/dL) and low-density lipoprotein cholesterol levels (114.6 ± 32.7 vs 119 ± 30.8 mg/dL). Multivariate analysis demonstrated that neither hyperlipidemia (adjusted OR (aOR), 0.81; 95% confidence interval (CI), 0.49-1.34) nor LLT (aOR, 1.10; 95% CI, 0.58-2.09) was associated with DPN. Subgroup analysis revealed that neither total cholesterol (aOR, 0.72; 95% CI, 0.2-2.62), low-density lipoprotein cholesterol levels (aOR, 0.75; 95% CI, 0.2-2.79), statin (aOR, 1.09; 95% CI, 0.59-2.03) nor fibrate (aOR, 1.73; 95% CI, 0.33-1.61) was associated with DPN. CONCLUSION Our results suggest that neither hyperlipidemia nor lipid-lowering medication was associated with DPN in adults with T2D. DPN is a multifactorial disease, and our findings indicate that lipid metabolism may play a minor role in its pathogenesis.
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Affiliation(s)
- Kuo-Cheng Chang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yen-Wei Pai
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ming-Hong Chang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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Allwright M, Karrasch JF, O'Brien JA, Guennewig B, Austin PJ. MACHINE LEARNING ANALYSIS OF THE UK BIOBANK REVEALS PROGNOSTIC AND DIAGNOSTIC IMMUNE BIOMARKERS FOR POLYNEUROPATHY AND NEUROPATHIC PAIN IN DIABETES. Diabetes Res Clin Pract 2023; 201:110725. [PMID: 37211253 DOI: 10.1016/j.diabres.2023.110725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 05/23/2023]
Abstract
AIMS We assessed the health data of 11,047 people with diabetes in the UK Biobank to rank 329 risk factors for diabetic polyneuropathy (DPN) and DPN with chronic neuropathic pain without a priori assumption. METHODS The Integrated Disease Explanation and Risk Scoring (IDEARS) platform applies machine learning algorithms to multimodal data to determine individual disease risk, and rank risk factor importance using mean SHapley Additive exPlanations (SHAP) score. RESULTS IDEARS models showed discriminative performances with AUC > 0.64. Lower socioeconomic status, being overweight, poor overall health, cystatin C, HbA1C, and immune activation marker, C-reactive protein (CRP), predict DPN risk. Neutrophils and monocytes were higher in males and lymphocytes lower in females with diabetes that develop DPN. Neutrophil-to-Lymphocyte Ratio (NLR) was increased and IGF-1 levels decreased in people with type 2 diabetes that later develop DPN. CRP was significantly elevated in those with DPN and chronic neuropathic pain compared to DPN without pain. CONCLUSIONS Lifestyle factors and blood biomarkers predict the later development of DPN and may relate to DPN pathomechanisms. Our results are consistent with DPN as a disease involving systemic inflammation. We advocate for the use of these biomarkers clinically to predict future DPN risk and improve early diagnosis.
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Affiliation(s)
- Michael Allwright
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, 2050, Australia
| | - Jackson F Karrasch
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, 2050, Australia
| | - Jayden A O'Brien
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, 2050, Australia
| | - Boris Guennewig
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, 2050, Australia
| | - Paul J Austin
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, 2050, Australia.
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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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Zhang T, Zhang D, Zhang Z, Tian J, An J, Zhang W, Ben Y. Alpha-lipoic acid activates AMPK to protect against oxidative stress and apoptosis in rats with diabetic peripheral neuropathy. Hormones (Athens) 2023; 22:95-105. [PMID: 36289188 DOI: 10.1007/s42000-022-00413-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/18/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To investigate the AMPK pathway-mediated effect of alpha-lipoic acid (ALA) on the dorsal root ganglia (DRGs) of rats with diabetic peripheral neuropathy (DPN) and to attempt to elucidate the underlying mechanism. METHODS Sprague-Dawley rats (n = 15) were randomly divided into three groups. The control group was fed a standard diet, and the other groups were fed a high-carbohydrate/high-fat diet. Diabetes was established by a single streptozotocin (STZ) (30 mg/kg) injection, and control rats were injected with an equal volume of citrate buffer. ALA (60 mg/kg/day) was administered for 12 weeks. The nerve conduction velocity (NCV) of the sciatic nerve was measured. Glutathione (GSH) and malondialdehyde (MDA) concentrations in serum were measured with the thiobarbituric acid method and biochemistry. Pathological changes in the rat DRGs were observed. AMPK, phospho-AMPK (p-AMPK), nuclear factor erythroid-2-related factor 2 (Nrf2), phospho-nuclear factor erythroid-2-related factor 2 (p-Nrf2), heme oxygenase 1 (HO-1), quinone oxidoreductase 1 (NQO1), Forkhead box O3 (FoxO3a), phospho-Forkhead box O3 (p-FoxO3a), and Bcl-2 interacting mediator of cell death (Bim) expression levels were assessed by immunohistochemistry and western blotting. RESULTS ALA improved the motor NCV (MNCV) and sensory NCV (SNCV) of rats with DPN and reduced their mechanical pain threshold. ALA increased serum GSH concentrations and decreased serum MDA concentrations. Additionally, AMPK was activated by ALA. Nrf2, p-Nrf2, HO-1, and NQO1 expression was upregulated, while FoxO3a, p-FoxO3a, and Bim expression was downregulated. ALA reduced oxidative stress and apoptosis in DRG. CONCLUSION ALA alleviates DPN and improves peripheral nerve function. ALA reduces oxidative stress by activating Nrf2 through AMPK and inhibits FoxO3a and Bim thereby reducing neuronal apoptosis.
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Affiliation(s)
- Tianya Zhang
- Hebei University of Chinese Medicine, Shijiazhuang, Hebei, People's Republic of China
| | - Dong Zhang
- Hebei University of Chinese Medicine, Shijiazhuang, Hebei, People's Republic of China
| | - Zhihong Zhang
- Hebei University of Chinese Medicine, Shijiazhuang, Hebei, People's Republic of China
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, People's Republic of China
| | - Jiaxin Tian
- Hebei University of Chinese Medicine, Shijiazhuang, Hebei, People's Republic of China
| | - Jingwen An
- Hebei University of Chinese Medicine, Shijiazhuang, Hebei, People's Republic of China
| | - Wang Zhang
- Hebei University of Chinese Medicine, Shijiazhuang, Hebei, People's Republic of China
| | - Ying Ben
- Hebei University of Chinese Medicine, Shijiazhuang, Hebei, People's Republic of China.
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, People's Republic of China.
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9
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Liu X, Chen D, Fu H, Liu X, Zhang Q, Zhang J, Ding M, Wen J, Chang B. Development and validation of a risk prediction model for early diabetic peripheral neuropathy based on a systematic review and meta-analysis. Front Public Health 2023; 11:1128069. [PMID: 36908480 PMCID: PMC9992641 DOI: 10.3389/fpubh.2023.1128069] [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: 12/20/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
Background Early identification and intervention of diabetic peripheral neuropathy is beneficial to improve clinical outcome. Objective To establish a risk prediction model for diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM). Methods The derivation cohort was from a meta-analysis. Risk factors and the corresponding risk ratio (RR) were extracted. Only risk factors with statistical significance were included in the model and were scored by their weightings. An external cohort were used to validate this model. The outcome was the occurrence of DPN. Results A total of 95,604 patients with T2DM from 18 cohorts were included. Age, smoking, body mass index, duration of diabetes, hemoglobin A1c, low HDL-c, high triglyceride, hypertension, diabetic retinopathy, diabetic kidney disease, and cardiovascular disease were enrolled in the final model. The highest score was 52.0. The median follow-up of validation cohort was 4.29 years. The optimal cut-off point was 17.0, with a sensitivity of 0.846 and a specificity of 0.668, respectively. According to the total scores, patients from the validation cohort were divided into low-, moderate-, high- and very high-risk groups. The risk of developing DPN was significantly increased in moderate- (RR 3.3, 95% CI 1.5-7.2, P = 0.020), high- (RR 15.5, 95% CI 7.6-31.6, P < 0.001), and very high-risk groups (RR 45.0, 95% CI 20.5-98.8, P < 0.001) compared with the low-risk group. Conclusion A risk prediction model for DPN including 11 common clinical indicators were established. It is a simple and reliable tool for early prevention and intervention of DPN in patients with T2DM.
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Affiliation(s)
- Xixi Liu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Dong Chen
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Hongmin Fu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Xinbang Liu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Qiumei Zhang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Jingyun Zhang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Min Ding
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Juanjuan Wen
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Bai Chang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
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Firouzabadi MD, Poopak A, Sheikhy A, Samimi S, Nakhaei P, Firouzabadi FD, Moosaie F, Rabizadeh S, Nakhjavani M, Esteghamati A. Glycemic profile variability: An independent risk factor for diabetic neuropathy in patients with type 2 diabetes. Prim Care Diabetes 2023; 17:38-42. [PMID: 36464622 DOI: 10.1016/j.pcd.2022.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Impaired glycemic control is a potential predictor for macro- and microvascular complications of diabetes, which could be recognized by glycemic variability. The aim of this 10-year prospective cohort study presented here is to gain a better understanding of the correlation between GV and diabetic peripheral neuropathy (DPN) as one of the most common complications of T2DM. METHODS Since February 2010, 1152 adult patients with T2DM have been followed-up. Baseline features, anthropometric measurements, and laboratory findings were collected and documented during ten years. The association between DPN incidence and glycemic profile variability was evaluated using cox regression analysis. The coefficient of variation of glycemic indices within subjects was calculated and compared using an independent sample t-test. RESULTS Individuals who developed neuropathy had significantly higher mean levels of glycemic indices (HbA1c, FBS, and 2hpp), urinary albumin excretion, mean creatinine levels, and a longer duration of diabetes. A significant positive correlation between incidence of DPN and glycemic profile variability (cv-FBS10 %, cv-FBS20 %, cv-2hpp20 %, cv-HbA1c5 % and cv-HbA1c10 %) was revealed. Results also showed that higher variability of FBS was associated with the higher risk of neuropathy incidence (HR: 12.29, p-value: 0.045), which indicates that glycemic profile variability is an independent risk factor for DPN in patients with T2DM. CONCLUSION Variability of glycemic profiles from a visit to visit, regardless of sustained hyperglycemia, was indeed a significant risk factor for DPN in diabetic type 2 patients. CV-FBS was the most critical glycemic variability indices for DPN development.
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Affiliation(s)
- Mohammad Dehghani Firouzabadi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, USA
| | - Amirhossein Poopak
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheikhy
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Samimi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pooria Nakhaei
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatmeh Dehghani Firouzabadi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Moosaie
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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11
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Wang L, Guan B, Li G, Feng L, Sun H, Xu J. The efficacy and safety of traditional Chinese medicine physiotherapy combined with acupoint injection on diabetic peripheral neuropathy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31467. [PMID: 36550907 PMCID: PMC9771249 DOI: 10.1097/md.0000000000031467] [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: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The efficacy and safety of traditional Chinese medicine physiotherapy combined with acupoint injection in treating diabetic peripheral neuropathy remains unknown. As a result, we will conduct a systematic review and meta-analysis to assess the evidence. METHODS We will look for pertinent randomized controlled trials in the following databases: China National Knowledge Infrastructure, WanFangData, Chinese biological medical database, Medline, Cochrane Library, PubMed, and Embase up to January 2022. Following the standards of Cochrane Review 6.2, 2 researchers independently evaluated the quality of the evidence in the relevant papers. Data analysis will be conducted by using Review Manager 5.4, including statistical analysis, subgroup analysis, making forest plot and funnel chart. RESULTS The results will be submitted to a peer-reviewed journal. CONCLUSION The research will verify the safety and efficacy of traditional Chinese medicine physiotherapy in combination with acupoint injection for diabetic peripheral neuropathy.
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Affiliation(s)
- Lin Wang
- Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province, China
| | - Bugao Guan
- Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province, China
| | - Guangrun Li
- Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province, China
| | - Liquan Feng
- Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province, China
| | - Hui Sun
- Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province, China
| | - Jin Xu
- Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province, China
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12
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Zhuang Y, Huang H, Fu Z, Zhang J, Cai Q. The predictive value of fibrinogen in the occurrence of mild cognitive impairment events in patients with diabetic peripheral neuropathy. BMC Endocr Disord 2022; 22:267. [PMID: 36324107 PMCID: PMC9628023 DOI: 10.1186/s12902-022-01185-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Research suggests that fibrinogen (Fib) is related to mild cognitive impairment (MCI) and diabetic peripheral neuropathy (DPN) and the risk of MCI in patients with DPN is greatly increased, although no studies have evaluated the predictive value of Fib for the risk of MCI in patients with DPN. METHODS This prospective observational clinical study enrolled 207 type 2 diabetes mellitus (T2DM) patients, who were divided into diabetes with no neuropathy (102 cases) and diabetes with neuropathy (105 cases) groups. Meanwhile, 90 healthy unrelated subjects were recruited as controls. The incidence of MCI in the DPN patients was followed up for 2 years. Divide patients in the DPN group into subgroups according to whether MCI occur, use multivariate logistic regression to analyze independent factors of MCIs in DPN patients within 2 years, and use ROC curve to analyze the predictive value of Fib for MCI in DPN patients. RESULTS Fib levels were significantly higher in diabetic subjects with neuropathy compared with those without (P < 0.001). In further subgroup analysis of DPN patients who were divided according to the occurrence of MCI, baseline data of the MCI subgroup showed Fib levels were higher than that in the non-MCI group while education levels declined (P < 0.001). The education level and increased Fib levels were independent factors for the occurrence of MCI within 2 years after the onset of DPN (OR = 0.769, 95% CI: 0.605 ~ 0.968, P = 0.037; OR = 2.674, 95% CI: 1.094 ~ 3.168, P = 0.002). The ROC curve indicated that the predictive value of Fib was (AUC = 0.764, 95% CI: 0.671 ~ 0.842, P < 0.001). CONCLUSIONS Fib may function as a predictor for assessing the risk of MCI in DPN patients.
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Affiliation(s)
- Yong Zhuang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, No.950 Donghai Street, Fengze District, Quanzhou City, Fujian Province China
| | - Huibin Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, No.950 Donghai Street, Fengze District, Quanzhou City, Fujian Province China
| | - Zhenfei Fu
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, No.950 Donghai Street, Fengze District, Quanzhou City, Fujian Province China
| | - Jinying Zhang
- Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000 China
| | - Qingyan Cai
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, No.950 Donghai Street, Fengze District, Quanzhou City, Fujian Province China
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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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Wang CS, Pai YW, Lin CH, Lee IT, Chang MH. Renal impairment is one of appropriate predictors of future diabetic peripheral neuropathy: a hospital-based 6-year follow-up study. Sci Rep 2022; 12:5240. [PMID: 35347201 PMCID: PMC8960825 DOI: 10.1038/s41598-022-09333-3] [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: 09/30/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
The relationship between renal impairment and diabetic peripheral neuropathy (DPN) remains inconclusive. We aim to investigate the risk factors for the occurrence of DPN in Taiwanese adults with type 2 diabetes mellitus (T2DM) and focus on renal impairment. A hospital-based study was conducted from 2013 to 2019 and 552 Taiwanese people who had T2DM without DPN at baseline were enrolled. DPN was diagnosed using the Michigan Neuropathy Screening Instrument. Potential risk factors were recorded, including patient’s sociodemographic factors, current medication usage and biochemical markers. As of 2019, 73 developed DPN and 479 had no DPN. The cumulative incidence during the 6-year period was 13.22%. Multivariable logistic regression analysis revealed that lower estimated glomerular filtration rate (eGFR) (odds ratio [OR] 0.98, p = 0.005), advanced age (OR 1.06, p = 0.001), increased body weight (OR 1.04, p = 0.018), duration of DM (OR 1.05, p = 0.036) and male gender (OR 3.69, p = 0.011) were significantly associated with future DPN. In addition, patients with T2DM under the age of 65 with higher serum creatinine concentration (OR 8.91, p = 0.005) and higher baseline HbA1C (OR 1.71, p < 0.001) revealed significantly associated with future DPN. In conclusion, this is the first large scaled hospital-based study with long term follow-up to investigate risk factors for DPN in Taiwanese. Lower eGFR and higher serum creatinine concentration, particularly in people under the age of 65, are predictors of future DPN in Taiwanese people with T2DM. Other predictors included advanced age, increased body weight, duration of DM, male gender for all ages and HbA1c in enrolled patients under the age of 65. Our study not only confirms the association between renal impairment and future DPN but also provides a commonly available assessment to predict the future DPN.
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Affiliation(s)
- Chi-Sheng Wang
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC
| | - Yen-Wei Pai
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC.,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, No 145, XingDa Road, South Dist., Taichung, Taiwan, ROC
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC.,Department of Medicine, School of Medicine, Chung Shan Medical University, No.110, Sec. 1, Jianguo N. Road, Taichung City, 40201, Taiwan, ROC
| | - Ming-Hong Chang
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC. .,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, No 145, XingDa Road, South Dist., Taichung, Taiwan, ROC.
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15
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Rashid M, Alkhodari M, Mukit A, Ahmed KIU, Mostafa R, Parveen S, Khandoker AH. Machine Learning for Screening Microvascular Complications in Type 2 Diabetic Patients Using Demographic, Clinical, and Laboratory Profiles. J Clin Med 2022; 11:jcm11040903. [PMID: 35207179 PMCID: PMC8879306 DOI: 10.3390/jcm11040903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/23/2022] [Accepted: 01/30/2022] [Indexed: 12/30/2022] Open
Abstract
Microvascular complications are one of the key causes of mortality among type 2 diabetic patients. This study was sought to investigate the use of a novel machine learning approach for predicting these complications using only the patient demographic, clinical, and laboratory profiles. A total of 96 Bangladeshi participants with type 2 diabetes were recruited during their routine hospital visits. All patient profiles were assessed by using a chi-squared (χ2) test to statistically determine the most important markers in predicting three microvascular complications: cardiac autonomic neuropathy (CAN), diabetic peripheral neuropathy (DPN), and diabetic retinopathy (RET). A machine learning approach based on logistic regression, random forest (RF), and support vector machine (SVM) algorithms was then developed to ensure automated clinical testing for microvascular complications in diabetic patients. The highest prediction accuracies were obtained by RF using diastolic blood pressure, albumin–creatinine ratio, and gender for CAN testing (98.67%); microalbuminuria, smoking history, and hemoglobin A1C for DPN testing (67.78%); and hemoglobin A1C, microalbuminuria, and smoking history for RET testing (84.38%). This study suggests machine learning as a promising automated tool for predicting microvascular complications in diabetic patients using their profiles, which could help prevent those patients from further microvascular complications leading to early death.
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Affiliation(s)
- Mamunur Rashid
- Department of Electrical and Electronic Engineering, United International University, Dhaka 1212, Bangladesh; (M.R.); (A.M.); (K.I.U.A.); (R.M.)
| | - Mohanad Alkhodari
- Healthcare Engineering Innovation Center (HEIC), Department of Biomedical Engineering, Khalifa University, Abu Dhabi 127788, United Arab Emirates;
- Correspondence:
| | - Abdul Mukit
- Department of Electrical and Electronic Engineering, United International University, Dhaka 1212, Bangladesh; (M.R.); (A.M.); (K.I.U.A.); (R.M.)
- Department of Electrical and Computer Engineering, University of Oklahoma, Tulsa, OK 74135, USA
| | - Khawza Iftekhar Uddin Ahmed
- Department of Electrical and Electronic Engineering, United International University, Dhaka 1212, Bangladesh; (M.R.); (A.M.); (K.I.U.A.); (R.M.)
| | - Raqibul Mostafa
- Department of Electrical and Electronic Engineering, United International University, Dhaka 1212, Bangladesh; (M.R.); (A.M.); (K.I.U.A.); (R.M.)
| | - Sharmin Parveen
- Department of Health Informatics, Bangladesh University of Health Sciences, Dhaka 1216, Bangladesh;
| | - Ahsan H. Khandoker
- Healthcare Engineering Innovation Center (HEIC), Department of Biomedical Engineering, Khalifa University, Abu Dhabi 127788, United Arab Emirates;
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Zhuang Y, Lin X, Chen X, Wu X, Zhang J. Fibrinogen function indexes are potential biomarkers of diabetic peripheral neuropathy. Diabetol Metab Syndr 2022; 14:13. [PMID: 35042559 PMCID: PMC8764774 DOI: 10.1186/s13098-021-00777-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/28/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Research suggests that diabetic peripheral neuropathy (DPN) is related to plasma fibrinogen (Fib) concentrations, although its correlation with Fib function has not been reported. Here, the k value and angle α, reflecting the plasma Fib function, were used to analyse its correlation with DPN, and their potential as biological indicators for diagnosing DPN was explored. SUBJECTS AND METHODS This prospective observational clinical study enrolled 561 type 2 diabetes mellitus (T2DM) patients, who were divided into the diabetes with symptomatic neuropathy (161 cases), diabetes with asymptomatic neuropathy (132 cases) and diabetes with no neuropathy (268 cases) groups. Meanwhile, 160 healthy unrelated subjects were recruited as controls. RESULTS Fib levels increased slightly in diabetic subjects with neuropathy compared with those without. The angle α levels increased slightly in subjects with asymptomatic DPN compared with those with no neuropathy and increased greatly in subjects with symptomatic DPN compared with those without. The k value levels slightly decreased in subjects with asymptomatic DPN compared with those with no neuropathy and greatly decreased in subjects with symptomatic DPN compared with those without. The association of the k value and angle α with diabetic neuropathy was independent of the hyperglycaemic state and other potential confounders (odds ratio 0.080 [0.051-0.124], P < 0.001; odds ratio 1.131 [1.063-1.204], P < 0.001). The k value and angle α levels were closely correlated with neuropathy stage (r = - 0.686, P < 0.000; r = 0.314, P < 0.001). The optimal cut-off point for k value levels to distinguish patients with diabetic neuropathy from those without was 1.8 min, with a sensitivity of 73.7% and a specificity of 83.2% (AUC = 0.873). The optimal cut-off point for angle α levels was 60°, with a sensitivity of 41.0% and a specificity of 95.6% (AUC = 0.669). CONCLUSIONS The k value and angle α are closely associated with DPN. The levels of the k value and angle α may be helpful in the early diagnosis of DPN.
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Affiliation(s)
- Yong Zhuang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000 China
| | - Xiahong Lin
- Department of Endocrinology, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 950 Donghai Street, Fengze District, Quanzhou City, 518000 Fujian China
| | - Xiaoyu Chen
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000 China
| | - Xiaohong Wu
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000 China
| | - Jinying Zhang
- Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000 China
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Alshammari NA, Alodhayani AA, Joy SS, Isnani A, Mujammami M, Alfadda AA, Siddiqui K. Evaluation of Risk Factors for Diabetic Peripheral Neuropathy Among Saudi Type 2 Diabetic Patients with Longer Duration of Diabetes. Diabetes Metab Syndr Obes 2022; 15:3007-3014. [PMID: 36200063 PMCID: PMC9527617 DOI: 10.2147/dmso.s364933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Neuropathy is the most common microvascular complications among diabetic patients. Diabetic peripheral neuropathy (DPN) is the predominant variety which may associate with increased in mortality and morbidity among type 2 diabetes mellitus (T2DM). OBJECTIVE To assess the prevalence of diabetic peripheral neuropathy and its correlation with risk factors among T2DM. METHODS This was a cross-sectional retrospective study, data was collected from a previous cohort study conducted at the University Diabetes Center, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia. The data of T2DM patients were collected from case report form, included demographic data, history of chronic diabetes neuropathy, and laboratory reports. Statistical analysis includes Student`s t test, chi square test, and Pearson correlation and logistic regression were performed. RESULTS A total of 430 patients with T2DM data was collected and analyzed, and of them 54% were females, with the mean age of 55.88 years. The prevalence of diabetic neuropathy among study participants were 40.2%, and 73.3% of them having the subtype polyneuropathy. The mean BMI; p = 0.006, FBS; p < 0.001, HbA1c; p < 0.001, cholesterol p = 0.001, LDL; p < 0.001, and triglyceride; p < 0.001 levels were a significantly higher among participants with diabetic neuropathy than without neuropathy. The male gender (Risk Ratio: 1.294, 95% CI:1.090, 1.536) p = 0.003, fasting blood glucose (Risk Ratio: 1.157, 95% CI:1.051, 1.273) p = 0.003 Cholesterol (Risk Ratio: 1.588, 95% CI:1.174, 2.147) p = 0.003, triglyceride (Risk Ratio: 1.290, 95% CI:1.086, 1.538), p = 0.004, and LDL (Risk Ratio: 1.299, 95% CI:1.073, 1.574), p = 0.007) were found to be significant risk factors for DPN. CONCLUSION DPN is highly prevalent among T2DM patients in Saudi Arabia. Poor glycemic control and hyperlipidemia were associated with significantly higher risk for DPN patients among T2DM.
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Affiliation(s)
- Nawaf A Alshammari
- University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- King Salman Specialist Hospital, Diabetes and Endocrine Center, Hail Health Cluster, Hail, Hail Region, Saudi Arabia
| | - Abdulaziz A Alodhayani
- Department of Family and Community Medicine College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salini S Joy
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Arthur Isnani
- Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Mujammami
- University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Assim A Alfadda
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Siddiqui
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Khalid Siddiqui, Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Saudi Arabia, Email
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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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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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Lin J, Xiang X, Qin Y, Gui J, Wan Q. Correlation of thyroid-related hormones with vascular complications in type 2 diabetes patients with euthyroid. Front Endocrinol (Lausanne) 2022; 13:1037969. [PMID: 36465631 PMCID: PMC9715611 DOI: 10.3389/fendo.2022.1037969] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the relationship between thyroid-related hormones and vascular complications in type 2 diabetes mellitus (T2DM) patients with euthyroidism. METHODS We enrolled 849 patients with T2DM after screening out the ineligible. Multivariate logistic regression was used to analyze the relationship between fT3, fT4, the fT3/fT4 ratio, thyroid-stimulating hormone, and diabetic vascular complications. Spearman correlation analysis was used to determine the correlation between thyroid-related hormones and vascular complications. RESULTS In this cross-sectional study of T2DM, 538 patients with carotid atherosclerosis (CA) and 299 patients with diabetic peripheral neuropathy (DPN). The prevalence of DPN was negatively correlated with fT3 and the fT3/fT4 ratio but positively correlated with fT4 (all P<0.01). At the same time, the odds ratio for DPN decreased with increasing fT3 (T1: reference; T2: OR: 0.689, 95%CI: 0.477, 0.993; T3: OR: 0.426, 95% CI: 0.286, 0.633, all P<0.05) and fT3/fT4 ratio (T1: reference; T2: OR: 0.528, 95% CI: 0.365, 0.763; T3: OR: 0.413, 95% CI: 0.278, 0.613, all P<0.001). In terms of sensitivity and specificity, fT4 was found to be 39.5% and 71.4% accurate, respectively, with a 95% CI of 0.531-0.611. CONCLUSIONS We found a negative correlation between fT3 and fT3/fT4 ratio and the number of individuals with DPN, and a positive correlation between fT4 and the prevalence of DPN.
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Affiliation(s)
- Jie Lin
- Department of Endocrinology and Metabolism, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, China
| | - Xin Xiang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, China
| | - Yahui Qin
- Department of Endocrinology and Metabolism, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, China
| | - Jing Gui
- Department of Endocrinology and Metabolism, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, China
| | - Qin Wan
- Department of Endocrinology and Metabolism, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, China
- *Correspondence: Qin Wan,
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Li L, Yang Y, Bai J, Zhang Y, Yang H, Zhang Y, Lv H. Impaired Vascular Endothelial Function is Associated with Peripheral Neuropathy in Patients with Type 2 Diabetes. Diabetes Metab Syndr Obes 2022; 15:1437-1449. [PMID: 35573865 PMCID: PMC9091688 DOI: 10.2147/dmso.s352316] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/15/2022] [Indexed: 12/28/2022] Open
Abstract
PURPOSE It is believed that vascular endothelial dysfunction is involved in the occurrence of cardiovascular disease (CVD), and diabetic peripheral neuropathy (DPN) is associated with flow-mediated dilation (FMD), however, the correlation is still unclear. Aims of the present study is to explore the relationship between DPN parameters and FMD, providing a new approach for the prevention of CVD. PATIENTS AND METHODS A total of 272 patients with T2DM from the Department of Endocrinology of The First Hospital of Lanzhou University according to the grading criteria were selected. FMD was measured by a new vascular ultrasound system and patients were divided into FMD>7%, 4%≤FMD≤7%, and FMD<4% groups. The Toronto Clinical Scoring System (TCSS) was used to assess the severity of DPN. The nerve conduction studies (NCS) assessed large fibre neuropathy by nerve conduction velocity (CV), compound muscle action potential (CMAP) amplitude (Amp), and distal motor latency (DML). SPSS 25.0 was used for statistical analysis. RESULTS TCSS evaluation revealed that the percentage of patients with severe nerve injury was significantly higher in FMD<4% (70%) compared to FMD>7% (2%). Among the TCSS indicators of all subjects, the proportion of temperature disturbance was the most (73%), and joint position disturbance was the least (0). TCSS scores were negatively correlated with FMD (r=-0.756, p<0.001). More interesting, in FMD<4% group, CV and Amp were positively correlated with FMD, while DML was negatively correlated (p<0.05). Linear regression analysis model showed that different systolic blood pressure (SBP), triglyceride (TG), TCSS and CV had statistically different effects on FMD. CONCLUSION High TCSS score and decreased CV of common peroneal and tibial nerves are risk factors of FMD injury, which provide potential value for timely prevention and treatment of cardiovascular diseases.
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Affiliation(s)
- Lingling Li
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
| | - Ying Yang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
| | - Jia Bai
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
| | - Yangyang Zhang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
| | - Hong Yang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
| | - Yuqi Zhang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
| | - Haihong Lv
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
- Correspondence: Haihong Lv, Email
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22
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Wu B, Niu Z, Hu F. Study on Risk Factors of Peripheral Neuropathy in Type 2 Diabetes Mellitus and Establishment of Prediction Model. Diabetes Metab J 2021; 45:526-538. [PMID: 34352988 PMCID: PMC8369209 DOI: 10.4093/dmj.2020.0100] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/12/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is one of the most serious complications of type 2 diabetes mellitus (T2DM). DPN increases the risk of ulcers, foot infections, and noninvasive amputations, ultimately leading to long-term disability. METHODS Seven hundred patients with T2DM were investigated from 2013 to 2017 in the Sanlin community by obtaining basic data from the electronic medical record system (EMRS). From September 2018 to July 2019, 681 patients (19 missing) were investigated using a questionnaire, physical examination, biochemical index test, and follow-up Toronto clinical scoring system (TCSS) test. Patients with a TCSS score ≥6 points were diagnosed with DPN. After removing missing values, 612 patients were divided into groups in a 3:1 ratio for external validation. Using different Lasso analyses (misclassification error, mean squared error, -2log-likelihood, and area under curve) and a logistic regression analysis of the training set, models A, B, C, and D were established. The receiver operating characteristic (ROC) curve, calibration plot, dynamic component analysis (DCA) measurements, net classification improvement (NRI) and integrated discrimination improvement (IDI) were used to validate discrimination and clinical practicality of the model. RESULTS Through data analysis, model A (containing four factors), model B (containing five factors), model C (containing seven factors), and model D (containing seven factors) were built. After calibration, ROC curve, DCA, NRI and IDI, models C and D exhibited better accuracy and greater predictive power. CONCLUSION Four prediction models were established to assist with the early screening of DPN in patients with T2DM. The influencing factors in model C and D are more important factors for patients with T2DM diagnosed with DPN.
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Affiliation(s)
- Birong Wu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zheyun Niu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fan Hu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Corresponding author: Fan Hu https://orcid.org/0000-0002-7929-6953 School of Public Health, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, China E-mail:
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Casadei G, Filippini M, Brognara L. Glycated Hemoglobin (HbA1c) as a Biomarker for Diabetic Foot Peripheral Neuropathy. Diseases 2021; 9:16. [PMID: 33671807 PMCID: PMC8006047 DOI: 10.3390/diseases9010016] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is known to predict foot ulceration, lower-extremity amputation and mortality. Patients with diabetes mellitus have a predisposition toward developing chronic inflammatory demyelinating polyneuropathy, and this may also facilitate the formation of diabetic foot and cutaneous impairment, which are considered one of the most serious impairments of diabetes mellitus, with a prevalence of 4-10% in this population. Biomarkers research provides opportunities for the early diagnosis of these complications for specific treatments useful to prevent amputation and, therefore, physical inability and mental disturbance. The recent literature has suggested that glycemic levels may be a novel factor in the pathogenesis of diabetic foot complications and is an important mediator of axonal dysfunction. The aim of this systematic literary review is to determine whether hemoglobin A1c (HbA1c) is a positive predictor for diabetic foot peripheral neuropathy and its complications, such as foot cutaneous impairments. There is a lack of consensus regarding the effect of glycemic variability on diabetic foot peripheral neuropathy, unlike other complications such as retinopathy, nephropathy or micro/macrovascular pathology Methods: Relevant articles were searched in the Medline database using PubMed and Scopus and relevant keywords. The primary search terms used were "glycated hemoglobin" OR "HbA1c" AND "diabetic neuropathies" AND "Foot". RESULTS A number of articles (336) were initially identified while searching the scientific literature regarding this topic, and 32 articles were selected and included in this review. CONCLUSIONS This review highlights the role of HbA1c in diabetic foot peripheral neuropathy. Biomarkers play an important role in the decision-making process, and HbA1c levels are extensively used for diabetic foot clinical outcomes and settings, but biomarker research in diabetic foot peripheral neuropathy is in its infancy and will require careful attention to a number of factors and associations, since the consequences of DPN also include neurological alterations. HbA1c is an accurate and easy-to-administer test and can be an effective biomarker in establishing the diagnosis of diabetes, but future research should focus on standardizing the HbA1c level and selecting which DPN value and its correlated complications, such as foot cutaneous impairments, are the most informative.
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Affiliation(s)
- Giulia Casadei
- Medical Clinic of Doctor Accorsi, Via della Ghisiliera 5, 40123 Bologna, Italy; (G.C.); (M.F.)
| | - Marta Filippini
- Medical Clinic of Doctor Accorsi, Via della Ghisiliera 5, 40123 Bologna, Italy; (G.C.); (M.F.)
| | - Lorenzo Brognara
- Department of Biomedical and Neuromotor Science, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy
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Gudise V, Chowdhury B. Molecular mechanisms and the vital roles of resistin, TLR 4, and NF-κB in treating type 2 diabetic complications. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2020. [DOI: 10.1186/s43088-020-00078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Type 2 diabetes in obese (≥ 25 and ≥ 30 kg/m2) patients is the foremost cause of cardiovascular complications like stroke, osteoarthritis, cancers (endometrial, breast, ovarian, liver, kidney, colon, and prostate), and vascular complications like diabetic neuropathy, diabetic and retinopathy, and diabetic nephropathy. It is recognized as a global burden disorder with high prevalence in middle-income nations which might lead to a double burden on health care professionals. Hence, this review emphasizes on understanding the complexity and vital signaling tracts involved in diabetic complications for effective treatment.
Main body
Type 2 diabetes in overweight patients induces the creation of specific ROS that further leads to changes in cellular proliferation, hypothalamus, and fringe. The resistin, TLR4, and NF-κB signalings are mainly involved in the progression of central and fringe changes such as insulin resistance and inflammation in diabetic patients. The overexpression of these signals might lead to the rapid progression of diabetic vascular complications induced by the release of proinflammatory cytokines, chemokines, interleukins, and cyclooxygenase-mediated chemicals. Until now, there has been no curative treatment for diabetes. Therefore, to effectively treat complications of type 2 diabetes, the researchers need to concentrate on the molecular mechanisms and important signaling tracts involved.
Conclusion
In this review, we suggested the molecular mechanism of STZ-HFD induced type 2 diabetes and the vital roles of resistin, TLR4, and NF-κB signalings in central, fringe changes, and development diabetic complications for its effective treatment.
Graphical abstract
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25
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Hornemann T. Mini review: Lipids in Peripheral Nerve Disorders. Neurosci Lett 2020; 740:135455. [PMID: 33166639 DOI: 10.1016/j.neulet.2020.135455] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023]
Abstract
Neurons are polarized cells whose fundamental functions are to receive, conduct and transmit signals. In bilateral animals, the nervous system is divided into the central (CNS) and peripheral (PNS) nervous system. The main function of the PNS is to connect the CNS to the limbs and organs, essentially serving as a relay between the brain and spinal cord and the rest of the body. Sensory axons can be up to 3 feet in length. Because of its long-reaching and complex structure, the peripheral nervous system (PNS) is exposed and vulnerable to many genetic, metabolic and environmental predispositions. Lipids and lipid intermediates are essential components of nerves. About 50 % of the brain dry weight consist of lipids, which makes it the second highest lipid rich tissue after adipose tissue. However, the role of lipids in neurological disorders in particular of the peripheral nerves is not well understood. This review aims to provide an overview about the role of lipids in the disorders of the PNS.
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Affiliation(s)
- Th Hornemann
- Institute for Clinical Chemistry, University Hospital and University Zurich, 8091, Zürich, Switzerland.
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Aleidan FAS, Ahmad BA, Alotaibi FA, Aleesa DH, Alhefdhi NA, Badri M, Abdel Gader AG. Prevalence and Risk Factors for Diabetic Peripheral Neuropathy Among Saudi Hospitalized Diabetic Patients: A Nested Case-Control Study. Int J Gen Med 2020; 13:881-889. [PMID: 33116780 PMCID: PMC7584505 DOI: 10.2147/ijgm.s273807] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/16/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To determine the prevalence and the risk factors of diabetic peripheral neuropathy (DPN) in hospitalized adult Saudi diabetics. METHODS This is a retrospective, nested case-control study conducted at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. All diabetic patients admitted to the hospital between the January 1, and December 31, 2018 were considered for inclusion in the study. Patients with DPN were identified and three controls per case were randomly selected from the remaining diabetic patients without peripheral neuropathy (PN). RESULTS A total of 2,096 adult diabetic patients were identified during the study period. Of these, 73 patients (3.5%) were confirmed to be suffering from DPN and 219 were included as controls. When comparing diabetic with the control cases, DPN cases were significantly older (p=0.002), had a significantly higher proportion of type 2 diabetes (p=0.023), chronic kidney disease (p<0.0001), cerebral vascular stroke (p=0.027), hypertension (p=0.005), dyslipidemia (p=0.002), peripheral vascular disease (p<0.0001), osteoarthritis (p=0.034), diabetic ketoacidosis (p=0.003), foot ulcers (p=0.006), gangrene (p=0.001), lower limb ischemia (p=0.001), increased duration with diabetic disease (p=0.031), increased BMI (p=0.003), higher serum creatinine (p<0.001) and lower serum albumin levels (p=0.035). In the multivariate logistic regression, only older age {odds ratio (OR) 1.02, 95% CI 1.01-1.04, p=0.031}, chronic kidney disease (OR 2.39, 95% CI 1.23-4.64, p=0.010) and peripheral vascular disease (OR 3.14, 95% CI 1.39-7.13, p=0.006) were independently associated with DPN. CONCLUSION This study identified several risk factors that contributed to the development of DPN in Saudis. These must be considered in strategies and campaigns aimed at risk reduction of cardiovascular and chronic diseases, and consequently progression of DPN.
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Affiliation(s)
- Fahad A S Aleidan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- College of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Banderi A Ahmad
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Farah A Alotaibi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Dalal H Aleesa
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nuha A Alhefdhi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Motasim Badri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdel Galil Abdel Gader
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Lapin BR, Pantalone KM, Milinovich A, Morrison S, Schuster A, Boulos F, Johnson K, Thakore NJ. Pain in Patients With Type 2 Diabetes-Related Polyneuropathy Is Associated With Vascular Events and Mortality. J Clin Endocrinol Metab 2020; 105:5861640. [PMID: 32575118 DOI: 10.1210/clinem/dgaa394] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Type 2 diabetes-related polyneuropathy (DPN) is associated with increased vascular events and mortality, but determinants and outcomes of pain in DPN are poorly understood. We sought to examine the effect of neuropathic pain on vascular events and mortality in patients without DPN, DPN with pain (DPN + P), and DPN without pain (DPN-P). METHODS A retrospective cohort study was conducted within a large health system of adult patients with type 2 diabetes from January 1, 2009 through December 31, 2016. Using an electronic algorithm, patients were classified as no DPN, DPN + P, or DPN-P. Primary outcomes included number of vascular events and time to mortality. Independent associations with DPN + P were evaluated using multivariable negative binomial and Cox proportional hazards regression models, adjusting for demographics, socioeconomic characteristics, and comorbidities. RESULTS Of 43 945 patients with type 2 diabetes (age 64.6 ± 14.0 years; 52.1% female), 13 910 (31.7%) had DPN: 9104 DPN + P (65.4%) vs 4806 DPN-P (34.6%). Vascular events occurred in 4538 (15.1%) of no DPN patients, 2401 (26.4%) DPN + P, and 1006 (20.9%) DPN-P. After adjustment, DPN + P remained a significant predictor of number of vascular events (incidence rate ratio [IRR] = 1.55, 95% CI, 1.29-1.85), whereas no DPN was protective (IRR = 0.70, 95% CI, 0.60-0.82), as compared to DPN-P. Compared to DPN-P, DPN + P was also a significant predictor of mortality (hazard ratio = 1.42, 95% CI, 1.25-1.61). CONCLUSIONS Our study found a significant association between pain in DPN and an increased risk of vascular events and mortality. This observation warrants longitudinal study of the risk factors and natural history of pain in DPN.
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Affiliation(s)
- Brittany R Lapin
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kevin M Pantalone
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alex Milinovich
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shannon Morrison
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andrew Schuster
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fernanda Boulos
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Kristen Johnson
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Nimish J Thakore
- Department of Neurology/Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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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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Ponirakis G, Petropoulos IN, Alam U, Ferdousi M, Asghar O, Marshall A, Azmi S, Jeziorska M, Mahfoud ZR, Boulton AJM, Efron N, Nukada H, Malik RA. Hypertension Contributes to Neuropathy in Patients With Type 1 Diabetes. Am J Hypertens 2019; 32:796-803. [PMID: 31013342 PMCID: PMC6636691 DOI: 10.1093/ajh/hpz058] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) can lead to foot ulceration and amputation. There are currently no disease-modifying therapies for DPN. The aim of this study was to determine if hypertension contributes to DPN in patients with type 1 diabetes mellitus (T1DM). METHODS Subjects with T1DM (n = 70) and controls (n = 78) underwent a comprehensive assessment of DPN. RESULTS Hypertension was present in 40 of 70 T1DM subjects and 20 of 78 controls. Hypertension was associated with abnormal nerve conduction parameters (P = 0.03 to <0.001), increased vibration perception threshold (P = 0.01) and reduced corneal nerve fiber density and length (P = 0.02) in subjects with T1DM. However, after adjusting for confounding factors only tibial compound motor action potential and nerve conduction velocity were associated with hypertension (P = 0.03) and systolic blood pressure (P < 0.01 to <0.0001). Hypertension had no effect on neuropathy in subjects without diabetes. CONCLUSIONS This study shows that hypertension is associated with impaired nerve conduction in T1DM. It supports previous small trials showing that angiotensin-converting enzyme inhibitors improve nerve conduction and advocates the need for larger clinical trials with blood pressure lowering agents in DPN.
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Affiliation(s)
- Georgios Ponirakis
- Weill Cornell Medicine–Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Uazman Alam
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
- Eye and Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool, UK
| | - Maryam Ferdousi
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Omar Asghar
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Andrew Marshall
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Shazli Azmi
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Maria Jeziorska
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Ziyad R Mahfoud
- Weill Cornell Medicine–Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Andrew J M Boulton
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Hitoshi Nukada
- Nukada Institute for Medical and Biological Research, Chiba, Japan
| | - Rayaz A Malik
- Weill Cornell Medicine–Qatar, Qatar Foundation, Education City, Doha, Qatar
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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30
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Liu X, Xu Y, An M, Zeng Q. The risk factors for diabetic peripheral neuropathy: A meta-analysis. PLoS One 2019; 14:e0212574. [PMID: 30785930 PMCID: PMC6382168 DOI: 10.1371/journal.pone.0212574] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/05/2019] [Indexed: 01/24/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN), the most common chronic complication of diabetes, has become an important public health crisis worldwide. Given that DPN is extremely difficult to treat, determining its risk factors and controlling it at an early stage is critical to preventing its serious consequences and the burden of social disease. Current studies suggest that the risk factors for diabetic peripheral neuropathy are the duration of diabetes, age, glycosylated hemoglobin A1c (HbA1c), diabetic retinopathy (DR), smoking, and body mass Index (BMI). However, most of the aforementioned studies are cross-sectional, and the sample sizes are very limited, so the strength of causal reasoning is relatively low. The current study systematically evaluated DPN’s influencing factors in patients with type 2 diabetes using evidence-based medicine. Overall, 16 included studies (14 cross-sectional studies and 2 case-control studies including 12,116 cases) that conformed to the present criteria were included in the final analysis. The results suggested that the duration of diabetes (MD 2.5, 95% CI 1.71~3.29), age (MD 4.00, 95% CI 3.05~4.95), HbA1c (MD 0.48, 95% CI 0.33~0.64), and DR (OR 2.34, 95% CI 1.74~3.16) are associated with significantly increased risks of DPN among diabetic patients, while BMI, smoking, total triglyceride (TG), and total cholesterol (TC) did not indicate any risks of increasing DPN. The findings provide a scientific basis for a further understanding of the causes of type 2 diabetes complicated with peripheral neuropathy and the improvement of preventive strategies. The next step is to conduct further high-quality prospective cohort studies to validate this paper’s findings.
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Affiliation(s)
- Xiuxiu Liu
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Department of Toxicology, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China
| | - Yuyan Xu
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Department of Toxicology, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China
| | - Miaomiao An
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Department of Toxicology, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China
| | - Qibing Zeng
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Department of Toxicology, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China
- * E-mail:
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31
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Bönhof GJ, Herder C, Strom A, Papanas N, Roden M, Ziegler D. Emerging Biomarkers, Tools, and Treatments for Diabetic Polyneuropathy. Endocr Rev 2019; 40:153-192. [PMID: 30256929 DOI: 10.1210/er.2018-00107] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/23/2018] [Indexed: 12/12/2022]
Abstract
Diabetic neuropathy, with its major clinical sequels, notably neuropathic pain, foot ulcers, and autonomic dysfunction, is associated with substantial morbidity, increased risk of mortality, and reduced quality of life. Despite its major clinical impact, diabetic neuropathy remains underdiagnosed and undertreated. Moreover, the evidence supporting a benefit for causal treatment is weak at least in patients with type 2 diabetes, and current pharmacotherapy is largely limited to symptomatic treatment options. Thus, a better understanding of the underlying pathophysiology is mandatory for translation into new diagnostic and treatment approaches. Improved knowledge about pathogenic pathways implicated in the development of diabetic neuropathy could lead to novel diagnostic techniques that have the potential of improving the early detection of neuropathy in diabetes and prediabetes to eventually embark on new treatment strategies. In this review, we first provide an overview on the current clinical aspects and illustrate the pathogenetic concepts of (pre)diabetic neuropathy. We then describe the biomarkers emerging from these concepts and novel diagnostic tools and appraise their utility in the early detection and prediction of predominantly distal sensorimotor polyneuropathy. Finally, we discuss the evidence for and limitations of the current and novel therapy options with particular emphasis on lifestyle modification and pathogenesis-derived treatment approaches. Altogether, recent years have brought forth a multitude of emerging biomarkers reflecting different pathogenic pathways such as oxidative stress and inflammation and diagnostic tools for an early detection and prediction of (pre)diabetic neuropathy. Ultimately, these insights should culminate in improving our therapeutic armamentarium against this common and debilitating or even life-threatening condition.
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Affiliation(s)
- Gidon J Bönhof
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research, Munich-Neuherberg, Neuherberg, Partner Düsseldorf, Düsseldorf, Germany.,Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research, Munich-Neuherberg, Neuherberg, Partner Düsseldorf, Düsseldorf, Germany
| | - Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Center, Diabetic Foot Clinic, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research, Munich-Neuherberg, Neuherberg, Partner Düsseldorf, Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research, Munich-Neuherberg, Neuherberg, Partner Düsseldorf, Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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32
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Zhang HH, Han X, Wang M, Hu Q, Li S, Wang M, Hu J. The Association between Genomic DNA Methylation and Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes Mellitus. J Diabetes Res 2019; 2019:2494057. [PMID: 31781662 PMCID: PMC6875377 DOI: 10.1155/2019/2494057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/12/2019] [Indexed: 12/28/2022] Open
Abstract
AIM DNA methylation is thought to be involved in regulating the expression of key genes and inducing diabetic peripheral neuropathy (DPN). However, clinically, the level of whole-genome DNA methylation and its relationship with DPN remains unclear. METHODS 186 patients with type 2 diabetes mellitus (T2DM) admitted to the Second Affiliated Hospital of Soochow University since Jul. 2016 to Oct. 2017 were enrolled in the study, including 100 patients in the DPN group and 86 patients in the non-DPN group, diagnosed with Toronto Clinical Scoring System (TCSS). Clinical and biochemical characteristics between the two groups were compared, and the correlations with TCSS scores were analyzed. Furthermore, the levels of genomic DNA methylation of leukocytes, measured with high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS), were also analyzed between the two groups. RESULTS Age, duration, triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL-C), creatinine, uric acid (UA), blood urea nitrogen (BUN), and C-reactive protein (CRP) were significantly higher in the DPN group. Estimated glomerular filtration rate (eGFR) and the level of genomic DNA methylation were much lower in the DPN group. Spearman correlation analysis showed that TCSS was positively correlated with age, duration, UA, and CRP and was negatively correlated with body mass index (BMI), eGFR, and the level of genomic DNA methylation. Interestingly, multiple stepwise regression analysis showed that only duration, genomic DNA methylation, and eGFR had impacts on TCSS. The results also showed that the levels of genomic DNA methylation did not change significantly whether or not there was renal injury. Another multiple stepwise regression analysis showed that TCSS and BMI were the influencing factors of genomic DNA methylation. Finally, we found that genomic DNA methylation levels were decreased significantly in the DPN group compared with the non-DPN group when the duration is ≥5 years or BMI ≥ 25 kg/m2. CONCLUSION Low level of genomic DNA methylation is a relative specific risk factor of diabetic peripheral neuropathy in patients with type 2 diabetes.
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Affiliation(s)
- Hong-Hong Zhang
- Department of Endocrinology, The Second Affiliated Hospital, Soochow University, Suzhou 215004, China
| | - Xingfa Han
- Department of Endocrinology, Suzhou Science and Technology Town Hospital, Nanjing Medical University, Suzhou 215004, China
| | - Mengmeng Wang
- Clinical Pharmacology Laboratory, The Second Affiliated Hospital, Soochow University, Suzhou 215004, China
| | - Qingfang Hu
- Department of Endocrinology, The Second Affiliated Hospital, Soochow University, Suzhou 215004, China
| | - Sicheng Li
- Department of Endocrinology, The Second Affiliated Hospital, Soochow University, Suzhou 215004, China
| | - Meng Wang
- Clinical Pharmacology Laboratory, The Second Affiliated Hospital, Soochow University, Suzhou 215004, China
| | - Ji Hu
- Department of Endocrinology, The Second Affiliated Hospital, Soochow University, Suzhou 215004, China
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33
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Feng L, Dou C, Wang J, Jiang C, Ma X, Liu J. Upregulated 14‑3‑3β aggravates restenosis by promoting cell migration following vascular injury in diabetic rats with elevated levels of free fatty acids. Int J Mol Med 2018; 42:1074-1085. [PMID: 29749466 DOI: 10.3892/ijmm.2018.3671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/09/2018] [Indexed: 11/05/2022] Open
Abstract
Mono‑unsaturated free fatty acids (FFAs) can serve as a predictive indicator of vascular restenosis following interventional therapy, particularly in individuals with high‑fat diet‑induced type 2 diabetes. However, the pathogenic mechanism remains to be fully elucidated. In the present study, the levels of tyrosine 3‑monooxygenase/tryptophan 5‑monooxygenase activation protein β (YWHAB; also known as 14‑3‑3β), in vascular smooth muscle cells (VSMCs) treated with different concentrations of oleic acid (OA) were examined by reverse transcription‑quantitative polymerase chain reaction and western blot analyses. The migration of VSMCs was examined using wound‑healing and Transwell migration assays. The protein distribution of B‑cell lymphoma 2 (BCL‑2)‑associated death promoter (BAD) in VSMCs treated with OA was examined by immunofluorescence and western blot analyses. In in vivo experiments, the carotid artery morphology of rats in different groups was assessed at 14 days post‑injury by non-invasive ultrasonographic imaging and confirmed by histological staining. The expression of YWHAB was upregulated by OA in a concentration‑dependent manner in VSMCs. In the in vivo experiments, carotid stenosis was more serious among high‑FFA diabetic rats. However, silencing of YWHAB significantly alleviated carotid neointimal hyperplasia among the diabetic rats with elevated FFA levels. In addition, YWHAB silencing alleviated the migration of OA‑treated VSMCs and increased translocation of the BAD protein from the cytoplasm to the mitochondria. In conclusion, the results showed that FFA‑induced upregulation of YWHAB was involved in neointimal hyperplasia by enhancing the migration of VSMCs following carotid artery injury. The inhibition of YWHAB may serve as a novel potential pharmacological target for preventing vascular restenosis following interventional therapy in diabetic individuals with high FFA levels.
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Affiliation(s)
- Lishuai Feng
- Department of Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Chaoran Dou
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Jianbo Wang
- Department of Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Chunyu Jiang
- Department of Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Xu Ma
- Department of Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Jingjing Liu
- Department of Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
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Pai YW, Lin CH, Lee IT, Chang MH. Prevalence and biochemical risk factors of diabetic peripheral neuropathy with or without neuropathic pain in Taiwanese adults with type 2 diabetes mellitus. Diabetes Metab Syndr 2018; 12:111-116. [PMID: 29042249 DOI: 10.1016/j.dsx.2017.09.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/26/2017] [Indexed: 12/20/2022]
Abstract
AIMS To investigate the prevalence and risk factors for diabetic peripheral neuropathy with or without neuropathic pain in Taiwanese. METHODS A cross-sectional, hospital-based observational study was conducted. We enrolled 2837 adults with type 2 diabetes mellitus. Diabetic peripheral neuropathy with or without pain were diagnosed using 2 validated screening tools, namely the Michigan Neuropathy Screening Instrument and Douleur Neuropathique 4 questionnaire. RESULTS In our sample, 2233 participants had no neuropathy, 476 had diabetic peripheral neuropathy without pain, and 128 had diabetic peripheral neuropathy with neuropathic pain, representing an overall diabetic peripheral neuropathy prevalence of 21.3%, and the prevalence of neuropathic pain in diabetic peripheral neuropathy was 21.2%. Multivariate analysis revealed that older age (P<0.001), treatment with insulin (P=0.004), microalbuminuria (P=0.001) or overt proteinuria (P<0.001) were independently associated with diabetic peripheral neuropathy, whereas older age (P<0.001), elevated glycated haemoglobin (P=0.011), lower high-density lipoprotein cholesterol (P=0.033), and overt proteinuria (P<0.001) were independently associated with diabetic peripheral neuropathy with neuropathic pain. CONCLUSIONS During clinical visits involving biochemical studies, the risk for diabetic peripheral neuropathy with neuropathic pain should be considered for people with older age, elevated glycated haemoglobin, low high-density lipoprotein cholesterol and overt proteinuria, with particular attention given to increased levels of albuminuria while concerning neuropathic pain.
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Affiliation(s)
- Yen-Wei Pai
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan; Department of Medicine, School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei City 112, Taiwan; Department of Medicine, School of Medicine, Chung Shan Medical University, No.110, Sec.1, Jianguo N. Rd., Taichung City 40201, Taiwan
| | - Ming-Hong Chang
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei City 112, Taiwan.
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35
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Li TC, Yang CP, Tseng ST, Li CI, Liu CS, Lin WY, Hwang KL, Yang SY, Chiang JH, Lin CC. Visit-to-Visit Variations in Fasting Plasma Glucose and HbA 1c Associated With an Increased Risk of Alzheimer Disease: Taiwan Diabetes Study. Diabetes Care 2017; 40:1210-1217. [PMID: 28705834 DOI: 10.2337/dc16-2238] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 06/19/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The relationship between glycemic variability and the incidence of Alzheimer disease (AD) in patients with type 2 diabetes mellitus (T2DM) is unclear. The aim of this study was to examine visit-to-visit variations in fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) represented by the coefficient of variation (CV) and to determine whether they were independently associated with AD, irrespective of HbA1c and other traditional risk factors in such patients. RESEARCH DESIGN AND METHODS Patients with T2DM enrolled in the National Diabetes Care Management Program, age ≥60 years, and without diagnosis of AD (n = 16,706) were included in the study. Potential risk factors were analyzed using extended Cox proportional hazards regression models for competing risk of mortality on AD incidence. RESULTS During a median follow-up of 8.88 years, 831 incident cases of AD were identified, with a crude incidence rate of 3.5/1,000 person-years. After adjustment for sociodemographic factors, lifestyle behaviors, diabetes-related variables, FPG and HbA1c, drug-related variables, and comorbidities, both FPG CV and HbA1c CV were found to be significant predictors of AD, with corresponding hazard ratios of 1.27 (95% CI 1.06-1.52) for the third tertile in FPG CV and 1.32 (95% CI 1.11-1.58) for the third tertile in HbA1c CV. CONCLUSIONS FPG CV and HbA1c CV are independently associated with AD. The associations between glycemic variability and AD demonstrated in this study suggest a linked pathophysiological mechanism, which is worthy of further investigation. Further research is required to confirm our results and to evaluate whether FPG CV and HbA1c CV can be valuable therapeutic targets for patients with T2DM at risk.
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Affiliation(s)
- Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chun-Pai Yang
- Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan.,Department of Nutrition, Hungkuang University, Taichung, Taiwan
| | - Shih-Ting Tseng
- Department of Food and Nutrition, Providence University, Taichung, Taiwan.,Department of Endocrinology and Metabolism, Kuang Tien General Hospital, Taichung, Taiwan
| | - Chia-Ing Li
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chiu-Shong Liu
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Kai-Lin Hwang
- Department of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Sing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Jen-Huai Chiang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan .,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
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36
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Can both normal and mildly abnormal albuminuria and glomerular filtration rate be a danger signal for diabetic peripheral neuropathy in type 2 diabetes mellitus? Neurol Sci 2017; 38:1381-1390. [DOI: 10.1007/s10072-017-2946-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/01/2017] [Indexed: 10/19/2022]
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37
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Jember G, Melsew YA, Fisseha B, Sany K, Gelaw AY, Janakiraman B. Peripheral Sensory Neuropathy and associated factors among adult diabetes mellitus patients in Bahr Dar, Ethiopia. J Diabetes Metab Disord 2017; 16:16. [PMID: 28396852 PMCID: PMC5381058 DOI: 10.1186/s40200-017-0295-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/12/2017] [Indexed: 12/24/2022]
Abstract
Background Diabetic sensory neuropathy is a common form of microvascular complication among diabetic patients. The swiftly growing population of people living with diabetes in Ethiopia and lack of elaborated scientific data on peripheral sensory neuropathy among diabetic population in Ethiopia prompted this work. This study was set out to assess the enormity and associated factors of peripheral sensory neuropathy among diabetes patients attending chronic illness clinic of Felege Hiwot Regional Referral Hospital, Bahr Dar, Northwest Ethiopia. Methods An institution based cross-sectional study was conducted at Felege Hiwot Referral Hospital chronic illness clinic using Michigan neuropathy screening instrument tool for diabetic peripheral sensory neuropathy on 408 diabetic patients during 2016. Data were collected using interview, patient record review, anthropometric measurements and physical examination. Both bivariate and multivariate binary logistic regression was employed to identify factors associated with peripheral sensory neuropathy. Odds ratios with their 95% CI and P value less than 0.05 used to determine statistically significant associations. Results A total of 368 patients were included with the mean age of 49 ± 14.3 years. The overall prevalence of Peripheral Sensory Neuropathy was found to be 52.2%. The major associated factors identified by multivariate analysis were age >50 years: AOR: 3.0 CI [1.11, 7.89]; overweight and obese: AOR: 7.3 CI [3.57, 14.99]; duration of DM: AOR: 3.4 CI [1.75, 6.60]; not involved in physical exercise: AOR: 4.8 CI [1.90, 7.89]; male gender: AOR: 2.4 CI [1.18, 5.05]. Conclusion Almost half of the diabetic patients who attended Felege Hiwot regional referral hospital during study period were found to present with peripheral sensory neuropathy. Socio-demographic and bio characteristics like patients age, Body Mass Index, level of physical activity and marital status were significantly associated with diabetic peripheral sensory neuropathy.
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Affiliation(s)
- Gashaw Jember
- Department of physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yayehirad Alemu Melsew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berihu Fisseha
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder comprehensive specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Kedir Sany
- Department of physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmare Yitayeh Gelaw
- Department of physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Balamurugan Janakiraman
- Department of physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Grisold A, Callaghan BC, Feldman EL. Mediators of diabetic neuropathy: is hyperglycemia the only culprit? Curr Opin Endocrinol Diabetes Obes 2017; 24:103-111. [PMID: 28098594 PMCID: PMC5831542 DOI: 10.1097/med.0000000000000320] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Diabetic peripheral neuropathy (DPN) is a disabling, highly prevalent complication of both type 1 and type 2 diabetes mellitus (T1DM and T2DM). Large clinical studies support the concept that, in addition to hyperglycemia, components of the metabolic syndrome (MetS) may underlie the pathogenesis of DPN, especially in T2DM. This review will present the evidence supporting the MetS and its individual components as potential causal factors for the development of neuropathy. RECENT FINDINGS In addition to poor glycemic control and duration of diabetes, components of MetS such as dyslipidemia, obesity, and hypertension may have an important impact on the prevalence of DPN. Obesity and prediabetes have the most data to support their role in neuropathy, whereas hypertension and dyslipidemia have more mixed results. Nonmetabolic factors, such as genetic susceptibility, age, height, sex, smoking, and alcohol, have also been highlighted as potential risk factors in peripheral neuropathy, although the exact contribution of these factors to DPN remains unknown. SUMMARY DPN is a chronic and disabling disease, and the accurate identification and modification of DPN risk factors is important for clinical management. Recent data support a role for components of the MetS and other risk factors in the development of DPN, offering novel targets beyond hyperglycemia for therapeutic development.
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Affiliation(s)
- Anna Grisold
- Department of Neurology, Medical University of Vienna, Austria
| | | | - Eva L. Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI
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Yang CP, Li CI, Liu CS, Lin WY, Hwang KL, Yang SY, Li TC, Lin CC. Variability of fasting plasma glucose increased risks of diabetic polyneuropathy in T2DM. Neurology 2017; 88:944-951. [PMID: 28179465 DOI: 10.1212/wnl.0000000000003682] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/12/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine whether variations in fasting plasma glucose (FPG), as measured by the coefficient of variation (CV), is a predictor of diabetic polyneuropathy (DPN) risk, considering glycated hemoglobin (HbA1c) and other traditional risk factors. METHODS Type 2 diabetic patients enrolled in the National Diabetes Care Management Program were ≥30 years of age and free of DPN (n = 36,152). They were enrolled in 2002-2004 and were monitored until 2011. The related factors were analyzed using Cox proportional hazards regression models. RESULTS During an average 7.23 years of follow-up, a total of 7,219 incident cases of DPN were identified, with a crude incidence rate of 27.62/1,000 person-years (25.83 for men and 29.31 for women). After multivariate adjustment, both FPG-CV and HbA1c were significant predictors of DPN, with corresponding hazard ratios of 1.14 (95% confidence interval [CI] 1.05-1.23) and 1.15 (95% CI 1.06-1.24) for FPG-CV in the fourth to fifth quintiles and 1.13 (95% CI 1.07-1.20) for HbA1c ≥7%. This finding maintained consistency after excluding potential confounders in the sensitivity analysis, further validating the results. CONCLUSIONS FPG-CV and HbA1c ≥7% were potent predictors of DPN in type 2 diabetic patients. The associations among HbA1c, glycemic variability, and DPN suggest a linked pathophysiologic mechanism, which may play a crucial role in clinical risk assessments.
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Affiliation(s)
- Chun-Pai Yang
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chia-Ing Li
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chiu-Shong Liu
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Wen-Yuan Lin
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Kai-Lin Hwang
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Sing-Yu Yang
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Tsai-Chung Li
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - Cheng-Chieh Lin
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Gong J, Fang K, Dong H, Wang D, Hu M, Lu F. Effect of fenugreek on hyperglycaemia and hyperlipidemia in diabetes and prediabetes: A meta-analysis. JOURNAL OF ETHNOPHARMACOLOGY 2016; 194:260-268. [PMID: 27496582 DOI: 10.1016/j.jep.2016.08.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/31/2016] [Accepted: 08/01/2016] [Indexed: 06/06/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Fenugreek is a widely used herb for the treatment of diabetes mellitus (DM) but the effects in randomized controlled trials (RCTs) were controversial. Therefore, a meta-analysis was conducted to estimate the overall effects of fenugreek on hyperglycaemia and hyperlipidemia in diabetes and prediabetes. MATERIALS AND METHODS PubMed, EMBASE, web of science, Chinese Biomedical Literature database (CBM), the Cochrane library, China Doctor Dissertations Full-text Database (CDFD), Wan Fang medical database, China Proceedings of Conference Full-text Database (CPCD), China national knowledge internet (CNKI) and China Master's Theses Full-text Database (CMFD) were searched to find the available literatures. RCTs with regard to the efficacy and safety of fenugreek on prediabetes or DM were included. The data of fasting blood glucose (FBG), postprandial 2h blood glucose (2hBG), glycosylated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-c) and high density lipoprotein cholesterol (HDL-c) were extracted to appraise the net change with fixed or randomized effect model. RESULTS A total of 10 articles (12 studies) were included in the analysis. Pooled results showed fenugreek significantly decreased the levels of FBG (MD -0.84mmol/L; 95% CI -1.38 to -0.31; p=0.002), 2hBG (MD -1.30mmol/L; 95% CI -1.78 to -0.83; p<0.0001), HbA1c (MD -1.16; 95% CI -1.23 to -1.09; p<0.00001) and TC (MD -0.30mmol/L; 95% CI-0.56 to -0.03; p=0.03). In spite of the reductive trends in the TG or LDL-c levels and incremental trends of HDL-c, these results were not statistically significant or need further verification for fenugreek in the treatment of DM and prediabetes. Some studies were of low quality. No liver and kidney toxicity were found in all included studies, and the main side effects were gastrointestinal discomfort. CONCLUSIONS The results suggest fenugreek has the hypoglycaemic and TC-lowering efficacy; however, the effects on TG, LDL-c and HDL-c need further confirmations.
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Affiliation(s)
- Jing Gong
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Ke Fang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Hui Dong
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Dingkun Wang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Meilin Hu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Fuer Lu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
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4-Hydroxyisoleucine from Fenugreek (Trigonella foenum-graecum): Effects on Insulin Resistance Associated with Obesity. Molecules 2016; 21:molecules21111596. [PMID: 27879673 PMCID: PMC6273931 DOI: 10.3390/molecules21111596] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/31/2016] [Accepted: 11/10/2016] [Indexed: 01/22/2023] Open
Abstract
Obesity and insulin resistance (IR) are interdependent multifactorial processes that cannot be understood separately. Obesity leads to systemic inflammation and increased levels of free fatty acids that provoke IR and lipotoxicity. At the same time, IR exacerbates adipose cell dysfunction, resulting in chronic inflammation and major lipotoxic effects on nonadipose tissues. 4-Hydroxyisoleucine (4-OHIle), a peculiar nonprotein amino acid isolated from fenugreek (Trigonella foenum-graecum) seeds, exhibits interesting effects on IR related to obesity. 4-OHIle increases glucose-induced insulin release, and the insulin response mediated by 4-OHIle depends on glucose concentration. The beneficial effects observed are related to the regulation of blood glucose, plasma triglycerides, total cholesterol, free fatty acid levels, and the improvement of liver function. The mechanism of action is related to increased Akt phosphorylation and reduced activation of Jun N-terminal kinase (JNK)1/2, extracellular signal-regulated kinase (ERK)1/2, p38 mitogen-activated protein kinase (MAPK), and nuclear factor (NF)-κB. Here, we present a review of the research regarding the insulinotropic and insulin-sensitising activity of 4-OHIle in in vitro and in vivo models.
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Roustit M, Loader J, Deusenbery C, Baltzis D, Veves A. Endothelial Dysfunction as a Link Between Cardiovascular Risk Factors and Peripheral Neuropathy in Diabetes. J Clin Endocrinol Metab 2016; 101:3401-8. [PMID: 27399351 PMCID: PMC5010566 DOI: 10.1210/jc.2016-2030] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Cardiovascular risk factors are well-known predictors of the development of diabetic peripheral neuropathy (DPN), which has traditionally been considered as a manifestation of diabetes-associated microangiopathy. Because endothelial dysfunction is strongly associated with all cardiovascular risk factors, we hypothesized that it may be a link between cardiovascular risk factors and DPN. OBJECTIVE The primary objective of this study was to test whether endothelial dysfunction is a predictor of DPN. DESIGN AND SETTING This is a cross-sectional analysis of a cohort composed of patients followed at the Microcirculatory Laboratory, Beth Israel Deaconess Medical Center. PATIENTS Participants with diabetes without DPN (n = 192) and with DPN (n = 166), subjects with prediabetes (n = 75), and nondiabetic controls (n = 59) were included. INTERVENTIONS Endothelial function was assessed with flow-mediated dilation (FMD) of the brachial artery. Inflammatory cytokines and biomarkers of endothelial function (soluble intercellular and vascular cell adhesion molecules) were quantified using a multiplex bead-based immunoassay. Neurological assessment included the neuropathy disability score (NDS). MAIN OUTCOME MEASURE The relationship between FMD and NDS assessed using multiple linear regression. RESULTS In addition to already known risk factors of DPN, FMD was strongly associated with NDS (β = -0.24; P < .001). Sensitivity analysis that removed FMD from the model provided similar results for soluble intercellular cell adhesion molecule-1, another biomarker of endothelial function. Confirmatory factor analysis further showed that endothelial dysfunction is a significant mediator between glycosylated hemoglobin and diabetes duration and diabetic complications. CONCLUSIONS This study shows that endothelial dysfunction occurs early in the pathophysiology of diabetes and is a link between cardiovascular risk factors and DPN.
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Affiliation(s)
- Matthieu Roustit
- Microcirculatory Lab and Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215
| | - Jordan Loader
- Microcirculatory Lab and Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215
| | - Carly Deusenbery
- Microcirculatory Lab and Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215
| | - Dimitrios Baltzis
- Microcirculatory Lab and Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215
| | - Aristidis Veves
- Microcirculatory Lab and Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215
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Wu HY, Peng YS, Chen HY, Tsai WC, Yang JY, Hsu SP, Pai MF, Lu HM, Chiang JF, Ko MJ, Wen SY, Chiu HC. A Comparison of Uremic Pruritus in Patients Receiving Peritoneal Dialysis and Hemodialysis. Medicine (Baltimore) 2016; 95:e2935. [PMID: 26945400 PMCID: PMC4782884 DOI: 10.1097/md.0000000000002935] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Uremic pruritus is common and bothersome in patients receiving either peritoneal dialysis (PD) or hemodialysis (HD). To date, the preferred dialysis modality regarding the alleviation of uremic pruritus remains controversial. We conducted this cross-sectional study to compare the prevalence, intensity, and characteristics of uremic pruritus between PD and HD patients. Patients receiving maintenance dialysis at a referral medical center in Taiwan were recruited. Dialysis modality, patient demographic, clinical characteristics, and laboratory data were recorded. The intensity of uremic pruritus was measured using visual analogue scale (VAS) scores. Multivariate linear regression analysis was conducted to compare the severity of uremic pruritus between PD and HD patients. Generalized additive models were applied to detect nonlinear effects between pruritus intensity and continuous covariates. A total of 380 patients completed this study, with a mean age of 60.3 years and 49.2% being female. Uremic pruritus was presented in 24 (28.6%) of the 84 PD patients and 113 (38.2%) of the 296 HD patients (P = .12). The VAS score of pruritus intensity was significantly lower among the PD patients than the HD patients (1.32 ± 2.46 vs 2.26 ± 3.30, P = .04). Multivariate linear regression analysis showed that PD was an independent predictor for lower VAS scores of pruritus intensity compared with HD (β-value -0.88, 95% confidence interval -1.62 to -0.13). The use of active vitamin D was also an independent predictor for a lower intensity of uremic pruritus, whereas hyperphosphatemia and higher serum levels of triglyceride and aspartate transaminase were significantly associated with higher pruritus intensity. There was a trend toward a less affected body surface area of uremic pruritus in the PD patients than in the HD patients, but the difference did not reach statistical significance (P = .13).In conclusion, the severity of uremic pruritus was lower among PD patients than HD patients, and PD may provide better alleviation of pruritus symptoms. The result provides a valuable reference for clinicians and patients when choosing a dialysis modality.
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Affiliation(s)
- Hon-Yen Wu
- From the Department of Internal Medicine (H-YW, Y-SP, H-YC, W-CT, J-YY, S-PH, M-FP); Department of Nursing (H-ML, J-FC), Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Internal Medicine (H-YW, Y-SP, H-YC, J-YY, S-PH, M-FP); Department of Dermatology (M-JK, H-CC), National Taiwan University Hospital and College of Medicine; Institute of Epidemiology and Preventive Medicine, National Taiwan University (H-YW, W-CT); and Department of Dermatology (M-JK, S-YW), Taipei City Hospital, Taipei, Taiwan
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