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Gad H, Elgassim E, Mohammed I, Alhaddad AY, Ahmed Hussein Zaky Aly H, Cabibihan JJ, Al-Ali A, Sadasivuni KK, Haji A, Lamine N, Khan A, Petropoulos IN, Ponirakis G, Kalteniece A, Ferdousi M, Azmi S, Alam U, Abuhelaiqa W, Jayyousi A, AlMohanadi D, Baagar K, Malik RA. Continuous glucose monitoring reveals a novel association between duration and severity of hypoglycemia, and small nerve fiber injury in patients with diabetes. Endocr Connect 2022; 11:e220352. [PMID: 36240043 PMCID: PMC9716363 DOI: 10.1530/ec-22-0352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/08/2022]
Abstract
Objective Continuous glucose monitoring (CGM) has revealed that glycemic variability and low time in range are associated with albuminuria and retinopathy. We have investigated the relationship between glucose metrics derived from CGM and a highly sensitive measure of neuropathy using corneal confocal microscopy in participants with type 1 and type 2 diabetes. Methods A total of 40 participants with diabetes and 28 healthy controls underwent quantification of corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL) and inferior whorl length (IWL) and those with diabetes underwent CGM for four consecutive days. Results CNBD was significantly lower in patients with high glycemic variability (GV) compared to low GV (median (range) (25.0 (19.0-37.5) vs 38.6 (29.2-46.9); P = 0.007); in patients who spent >4% compared to <4% time in level 1 hypoglycemia (54-69 mg/dL) (25.0 (22.9-37.5) vs 37.5 (29.2-46.9); P = 0.045) and in patients who spent >1% compared to <1% time in level 2 hypoglycemia (<54 mg/dL) (25.0 (19.8-41.7) vs 35.4 (28.1-44.8); P = 0.04). Duration in level 1 hypoglycemia correlated with CNBD (r = -0.342, P = 0.031). Duration in level 1 (181-250 mg/dL) and level 2 (>250 mg/dL) hyperglycemia did not correlate with CNFD (P > 0.05), CNBD (P > 0.05), CNFL (P > 0.05) or IWL (P > 0.05). Conclusions Greater GV and duration in hypoglycemia, rather than hyperglycemia, are associated with nerve fiber loss in diabetes.
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Affiliation(s)
- Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Einas Elgassim
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ibrahim Mohammed
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- Department of Internal Medicine, Albany Medical Center Hospital, Albany, New York, USA
| | - Ahmad Yaser Alhaddad
- Department of Mechanical and Industrial Engineering, Qatar University, Doha, Qatar
| | | | - John-John Cabibihan
- Department of Mechanical and Industrial Engineering, Qatar University, Doha, Qatar
| | - Abdulaziz Al-Ali
- KINDI Center for computing research, Qatar University, Doha, Qatar
| | | | - Aliyaa Haji
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Neila Lamine
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Adnan Khan
- Faculty of Healthy Sciences, Khyber Medical University, Peshawar, Pakistan
| | | | | | - Alise Kalteniece
- Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK
| | - Maryam Ferdousi
- Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK
| | - Shazli Azmi
- Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK
| | - Uazman Alam
- Diabetes and Neuropathy Research, Department of Eye and Vision Sciences and Pain Research Institute, 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
| | | | - Amin Jayyousi
- Hamad Medical Corporation, National Diabetes Center, Doha, Qatar
| | - Dabia AlMohanadi
- Hamad Medical Corporation, National Diabetes Center, Doha, Qatar
| | - Khaled Baagar
- Hamad Medical Corporation, National Diabetes Center, Doha, Qatar
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK
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Expression and Mechanism of TXNIP/NLRP3 Inflammasome in Sciatic Nerve of Type 2 Diabetic Rats. DISEASE MARKERS 2022; 2022:9696303. [PMID: 35845136 PMCID: PMC9286945 DOI: 10.1155/2022/9696303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/18/2022]
Abstract
Objective To determine the expression profiling and mechanism of thioredoxin-interacting protein (TXNIP)/nucleotide-binding domain-like receptor protein 3 (NLRP3) inflammasome pathway in sciatic nerve (SN) of type 2 diabetes mellitus (T2DM) rats. Methods Ten out of the 35 healthy SD rats (specific pathogen free) purchased were randomized into the control group, while the others were established a T2DM model by feeding a high-fat and high-sugar diet plus laparoscopic injection of 1% streptozotocin (STZ). The successfully modeled rats were subgrouped into two arms: a DM group with 10 rats and a resveratrol- (RES-) treated DM intervention group with 11 rats. Normal saline to control and DM groups. Alterations in fasting blood glucose (FBG) and body weight (BW) at different time points after administration were observed. Sciatic nerve conduction velocity (SNCV) and mechanical pain threshold (MPT) were measured. TXNIP, NLRP3, caspase-1, and interleukin- (IL-) 1β levels in rat SN tissue were determined. Results DM group rats showed higher FBG and lower BW than control rats at different time points (P < 0.05). The FBG of DM intervention group at 2, 4, and 6 weeks after administration was lower, and the BW at 4 and 6 weeks after dosing was higher than DM group. Higher MPT and SNCV were determined in DM intervention group versus DM group (P < 0.05). DM group rats had disordered, swollen, and dissolved SN myelin sheath structure; TXNIP inhibition led to a small amount of nerve myelin fragments and mild pathological changes. Lower TXNIP, NLRP3, caspase-1, and IL-1β protein levels were found in DM intervention group versus DM group (P < 0.05). Conclusion The pathogenesis of peripheral neuropathy in T2DM rats may be linked to TXNIP/NLRP3 inflammasome pathway activation, indicating the potential of this pathway as a therapeutic target for diabetic peripheral neuropathy (DPN).
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