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Ziegler D, Herder C, Papanas N. Neuropathy in prediabetes. Diabetes Metab Res Rev 2023; 39:e3693. [PMID: 37470302 DOI: 10.1002/dmrr.3693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/13/2023] [Accepted: 06/18/2023] [Indexed: 07/21/2023]
Abstract
Diabetic neuropathies are the most frequent complications of diabetes, contributing to high morbidity, excess mortality, reduced quality of life, and increased healthcare costs. Prediabetes is characterised by glucose levels within an intermediate range above normoglycaemia yet below the diagnostic threshold for diabetes. In 2021, 10.6% and 6.2% of adults worldwide were estimated to have impaired glucose tolerance and impaired fasting glucose, respectively, the majority of whom are unaware of having prediabetes. Evidence has accumulated suggesting that prediabetes is a predictor of cardiovascular disease (CVD) and increased mortality. The past 2 decades have witnessed an extensive debate, particularly among diabetologists and neurologists, as to whether prediabetes is associated with peripheral neuropathy. In this review, we elaborate on the current evidence, particularly from population-based studies supporting an increased risk of distal sensorimotor polyneuropathy (DSPN) and cardiovascular autonomic neuropathy (CAN) in people with prediabetes. Moreover, we discuss whether lifestyle interventions showing efficacy in preventing or delaying the transition from prediabetes to diabetes in persons with prediabetes may also exert favourable effects on the development and progression of DSPN and CAN. This review should help in raising the awareness of and translating the current knowledge on neuropathies in people with prediabetes into clinical practice and public health. The current recommendation that adults who are overweight or obese should be screened for prediabetes and referred to or offered preventive interventions should ultimately culminate in preventing not only CVD but also prediabetic neuropathy.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nikolaos Papanas
- Diabetes Centre, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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2
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Chen Z, Wu LP, Peng TC. Prediabetes is associated with a higher serum neurofilament light chain level in adolescents. Front Endocrinol (Lausanne) 2023; 14:1207045. [PMID: 37435483 PMCID: PMC10332149 DOI: 10.3389/fendo.2023.1207045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
Objective Serum neurofilament light chain (sNfL) level, which is a biomarker indicative of neuroaxonal damage and cognitive impairment, has been reported in several neurological diseases. There has been a lack of studies on the association between sNfL levels and prediabetes in adolescents. This study investigated whether sNfL levels were higher in adolescents with prediabetes undergoing elective orthopedic surgery. Methods The sNfL level was measured in 149 adolescents aged from 12 to 18 years who underwent elective orthopedic surgery at the Hunan Children's Hospital (18 with and 131 without prediabetes). We evaluated the association between prediabetes and sNfL level after adjusting for age, sex, and triglycerides using a multivariable linear regression model. Results The prevalence of prediabetes in adolescents was 12.08%. Univariate logistic regression analysis showed that prediabetes was related to sNfL. In multivariate logistic regression analysis, the association between prediabetes with sNfL levels remained significant after adjustment for age, sex, and triglyceride. The relationship between the two was further visualized by a smoothed curve. Conclusions Prediabetes is associated with a higher sNfL. Further large-scale and prospective studies are needed to verify the clinical application of sNfL as a monitoring biomarker for adolescent prediabetes in adolescents and to evaluate the performance of sNfL in predicting the incidence of neuropathy and cognitive dysfunction in adolescents with prediabetes.
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Bonomo R, Kramer S, Aubert VM. Obesity-Associated Neuropathy: Recent Preclinical Studies and Proposed Mechanisms. Antioxid Redox Signal 2022; 37:597-612. [PMID: 35152780 PMCID: PMC9527047 DOI: 10.1089/ars.2021.0278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/25/2022] [Indexed: 11/13/2022]
Abstract
Significance: The prevalence of metabolic syndrome (MetS) and associated obesity has increased in recent years, affecting millions worldwide. One of the most common complications of obesity is damage to the peripheral nerve system, referred to as neuropathy. The lack of disease-modifying therapy for this complication is largely due to a poor understanding of the complex neurobiology underlying neuropathy. Recent preclinical studies suggest that in addition to glucotoxic events, other mechanisms, including lipid signaling, microbiome, or inflammation, may be viable targets to prevent nerve damage and neuropathic pain in obesity. Recent Advances: Clinical and preclinical studies using diet-induced obesity rodent models have identified novel interventions that improve neuropathy. Notably, mechanistic studies suggest that lipid, calcium signaling, and inflammation are converging pathways. Critical Issues: In this review, we focus on interventions and their mechanisms that are shown to ameliorate neuropathy in MetS obese models, including: (i) inhibition of a sensory neuron population, (ii), modification of dietary components, (iii) activation of nuclear and mitochondrial lipid pathways, (iv) exercise, and (v) modulation of gut microbiome composition and their metabolites. Future Directions: These past years, novel research increased our knowledge about neuropathy in obesity and discovered the involvement of nonglucose signaling. More studies are necessary to uncover the interplay between complex metabolic pathways in the peripheral nerve system of obese individuals. Further mechanistic studies in preclinical models and humans are crucial to create single- or multitarget interventions for this complex disease implying complex metabolic phenotyping. Antioxid. Redox Signal. 37, 597-612.
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Affiliation(s)
- Raiza Bonomo
- Department of Cell and Molecular Physiology, Loyola University Chicago, Maywood, Illinois, USA
| | - Sarah Kramer
- Department of Cell and Molecular Physiology, Loyola University Chicago, Maywood, Illinois, USA
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Virginie M. Aubert
- Department of Cell and Molecular Physiology, Loyola University Chicago, Maywood, Illinois, USA
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Kirthi V, Nderitu P, Alam U, Evans JR, Nevitt S, Malik RA, Hopkins D, Jackson TL. The prevalence of retinopathy in prediabetes: A systematic review. Surv Ophthalmol 2022; 67:1332-1345. [DOI: 10.1016/j.survophthal.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 12/21/2022]
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Newlin Lew K, Arnold T, Cantelmo C, Jacque F, Posada-Quintero H, Luthra P, Chon KH. Diabetes Distal Peripheral Neuropathy: Subtypes and Diagnostic and Screening Technologies. J Diabetes Sci Technol 2022; 16:295-320. [PMID: 34994241 PMCID: PMC8861801 DOI: 10.1177/19322968211035375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Diabetes distal symmetrical peripheral neuropathy (DSPN) is the most prevalent form of neuropathy in industrialized countries, substantially increasing risk for morbidity and pre-mature mortality. DSPN may manifest with small-fiber disease, large-fiber disease, or a combination of both. This review summarizes: (1) DSPN subtypes (small- and large-fiber disease) with attention to clinical signs and patient symptoms; and (2) technological diagnosis and screening for large- and small-fiber disease with inclusion of a comprehensive literature review of published studies from 2015-present (N = 66). Review findings, informed by the most up-to-date research, advance critical understanding of DSPN large- and small-fiber screening technologies, including those designed for point-of-care use in primary care and endocrinology practices.
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Affiliation(s)
- Kelley Newlin Lew
- School of Nursing, University of
Connecticut (UConn), Storrs, CT, USA
- Kelley Newlin Lew, School of Nursing,
University of Connecticut (UConn), 231 Glenbrook Road, Storrs, CT 06269, USA.
| | - Tracey Arnold
- School of Nursing, University of
Connecticut (UConn), Storrs, CT, USA
| | | | - Francky Jacque
- Hispanic Alliance of Southeastern
Connecticut, New London, CT, USA
| | - Hugo Posada-Quintero
- Biomedical Engineering Department,
University of Connecticut (UConn), Storrs, CT, USA
| | - Pooja Luthra
- Division of Endocrinology and
Metabolism, UConn Health, Farmington, CT, USA
| | - Ki H. Chon
- Biomedical Engineering Department,
University of Connecticut (UConn), Storrs, CT, USA
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6
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Yorek M. Treatment for Diabetic Peripheral Neuropathy: What have we Learned from Animal Models? Curr Diabetes Rev 2022; 18:e040521193121. [PMID: 33949936 PMCID: PMC8965779 DOI: 10.2174/1573399817666210504101609] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/07/2021] [Accepted: 02/13/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Animal models have been widely used to investigate the etiology and potential treatments for diabetic peripheral neuropathy. What we have learned from these studies and the extent to which this information has been adapted for the human condition will be the subject of this review article. METHODS A comprehensive search of the PubMed database was performed, and relevant articles on the topic were included in this review. RESULTS Extensive study of diabetic animal models has shown that the etiology of diabetic peripheral neuropathy is complex, with multiple mechanisms affecting neurons, Schwann cells, and the microvasculature, which contribute to the phenotypic nature of this most common complication of diabetes. Moreover, animal studies have demonstrated that the mechanisms related to peripheral neuropathy occurring in type 1 and type 2 diabetes are likely different, with hyperglycemia being the primary factor for neuropathology in type 1 diabetes, which contributes to a lesser extent in type 2 diabetes, whereas insulin resistance, hyperlipidemia, and other factors may have a greater role. Two of the earliest mechanisms described from animal studies as a cause for diabetic peripheral neuropathy were the activation of the aldose reductase pathway and increased non-enzymatic glycation. However, continuing research has identified numerous other potential factors that may contribute to diabetic peripheral neuropathy, including oxidative and inflammatory stress, dysregulation of protein kinase C and hexosamine pathways, and decreased neurotrophic support. In addition, recent studies have demonstrated that peripheral neuropathy-like symptoms are present in animal models, representing pre-diabetes in the absence of hyperglycemia. CONCLUSION This complexity complicates the successful treatment of diabetic peripheral neuropathy, and results in the poor outcome of translating successful treatments from animal studies to human clinical trials.
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Affiliation(s)
- Mark Yorek
- Department of Internal Medicine, University of Iowa, Iowa City, IA, 52242 USA
- Department of Veterans Affairs Iowa City Health Care System, Iowa City, IA, 52246 USA
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, 52242 USA
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7
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Kirthi V, Perumbalath A, Brown E, Nevitt S, Petropoulos IN, Burgess J, Roylance R, Cuthbertson DJ, Jackson TL, Malik RA, Alam U. Prevalence of peripheral neuropathy in pre-diabetes: a systematic review. BMJ Open Diabetes Res Care 2021; 9:9/1/e002040. [PMID: 34006607 PMCID: PMC8137250 DOI: 10.1136/bmjdrc-2020-002040] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/26/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
There is growing evidence of excess peripheral neuropathy in pre-diabetes. We aimed to determine its prevalence, including the impact of diagnostic methodology on prevalence rates, through a systematic review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive electronic bibliographic search was performed in MEDLINE, EMBASE, PubMed, Web of Science and the Cochrane Central Register of Controlled Trials from inception to June 1, 2020. Two reviewers independently selected studies, extracted data and assessed risk of bias. An evaluation was undertaken by method of neuropathy assessment. After screening 1784 abstracts and reviewing 84 full-text records, 29 studies (9351 participants) were included. There was a wide range of prevalence estimates (2%-77%, IQR: 6%-34%), but the majority of studies (n=21, 72%) reported a prevalence ≥10%. The three highest prevalence estimates of 77% (95% CI: 54% to 100%), 71% (95% CI: 55% to 88%) and 66% (95% CI: 53% to 78%) were reported using plantar thermography, multimodal quantitative sensory testing and nerve conduction tests, respectively. In general, studies evaluating small nerve fiber parameters yielded a higher prevalence of peripheral neuropathy. Due to a variety of study populations and methods of assessing neuropathy, there was marked heterogeneity in the prevalence estimates. Most studies reported a higher prevalence of peripheral neuropathy in pre-diabetes, primarily of a small nerve fiber origin, than would be expected in the background population. Given the marked rise in pre-diabetes, further consideration of targeting screening in this population is required. Development of risk-stratification tools may facilitate earlier interventions.
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Affiliation(s)
- Varo Kirthi
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Anugraha Perumbalath
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Emily Brown
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | | | - Jamie Burgess
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Rebecca Roylance
- Edge Hill University Library, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Timothy L Jackson
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Rayaz A Malik
- Research Division, Weill Cornell Medicine, Doha, Qatar
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Uazman Alam
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Division of Endocrinology, Diabetes & Gastroenterology, University of Manchester, Manchester, UK
- Pain Research Institute, University of Liverpool, Liverpool, UK
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Karagöz T, Bayir Ö, Çadalli Tatar E, Çakal E, Özdek A, Keseroğlu K, Şahin M, Korkmaz MH. Prognostic role of homeostasis model assessment and oral glucose tolerance test in nondiabetic patients with Bell’s palsy. Turk J Med Sci 2020; 50:405-410. [PMID: 32041386 PMCID: PMC7164762 DOI: 10.3906/sag-1901-151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/09/2020] [Indexed: 12/16/2022] Open
Abstract
Background/aim We aimed to reveal the incidence and predictive role of insulin resistance and distorted oral glucose tolerance test in nondiabetic patients with Bell’s Palsy (BP). Materials and methods Eighty-six patients with BP and 28 control subjects; all with normal blood glucose levels and no history of diabetes, were enrolled in the study. We investigated insulin resistance (IR) in all subjects, in terms of HOMA-IR greater than 2.7. Sixty-two of the patients also underwent an oral glucose tolerance test (OGTT). Results The mean HOMA-IR value was significantly increased in patients, compared to the control group (3.2 vs 1.6; P < 0.01). IR was detected more in BP patients than in controls (P < 0.05). The patients with higher HOMA-IR values had more severe facial dysfunction at the initial presentation and complete recovery time took longer than the patients with normal HOMA-IR value (75 days vs 42 days; P < 0.05). Following a 2h-OGTT, impaired glucose tolerance and newly diagnosed DM were found in 60% of the patients. Recovery time was significantly longer in prediabetics and newly diagnosed diabetic patients than in patients with normal glycemia (68 days, 52 days, and 32 days, respectively; P < 0.01). Conclusion There is a strong linkage between HOMA-IR value and BP prognosis so HOMA-IR value may have a significant role of predicting BP prognosis at presentation.
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Affiliation(s)
- Tuğba Karagöz
- Otorhinolaryngology and Head and Neck Surgery Clinic, Kaman State Hospital, Kırşehir, Turkey
| | - Ömer Bayir
- Department of Otorhinolaryngology and Head and Neck Surgery, Dıskapı Yıldırım Beyazıt Research andTraining Hospital, Ministry of Health, Ankara, Turkey
| | - Emel Çadalli Tatar
- Department of Otorhinolaryngology and Head and Neck Surgery, Dıskapı Yıldırım Beyazıt Research andTraining Hospital, Ministry of Health, Ankara, Turkey
| | - Erman Çakal
- Department of Endocrinology and Metabolism, Dıskapı Yıldırım Beyazıt Research and Training Hospital,Ministry of Health, Ankara, Turkey
| | - Ali Özdek
- Department of Otorhinolaryngology and Head and Neck Surgery, Dıskapı Yıldırım Beyazıt Research andTraining Hospital, Ministry of Health, Ankara, Turkey
| | - Kemal Keseroğlu
- Department of Otorhinolaryngology and Head and Neck Surgery, Dıskapı Yıldırım Beyazıt Research andTraining Hospital, Ministry of Health, Ankara, Turkey
| | - Mustafa Şahin
- Department of Otolaryngology and Head and Neck Surgery, Adnan Menderes University Medical School, Aydın, Turkey
| | - Mehmet Hakan Korkmaz
- Department of Otolaryngology and Head and Neck Surgery, Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
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9
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Lin Y, Lin CS, Chang T, Lee J, Tani J, Chen H, Sung J. Early sensory neurophysiological changes in prediabetes. J Diabetes Investig 2020; 11:458-465. [PMID: 31563156 PMCID: PMC7078118 DOI: 10.1111/jdi.13151] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 12/14/2022] Open
Abstract
AIMS/INTRODUCTION To elucidate whether axonal changes arise in the prediabetic state and to find a biomarker for early detection of neurophysiological changes. MATERIALS AND METHODS We enrolled asymptomatic diabetes patients, as well as prediabetic and normoglycemic individuals to test sensory nerve excitability, and we analyzed those findings and their correlation with clinical profiles. RESULTS In nerve excitability tests, superexcitability in the recovery cycle showed increasing changes in the normoglycemic, prediabetes and diabetes cohorts (-19.09 ± 4.56% in normoglycemia, -22.39 ± 3.16% in prediabetes and -23.71 ± 5.15% in diabetes, P = 0.002). Relatively prolonged distal sensory latency was observed in the median nerve (3.12 ± 0.29 ms in normoglycemia, 3.23 ± 0.38 ms in prediabetes and 3.45 ± 0.43 ms in diabetes, P = 0.019). Superexcitability was positively correlated with fasting plasma glucose (r = 0.291, P = 0.009) and glycated hemoglobin (r = 0.331, P = 0.003) in all participants. CONCLUSIONS Sensory superexcitability and latencies are the most sensitive parameters for detecting preclinical physiological dysfunction in prediabetes. In addition, changes in favor of superexcitability were positively correlated with glycated hemoglobin for all participants. These results suggest that early axonal changes start in the prediabetic stage, and that the monitoring strategy for polyneuropathy should start as early as prediabetes.
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Affiliation(s)
- Yi‐Chen Lin
- Department of NeurologyTaipei Municipal Wanfang HospitalTaipei Medical UniversityTaipeiTaiwan
- Neuroscience InstituteTaipei Medical UniversityTaipeiTaiwan
| | - Cindy Shin‐Yi Lin
- Neural Regenerative MedicineCollege of Medical Science and TechnologyTaipei Medical University and National Health Research InstitutesTaipeiTaiwan
- The Kam Ling Barbara Lo Chair in Neurodegenerative DisordersCentral Clinical SchoolFaculty of Medicine and Health, Brain and Mind CenterThe University of SydneySydneyAustralia
| | - Tsui‐San Chang
- Department of NeurologyTaipei Municipal Wanfang HospitalTaipei Medical UniversityTaipeiTaiwan
- Neuroscience InstituteTaipei Medical UniversityTaipeiTaiwan
- Department of NeurologySchool of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Jing‐Er Lee
- Department of NeurologyTaipei Municipal Wanfang HospitalTaipei Medical UniversityTaipeiTaiwan
- Neuroscience InstituteTaipei Medical UniversityTaipeiTaiwan
| | - Jowy Tani
- Department of NeurologyTaipei Municipal Wanfang HospitalTaipei Medical UniversityTaipeiTaiwan
- Neuroscience InstituteTaipei Medical UniversityTaipeiTaiwan
- Neural Regenerative MedicineCollege of Medical Science and TechnologyTaipei Medical University and National Health Research InstitutesTaipeiTaiwan
- Ph.D. Program for Neural Regenerative MedicineCollege of Medical Science and TechnologyTaipei Medical University and National Health Research InstitutesTaipeiTaiwan
| | - Hung‐Ju Chen
- Department of NeurologyTaipei Municipal Wanfang HospitalTaipei Medical UniversityTaipeiTaiwan
- Neuroscience InstituteTaipei Medical UniversityTaipeiTaiwan
| | - Jia‐Ying Sung
- Department of NeurologyTaipei Municipal Wanfang HospitalTaipei Medical UniversityTaipeiTaiwan
- Neuroscience InstituteTaipei Medical UniversityTaipeiTaiwan
- Department of NeurologySchool of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
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Liu YP, Shao SJ, Guo HD. Schwann cells apoptosis is induced by high glucose in diabetic peripheral neuropathy. Life Sci 2020; 248:117459. [PMID: 32092332 DOI: 10.1016/j.lfs.2020.117459] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 02/06/2023]
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus that affects approximately half of patients with diabetes. Current treatment regimens cannot treat DPN effectively. Schwann cells (SCs) are very sensitive to glucose concentration and insulin, and closely associated with the occurrence and development of type 1 diabetic mellitus (T1DM) and DPN. Apoptosis of SCs is induced by hyperglycemia and is involved in the pathogenesis of DPN. This review considers the pathological processes of SCs apoptosis under high glucose, which include the following: oxidative stress, inflammatory reactions, endoplasmic reticulum stress, autophagy, nitrification and signaling pathways (PI3K/AKT, ERK, PERK/Nrf2, and Wnt/β-catenin). The clarification of mechanisms underlying SCs apoptosis induced by high glucose will help us to understand and identify more effective strategies for the treatment of T1DM DPN.
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Affiliation(s)
- Yu-Pu Liu
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Shui-Jin Shao
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Hai-Dong Guo
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
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11
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Gatev T, Gateva A, Assyov Y, Nacheva S, Petrova J, Poromanski I, Kamenov Z. The role of Sudoscan feet asymmetry in the diabetic foot. Prim Care Diabetes 2020; 14:47-52. [PMID: 31153799 DOI: 10.1016/j.pcd.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/04/2019] [Accepted: 05/12/2019] [Indexed: 12/13/2022]
Abstract
UNLABELLED The aim of this study was to investigate the role of Sudoscan asymmetry parameters in the diabetic foot. PATIENTS AND METHODS In this study we included 165 participants: 84 type 2 diabetes patients divided into three HbA1c matched groups - group 1: newly diagnosed diabetics (n = 31), group 2: people with longer diabetes duration and established neuropathy (n = 33), group 3: patients with diabetic foot ulcer (n = 20), and a control group of 81 people with prediabetes. All subjects underwent peripheral sudomotor evaluation using Sudoscan device (Impeto Medical, Paris). RESULTS Patients with diabetic foot had significantly higher Sudoscan feet asymmetry (19.6%) compared to those with only diabetic neuropathy (7.9%), compared to the group with newly diagnosed diabetes (7.44%), and compared to controls (2.5%). This test has shown a good discriminative value (with a threshold of 9.5%) for diabetic foot with area under the ROC curve of 0.955 (p = 0.001). Additionally, in a regression model feet asymmetry proved its predictive value for participants with diabetic foot. CONCLUSION In this study Sudoscan feet asymmetry proved to be a novel discriminator and predictor for diabetic foot patients. It might be considered as a marker for early damage in the neuropathy evaluation protocol.
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Affiliation(s)
- Tsvetan Gatev
- Clinic of Endocrinology, University Hospital "Alexandrovska", Medical University - Sofia, Sofia, Bulgaria.
| | - Antoaneta Gateva
- Clinic of Endocrinology, University Hospital "Alexandrovska", Medical University - Sofia, Sofia, Bulgaria.
| | - Yavor Assyov
- Clinic of Endocrinology, University Hospital "Alexandrovska", Medical University - Sofia, Sofia, Bulgaria.
| | - Sylvia Nacheva
- Clinic of Neurology, University Hospital "Alexandrovska", Medical University - Sofia, Sofia, Bulgaria.
| | - Julia Petrova
- Clinic of Neurology, University Hospital "Alexandrovska", Medical University - Sofia, Sofia, Bulgaria.
| | - Ivan Poromanski
- Clinic of Septic Surgery, Pirogov Hospital, Sofia, Bulgaria.
| | - Zdravko Kamenov
- Clinic of Endocrinology, University Hospital "Alexandrovska", Medical University - Sofia, Sofia, Bulgaria.
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12
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Schalkwijk CG, Stehouwer CDA. Methylglyoxal, a Highly Reactive Dicarbonyl Compound, in Diabetes, Its Vascular Complications, and Other Age-Related Diseases. Physiol Rev 2020; 100:407-461. [DOI: 10.1152/physrev.00001.2019] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The formation and accumulation of methylglyoxal (MGO), a highly reactive dicarbonyl compound, has been implicated in the pathogenesis of type 2 diabetes, vascular complications of diabetes, and several other age-related chronic inflammatory diseases such as cardiovascular disease, cancer, and disorders of the central nervous system. MGO is mainly formed as a byproduct of glycolysis and, under physiological circumstances, detoxified by the glyoxalase system. MGO is the major precursor of nonenzymatic glycation of proteins and DNA, subsequently leading to the formation of advanced glycation end products (AGEs). MGO and MGO-derived AGEs can impact on organs and tissues affecting their functions and structure. In this review we summarize the formation of MGO, the detoxification of MGO by the glyoxalase system, and the biochemical pathways through which MGO is linked to the development of diabetes, vascular complications of diabetes, and other age-related diseases. Although interventions to treat MGO-associated complications are not yet available in the clinical setting, several strategies to lower MGO have been developed over the years. We will summarize several new directions to target MGO stress including glyoxalase inducers and MGO scavengers. Targeting MGO burden may provide new therapeutic applications to mitigate diseases in which MGO plays a crucial role.
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Affiliation(s)
- C. G. Schalkwijk
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands; and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C. D. A. Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands; and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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13
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Ponirakis G, Elhadd T, Chinnaiyan S, Dabbous Z, Siddiqui M, Al‐muhannadi H, Petropoulos I, Khan A, Ashawesh KAE, Dukhan KMO, Mahfoud ZR, Murgatroyd C, Slevin M, Malik RA. Prevalence and risk factors for painful diabetic neuropathy in secondary healthcare in Qatar. J Diabetes Investig 2019; 10:1558-1564. [PMID: 30860314 PMCID: PMC6825939 DOI: 10.1111/jdi.13037] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/23/2019] [Accepted: 03/03/2019] [Indexed: 01/16/2023] Open
Abstract
AIMS/INTRODUCTION Painful diabetic peripheral neuropathy (PDPN) has a significant impact on the patient's quality of life. The prevalence of PDPN in the Middle East and North Africa region has been reported to be almost double that of populations in the UK. We sought to determine the prevalence of PDPN and its associated factors in type 2 diabetes mellitus patients attending secondary care in Qatar. MATERIALS AND METHODS This was a cross-sectional study of 1,095 participants with type 2 diabetes mellitus attending Qatar's two national diabetes centers. PDPN and impaired vibration perception on the pulp of the large toes were assessed using the Douleur Neuropathique en 4 questionnaire with a cut-off ≥4 and the neurothesiometer with a cut-off ≥15 V, respectively. RESULTS The prevalence of PDPN was 34.5% (95% confidence interval [CI] 31.7-37.3), but 80% of these patients had not previously been diagnosed or treated for this condition. Arabs had a higher prevalence of PDPN compared with South Asians (P < 0.05). PDPN was associated with impaired vibration perception adjusted odds ratio (AOR) 4.42 (95% CI 2.92-6.70), smoking AOR 2.43 (95% CI 1.43-4.15), obesity AOR 1.74 (95% CI 1.13-2.66), being female AOR 1.65 (95% CI: 1.03-2.64) and duration of diabetes AOR 1.08 (95% CI 1.05-1.11). Age, poor glycemic control, hypertension, physical activity and proteinuria showed no association with PDPN. CONCLUSIONS PDPN occurs in one-third of type 2 diabetes mellitus patients attending secondary care in Qatar, but the majority have not been diagnosed. Arabs are at higher risk for PDPN. Impaired vibration perception, obesity and smoking are associated with PDPN in Qatar.
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Affiliation(s)
- Georgios Ponirakis
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
- Faculty of Science and EngineeringManchester Metropolitan UniversityManchesterUK
| | - Tarik Elhadd
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
- National Diabetes and Endocrine CentreHamad Medical CorporationAl‐Wakra HospitalDohaQatar
| | - Subitha Chinnaiyan
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
| | - Zeinab Dabbous
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
| | - Mashhood Siddiqui
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
| | | | | | - Adnan Khan
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | - Khaled AE Ashawesh
- National Diabetes and Endocrine CentreHamad Medical CorporationAl‐Wakra HospitalDohaQatar
| | - Khaled MO Dukhan
- National Diabetes and Endocrine CentreHamad Medical CorporationAl‐Wakra HospitalDohaQatar
| | - Ziyad R Mahfoud
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | | | - Mark Slevin
- Faculty of Science and EngineeringManchester Metropolitan UniversityManchesterUK
| | - Rayaz A Malik
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
- Faculty of Science and EngineeringManchester Metropolitan UniversityManchesterUK
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
- Institute of Cardiovascular ScienceUniversity of ManchesterManchesterUK
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14
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Kandula T, Farrar MA, Cohn RJ, Mizrahi D, Carey K, Johnston K, Kiernan MC, Krishnan AV, Park SB. Chemotherapy-Induced Peripheral Neuropathy in Long-term Survivors of Childhood Cancer: Clinical, Neurophysiological, Functional, and Patient-Reported Outcomes. JAMA Neurol 2019; 75:980-988. [PMID: 29799906 DOI: 10.1001/jamaneurol.2018.0963] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance In light of the excellent long-term survival of childhood cancer patients, it is imperative to screen for factors affecting health, function, and quality of life in long-term survivors. Objective To comprehensively assess chemotherapy-induced peripheral neuropathy in childhood cancer survivors to define disease burden and functional effect and to inform screening recommendations. Design, Setting, and Participants In this cross-sectional observational study, cancer survivors who were treated with chemotherapy for extracranial malignancy before age 17 years were recruited consecutively between April 2015 and December 2016 from a single tertiary hospital-based comprehensive cancer survivorship clinic and compared with healthy age-matched controls. Investigators were blinded to the type of chemotherapy. A total of 169 patients met inclusion criteria, of whom 48 (28.4%) were unable to be contacted or declined participation. Exposures Chemotherapy agents known to be toxic to peripheral nerves. Main Outcomes and Measures The clinical peripheral neurological assessment using the Total Neuropathy Score was compared between recipients of different neurotoxic chemotherapy agents and control participants and was correlated with neurophysiological, functional, and patient-reported outcome measures. Results Of the 121 childhood cancer survivors included in this study, 65 (53.7%) were male, and the cohort underwent neurotoxicity assessments at a median (range) age of 16 (7-47) years, a median (range) 8.5 (1.5-29) years after treatment completion. Vinca alkaloids and platinum compounds were the main neurotoxic agents. Clinical abnormalities consistent with peripheral neuropathy were common, seen in 53 of 100 participants (53.0%) treated with neurotoxic chemotherapy (mean Total Neuropathy Score increase, 2.1; 95% CI, 1.4-2.9; P < .001), and were associated with lower limb predominant sensory axonal neuropathy (mean amplitude reduction, 5.8 μV; 95% CI, 2.8-8.8; P < .001). Functional deficits were seen in manual dexterity, distal sensation, and balance. Patient-reported outcomes demonstrating reduction in global quality of life and physical functioning were associated with the Total Neuropathy Score. Cisplatin produced long-term neurotoxicity more frequently than vinca alkaloids. Conclusions and Relevance Clinical abnormalities attributable to peripheral neuropathy were common in childhood cancer survivors and persisted long term, with concurrent deficits in patient-reported outcomes. Both the type of neurotoxic agent and a targeted clinical neurological assessment are important considerations when screening survivors for long-term neuropathy. Further development of peripheral neuropathy-specific pediatric assessment tools will aid research into neuroprotective and rehabilitative strategies.
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Affiliation(s)
- Tejaswi Kandula
- School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Michelle Anne Farrar
- School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - David Mizrahi
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Kate Carey
- School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Karen Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Susanna B Park
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
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15
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Azmi S, Petropoulos IN, Ferdousi M, Ponirakis G, Alam U, Malik RA. An update on the diagnosis and treatment of diabetic somatic and autonomic neuropathy. F1000Res 2019; 8. [PMID: 30828432 PMCID: PMC6381801 DOI: 10.12688/f1000research.17118.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 12/30/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the most common chronic complication of diabetes. It poses a significant challenge for clinicians as it is often diagnosed late when patients present with advanced consequences such as foot ulceration. Autonomic neuropathy (AN) is also a frequent and under-diagnosed complication unless it is overtly symptomatic. Both somatic and autonomic neuropathy are associated with increased mortality. Multiple clinical trials have failed because of limited efficacy in advanced disease, inadequate trial duration, lack of effective surrogate end-points and a lack of deterioration in the placebo arm in clinical trials of DPN. Multifactorial risk factor reduction, targeting glycaemia, blood pressure and lipids can reduce the progression of DPN and AN. Treatment of painful DPN reduces painful symptoms by about 50% at best, but there is limited efficacy with any single agent. This reflects the complex aetiology of painful DPN and argues for improved clinical phenotyping with the use of targeted therapy, taking into account co-morbid conditions such as anxiety, depression and sleep disturbance.
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Affiliation(s)
- Shazli Azmi
- Institute of Cardiovascular Sciences, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Manchester Diabetes Centre, Manchester University Foundation Trust, Manchester, UK
| | | | - Maryam Ferdousi
- Institute of Cardiovascular Sciences, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Uazman Alam
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.,Department of Diabetes and Endocrinology, Royal Liverpool and Broadgreen University NHS Hospital Trust, Liverpool, UK
| | - Rayaz A Malik
- Institute of Cardiovascular Sciences, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
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16
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Azmi S, Ferdousi M, Kalteniece A, Al-Muhannadi H, Al-Mohamedi A, Hadid NH, Mahmoud S, Bhat HA, Gad HYA, Khan A, Ponirakis G, Petropoulos IN, Alam U, Malik RA. Diagnosing and managing diabetic somatic and autonomic neuropathy. Ther Adv Endocrinol Metab 2019; 10:2042018819826890. [PMID: 30783521 PMCID: PMC6365998 DOI: 10.1177/2042018819826890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/07/2019] [Indexed: 12/16/2022] Open
Abstract
The diagnosis and management of diabetic neuropathy can be a major challenge. Late diagnosis contributes to significant morbidity in the form of painful diabetic neuropathy, foot ulceration, amputation, and increased mortality. Both hyperglycaemia and cardiovascular risk factors are implicated in the development of somatic and autonomic neuropathy and an improvement in these risk factors can reduce their rate of development and progression. There are currently no US Food and Drug Administration (FDA)-approved disease-modifying treatments for either somatic or autonomic neuropathy, as a consequence of multiple failed phase III clinical trials. While this may be partly attributed to premature translation, there are major shortcomings in trial design and outcome measures. There are a limited number of partially effective FDA-approved treatments for the symptomatic relief of painful diabetic neuropathy and autonomic neuropathy.
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Affiliation(s)
- Shazli Azmi
- Institute of Cardiovascular Sciences, University of Manchester and Central Manchester NHS Foundation Trust, Manchester, UK
| | - Maryam Ferdousi
- Institute of Cardiovascular Sciences, University of Manchester and Central Manchester NHS Foundation Trust, Manchester, UK
| | - Alise Kalteniece
- Institute of Cardiovascular Sciences, University of Manchester and Central Manchester NHS Foundation Trust, Manchester, UK
| | | | | | | | - Salah Mahmoud
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Harun A. Bhat
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Hoda Y. A. Gad
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Adnan Khan
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | | | - Uazman Alam
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
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17
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Grayston R, Czanner G, Elhadd K, Goebel A, Frank B, Üçeyler N, Malik RA, Alam U. A systematic review and meta-analysis of the prevalence of small fiber pathology in fibromyalgia: Implications for a new paradigm in fibromyalgia etiopathogenesis. Semin Arthritis Rheum 2018; 48:933-940. [PMID: 30314675 DOI: 10.1016/j.semarthrit.2018.08.003] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/01/2018] [Accepted: 08/14/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Fibromyalgia is a condition which exhibits chronic widespread pain with neuropathic pain features and has a major impact on health-related quality of life. The pathophysiology remains unclear, however, there is increasing evidence for involvement of the peripheral nervous system with a high prevalence of small fiber pathology (SFP). The aim of this systematic literature review is to establish the prevalence of SFP in fibromyalgia. METHODS An electronic literature search was performed using MEDLINE, EMBASE, PubMed, Web of Science, CINAHL and the Cochrane Library databases. Published full-text, English language articles that provide SFP prevalence data in studies of fibromyalgia of patients over 18years old were included. All articles were screened by two independent reviewers using a priori criteria. Methodological quality and risk of bias were evaluated using the critical appraisal tool by Munn et al. Overall and subgroup pooled prevalence were calculated by random-effects meta-analysis with 95% CI. RESULTS Database searches found 935 studies; 45 articles were screened of which 8 full text articles satisfied the inclusion criteria, providing data from 222 participants. The meta-analysis demonstrated the pooled prevalence of SFP in fibromyalgia is 49% (95% CI: 38-60%) with a moderate degree of heterogeneity, (I2 = 68%). The prevalence estimate attained by a skin biopsy was 45% (95% CI: 32-59%, I2 = 70%) and for corneal confocal microscopy it was 59% (95% CI: 40-78%, I2 = 51%). CONCLUSION There is a high prevalence of SFP in fibromyalgia. This study provides compelling evidence of a distinct phenotype involving SFP in fibromyalgia. Identifying SFP will aid in determining its relationship to pain and potentially facilitate the development of future interventions and pharmacotherapy.
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Affiliation(s)
- Rebecca Grayston
- Department of Eye & Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Gabriela Czanner
- Department of Eye & Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK; Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Kareim Elhadd
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andreas Goebel
- The Pain Research Institute, University of Liverpool and The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Bernhard Frank
- The Pain Research Institute, University of Liverpool and The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Nurcan Üçeyler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | | | - Uazman Alam
- Department of Eye & Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK; Diabetes & Endocrinology Research & Pain Research Institute, Department of Eye & Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK; Department of Diabetes and Endocrinology, Royal Liverpool and Broadgreen University NHS Hospital Trust, Liverpool, UK; Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, UK.
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18
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Abraham A, Barnett C, Katzberg HD, Lovblom LE, Perkins BA, Bril V. Nerve function varies with hemoglobin A1c in controls and type 2 diabetes. J Diabetes Complications 2018; 32:424-428. [PMID: 29422233 DOI: 10.1016/j.jdiacomp.2017.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/02/2017] [Accepted: 12/17/2017] [Indexed: 11/26/2022]
Abstract
AIMS To determine the cross-sectional threshold at which hemoglobin A1c (HbA1c) is associated with polyneuropathy in healthy controls, and the values associated with the most pronounced decline in nerve function in patients with diabetes. METHODS We used data from a cross-sectional cohort study of healthy controls and type 2 diabetes patients assessed between November 2010 and May 2013. Healthy controls and patients with diabetes were compared at different HbA1c ranges: <5.5%, 5.5-5.9%, and 6-6.4% for controls, and 6.5-7.4% and >7.5% for patients with diabetes. RESULTS The total cohort included 53 controls and 164 patients with diabetes. Subclinical small nerve fiber impairments were observed in controls at HbA1c levels of 5.5-6%, compared with HbA1c <5.5%, for example: lower Laser Doppler flare imaging area of 2.8 ± 1.4 versus 3.9 ± 2 mm2. The most prominent decline in both small and large nerve fiber function was seen with less impaired glycemic control and shorter duration of diabetes, i.e. at HbA1c levels of 6.5-7.4%, compared with >7.5%. CONCLUSIONS These findings underscore the importance of early treatment at the prediabetes and early diabetes stages to prevent nerve fiber decline that is likely irreversible.
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Affiliation(s)
- Alon Abraham
- Neuromuscular Service of the Department of Neurology, Tel Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carolina Barnett
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Hans D Katzberg
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Leif E Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, Sinai Health System, Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Bruce A Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, Sinai Health System, Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.
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19
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Abstract
OBJECTIVE We report the results of a pilot, enrichment-design, placebo-controlled crossover trial of pregabalin for the treatment of prediabetic small-fiber neuropathic pain. METHODS Individuals with impaired fasting glucose or impaired glucose tolerance and neuropathic pain were evaluated according to UTAH Early Neuropathy Scale (UENS), Quantitative Sensory Testing, and intraepidermal nerve fiber density (IENFD). Symptoms were graded according to the Numeric Rating Scale (NRS). Individuals who responded to the administration of placebo were not eligible. Pregabalin was initiated at a dose of 75 mg qid and tapered up to 300 mg bid. Only individuals with a reduction of pain scores ≥30% were eligible to continue with the double-blind phase, which consisted of a randomized crossover period of 1 month of pregabalin and 1 month of placebo, with 7 days of washout between periods. RESULTS Forty-five participants were enrolled in the study. There was 36% reduction in the NRS from baseline after 1 month of single-blind pregabalin (NRS=5.1±2.6). Twenty-six participants were eligible for the double-blind phase. There was further reduction of pain in the double-blind pregabalin and the placebo groups, but the pregabalin group had a statistically significant reduction of pain (NRS=3.2±2.2 vs. 4.0±2; P<0.05). Participants who did not respond showed a lower IENFD than those who responded, suggesting more severe nerve damage. CONCLUSIONS This pilot study showed improvement of prediabetic neuropathic pain. Participants with higher pain scores at baseline had higher UENS scores and a lower IENFD. Limitations of the study include the small number of participants and the carry-over effect.
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20
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Orosz A, Baczkó I, Nyiraty S, Körei AE, Putz Z, Takács R, Nemes A, Várkonyi TT, Balogh L, Ábrahám G, Kempler P, Papp JG, Varró A, Lengyel C. Increased Short-Term Beat-to-Beat QT Interval Variability in Patients with Impaired Glucose Tolerance. Front Endocrinol (Lausanne) 2017; 8:129. [PMID: 28659867 PMCID: PMC5468431 DOI: 10.3389/fendo.2017.00129] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 05/29/2017] [Indexed: 01/02/2023] Open
Abstract
Prediabetic states and diabetes are important risk factors for cardiovascular morbidity and mortality. Determination of short-term QT interval variability (STVQT) is a non-invasive method for assessment of proarrhythmic risk. The aim of the study was to evaluate the STVQT in patients with impaired glucose tolerance (IGT). 18 IGT patients [age: 63 ± 11 years, body mass index (BMI): 31 ± 6 kg/m2, fasting glucose: 6.0 ± 0.4 mmol/l, 120 min postload glucose: 9.0 ± 1.0 mmol/l, hemoglobin A1c (HbA1c): 5.9 ± 0.4%; mean ± SD] and 18 healthy controls (age: 56 ± 9 years, BMI: 27 ± 5 kg/m2, fasting glucose: 5.2 ± 0.4 mmol/l, 120 min postload glucose: 5.5 ± 1.3 mmol/l, HbA1c: 5.4 ± 0.3%) were enrolled into the study. ECGs were recorded, processed, and analyzed off-line. The RR and QT intervals were expressed as the average of 30 consecutive beats, the temporal instability of beat-to-beat repolarization was characterized by calculating STVQT as follows: STVQT = Σ|QTn + 1 - QTn| (30x√2)-1. Autonomic function was assessed by means of standard cardiovascular reflex tests. There were no differences between IGT and control groups in QT (411 ± 43 vs 402 ± 39 ms) and QTc (431 ± 25 vs 424 ± 19 ms) intervals or QT dispersion (44 ± 13 vs 42 ± 17 ms). However, STVQT was significantly higher in IGT patients (5.0 ± 0.7 vs 3.7 ± 0.7, P < 0.0001). The elevated temporal STVQT in patients with IGT may be an early indicator of increased instability of cardiac repolarization during prediabetic conditions.
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Affiliation(s)
- Andrea Orosz
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Szabolcs Nyiraty
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna E. Körei
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Putz
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Róbert Takács
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- Second Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | | | - László Balogh
- Juhász Gyula Faculty of Education, Institute of Physical Education and Sport Science, University of Szeged, Szeged, Hungary
| | - György Ábrahám
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Kempler
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Julius Gy. Papp
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - András Varró
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - Csaba Lengyel
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- First Department of Medicine, University of Szeged, Szeged, Hungary
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21
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Scarr D, Lovblom LE, Ostrovski I, Kelly D, Wu T, Farooqi MA, Halpern EM, Ngo M, Ng E, Orszag A, Bril V, Perkins BA. Agreement between automated and manual quantification of corneal nerve fiber length: Implications for diabetic neuropathy research. J Diabetes Complications 2017; 31:1066-1073. [PMID: 28347694 DOI: 10.1016/j.jdiacomp.2016.07.024] [Citation(s) in RCA: 21] [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: 03/29/2016] [Revised: 06/24/2016] [Accepted: 07/22/2016] [Indexed: 11/22/2022]
Abstract
AIMS Quantification of corneal nerve fiber length (CNFL) by in vivo corneal confocal microscopy represents a promising diabetic neuropathy biomarker, but applicability is limited by resource-intensive image analysis. We aimed to evaluate, in cross-sectional analysis of non-diabetic controls and patients with type 1 and type 2 diabetes with and without neuropathy, the agreement between manual and automated analysis protocols. METHODS Sixty-eight controls, 139 type 1 diabetes, and 249 type 2 diabetes participants underwent CNFL measurement (N=456). Neuropathy status was determined by clinical and electrophysiological criteria. CNFL was determined by manual (CNFLManual, reference standard) and automated (CNFLAuto) protocols, and results were compared for correlation and agreement using Spearman coefficients and the method of Bland and Altman (CNFLManual subtracted from CNFLAuto). RESULTS Participants demonstrated broad variability in clinical characteristics associated with neuropathy. The mean age, diabetes duration, and HbA1c were 53±18years, 15.9±12.6years, and 7.4±1.7%, respectively, and 218 (56%) individuals with diabetes had neuropathy. Mean CNFLManual was 15.1±4.9mm/mm2, and mean CNFLAuto was 10.5±3.7mm/mm2 (CNFLAuto underestimation bias, -4.6±2.6mm/mm2 corresponding to -29±17%). Percent bias was similar across non-diabetic controls (-33±12%), type 1 (-30±20%), and type 2 diabetes (-28±16%) subgroups (ANOVA, p=0.068), and similarly in diabetes participants with and without neuropathy. Levels of CNFLAuto and CNFLManual were both inversely associated with neuropathy status. CONCLUSIONS Although CNFLAuto substantially underestimated CNFLManual, its bias was non-differential between diverse patient groups and its relationship with neuropathy status was preserved. Determination of diagnostic thresholds specific to CNFLAuto should be pursued in diagnostic studies of diabetic neuropathy.
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MESH Headings
- Adult
- Aged
- Case-Control Studies
- Cornea/innervation
- Cornea/pathology
- Cross-Sectional Studies
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/pathology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/pathology
- Diabetic Neuropathies/diagnosis
- Diabetic Neuropathies/pathology
- Diabetic Retinopathy/diagnosis
- Diabetic Retinopathy/pathology
- Diagnostic Techniques, Ophthalmological
- Female
- Humans
- Image Processing, Computer-Assisted/methods
- Male
- Microscopy, Confocal
- Middle Aged
- Nerve Fibers/pathology
- Pattern Recognition, Automated/methods
- Physical Examination/methods
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Affiliation(s)
- Daniel Scarr
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Leif E Lovblom
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ilia Ostrovski
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Dylan Kelly
- Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Tong Wu
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mohammed A Farooqi
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Elise M Halpern
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mylan Ngo
- The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Krembil Neuroscience Centre, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eduardo Ng
- The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Krembil Neuroscience Centre, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrej Orszag
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Vera Bril
- The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Krembil Neuroscience Centre, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
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Dimova R, Tankova T, Chakarova N, Grozeva G, Dakovska L. Cardio-metabolic profile of subjects with early stages of glucose intolerance and cardiovascular autonomic dysfunction. Diabetes Res Clin Pract 2017; 126:115-121. [PMID: 28242436 DOI: 10.1016/j.diabres.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/02/2017] [Indexed: 01/25/2023]
Abstract
AIMS The present study evaluates the cardio-metabolic profile of subjects with early stages of glucose intolerance and presence of cardiovascular autonomic dysfunction (CAD). MATERIALS AND METHODS 478 subjects, of mean age 49.3±13.7years and mean BMI 31.0±6.2kg/m2, divided according to glucose tolerance: 130 with normal glucose tolerance, 227 with prediabetes, and 121 with newly-diagnosed type 2 diabetes, were enrolled. Glucose tolerance was studied during OGTT applying 2006 WHO criteria. Anthropometric indices, blood pressure, HbA1c, serum lipids, hsCRP, and albumin-to-creatinine ratio (ACR) were measured. Body fat distribution was estimated by a bioimpedance method (InBody720, BioSpace). Tissue AGEs accumulation was assessed by skin autofluorescence (AGE-Reader-DiagnOptics™). CAD was assessed by ANX-3.0 method. RESULTS CAD was found in 24.1% of subjects with any disorder of glucose tolerance in comparison to 12.3% in NGT, OR 2.0 (95% CI: 1.2-3.2), p=0.005. Sympathetic and parasympathetic tone declined with the progression of glucose intolerance. Age, waist circumference, visceral fat area, fasting and 120-min plasma glucose, HbA1c, AGEs, ACR and QTc interval were higher in subjects with CAD, p<0.05. In a logistic regression analysis the panel of age >53years (76% sensitivity, 61% specificity), HbA1c >6.0% (66% sensitivity, 60% specificity), QTc interval >423ms (65% sensitivity, 61% specificity) and presence of arterial hypertension (83% sensitivity, 55% specificity) was related to the presence of CAD - AUC 0.778 (95% CI: 0.73-0.83), p<0.001. CONCLUSION Our results demonstrate a high prevalence of CAD in early stages of glucose dysmetabolism. Age, HbA1c, QTc interval and presence of arterial hypertension are related to the presence of CAD in this population.
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Affiliation(s)
- Rumyana Dimova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, 2, Zdrave Str., Sofia 1431, Bulgaria.
| | - Tsvetalina Tankova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, 2, Zdrave Str., Sofia 1431, Bulgaria
| | - Nevena Chakarova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, 2, Zdrave Str., Sofia 1431, Bulgaria
| | - Greta Grozeva
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, 2, Zdrave Str., Sofia 1431, Bulgaria
| | - Lilia Dakovska
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, 2, Zdrave Str., Sofia 1431, Bulgaria
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Krentz AJ, Hompesch M. Glucose: archetypal biomarker in diabetes diagnosis, clinical management and research. Biomark Med 2016; 10:1153-1166. [DOI: 10.2217/bmm-2016-0170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The clinical utility of diabetes biomarkers can be considered in terms of diagnosis, management and prediction of long-term vascular complications. Glucose satisfies all of these requirements. Thresholds of hyperglycemia diagnostic of diabetes reflect inflections that confer a risk of developing long-term microvascular complications. Degrees of hyperglycemia (impaired fasting glucose, impaired glucose tolerance) that lie below the diagnostic threshold for diabetes identify individuals at risk of progression to diabetes and/or development of atherothrombotic cardiovascular disease. Self-measured glucose levels usefully complement hemoglobin A1c levels to guide daily management decisions. Continuous glucose monitoring provides detailed real-time data that is of value in clinical decision making, assessing response to new diabetes drugs and the development of closed-loop artificial pancreas technology.
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Affiliation(s)
- Andrew J Krentz
- Institute for Translational Medicine, Clore Life Sciences, University of Buckingham, Hunter Street, Buckingham, MK18 1EG, UK
- Profil Institute for Clinical Research, 855 3rd Avenue Suite 4400, Chula Vista, CA 91911, USA
| | - Marcus Hompesch
- Profil Institute for Clinical Research, 855 3rd Avenue Suite 4400, Chula Vista, CA 91911, USA
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24
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Lang M, Treister R, Oaklander AL. Diagnostic value of blood tests for occult causes of initially idiopathic small-fiber polyneuropathy. J Neurol 2016; 263:2515-2527. [PMID: 27730378 DOI: 10.1007/s00415-016-8270-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/14/2022]
Abstract
Small-fiber polyneuropathy (SFPN) causes non-specific symptoms including chronic pain, cardiovascular, gastrointestinal, and sweating complaints. Diagnosis is made from history and exam in patients with known risk factors such as diabetes, but objective test confirmation is recommended for patients without known risks. If tests confirm SFPN, and it is "initially idiopathic" (iiSFPN), screening for occult causes is indicated. This study's aim was to evaluate the 21 widely available, recommended blood tests to identify the most cost-effective ones and to learn about occult causes of iiSFPN. Records were reviewed from all 213 patients with SFPN confirmed by distal-leg skin biopsy, nerve biopsy, or autonomic-function testing in our academic center during 2013. We determined the prevalence of each abnormal blood-test result (ABTR) in the iiSFPN cohort, compared this to population averages, and measured the costs of screening subjects to obtain one ABTR. Participants were 70 % female and aged 43.0 ± 18.6 years. High erythrocyte sedimentation rate (ESR) and antinuclear antibody (ANA; ≥1:160 titer) were most common, each present in 28 % of subjects. The ABTR ≥3 × more prevalent in iiSFPN than in the total population were high ESR, high ANA, low C3, and Sjögren's and celiac autoantibodies. Together, these suggest the possibility of a specific association between iiSFPN and dysimmunity. ABTR identifying diabetes, prediabetes, and hypertriglyceridemia were less common in iiSFPN than in the population and thus were not associated with iiSFPN here. The six most cost-effective iiSFPN-associated blood tests-ESR, ANA, C3, autoantibodies for Sjögren's and celiac, plus thyroid-stimulating hormone-had estimated cost of $99.57/person and 45.6 % probability of obtaining one abnormal result. Angiotensin-converting enzyme was elevated in 45 %, but no patients had sarcoidosis, so this test was futile here.
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Affiliation(s)
- Magdalena Lang
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 275 Charles St./Warren Bldg. 310, Boston, MA, 02114, USA
| | - Roi Treister
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 275 Charles St./Warren Bldg. 310, Boston, MA, 02114, USA
| | - Anne Louise Oaklander
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 275 Charles St./Warren Bldg. 310, Boston, MA, 02114, USA. .,Department of Pathology (Neuropathology), Massachusetts General Hospital, Boston, MA, 02114, USA.
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25
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Abstract
The study of diabetic neuropathy has relied primarily on the use of streptozotocin-treated rat and mouse models of type 1 diabetes. This chapter will review the creation and use of other rodent models that have been developed in order to investigate the contribution of factors besides insulin deficiency to the development and progression of diabetic neuropathy as it occurs in obesity, type 1 or type 2 diabetes. Diabetic peripheral neuropathy is a complex disorder with multiple mechanisms contributing to its development and progression. Even though many animal models have been developed and investigated, no single model can mimic diabetic peripheral neuropathy as it occurs in humans. Nonetheless, animal models can play an important role in improving our understanding of the etiology of diabetic peripheral neuropathy and in performing preclinical screening of potential new treatments. To date treatments found to be effective for diabetic peripheral neuropathy in rodent models have failed in clinical trials. However, with the identification of new endpoints for the early detection of diabetic peripheral neuropathy and the understanding that a successful treatment may require a combination therapeutic approach there is hope that an effective treatment will be found.
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Affiliation(s)
- M A Yorek
- Iowa City Health Care System, Iowa City, IA, United States; University of Iowa, Iowa City, IA, United States; Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, United States.
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26
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Reproducibility of In Vivo Corneal Confocal Microscopy Using an Automated Analysis Program for Detection of Diabetic Sensorimotor Polyneuropathy. PLoS One 2015; 10:e0142309. [PMID: 26539984 PMCID: PMC4634969 DOI: 10.1371/journal.pone.0142309] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/19/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE In vivo Corneal Confocal Microscopy (IVCCM) is a validated, non-invasive test for diabetic sensorimotor polyneuropathy (DSP) detection, but its utility is limited by the image analysis time and expertise required. We aimed to determine the inter- and intra-observer reproducibility of a novel automated analysis program compared to manual analysis. METHODS In a cross-sectional diagnostic study, 20 non-diabetes controls (mean age 41.4±17.3y, HbA1c 5.5±0.4%) and 26 participants with type 1 diabetes (42.8±16.9y, 8.0±1.9%) underwent two separate IVCCM examinations by one observer and a third by an independent observer. Along with nerve density and branch density, corneal nerve fibre length (CNFL) was obtained by manual analysis (CNFLMANUAL), a protocol in which images were manually selected for automated analysis (CNFLSEMI-AUTOMATED), and one in which selection and analysis were performed electronically (CNFLFULLY-AUTOMATED). Reproducibility of each protocol was determined using intraclass correlation coefficients (ICC) and, as a secondary objective, the method of Bland and Altman was used to explore agreement between protocols. RESULTS Mean CNFLManual was 16.7±4.0, 13.9±4.2 mm/mm2 for non-diabetes controls and diabetes participants, while CNFLSemi-Automated was 10.2±3.3, 8.6±3.0 mm/mm2 and CNFLFully-Automated was 12.5±2.8, 10.9 ± 2.9 mm/mm2. Inter-observer ICC and 95% confidence intervals (95%CI) were 0.73(0.56, 0.84), 0.75(0.59, 0.85), and 0.78(0.63, 0.87), respectively (p = NS for all comparisons). Intra-observer ICC and 95%CI were 0.72(0.55, 0.83), 0.74(0.57, 0.85), and 0.84(0.73, 0.91), respectively (p<0.05 for CNFLFully-Automated compared to others). The other IVCCM parameters had substantially lower ICC compared to those for CNFL. CNFLSemi-Automated and CNFLFully-Automated underestimated CNFLManual by mean and 95%CI of 35.1(-4.5, 67.5)% and 21.0(-21.6, 46.1)%, respectively. CONCLUSIONS Despite an apparent measurement (underestimation) bias in comparison to the manual strategy of image analysis, fully-automated analysis preserves CNFL reproducibility. Future work must determine the diagnostic thresholds specific to the fully-automated measure of CNFL.
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Jaiswal M, Martin CL, Brown MB, Callaghan B, Albers JW, Feldman EL, Pop-Busui R. Effects of exenatide on measures of diabetic neuropathy in subjects with type 2 diabetes: results from an 18-month proof-of-concept open-label randomized study. J Diabetes Complications 2015; 29:1287-94. [PMID: 26264399 PMCID: PMC4656068 DOI: 10.1016/j.jdiacomp.2015.07.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/10/2015] [Accepted: 07/11/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Experimental studies have reported potential benefit of glucagon-like peptide-1(GLP-1) receptor agonists in preventing diabetic peripheral neuropathy (DPN). We therefore performed a proof-of-concept pilot study to evaluate the effect of exenatide, a GLP-1 agonist, on measures of DPN and cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Forty-six T2D subjects (age 54±10years, diabetes duration 8±5years, HbA1c 8.2±1.3%) with mild to moderate DPN at baseline were randomized to receive either twice daily exenatide (n=22) or daily insulin glargine (n=24). The subjects, with similar HbA1c levels, were followed for 18months. The primary end point was the prevalence of confirmed clinical neuropathy (CCN). Changes in measures of CAN, other measures of small fiber neuropathy such as intra-epidermal nerve fiber density (IENFD), and quality of life were also analyzed. RESULTS Glucose control was similar in both groups during the study. There were no statistically significant treatment group differences in the prevalence of CCN, IENFD, measures of CAN, nerve conductions studies, or quality of life indices. CONCLUSIONS In this pilot study of patients with T2D and mild to moderate DPN, 18months of exenatide treatment had no significant effect on measures of neuropathy compared with glargine treatment.
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Affiliation(s)
- Mamta Jaiswal
- Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Catherine L Martin
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Morton B Brown
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Brian Callaghan
- Department of Neurology, University of Michigan, Ann Arbor, MI
| | - James W Albers
- Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
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Bowling FL, Rashid ST, Boulton AJM. Preventing and treating foot complications associated with diabetes mellitus. Nat Rev Endocrinol 2015; 11:606-16. [PMID: 26284447 DOI: 10.1038/nrendo.2015.130] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Diabetes mellitus is associated with a series of macrovascular and microvascular changes that can manifest as a wide range of complications. Foot ulcerations affect ∼2-4% of patients with diabetes mellitus. Risk factors for foot lesions include peripheral and autonomic neuropathy, vascular disease and previous foot ulceration, as well as other microvascular complications, such as retinopathy and end-stage renal disease. Ulceration is the result of a combination of components that together lead to tissue breakdown. The most frequently occurring causal pathways to the development of foot ulcers include peripheral neuropathy and vascular disease, foot deformity or trauma. Peripheral vascular disease is often not diagnosed in patients with diabetes mellitus until tissue loss is evident, usually in the form of a nonhealing ulcer. Identification of patients with diabetes mellitus who are at high risk of ulceration is important and can be achieved via annual foot screening with subsequent multidisciplinary foot-care interventions. Understanding the factors that place patients with diabetes mellitus at high risk of ulceration, together with an appreciation of the links between different aspects of the disease process, is essential to the prevention and management of diabetic foot complications.
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Affiliation(s)
- Frank L Bowling
- Manchester Royal Infirmary, University of Manchester, 193 Hathersage Road, Manchester M13 0JE, UK
| | - S Tawqeer Rashid
- Manchester Royal Infirmary, University of Manchester, 193 Hathersage Road, Manchester M13 0JE, UK
| | - Andrew J M Boulton
- Manchester Royal Infirmary, University of Manchester, 193 Hathersage Road, Manchester M13 0JE, UK
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29
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Ince H, Taşdemir HA, Aydin M, Ozyürek H, Tilki HE. Evaluation of Nerve Conduction Studies in Obese Children With Insulin Resistance or Impaired Glucose Tolerance. J Child Neurol 2015; 30:989-99. [PMID: 25342307 DOI: 10.1177/0883073814550188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 08/07/2014] [Indexed: 01/22/2023]
Abstract
The aim of the study was to investigate nerve conduction studies in terms of neuropathic characteristics in obese patients who were in prediabetes stage and also to determine the abnormal findings. The study included 69 obese adolescent patients between April 2009 and December 2010. All patients and control group underwent motor (median, ulnar, tibial, and peroneal) and sensory (median, ulnar, sural, and medial plantar) nerve conduction studies and sympathetic skin response test. Sensory response amplitude of the medial plantar nerve was significantly lower in the patients with impaired glucose tolerance and insulin resistance. To our knowledge, the present study is the first study demonstrating the development of sensory and autonomic neuropathy due to metabolic complications of obesity in adolescent children even in the period without development of diabetes mellitus. We recommend that routine electrophysiological examinations be performed, using medial plantar nerve conduction studies and sympathetic skin response test.
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Affiliation(s)
- Hülya Ince
- Department of Pediatric Neurology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Haydar Ali Taşdemir
- Department of Pediatric Neurology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Murat Aydin
- Department of Pediatric Endocrinology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Hamit Ozyürek
- Department of Pediatric Neurology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Hacer Erdem Tilki
- Department of Neurology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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30
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Lovblom LE, Halpern EM, Wu T, Kelly D, Ahmed A, Boulet G, Orszag A, Ng E, Ngo M, Bril V, Perkins BA. In vivo corneal confocal microscopy and prediction of future-incident neuropathy in type 1 diabetes: a preliminary longitudinal analysis. Can J Diabetes 2015; 39:390-7. [PMID: 25936902 DOI: 10.1016/j.jcjd.2015.02.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In vivo corneal confocal microscopy (IVCCM) has been established in cross-sectional studies as a valid measure for the identification of diabetic sensorimotor polyneuropathy (DSP). We aimed to determine the predictive validity of a baseline IVCCM measure in identifying future DSP onset in patients with type 1 diabetes. METHODS We followed 65 patients with type 1 diabetes without DSP at baseline. They were followed longitudinally for a mean of 3.5±0.9 years and underwent IVCCM, clinical and electrophysiologic examinations at baseline and follow up. At the end of follow up, participants were assigned as new-onset cases of DSP or as controls. Predictive validity was assessed using receiver operating characteristic curves. RESULTS At baseline, participants were 34±15 years of age with mean diabetes duration of 18±12 years. The 11 (17%) new-onset cases of DSP were similar to the 54 (83%) controls in baseline age, diabetes duration, gender, glycated hemoglobin levels and electrophysiologic parameters (p≥0.20). However, cases of new onset had significantly lower baseline corneal nerve fibre length (CNFL) and branch density (p<0.05). For identification of new-onset cases, area under the receiver operating characteristic curve for CNFL was 0.78 with an optimal threshold of 14.9 mm/mm(2) (sensitivity=0.82, specificity=0.69). CONCLUSIONS Despite similar clinical and electrophysiologic parameters, participants with type 1 diabetes at risk for future DSP had significantly lower baseline IVCCM measures. CNFL may have applicability in identifying high-risk patients for therapeutic intervention in clinical research and practice.
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Affiliation(s)
- Leif E Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elise M Halpern
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tong Wu
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dylan Kelly
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ausma Ahmed
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Genevieve Boulet
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrej Orszag
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eduardo Ng
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mylan Ngo
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vera Bril
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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31
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Abu-Qamar MZ. Diabetic foot examination: findings of a screening survey performed in Jordan. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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32
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Lysy Z, Lovblom LE, Halpern EM, Ngo M, Ng E, Orszag A, Breiner A, Bril V, Perkins BA. Measurement of cooling detection thresholds for identification of diabetic sensorimotor polyneuropathy in type 1 diabetes. PLoS One 2014; 9:e106995. [PMID: 25216179 PMCID: PMC4162569 DOI: 10.1371/journal.pone.0106995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/06/2014] [Indexed: 12/22/2022] Open
Abstract
Objective Compared to recently-studied novel morphological measures, conventional small nerve fiber functional tests have not been systematically studied for identification of diabetic sensorimotor polyneuropathy (DSP). We aimed to determine and compare the diagnostic performance of cooling detection thresholds (CDT) in a cross-sectional type 1 diabetes cohort. Research Design and Methods 136 subjects with type 1 diabetes and 52 healthy volunteers underwent clinical and electrophysiological examination for DSP classification concomitantly with the Toronto Clinical Neuropathy Score (TCNS) and three small fiber function tests: CDT, heart rate variability (HRV), and laser doppler imaging of axon-mediated neurogenic flare responses to cutaneous heating (LDIFLARE). Area under the curve (AUC) and optimal thresholds were determined by receiver operating characteristic (ROC) curves in the type 1 diabetes cohort. Results Type 1 diabetes subjects were 42±17 years of age with mean HbA1c 7.9±1.7%. Fifty-nine (45%) met the case definition for DSP. CDT values were lowest in cases with DSP (18.3±8.4°C) compared to controls without DSP (28.4±3.5°C) and to healthy volunteers (29.6±1.8°C; p-value for both comparisons<0.0001). AUCCDT was 0.863 which was similar to AUCTCNS (0.858, p = 0.24) and AUCHRV (0.788, p = 0.05), but exceeded AUCLDIFLARE (0.750, p = 0.001). The threshold of <25.1°C was equivalent to the lower bound of the healthy volunteer 95% distribution [25.1, 30.8°C] and performed with 83% sensitivity and 82% specificity. Conclusions Akin to novel small fiber morphological measures, CDT is a functional test that identifies DSP with very good diagnostic performance. These findings support further research that revisits the role of CDT in early DSP detection.
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Affiliation(s)
- Zoe Lysy
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Leif E Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elise M Halpern
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mylan Ngo
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eduardo Ng
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrej Orszag
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ari Breiner
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vera Bril
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Spa adjuvant therapy improves diabetic lower extremity arterial disease. Complement Ther Med 2014; 22:655-61. [DOI: 10.1016/j.ctim.2014.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 04/09/2014] [Accepted: 05/04/2014] [Indexed: 01/16/2023] Open
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Dunn TN, Adams SH. Relations between metabolic homeostasis, diet, and peripheral afferent neuron biology. Adv Nutr 2014; 5:386-93. [PMID: 25022988 PMCID: PMC4085187 DOI: 10.3945/an.113.005439] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
It is well established that food intake behavior and energy balance are regulated by crosstalk between peripheral organ systems and the central nervous system (CNS), for instance, through the actions of peripherally derived leptin on hindbrain and hypothalamic loci. Diet- or obesity-associated disturbances in metabolic and hormonal signals to the CNS can perturb metabolic homeostasis bodywide. Although interrelations between metabolic status and diet with CNS biology are well characterized, afferent networks (those sending information to the CNS from the periphery) have received far less attention. It is increasingly appreciated that afferent neurons in adipose tissue, the intestines, liver, and other tissues are important controllers of energy balance and feeding behavior. Disruption in their signaling may have consequences for cardiovascular, pancreatic, adipose, and immune function. This review discusses the diverse ways that afferent neurons participate in metabolic homeostasis and highlights how changes in their function associate with dysmetabolic states, such as obesity and insulin resistance.
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Affiliation(s)
- Tamara N. Dunn
- Graduate Group in Nutritional Biology and Department of Nutrition, University of California, Davis, CA; and
| | - Sean H. Adams
- Graduate Group in Nutritional Biology and Department of Nutrition, University of California, Davis, CA; and,Obesity and Metabolism Research Unit, USDA–Agricultural Research Service Western Human Nutrition Research Center, Davis, CA,To whom correspondence should be addressed. E-mail:
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35
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Hoeijmakers JGJ, Faber CG, Merkies ISJ, Waxman SG. Channelopathies, painful neuropathy, and diabetes: which way does the causal arrow point? Trends Mol Med 2014; 20:544-50. [PMID: 25008557 DOI: 10.1016/j.molmed.2014.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/09/2014] [Accepted: 06/12/2014] [Indexed: 12/13/2022]
Abstract
Diabetes mellitus, a major global health problem, is commonly associated with painful peripheral neuropathy, which can substantially erode quality of life. Despite its clinical importance, the pathophysiology of painful diabetic neuropathy is incompletely understood. It has traditionally been thought that diabetes may cause neuropathy in patients with appropriate genetic makeup. Here, we propose a hypothesis whereby painful neuropathy is not a complication of diabetes, but rather occurs as a result of mutations that, in parallel, confer vulnerability to injury in pancreatic β cells and pain-signaling dorsal root ganglion (DRG) neurons. We suggest that mutations of sodium channel NaV1.7, which is present in both cell types, may increase susceptibility for development of diabetes via β cell injury and produce painful neuropathy via a distinct effect on DRG neurons.
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Affiliation(s)
- Janneke G J Hoeijmakers
- Department of Neurology, Maastricht University Medical Center, Maastricht, 6202 AZ, The Netherlands
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Center, Maastricht, 6202 AZ, The Netherlands
| | - Ingemar S J Merkies
- Department of Neurology, Maastricht University Medical Center, Maastricht, 6202 AZ, The Netherlands; Department of Neurology, Spaarne Hospital, Hoofddorp, 2130 AT, The Netherlands
| | - Stephen G Waxman
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06515, USA; Center for Neuroscience and Regeneration Research, Veterans Affairs Medical Center, West Haven, CT 06515, USA.
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Celikbilek A, Tanik N, Sabah S, Borekci E, Akyol L, Ak H, Adam M, Suher M, Yilmaz N. Elevated neurofilament light chain (NFL) mRNA levels in prediabetic peripheral neuropathy. Mol Biol Rep 2014; 41:4017-22. [PMID: 24733614 DOI: 10.1007/s11033-014-3270-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 02/12/2014] [Indexed: 11/25/2022]
Abstract
Evidence suggests that peripheral nerve injury occurs during the early stages of disease with mild glycemic dysregulation. Two proteins, neuron-specific enolase (NSE) and neurofilament light chain (NFL), have been examined previously as possible markers of neuronal damage in the pathophysiology of neuropathies. Herein, we aimed to determine the potential value of circulatory NSE and NFL mRNA levels in prediabetic patients and in those with peripheral neuropathy. This prospective clinical study included 45 prediabetic patients and 30 age- and sex-matched controls. All prediabetic patients were assessed with respect to diabetes-related microvascular complications, such as peripheral neuropathy, retinopathy and nephropathy. mRNA levels of NSE and NFL were determined in the blood by real-time polymerase chain reaction. NSE mRNA levels were similar between prediabetic and control groups (p > 0.05), whereas NFL mRNA levels were significantly higher in prediabetics than in controls (p < 0.001). NSE mRNA levels did not significantly differ between prediabetic patients with and without peripheral neuropathy (p > 0.05), while NFL mRNA levels were significantly higher in prediabetics with peripheral neuropathy than in those without (p = 0.038). According to correlation analysis, NFL mRNA levels were positively correlated with the Douleur Neuropathique 4 questionnaire score in prediabetic patients (r = 0.302, p = 0.044). This is the first study to suggest blood NFL mRNA as a surrogate marker for early prediction of prediabetic peripheral neuropathy, while NSE mRNA levels may be of no diagnostic value in prediabetic patients.
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Affiliation(s)
- Asuman Celikbilek
- Department of Neurology, Medical School, Bozok University, 66200, Yozgat, Turkey,
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Abstract
More than half of all patients with diabetes develop neuropathic disorders affecting the distal sensory and/or motor nerves, or autonomic or cranial nerve functions. Glycemic control can decrease the incidence of neuropathy but is not adequate alone to prevent or treat the disease. This chapter introduces diabetic neuropathy with a morphological description of the disease then describes our current understanding of metabolic and molecular mechanisms that contribute to neurovascular dysfunctions. Key mechanisms include glucose and lipid imbalances and insulin resistance that are interconnected via oxidative stress, inflammation, and altered gene expression. These complex interactions should be considered for the development of new treatment strategies against the onset or progression of neuropathy. Advances in understanding the combined metabolic stressors and the novel study of epigenetics suggest new therapeutic targets to combat this morbid and intractable disease affecting millions of patients with type 1 or type 2 diabetes.
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Colberg SR, Vinik AI. Exercising with peripheral or autonomic neuropathy: what health care providers and diabetic patients need to know. PHYSICIAN SPORTSMED 2014; 42:15-23. [PMID: 24565817 DOI: 10.3810/psm.2014.02.2043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Both peripheral and autonomic neuropathies are characterized by a progressive loss of nerve fiber function. Most peripheral neuropathy affects the extremities, particularly the lower legs and the feet, but also the hands, whereas damage to the autonomic nervous system may lead to imbalances between the sympathetic and parasympathetic nerve fibers that innervate the heart and blood vessels, as well as abnormalities in heart rate control and vascular dynamics. To prescribe or engage in exercise that is both safe and effective, health care providers and patients with diabetes mellitus need to increase their understanding of the pathophysiological nature of neuropathies and the physical activity hurdles that may arise from the presence of a neuropathy. With proper care and preventative measures, patients with diabetes mellitus that experience either type of neuropathy can benefit from regular participation in mild to moderate aerobic, resistance, and balance activities, assuming they take any potential alterations into account to ensure that exercise is safe and effective.
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Affiliation(s)
- Sheri R Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, VA.
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Cortez M, Singleton JR, Smith AG. Glucose intolerance, metabolic syndrome, and neuropathy. ACTA ACUST UNITED AC 2014; 126:109-22. [DOI: 10.1016/b978-0-444-53480-4.00009-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Sveen KA, Karimé B, Jørum E, Mellgren SI, Fagerland MW, Monnier VM, Dahl-Jørgensen K, Hanssen KF. Small- and large-fiber neuropathy after 40 years of type 1 diabetes: associations with glycemic control and advanced protein glycation: the Oslo Study. Diabetes Care 2013; 36:3712-7. [PMID: 24026557 PMCID: PMC3816884 DOI: 10.2337/dc13-0788] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study large- and small-nerve fiber function in type 1 diabetes of long duration and associations with HbA1c and the advanced glycation end products (AGEs) N-ε-(carboxymethyl)lysine (CML) and methylglyoxal-derived hydroimidazolone. RESEARCH DESIGN AND METHODS In a long-term follow-up study, 27 persons with type 1 diabetes of 40 ± 3 years duration underwent large-nerve fiber examinations, with nerve conduction studies at baseline and years 8, 17, and 27. Small-fiber functions were assessed by quantitative sensory thresholds (QST) and intraepidermal nerve fiber density (IENFD) at year 27. HbA1c was measured prospectively through 27 years. Serum CML was measured at year 17 by immunoassay. Serum hydroimidazolone was measured at year 27 with liquid chromatography-mass spectrometry. RESULTS Sixteen patients (59%) had large-fiber neuropathy. Twenty-two (81%) had small-fiber dysfunction by QST. Heat pain thresholds in the foot were associated with hydroimidazolone and HbA1c. IENFD was abnormal in 19 (70%) and significantly lower in diabetic patients than in age-matched control subjects (4.3 ± 2.3 vs. 11.2 ± 3.5 mm, P < 0.001). IENFD correlated negatively with HbA1c over 27 years (r = -0.4, P = 0.04) and CML (r = -0.5, P = 0.01). After adjustment for age, height, and BMI in a multiple linear regression model, CML was still independently associated with IENFD. CONCLUSIONS Small-fiber sensory neuropathy is a major manifestation in type 1 diabetes of 40 years duration and more prevalent than large-fiber neuropathy. HbA1c and the AGEs CML and hydroimidazolone are important risk factors in the development of large- and small-fiber dysfunction in long-term type 1 diabetes.
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Yesil Y, Ugur-Altun B, Turgut N, Ozturk ZA, Kuyumcu ME, Yesil NK, Caner S, Balci K. Phrenic neuropathy in diabetic and prediabetic patients without neuromuscular complaint. Acta Diabetol 2013; 50:673-7. [PMID: 22286542 DOI: 10.1007/s00592-012-0371-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neuropathy, one of the major reasons of morbidity in diabetes mellitus (DM), is associated with prediabetic conditions as well as DM. The present study aims to compare phrenic and peripheral nerves in prediabetic, diabetic patients and healthy controls. A total of 37 diabetic, 40 prediabetic patients and 18 healthy controls were enrolled in the study. All subjects underwent conventional sensory and motor nerve conduction studies. Bilateral phrenic and peripheric nerve conduction studies were performed. In both right and left phrenic nerves, the amplitudes were lower in prediabetic and diabetic patients than control subjects, respectively (p: 0.005 and p: 0.001). Both of the phrenic nerve conductions were altered similarly. The results of our study demonstrate that phrenic nerves are affected like peripheric nerves in prediabetic and diabetic patients. We suggest reminding phrenic neuropathy in newly onset respiratory failure in diabetic and prediabetic patients.
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Affiliation(s)
- Yusuf Yesil
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
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Lu B, Hu J, Wen J, Zhang Z, Zhou L, Li Y, Hu R. Determination of peripheral neuropathy prevalence and associated factors in Chinese subjects with diabetes and pre-diabetes - ShangHai Diabetic neuRopathy Epidemiology and Molecular Genetics Study (SH-DREAMS). PLoS One 2013; 8:e61053. [PMID: 23613782 PMCID: PMC3628856 DOI: 10.1371/journal.pone.0061053] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/05/2013] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE This study determined the prevalence and factors associated with peripheral neuropathy (PN) in subjects with diabetes mellitus, impaired glucose regulation (IGR), and normal glucose tolerance (NGT) in a community-based Chinese population. RESEARCH DESIGN AND METHODS A total of 2035 subjects in Shanghai were classified as having NGT, IGR, or diabetes. All subjects underwent complete foot examination. PN was assessed according to the neuropathy symptom and neuropathy disability scores. Binary logistic regression was performed to analyze the contributions of factors to PN. RESULTS The prevalence of PN was 8.4%, 2.8%, and 1.5% in diabetes mellitus, IGR, and NGT subjects, respectively (P<0.05 for diabetes vs. NGT, and IGR). The subjects with known diabetes had the highest frequency of PN (13.1%). Among the subjects without diabetes, those with PN were older, had a higher waist circumference and 2-h postprandial plasma glucose levels, and were more likely to be hypertensive. Among the IGR subjects, other than age, the 2-h postprandial plasma glucose level was an independent factor significantly associated with PN. Meanwhile, among the subjects with diabetes, PN was associated with fasting plasma glucose, duration of diabetes, and decreased estimated glomerular filtration rate. CONCLUSIONS The prevalence of PN is slightly higher in individuals with IGR than that in individuals with NGT, but small fibre damage in IGR as the earliest nerve fibre deficit may be underestimated in our study. As an independent risk factor, postprandial plasma glucose level may be an important target for strategies to prevent or improve PN in IGR subjects.
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Affiliation(s)
- Bin Lu
- Department of Endocrinology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ji Hu
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Jian Wen
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Zhaoyun Zhang
- Department of Endocrinology, Huashan Hospital, Fudan University, Shanghai, China
| | - Linuo Zhou
- Department of Endocrinology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiming Li
- Department of Endocrinology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Endocrinology, Jing’An District Centre Hospital of Shanghai, Shanghai, China
| | - Renming Hu
- Department of Endocrinology, Huashan Hospital, Fudan University, Shanghai, China
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Xie F, Fu H, Hou JF, Jiao K, Costigan M, Chen J. High energy diets-induced metabolic and prediabetic painful polyneuropathy in rats. PLoS One 2013; 8:e57427. [PMID: 23451227 PMCID: PMC3581455 DOI: 10.1371/journal.pone.0057427] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/22/2013] [Indexed: 12/16/2022] Open
Abstract
To establish the role of the metabolic state in the pathogenesis of polyneuropathy, an age- and sex-matched, longitudinal study in rats fed high-fat and high-sucrose diets (HFSD) or high-fat, high-sucrose and high-salt diets (HFSSD) relative to controls was performed. Time courses of body weight, systolic blood pressure, fasting plasma glucose (FPG), insulin, free fatty acids (FFA), homeostasis model assessment-insulin resistance index (HOMA-IR), thermal and mechanical sensitivity and motor coordination were measured in parallel. Finally, large and small myelinated fibers (LMF, SMF) as well as unmyelinated fibers (UMF) in the sciatic nerves and ascending fibers in the spinal dorsal column were quantitatively assessed under electron microscopy. The results showed that early metabolic syndrome (hyperinsulinemia, dyslipidemia, and hypertension) and prediabetic conditions (impaired fasting glucose) could be induced by high energy diet, and these animals later developed painful polyneuropathy characterized by myelin breakdown and LMF loss in both peripheral and central nervous system. In contrast SMF and UMF in the sciatic nerves were changed little, in the same animals. Therefore the phenomenon that high energy diets induce bilateral mechanical, but not thermal, pain hypersensitivity is reflected by severe damage to LMF, but mild damage to SMF and UMF. Moreover, dietary sodium (high-salt) deteriorates the neuropathic pathological process induced by high energy diets, but paradoxically high salt consumption, may reduce, at least temporarily, chronic pain perception in these animals.
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Affiliation(s)
- Fang Xie
- Institute for Biomedical Sciences of Pain and Institute for Functional Brain Disorders, Tangdu Hospital, The Fourth Military Medical University, Xi'an, P. R. China
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Baum P, Petroff D, Classen J, Kiess W, Blüher S. Dysfunction of autonomic nervous system in childhood obesity: a cross-sectional study. PLoS One 2013; 8:e54546. [PMID: 23358101 PMCID: PMC3554723 DOI: 10.1371/journal.pone.0054546] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 12/14/2012] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To assess the distribution of autonomic nervous system (ANS) dysfunction in overweight and obese children. METHODS Parasympathetic and sympathetic ANS function was assessed in children and adolescents with no evidence of impaired glucose metabolism by analysis of heart rate variability (low frequency power ln(LF), high frequency power, ln(HF); ln(LF/HF) ratio, ratio of longest RR interval during expiration to shortest interval during inspiration (E/I ratio), root mean square of successive differences (RMSSD); sympathetic skin response (SSR); and quantitative pupillography (pupil diameter in darkness, light reflex amplitude, latency, constriction velocity, re-dilation velocity). The relationship of each ANS variable to the standard deviation score of body mass index (BMI-SDS) was assessed in a linear model considering age, gender and pubertal stage as co-variates and employing an F-statistic to compare the fit of nested models. Group comparisons between normal weight and obese children as well as an analysis of dependence on insulin resistance (as indexed by the Homeostasis Model Assessment of Insulin Resistance, HOMA-IR) were performed for parameters shown to correlate with BMI-SDS. Statistical significance was set at 5%. RESULTS Measurements were performed in 149 individuals (mean age 12.0 y; 90 obese 45 boys; 59 normal weight, 34 boys). E/I ratio (p = 0.003), ln(HF) (p = 0.03), pupil diameter in darkness (p = 0.01) were negatively correlated with BMI-SDS, whereas ln(LF/HF) was positively correlated (p = 0.05). Early re-dilation velocity was in trend negatively correlated to BMI-SDS (p = 0.08). None of the parameters that depended significantly on BMI-SDS was found to be significantly correlated with HOMA-IR. CONCLUSION These findings demonstrate extended ANS dysfunction in obese children and adolescents, affecting several organ systems. Both parasympathetic activity and sympathetic activity are reduced. The conspicuous pattern of ANS dysfunction raises the possibility that obesity may give rise to dysfunction of the peripheral autonomic nerves resembling that observed in normal-weight diabetic children and adolescents.
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Affiliation(s)
- Petra Baum
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Joseph Classen
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
- Department of Women and Child Health, University Hospital for Children and Adolescents, Leipzig, Germany
| | - Susann Blüher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
- Department of Women and Child Health, University Hospital for Children and Adolescents, Leipzig, Germany
- * E-mail:
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Bloomgarden ZT. Diabetes: East meets West. The Joint American Association of Clinical Endocrinologists-Chinese Society of Endocrinology (AACE-CSE) Symposium. J Diabetes 2012; 4:221-6. [PMID: 22898104 DOI: 10.1111/j.1753-0407.2012.00228.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Farmer KL, Li C, Dobrowsky RT. Diabetic peripheral neuropathy: should a chaperone accompany our therapeutic approach? Pharmacol Rev 2012; 64:880-900. [PMID: 22885705 DOI: 10.1124/pr.111.005314] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes that is associated with axonal atrophy, demyelination, blunted regenerative potential, and loss of peripheral nerve fibers. The development and progression of DPN is due in large part to hyperglycemia but is also affected by insulin deficiency and dyslipidemia. Although numerous biochemical mechanisms contribute to DPN, increased oxidative/nitrosative stress and mitochondrial dysfunction seem intimately associated with nerve dysfunction and diminished regenerative capacity. Despite advances in understanding the etiology of DPN, few approved therapies exist for the pharmacological management of painful or insensate DPN. Therefore, identifying novel therapeutic strategies remains paramount. Because DPN does not develop with either temporal or biochemical uniformity, its therapeutic management may benefit from a multifaceted approach that inhibits pathogenic mechanisms, manages inflammation, and increases cytoprotective responses. Finally, exercise has long been recognized as a part of the therapeutic management of diabetes, and exercise can delay and/or prevent the development of painful DPN. This review presents an overview of existing therapies that target both causal and symptomatic features of DPN and discusses the role of up-regulating cytoprotective pathways via modulating molecular chaperones. Overall, it may be unrealistic to expect that a single pharmacologic entity will suffice to ameliorate the multiple symptoms of human DPN. Thus, combinatorial therapies that target causal mechanisms and enhance endogenous reparative capacity may enhance nerve function and improve regeneration in DPN if they converge to decrease oxidative stress, improve mitochondrial bioenergetics, and increase response to trophic factors.
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Affiliation(s)
- Kevin L Farmer
- Department of Pharmacology and Toxicology, The University of Kansas, Lawrence, KS 66045, USA
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Abstract
It is now increasingly being appreciated that a substantial proportion of subjects with prediabetes may exhibit peripheral neuropathy and/or neuropathic pain. The reverse is also true, inasmuch as examining patients with idiopathic peripheral neuropathy will frequently reveal prediabetes. In the general population, the prevalence of neuropathy in prediabetes is intermediate between overt diabetes and subjects with normoglycemia. This prediabetic neuropathy is, generally, milder in comparison to diabetic neuropathy and mainly affects small fibers mediating sensory function. Hyperglycemia, microangiopathy, dyslipidemia and the metabolic syndrome have been implicated as pathogenic mechanisms. In practice, therapy of prediabetic neuropathy should be addressed towards normoglycemia and correction of cardiovascular risk factors. However, additional work is needed to establish the long-term results of this approach.
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Affiliation(s)
- Nikolaos Papanas
- Institute for Clinical Diabetology, German Diabetes Center at the Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany.
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Hoeijmakers JG, Faber CG, Lauria G, Merkies IS, Waxman SG. Small-fibre neuropathies—advances in diagnosis, pathophysiology and management. Nat Rev Neurol 2012; 8:369-79. [DOI: 10.1038/nrneurol.2012.97] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Diabetic neuropathy and axon reflex-mediated neurogenic vasodilatation in type 1 diabetes. PLoS One 2012; 7:e34807. [PMID: 22529938 PMCID: PMC3328500 DOI: 10.1371/journal.pone.0034807] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 03/08/2012] [Indexed: 11/29/2022] Open
Abstract
Objective Axon reflex-mediated neurogenic vasodilatation in response to cutaneous heating may reflect early, pre-clinical small fibre dysfunction. We aimed to evaluate the distribution of the vascular flare area measured by laser doppler imaging (“LDIFLARE area”) in type 1 diabetes and in healthy volunteers. Research and Methods Concurrent with clinical and electrophysiological examination to classify diabetic sensorimotor polyneuropathy (DSP), LDIFLARE area (cm2) was determined in 89 type 1 diabetes subjects matched to 64 healthy volunteers. We examined the association and diagnostic performance of LDI with clinical and subclinical measures of DSP and its severity. Results Compared to the 64 healthy volunteers, the 56 diabetes controls without DSP had significantly lower LDIFLARE area (p = 0.006). The 33 diabetes cases with DSP had substantially lower LDIFLARE area as compared to controls without DSP (p = 0.002). There was considerable overlap in LDIFLARE area between all groups such that the ROC curve had an AUC of 0.72 and optimal sensitivity of 70% for the detection of clinical DSP. Use of a subclinical definition for DSP, according to subclinical sural nerve impairment, was associated with improved AUC of 0.75 and sensitivity of 79%. In multivariate analysis higher HbA1c and body mass index had independent associations with smaller LDIFLARE area. Conclusions Axon reflex-mediated neurogenic vasodilatation in response to cutaneous heating is a biomarker of early nerve dysfunction in DSP. Its independent association with glycemic exposure in diabetes subjects and both glycemic exposure and BMI in healthy volunteers highlights the existence of small-fibre dysfunction in the natural history of DSP.
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50
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Lupachyk S, Watcho P, Hasanova N, Julius U, G.Obrosova I. Triglyceride, nonesterified fatty acids, and prediabetic neuropathy: role for oxidative-nitrosative stress. Free Radic Biol Med 2012; 52:1255-63. [PMID: 22366714 PMCID: PMC3312982 DOI: 10.1016/j.freeradbiomed.2012.01.029] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 01/27/2012] [Accepted: 01/27/2012] [Indexed: 01/16/2023]
Abstract
Peripheral neuropathy develops in human subjects with prediabetes and metabolic syndrome before overt hyperglycemia. The contributions of impaired glucose tolerance and insulin signaling, hypertriglyceridemia and/or increased nonesterified fatty acids (NEFA), and hypercholesterolemia to this condition remain unknown. Niacin and its derivatives alleviate dyslipidemia with a minor effect on glucose homeostasis. This study evaluated the roles of impaired glucose tolerance versus dyslipidemia in prediabetic neuropathy using Zucker fatty (fa/fa) rats and the niacin derivative acipimox, as well as the interplay of hypertriglyceridemia, increased NEFA, and oxidative-nitrosative stress. Sixteen-week-old Zucker fatty rats with impaired glucose tolerance, obesity, hyperinsulinemia, hypertriglyceridemia, hypercholesterolemia, and increased NEFA displayed sensory nerve conduction velocity deficit, thermal and mechanical hypoalgesia, and tactile allodynia. Acipimox (100 mg kg(-1) day(-1), 4 weeks) reduced serum insulin, NEFA, and triglyceride concentrations without affecting glucose tolerance and hypercholesterolemia. It alleviated sensory nerve conduction velocity deficit and changes in behavioral measures of sensory function and corrected oxidative-nitrosative stress, but not impaired insulin signaling, in peripheral nerve. Elevated NEFA increased total and mitochondrial superoxide production and NAD(P)H oxidase activity in cultured human Schwann cells. In conclusion, hypertriglyceridemia and/or increased NEFA concentrations cause prediabetic neuropathy through oxidative-nitrosative stress. Lipid-lowering agents and antioxidants may find a use in the management of this condition.
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Affiliation(s)
- Sergey Lupachyk
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Pierre Watcho
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Nailia Hasanova
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Ulrich Julius
- University Hospital, Technical University of Dresden, Dresden Germany
| | - Irina G.Obrosova
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
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