Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications

Peripheral Neuropathy Symptoms and Ocular Surface Lesions in Patients with Type 2 Diabetes Mellitus and Dry Eye: A Clinical Correlational Study

INTRODUCTION

Reduced corneal sensation in individuals with type 2 diabetes mellitus (T2DM) leads to a dissociation between dry eye disease (DED) signs and symptoms, thereby affecting diagnostic accuracy. This study aimed to investigate the correlation between ocular surface signs and diabetic peripheral neuropathy (DPN) symptoms in patients with T2DM-associated DED.

METHODS

The Michigan Neuropathy Screening Instrument Questionnaire (MNSIQ) was used to categorize patients with T2DM into MNSIQ-DPN and non-DPN groups. Ocular irritation symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Ocular surface lesions were assessed via Cochet-Bonnet esthesiometry, corneal fluorescein staining (CFS), the Schirmer I tear test (SIT), tear meniscus height (TMH), noninvasive keratography break-up time (NIKf-BUT), and the meibomian gland loss (MGL) grade detected by OCULUS. Corneal nerve fiber parameters were evaluated using in vivo confocal microscopy (IVCM).

RESULTS

A total of 116 patients with T2DM, comprising 76 non-DPN patients and 40 MNSIQ-DPN patients, along with 51 age-matched participants without diabetes, were enrolled. Although OSDI scores were equivalent between MNSIQ-DPN patients and non-DPN patients, MNSIQ-DPN patients presented significantly more severe CFS (p < 0.001), meibomian gland dysfunction (MGD) (p < 0.001), corneal nerve fiber loss (p < 0.001), sensory dysfunction (p = 0.02), and corneal microneuromas (p < 0.001). The MNSIQ score was significantly positively correlated with CFS (p < 0.001); MGD (p < 0.01); corneal nerve fiber loss, including corneal nerve fiber density and length and branch density, in the paracentral (all p < 0.001) and inferior-whorl areas (p < 0.01, p < 0.05 and p < 0.01, respectively); and corneal microneuromas, characterized by increased microneuroma numbers (p < 0.001) and areas (p < 0.001) in these regions.

CONCLUSION

MNSIQ scores were significantly and robustly correlated with the presence of corneal epithelial defects, MGD, and nerve fiber loss in patients with T2DM. These findings suggest that DPN is a critical factor in diabetic ocular surface complications, highlighting the importance of the MNSIQ for assessing these conditions.

Beyond overweight, visceral adiposity is associated with estimation of cardiovascular risk in patients living with type 1 diabetes: findings from the SFDT1 cohort

INTRODUCTION & OBJECTIVES

As in the general population, people living with type 1 diabetes (PWT1D) are faced with overweight and obesity, which contribute to cardiovascular (CV) risk. However, the role of visceral adiposity, due to its adverse metabolic profile, should also be addressed in PWT1D. We aimed to assess the 10-year CV risk of PWT1D according to body mass index (BMI) and waist-to-height ratio (WHtR), a parameter for estimating visceral adiposity.

METHODS

In this cross-sectional study, PWT1D in primary CV prevention from the SFDT1 cohort were categorized by BMI status, either normal (18.5-24.9 kg/m2) or overweight/obesity (≥ 25 kg/m2), and by WHtR according to the validated threshold of 0.5. The 10-year CV risk was estimated using the Steno Type 1 Risk Engine and classified into three categories: low (< 10%), intermediate (10-20%) and high (> 20%). The distribution of CV risk was assessed using density plots. In multivariable analysis, the association between BMI, WHtR, and high estimated 10-year CV risk was studied using spline regression models with sex stratification. Thresholds were determined by the Receiver Operating Characteristic (ROC) curve.

RESULTS

The study included 1,482 patients; 49.9% had a normal BMI, and 50.1% a BMI ≥ 25 kg/m2. The proportion of patients with high CV risk was higher in PWT1D with overweight/obesity (12% vs. 7%) and in those with WHtR ≥ 0.5 (13% vs. 4%). BMI was significantly associated with high CV risk in men (p = 0.001) but a non-significant trend was found in women (p = 0.053). WHtR was significantly associated with high CV risk in both men (p < 0.001) and women (p = 0.046). The BMI threshold associated with high CV risk was 24.9 kg/m2 for men, and the WHtR threshold was 0.5 for both men and women.

CONCLUSION

In PWT1D in condition of primary CV prevention, visceral adiposity, assessed by WHtR, is a more robust marker of estimated 10-year CV risk than overweight/obesity status in both men and women.

Diagnostic performance of graded tuning fork vibration thresholds as a stand-alone test and within clinical assessments of diabetic neuropathy

AIMS

We aimed to provide new reference data for C64 Hz-Rydel-Seiffer tuning fork Vibration Sensation Thresholds (VST) for the clinical diagnosis of Diabetic Sensorimotor Polyneuropathy (DSPN) and to evaluate the diagnostic performance when used in combination with other clinical tests as implemented in the Neuropathy Disability Score (NDS).

METHODS

The study included 1,215 individuals with type 1 or type 2 diabetes and 207 with Normal Glucose Tolerance (NGT), who underwent clinical, electrophysiological, and Quantitative Sensory Tests (QST). Multiple regression analyses were used to determine VST in individuals with NGT. The diagnostic performance of tests to detect confirmed small or large fibre DSPN according to Toronto consensus criteria was assessed in 373 individuals with diabetes who underwent skin biopsies do determine intraepidermal nerve fibre density (IENFD).

RESULTS

The new age-dependent lower normative VST showed 73.5% sensitivity, 85.4% specificity, and 82.3% accuracy in diagnosing confirmed DSPN. Combining VST with the PinPrick test resulted in 83.4% sensitivity, 80.3% specificity, and 81.2% accuracy. The NDS incorporating VST was associated with nerve conduction indices, QST, and IENFD.

CONCLUSIONS

The new VST reference data shall enable clinicians to detect DSPN with higher accuracy in clinical practice, particularly when combined with a single small fibre test.

Foot screening and customized health education program for patients with diabetic peripheral neuropathy: A nurse-led, real-world observational study

Background

Research has shown that DPN affects 50 % of individuals with diabetes and, in severe cases, can lead to amputation or death. Interventions led by doctors for DPN have demonstrated limited effectiveness in delaying its onset and progression. Nevertheless, there is an increasing recognition of the significance of nurse-led screening and health education in the early detection and slowing down of DPN.

Method

The present study conducted a retrospective analysis of medical records of 10,191 diabetic patients from 2019 to 2023, who also regularly attended outpatient clinics. Patients with incomplete medical data, transfers, critical conditions or death, existing foot ulcers or amputations, bedridden or uncooperative individuals (5,470 individuals) were excluded, and a total of 4,721 individuals were selected for analysis. The screening and intervention components of the FSCHE program were all led by nurses. A total of 2022 participants received foot screening and customized health education (FSCHE) program, while 2699 participants recevied regular care. The primary outcome is on determining the prevalence rate of DPN among all the included diabetic patients. The data was collected through experimental tests and nurse-led foot screening. Prevalence rates were reported as the number of cases per 1000 individuals. Odds Ratios were calculated to approximate Risk Ratios to determine the effectiveness of the FSCHE program.

Results

The prevalence of DPN in diabetic patients who received the FSCHE program decreased from 557 cases per 1000 individuals in 2019 to 199 cases per 1000 individuals in 2023. The hospitalization duration decreased from 11.2 days to 7.59 days. The risk of DPN in diabetic patients participating in the FSCHE program was 0.741 times higher than that of regular diabetes care (RR [95 % CI]: 0.741 [0.654, 0.840], p < 0.001). The DPN-related risk factors showed promising control results as well.

Conclusions

In this observational study conducted among Chinese patients with diabetes, it was found that the nurse-led FSCHE program effectively manages DPN and its associated risk factors. These results highlight the importance of employing objective screening tools to detect DPN at an early stage, as well as the significance of nurse-led interventions in promoting healthy behaviors and preventing the development and progression of DPN.

Clinical and Electrophysiological Characterization of Diabetic Neuropathy in a Sub-Saharan African Cohort

BACKGROUND

Diabetic neuropathy (DN) is the most frequent complication of diabetes mellitus, contributing to increased morbidity and mortality. Previous clinical studies on DN in sub-Saharan Africa (sSA) have used purely clinical approaches, potentially underestimating the true magnitude of this disease. This study was designed to determine the prevalence of definite diabetic neuropathy and describe the different subtypes using objective small and large fiber function measures.

METHODS

This was a hospital-based cross-sectional study that included diabetes and prediabetes patients, followed up at Jordan Medical Services, Yaoundé, Cameroon, between March 2022 and February 2023. The "Toronto Clinical Neuropathy Score" and "Douleur Neuropathique en 4" questionnaires were used for clinical evaluation. Autonomic symptoms were equally recorded. Nerve conduction studies and Sudoscan were used for electrophysiological assessments of large and small fibre functions.

RESULTS

Eighty-four participants were included; 91.7% had type 2 DM, 2.4% had type 1 DM, and 6% had glucose intolerance. DN was found in 73/84 (86.9%). Diabetic sensorimotor polyneuropathy (DSP) was the most frequent subtype (63.8%), followed by diabetic autonomic neuropathy (40.5%), mononeuropathy (36.9%), asymmetric axonal sensory neuropathy (4.8%) and treatment-induced neuropathy of diabetes (TIND) in 1.2% of patients. The prevalence of large and small fibre neuropathies was 38.1% and 25.0%, respectively.

CONCLUSION

The prevalence of DN and specifically DSP in our study was higher than previously described in African literature. We identified subtypes never before reported in sSA, mainly small fibre neuropathy and TIND. This may have management and policy implications.

Diabetic foot infection severity as a predictor of re-ulceration following partial forefoot amputation

Diabetic foot ulcer re-ulceration is a common complication following partial forefoot amputation. Re-ulceration refers to the occurrence of a skin break that penetrates through the epidermis and a portion of the dermis, occurring at any site on either the same or opposite foot where amputation took place. Treatment for diabetic foot ulcers often includes an extended course of local wound care and may entail surgical procedures. The aim of this study was to evaluate the incidence of re-ulceration in people who underwent a partial forefoot amputation. We hypothesized there is an association between amputation type and occurrence of re-ulceration. A retrospective chart review was performed for 253 individuals between December 2015 and September 2020. One hundred eleven people met eligibility criteria and were divided into two cohorts: those who re-ulcerated and those who did not. Univariable analysis was performed for available demographic, clinical, laboratory and outcome data. Seventy-nine of the 111 (71.2 %) subjects re-ulcerated status post partial forefoot amputation. Based on the Infectious Disease Society of America (IDSA) classification for assessment of infection, the average severity for the re-ulceration group was 2.62, while for the no re-ulceration group was 2.22 (p < 0.001). The median time to re-ulceration was 186 days. No association was demonstrated between amputation location and incidence of re-ulceration. Patients with higher diabetic foot infection severity based on IDSA classification are at greater risk for developing re-ulceration following a partial forefoot amputation.

Serum Neurofilament Light Chain and Structural and Functional Nerve Fiber Loss in Painful and Painless Diabetic Polyneuropathy

AIMS

To explore associations between the axonal protein neurofilament light chain (NfL) and severity of diabetic polyneuropathy (DPN) and pain.

METHODS

We performed cross-sectional analysis of a subset of the PiNS/DOLORisk cohort of people with DPN with and without neuropathic pain. Biobank samples were analyzed for serum NfL (s-NfL) using single molecule array. DPN was defined by Toronto criteria for probable or confirmed DPN. Painful DPN (PDPN) was evaluated according to IASP criteria. Measures of DPN severity included clinical DPN scales, quantitative sensory testing (QST) and intraepidermal nerve fiber density (IENFD).

RESULTS

Participants with confirmed (N = 172) or probable DPN (N = 29) were included. There was no s-NfL difference between participants with DPN (N = 79, 22.8 ng/L [IQR 17.4; 31.3]) and PDPN (N = 122, 22.2 ng/L [16.0; 34.4]). S-NfL was not associated with pain severity or DPN severity evaluated by clinical DPN scales. Higher s-NfL was associated with lower IENFD (13.6 % [95 % CI 3.1; 22.9], unit = 1 fiber/mm, N = 24) and more pronounced loss of nerve fiber function measured by QST (p-trend = 0.02).

CONCLUSIONS

Higher s-NfL was associated with nerve fiber dysfunction and loss quantified by QST and IENFD, but not with pain or clinical DPN scales. S-NfL may reflect the severity of nerve fiber damage underlying DPN.

Prevalence of peripheral neuropathy in Egyptian psoriatic arthritis patients and its correlation with disease activity

INTRODUCTION

Peripheral neuropathy (PN) may arise from various etiologies, including immune-mediated diseases. This study aimed to detect the prevalence and clinical determinants of PN in psoriatic arthritis (PsA) patients, with or without skin lesions, and to evaluate its correlation with disease activity.

RESEARCH DESIGN AND METHODS

This cross-sectional study included 60 PsA patients and 60 apparently healthy controls. Neuropathic pain was evaluated using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) score, while PN was assessed through the Michigan Neuropathy Screening Instrument (MNSI), in conjunction with electrophysiological assessment.

RESULTS

The LANSS score demonstrated the capability to predict neuropathic pain in PsA patients with a sensitivity of 93.89% and specificity of 83.33%. Furthermore, the MNSI Questionnaire score revealed a sensitivity of 91.67% and specificity of 77.78% in predicting PN among PsA patients. Carpal tunnel syndrome represented the most prevalent neuropathy identified in 36% of PsA patients, followed by peripheral polyneuropathy in 6% and ulnar neuropathy in 4%.

CONCLUSIONS

Patients with PsA have higher prevalence of neuropathy, particularly carpal tunnel syndrome, which negatively impacts pain perception, functional capability, and quality of life, particularly in those with higher disease activity suggesting potential association between inflammation and neurological dysfunction.

Diabetic neuropathy: cutting-edge research and future directions

Diabetic neuropathy (DN) is a prevalent and debilitating complication of diabetes mellitus, significantly impacting patient quality of life and contributing to morbidity and mortality. Affecting approximately 50% of patients with diabetes, DN is predominantly characterized by distal symmetric polyneuropathy, leading to sensory loss, pain, and motor dysfunction, often resulting in diabetic foot ulcers and lower-limb amputations. The pathogenesis of DN is multifaceted, involving hyperglycemia, dyslipidemia, oxidative stress, mitochondrial dysfunction, and inflammation, which collectively damage peripheral nerves. Despite extensive research, disease-modifying treatments remain elusive, with current management primarily focusing on symptom control. This review explores the complex mechanisms underlying DN and highlights recent advances in diagnostic and therapeutic strategies. Emerging insights into the molecular and cellular pathways have unveiled potential targets for intervention, including neuroprotective agents, gene and stem cell therapies, and innovative pharmacological approaches. Additionally, novel diagnostic tools, such as corneal confocal microscopy and biomarker-based tests, have improved early detection and intervention. Lifestyle modifications and multidisciplinary care strategies can enhance patient outcomes. While significant progress has been made, further research is required to develop therapies that can effectively halt or reverse disease progression, ultimately improving the lives of individuals with DN. This review provides a comprehensive overview of current understanding and future directions in DN research and management.

Therapeutic Challenges of Diabetes Mellitus-Related Erectile Dysfunction and The Potential Therapeutic Role of Medicinal Plants: A Narrative Review

Erectile dysfunction (ED) is a common male sexual dysfunction and can be induced by diabetes mellitus (DM). Diabetes mellitus-induced erectile dysfunction (DMED) affects various aspects of the patient's quality of life, mental well-being, and relationship dynamics. Given the increasing incidence of DM worldwide, the incidence of DMED is expected to increase accordingly. There are more challenges to treat DMED compared to non-DMED. The efficacy of oral phosphodiesterase-5 inhibitors is often ineffective in DMED and there is a need to search for effective drugs. Medicinal plants such as Eucommia ulmoides Oliv. Leaf, Cordycep militaris have been used in treating DMED in some experiments. And some ingredients from the medicinal plants such as Icariside II, Panax notoginseng Saponins have also shown to be beneficial in improving erectile function in animal models of DMED. These medicinal plants and ingredients may act by regulating hormone levels, ameliorating oxidative damage, and promoting NO/cGMP. We summarize the challenges in treating DMED due to related complicated pathogenesis and limited therapeutic options, while particularly highlight the role of the medicinal plants and their ingredients in DMED.

Adolescent Girls With Type 1 Diabetes Develop Changes in Bone Prior to Evidence of Clinical Neuropathy

CONTEXT

Neuropathy and fracture are prevalent complications of type 1 diabetes (T1D). Although correlated in the clinical literature, it remains unknown whether neuropathy contributes to the initiation of bone loss at the earliest stages of disease.

METHODS

We performed a single-center, cross-sectional study to quantify parameters of nerve and bone health in adolescent girls with T1D (n = 21) and associated controls (n = 12). Groups were well matched for age, height, strength, and physical activity.

RESULTS

By high-resolution peripheral quantitative computed tomograpy, participants with T1D had lower trabecular bone volume fraction at the distal radius (-14.6%, P-adj = .095) and the tibia (-12.8%, P-adj = .017) and decreased trabecular thickness (-8.3% radius, P-adj = .007; -7.5% tibia, P-adj = .034) after adjustment for body size. In the tibia only, cortical bone mineral density was increased by 8.6% (P-adj = .024) and porosity was decreased by 52.9% with T1D (P-adj = .012). There were no significant differences in bone density by dual-energy x-ray absorptiometry. Participants with T1D also had lower circulating levels of osteocalcin (-30%, P = .057), and type I collagen cross-linked C-telopeptide (-36%, P = .035), suggesting low bone formation and turnover in T1D. Based on the Michigan Neuropathy Screening Instrument, 9.5% of those with T1D had clinical evidence of diabetic peripheral neuropathy. However, consideration of neuropathy status failed to explain the widespread T1D-associated changes in bone.

CONCLUSION

Our study defines early deficits in trabecular bone microarchitecture, decreased cortical porosity in the tibia, and suppression of biomarkers of bone turnover in adolescent girls with T1D, prior to the onset of symptomatic peripheral neuropathy. These findings inform our understanding of the rapid progression of skeletal disease in young girls with T1D and suggests that early detection and management strategies may help to prevent fracture and related comorbidities later in life.

Chronic chemotherapy-induced peripheral neuropathy and pain following paclitaxel versus docetaxel in breast cancer survivors: A cross-sectional study

Chemotherapy-induced peripheral neuropathy (CIPN) is a concerning late effect of taxane treatment. This study aimed to explore and compare long-term symptoms and consequences of CIPN after docetaxel and paclitaxel treatment. Patients with breast cancer who had followed Danish recommended adjuvant docetaxel or paclitaxel treatment regimens completed an online questionnaire 2-3 years after treatment. The questionnaire comprised the Michigan Neuropathy Screen Instrument, the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CIPN20, EORTC QLQ C30, and CIPN-specific symptoms. Painful CIPN was assessed using the Douleur Neuropathique 4 Questions. Questionnaires from 411 patients (docetaxel: 192, paclitaxel: 219) were analyzed. No significant difference in the prevalence of possible CIPN between the two groups was observed (docetaxel: 48.4 % [93/192] vs. paclitaxel: 45.2 % [99/219]; 95 % CI: 6.4 - 12.9, p = 0.51). However, the EORTC-QLQ-CIPN20 sum score was higher in the docetaxel group (difference: 3.0; 95 % CI: 0.0-6.1, p = 0.05). Among patients with reported CIPN symptoms, significantly more in the docetaxel group reported painful CIPN (docetaxel: 53.8 % [50/93] than in the paclitaxel group: 34.3 % [34/99]; p = 0.01). Quality of life scores from the EORCT-QLQ-C30 questionnaire were significantly lower in those with possible CIPN than in those without and lower in patients with painful possible CIPN than in those with painless CIPN. Docetaxel caused more severe and painful CIPN symptoms than paclitaxel. These findings are highly relevant, as docetaxel remains a crucial component of cancer treatments.

Arterial Stiffness Is Related to Diabetes-Associated Microvascular Complications: The SEARCH for Diabetes in Youth Study

OBJECTIVE

To assess the relationship between arterial stiffness, an early marker of macrovascular cardiovascular disease, and microvascular complications in adolescents and young adults with youth-onset diabetes.

RESEARCH DESIGN AND METHODS

This study included 1,226 individuals (median age at initial visit 18 years; 58% female; 53% non-Hispanic White, 22% non-Hispanic Black, and 20% Hispanic) with youth-onset type 1 or type 2 diabetes from the SEARCH for Diabetes in Youth Study. Arterial stiffness measures included pulse wave velocity for carotid femoral, carotid radial, femoral foot, and augmentation index (AIx). Microvascular complications included microalbuminuria, peripheral neuropathy, and retinopathy. Participants were followed up once at ∼5 years.

RESULTS

Cross-sectionally, in type 1 diabetes, AIx was associated with higher odds of having any one microvascular complication (odds ratio [OR] 1.35; 95% CI 1.04-1.76), microalbuminuria (OR 2.76; 95% CI 1.78-4.39), neuropathy (OR 1.63; 95% CI 1.07-2.50), and retinopathy (OR 1.37; 95% CI 1.06-1.79). In type 2 diabetes, AIx was associated with higher odds of microalbuminuria (OR 2.05; 95% CI 1.04-4.33; all P < 0.05). In longitudinal analysis, in type 1 diabetes, a change in AIx was associated with the development of any one microvascular complication (OR 1.45; 95% CI 1.15-1.82), microalbuminuria (OR 5.42; 95% CI 1.98-14.80), neuropathy (OR 2.03; 95% CI 1.22-3.40), and retinopathy (OR 1.48; 95% CI 1.15-1.90). In type 2 diabetes, a change in AIx was associated with the development of microalbuminuria (OR 21.98; 95% CI 1.30-372.88; all P < 0.05).

CONCLUSIONS

Arterial stiffness is related to and predicts microvascular complications in youth-onset type 1 and type 2 diabetes.

Dellon decompression of the tarsal tunnel: An effective approach to improving blood flow, promoting ulcer healing and recovery of sensibility in diabetic patients

We hypothesized that tibial nerve decompression would improve sympathetic nerve function, leading to increased blood flow, enhanced plantar sensitivity, and reduced healing time for diabetic neuropathic ulcers. This prospective study involved 20 patients with non-healing diabetic neuropathic ulcers averaging 17.1 months in duration. Patients had good glycemic control and positive Tinel sign at the tarsal tunnel, with average ulcer size of 10.49 cm². Preoperatively, sensory symptoms were assessed using the Michigan Neuropathy Screening Instrument (MNSI) and two-point discrimination test, ulcer characteristics using DMIST scale, and blood flow via Doppler ultrasonography of the posterior tibial artery. "Dellon Decompression" of the 4 medial ankle tunnels was performed. At the 9-month follow-up, MNSI scores decreased significantly from a mean of 11.85 to 5.15 (p < 0.001). Positivity of the Tinel sign, quantified using the visual analog scale, dropped from a mean of 7 to 2 (p < 0.0001). Significant improvements in sensory function of the medial, lateral plantar, and calcaneal nerves were observed (p < 0.001). Doppler ultrasonography showed blood flow in the posterior tibial artery increased from 1.72 to 2.48 cm³/s at 6 months, with further improvement at 9 months (p < 0.0001). At 9 months, 55% of patients had completely healed ulcers, with 45% showing an 83.25% reduction in ulcer size (p < 0.0001). No infections or new ulcers occurred postoperatively. In conclusion, Dellon decompression of the 4 medial ankle tunnels can enhance blood flow in diabetic neuropathy, improves wound healing in the foot's plantar area, and emphasizes the crucial role of enhanced blood flow and sensitivity in promoting foot ulcer healing in diabetic patients.

Association of PTX3 Genetic Variants With Development of Diabetic Neuropathy

BACKGROUND/AIM

Pentraxin 3 (PTX3), initially discovered as a key player in the defense against infectious pathogens, is crucial for inflammation and tissue regeneration. This study aimed to explore the impact of PTX3 gene variants on the development and progression of diabetic neuropathy (DN).

MATERIALS AND METHODS

The potential impact of PTX3 gene variants on the susceptibility to DN was examined by genotyping four single-nucleotide polymorphisms (SNPs) of the PTX3 gene (rs1840680, rs2305619, rs3816527, and rs2120243) in a study involving 730 DN cases and 861 diabetic controls with normal neurologic function.

RESULTS

We demonstrated that diabetic subjects homozygous for the minor allele at rs1840680 [AA; adjusted odds ratio (AOR)=1.486; 95% confidence interval (CI)=1.050-2.103; p=0.02] or rs2120243 (AA; AOR=1.483; 95%CI=1.051-2.091; p=0.025) were more likely to develop neurologic complications compared to those homozygous for the corresponding major allele. Further stratification revealed that this correlation with DN risk was observed specifically in males but not in females. In addition, another SNP of the PTX3 gene, rs2305619, was found to be associated with the risk for DN in males (AA vs. GG, AOR=1.686; 95%CI=1.086-2.617, p=0.020), indicating a sex-specific impact of PTX3 gene polymorphisms on damage to the nerves in diabetic patients. Furthermore, DN patients homozygous for the minor allele of rs1840680 (AA), particularly males, had higher levels of LDL-cholesterol than those homozygous for the reference allele (GG) (p=0.034).

CONCLUSION

PTX3 gene polymorphisms are associated with dyslipidemia and nerve damage in diabetic patients in a sex-specific manner.

Barriers and new opportunities in developing effective therapies for diabetic neuropathy: International expert consensus recommendations

BACKGROUND

Diabetic neuropathy (DN) affects up to half of individuals with type 1 and type 2 diabetes. Despite evidence that improving metabolic and cardiovascular health can slow its progression, DN remains a significant clinical challenge due to the lack of disease-modifying therapies and effective pain management strategies. This consensus aimed to identify gaps and recommend strategies to address these challenges.

METHOD

A workshop, initiated by Steno Diabetes Centre Copenhagen and the Danish Diabetes and Endocrinology Academy, conducted a gap analysis based on insights from clinical studies, observational cohorts, and clinical practice. Online invitations targeted experienced clinicians, researchers, and drug developers committed to improving DN treatment through innovative clinical trials. Thirty-five participants from six countries reached consensus via a Delphi process on key steps to advance DN therapy.

RESULT

Four critical barriers and needs were addressed: (1) Translating bench research to clinical practice, (2) Enhancing clinical trial design, (3) Improving outcome measures, and (4) Identifying effective treatments for painful DN.

CONCLUSION

Successful interventional trials require robust outcome measures to capture clinically meaningful changes in DN phenotypes, providing the basis for developing effective, disease-modifying treatments.

Characterization of cognitive decline in long-duration type 1 diabetes by cognitive, neuroimaging, and pathological examinations

BACKGROUNDWe aimed to characterize factors associated with the under-studied complication of cognitive decline in aging people with long-duration type 1 diabetes (T1D).METHODSJoslin "Medalists" (n = 222; T1D ≥ 50 years) underwent cognitive testing. Medalists (n = 52) and age-matched nondiabetic controls (n = 20) underwent neuro- and retinal imaging. Brain pathology (n = 26) was examined. Relationships among clinical, cognitive, and neuroimaging parameters were evaluated.RESULTSCompared with controls, Medalists had worse psychomotor function and recall, which associated with female sex, lower visual acuity, reduced physical activity, longer diabetes duration, and higher inflammatory cytokines. On neuroimaging, compared with controls, Medalists had significantly lower total and regional brain volumes, equivalent to 9 years of accelerated aging, but small vessel disease markers did not differ. Reduced brain volumes associated with female sex, reduced psychomotor function, worse visual acuity, longer diabetes duration, and higher inflammation, but not with glycemic control. Worse cognitive function, lower brain volumes, and diabetic retinopathy correlated with thinning of the outer retinal nuclear layer. Worse baseline visual acuity associated with declining psychomotor function in longitudinal analysis. Brain volume mediated the association between visual acuity and psychomotor function by 57%. Brain pathologies showed decreased volumes, but predominantly mild vascular or Alzheimer's-related pathology.CONCLUSION To our knowledge, this is the first comprehensive study of cognitive function, neuroimaging, and pathology in aging T1D individuals demonstrated that cognitive decline was related to parenchymal rather than neurovascular abnormalities, unlike type 2 diabetes, suggestive of accelerated aging in T1D. Improving visual acuity could perhaps be an important preventive measure against cognitive decline in people with T1D.FUNDINGThe Beatson Foundation, NIH/NIDDK grants 3P30DK036836-34S1 and P30DK036836-37, and Mary Iacocca fellowships.

TangBi Formula for Painful Diabetic Distal Symmetric Polyneuropathy: A Multicenter, Randomized, Double-Blind, Placebo-Controlled and Parallel-Group Trial

OBJECTIVE

To determine whether the use of herbal medicines combined with conventional treatment is more effective than conventional medication alone in improving clinical symptoms in patients with diabetic distal symmetric polyneuropathy (DSPN).

METHODS

This multicenter, placebo-controlled, double-blind, randomized controlled clinical trial recruited patients from 6 clinical centers in mainland China. A total of 188 patients were randomly assigned in a 1:1 ratio to the treatment group (Tangbi Formula plus methylcobalamin) and the control group (placebo plus methylcobalamin). Subjects were reassessed after the 24-week intervention. The primary outcomes were differences in changes in clinical signs and symptoms and changes in the Michigan Diabetic Neuropathy Score (MDNS) between the two groups before and after treatment. Secondary outcomes were changes in nerve conduction velocity (NCV) and single clinical signs and symptoms as measured by the visual-analogue scale (VAS) and Toronto clinical scoring system (TCSS).

RESULTS

Compared with the placebo group, after 24 weeks of treatment, the MDNS score of TangBi Formula group was significantly reduced (p < 0.001). There were no significant changes in NCV results in either group before or after treatment. Compared with baseline, the difference in the change value of VAS score between the two groups after treatment was statistically significant (p = 0.031). A statistically significant difference in the change value of TCSS after treatment compared to baseline was found between the two groups (p = 0.033 at 12 weeks and p = 0.030 at 24 weeks). No severe adverse events due to study participation or study intervention were reported.

CONCLUSIONS AND RELEVANCE

This trial demonstrated that combining Tangbi Formula with basal therapy can be safer and more effective in improving the symptoms of DSPN patients.

D1S-Neuro Program: Frequency and Risk Factors for the Development of Diabetic Neuropathy in Pediatric Patients with Type 1 Diabetes Mellitus, a Single Center Study

Introduction: Diabetic neuropathy is the most common long-term complication of diabetes mellitus, widely studied in the adult population, but its prevalence in children and adolescents has not yet been clearly defined. Materials and Methods: Diabetic patients over 11 years old and with at least 5 years of diabetes were subjected to specific tests for the screening of diabetic peripheral neuropathy (DPN) and for the diagnosis of cardiac autonomic neuropathy (CAN). Additionally, all data related to the patients' average hemoglobin (HbA1c) levels over the last year and the past 5 years and the monitoring and insulin delivery technology used were collected. Results: Tests were performed on a total of 81 patients. DN diagnostic tests identified 17 patients with signs of neuropathy (21.0%), specifically 11 with DPN (13.6%) and 7 with CAN (8.6%). Data showed that the 5-year HbA1c of those diagnosed with DPN was significantly higher compared to those without a diagnosis. The analysis also highlighted that an average HbA1c level over 5 years greater than 8.5% increases the risk of DPN by 10 times. Conclusions: This article confirms that diabetic neuropathy begins to develop even in pediatric patients, that various nerve conduction systems may be affected, and that poorer glycometabolic control is associated with an increased risk of developing DN. These results highlight the importance of early screening and prevention through tight glycometabolic control.

Prevalence of painful and painless diabetic peripheral neuropathy in the Northern Danish Region: A population-based study

BACKGROUND

Diabetic peripheral neuropathy (DPN) is a common complication of diabetes, yet varying estimates of its prevalence exist. The present study aimed to estimate a questionnaire-centered prevalence of painful and painless DPN in the Northern Danish Region, examine its geographical distribution within the region, and investigate associations between DPN and potential risk factors.

METHODS

A questionnaire-based survey was sent to all persons living with diabetes in the Northern Danish Region using electronic mail. Persons with diabetes were identified using The National Health Insurance Service Registry. The survey included information on demographics, socioeconomics, municipality, diabetes type, duration, and treatment, as well as the validated questionnaires Michigan Neuropathy Screening Instrument-questionnaire (MNSIq) and the Douleur Neuropathique en 4 Questions (DN4)-interview. Possible DPN was defined as an MNSIq-score ≥ 4, while possible painful DPN was defined as pain in both feet and a DN4-interview score ≥ 3.

RESULTS

A total of 23,206 eligible people were identified as having diabetes and approximately 33 % answered all questionnaires. The prevalence of possible DPN was 23.3 % (95 % CI: 22.4-24.3 %), while the prevalence of possible painful DPN was 18.0 % (17.1-18.8 %). The prevalence of possible DPN ranged from 22.1 % to 35.0 % between municipalities, while the prevalence of possible painful DPN ranged from 15.6 % to 20.0 %. High body-mass index, long diabetes duration, insulin use, glucagon-like-peptide-1-analogue use, and low income were associated with increased risk of DPN.

CONCLUSION

The high prevalence of possible painless and painful DPN emphasizes the need for better prevention and careful screening even in high-income countries.

A Systematic Review of Dietary Lifestyle Interventions for Neuropathic Pain

Background/Objectives: Chronic severe neuropathic pain (NP) affects one in 10 individuals over the age of 30 in North America. Standard pharmacological interventions are associated with significant side effects and have limited effectiveness. Diets seeking to improve physiological health, support gut barrier integrity, and decrease systemic inflammation have recently emerged as powerful tools conferring neuroprotective and anti-inflammatory effects, potentially reducing the overall morbidity and mortality of multiple neurological and metabolic diseases. This systematic review aimed to synthesize the literature around NP outcomes following dietary interventions compared to routine standard of care. Methods: Following PRISMA guidelines, an initial search yielded 15,387 records after deduplication. Six interventional trials specifically assessing dietary interventions for neuropathic pain were included and analyzed. The dietary lifestyle interventions included low-fat plant-based, plant-based fasting-mimicking, low-calorie, potassium-reduced, gluten-free, and intermittent high-protein/Mediterranean diets. Results: The included studies described some statistically significant improvements in pain severity on objective quantitative sensory testing, electrophysiology, imaging, and subjective questionnaires. The overall risk of bias was moderate, with only one trial demonstrating a low risk of bias across all assessed domains. No serious adverse events were identified, and dietary interventions were generally well tolerated. Conclusions: The data collected and synthesized in this systematic review indicate that dietary lifestyle interventions may offer a low-risk, low-cost, low-tech option for chronic neuropathic pain management, potentially improving quality of life and reducing overall morbidity. However, given substantial variability across studies and a moderate risk of bias, further research is warranted to substantiate these findings.

Promising predictors of diabetic peripheral neuropathy in children and adolescents with type 1 diabetes mellitus

BACKGROUND

Diabetic peripheral neuropathy (DPN) in children and adolescents with type 1 diabetes mellitus (T1DM) is a growing issue, with controversial data in the terms of prevalence and evaluation timelines. Currently, there are no clear standards for its early detection. Therefore, our aim was to assess the contribution of the Michigan neuropathy screening instrument (MNSI), lipid profile, serum neuron specific enolase (NSE), and serum heat shock protein 27 (HSP 27) to the prediction of DPN in children and adolescents with T1DM.

METHODS

In this case-control study, fifty children diagnosed with T1DM for at least five years were enrolled and evaluated through complete neurological examination, MNSI, and nerve conduction study (NCS). Additionally, HbA1c, lipid profile, serum NSE, and serum HSP 27 levels were measured for patients and controls.

RESULTS

The prevalence of DPN in our study was 24% by NCS, and electrophysiological changes showed a statistically significant lower conduction velocity for the posterior tibial and sural nerves, as well as a prolonged latency period for the common peroneal and sural nerves in neuropathic patients. In these patients, older age, earlier age of diabetes onset, longer disease duration, higher total cholesterol, triglycerides, low density lipoprotein cholesterol, HbA1c, serum NSE, and HSP27 levels were observed. The MNSI examination score ≥ 1.5 cutoff point had an area under the curve (AUC) of 0.955, with 75% sensitivity and 94.74% specificity, according to receiver operating characteristic curve analysis. However, the questionnaire's cutoff point of ≥ 5 had an AUC of 0.720, 75% sensitivity, and 63% specificity, with improved overall instrument performance when combining both scores. Regarding blood biomarkers, serum NSE had greater sensitivity and specificity in discriminating neuropathic patients than HSP27 (92% and 74% versus 75% and 71%, respectively). Regression analysis revealed a substantial dependency for MNSI and serum NSE in predicting DPN in patients.

CONCLUSIONS

Despite limited research in pediatrics, MNSI and serum NSE are promising predictive tools for DPN in children and adolescents with T1DM, even when they are asymptomatic. Poor glycemic control and lipid profile changes may play a critical role in the development of DPN in these patients, despite conflicting results in various studies.

The global burden of erectile dysfunction and its associated risk factors in diabetic patients: an umbrella reviews

BACKGROUND

Erectile dysfunction is no longer a whisper in the shadows; it's a rising tide threatening the sexual health of millions of men in different regions. In the cases of diabetes, the condition worsens and has a potent cocktail of physical and psychological distress, chipping away at men's confidence, self-esteem, and mental health. This worrying trend shows no signs of slowing down, with projections claiming a staggering 322 million men globally could be affected in the near future. This urgent issue demands immediate attention and action. Thus, this umbrella review intended to estimate the current burden of erectile dysfunction and associated risk factors among diabetic patients in the global context.

METHODS

Following PRISMA guidelines, we searched for relevant studies in PubMed, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. These studies reported the prevalence of erectile dysfunction and associated risk factors in diabetic patients. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews 2 tool. To estimate the pooled prevalence of erectile dysfunction, we employed a weighted inverse variance random-effects model. We further conducted subgroup analyses, assessed heterogeneity and publication bias, and performed sensitivity analyses to strengthen the robustness of our findings. Prediction intervals were also calculated to estimate the range within which future observations will likely fall. In all statistical analyses, the statistical significance was declared at P- value < 0.05.

RESULTS

In this umbrella review, a total of 108 030 male diabetic patients were included to estimate the global prevalence of erectile dysfunction. The pooled global prevalence of erectile dysfunction in diabetic patients was 65.8% (95CI: 58.3 - 73.3%), while In Africa it was 62.9% (95CI: 46.1-79.7). Age (> 40 years) (AOR = 1.95, 95CI: 1.03-3.24), DM duration (> 10years) (AOR = 1.90,95CI: 1.16-2.65), peripheral vascular disease (AOR = 2.74, 95CI: 1.42-4.06) and BMI (> 30 kg/m2) (AOR = 1.07,95CI: 1.01-1.20) were identified as associated risk factors of erectile dysfunction in diabetic patient.

CONCLUSION

The high global prevalence of erectile dysfunction (ED) in diabetic patients is alarming, with an estimated two-thirds experiencing the condition. These findings underscore the significant burden of ED faced by diabetic men and emphasize the urgent need for global attention to the issue. This includes promoting early screening for erectile dysfunction in this population and ensuring access to appropriate treatment and support.

Efficacy of customized insoles in the distribution of the diabetic foot pressure: A randomized and controlled clinical trial

BACKGROUND

Diabetic neuropathy is a condition that can be early diagnosed in DM type 2 patients.

PURPOSE

Evaluate the influence of customized insoles in the plantar pressure of diabetic neuropathy patients when compared to the sham group at baseline and after three and six months.

METHODS

REBEC (Clinical Trial Brazilian Register) (http://www.ensaiosclinicos.gov.br/) RBR-5NQK4K, is a randomized, controlled, double-blinded clinical trial was carried out with a 46-volunteer sample in which participants were randomized to be directed to the intervention and control groups. This study was developed following the standards set for randomized clinical trials (CONSORT). The primary outcome was the analysis of plantar pressure points on the diabetic neuropathy patients' feet using podobarography in the intervention and control group patients. The secondary outcome was the foot functionality in activities of daily living assessed using the FAAM questionnaire in a 6-month follow-up period.

RESULTS

No significant differences were found between the groups regarding the primary and secondary outcomes in the 3rd or in the 6th month.

CONCLUSION

Is not possible to state that insoles provided patients with a significant improvement of the footstep structure in the intervention group in comparison to the control group in diabetic neuropathy patients.

Brain-derived neurotrophic factor (BDNF) and other neurotrophic factors in type 2 diabetes mellitus and their association with neuropathy

BACKGROUND

Diabetes mellitus (DM) is associated with increased risk of morbidity and premature mortality due to its various complications. In an Indian study, the prevalence of diabetic peripheral neuropathy (DPN) in type 2 diabetic subjects was shown to be 29.2%. There is increasing evidence that a deficiency of nerve growth factor (NGF) in diabetes, as well as the calcitonin gene-related peptide (CGRP), may also contribute to the development of DPN. The aim of the current study was to evaluate nerve growth factor levels with neuropathy in type 2 DM.

MATERIALS AND METHODS

Forty healthy controls and 40 patients with type 2 DM were recruited; they were asked to report to Dept. of Physiology for initial history taking, general examination and neuropathy examination. A total of 5 mL of blood was collected for neurotrophic factor estimation as well as glycemic profile estimation.

RESULTS

The brain-derived neurotrophic factor (BDNF) values were significantly lower in the DM group whereas the insulin levels were also quite high in DM. The hot thresholds for both the upper limb and lower limb were greater in the DM group suggesting the impending neuropathy. Similarly, the Michigan scores were also greater in the DM group. The neuropathy parameters especially the Michigan A and B and the hot thresholds were positively correlated with duration of DM and glucose profile.

CONCLUSION

The neurotrophic factors especially BDNF are drastically reduced in DM patients and are negatively associated with neuropathy, and hence, BDNF can be utilized as a therapeutic target to treat and prevent neuropathy.

Differences in corneal nerve fiber density and fiber length in patients with painful chronic idiopathic axonal polyneuropathy and diabetic polyneuropathy

INTRODUCTION/AIMS

Corneal confocal microscopy (CCM) detects small nerve fiber loss and correlates with skin biopsy findings in diabetic neuropathy. In chronic idiopathic axonal polyneuropathy (CIAP) this correlation is unknown. Therefore, we compared CCM and skin biopsy in patients with CIAP to healthy controls, patients with painful diabetic neuropathy (PDN) and diabetics without overt neuropathy (DM).

METHODS

Participants with CIAP and suspected small fiber neuropathy (n = 15), PDN (n = 16), DM (n = 15), and healthy controls (n = 16) underwent skin biopsy and CCM testing. Inter-center intraclass correlation coefficients (ICC) were calculated for CCM parameters.

RESULTS

Compared with healthy controls, patients with CIAP and PDN had significantly fewer nerve fibers in the skin (IENFD: 5.7 ± 2.3, 3.0 ± 1.8, 3.9 ± 1.5 fibers/mm, all p < .05). Corneal nerve parameters in CIAP (fiber density 23.8 ± 4.9 no./mm2, branch density 16.0 ± 8.8 no./mm2, fiber length 13.1 ± 2.6 mm/mm2) were not different from healthy controls (24.0 ± 6.8 no./mm2, 22.1 ± 9.7 no./mm2, 13.5 ± 3.5 mm/mm2, all p > .05). In patients with PDN, corneal nerve fiber density (17.8 ± 5.7 no./mm2) and fiber length (10.5 ± 2.7 mm/mm2) were reduced compared with healthy controls (p < .05). CCM results did not correlate with IENFD in CIAP patients. Inter-center ICC was 0.77 for fiber density and 0.87 for fiber length.

DISCUSSION

In contrast to patients with PDN, corneal nerve parameters were not decreased in patients with CIAP and small nerve fiber damage. Therefore, CCM is not a good biomarker for small nerve fiber loss in CIAP patients.

Glycemic variability's impact on painful diabetic peripheral neuropathy in type 2 diabetes patients

Hyperglycemia in type 2 diabetes leads to diabetic peripheral neuropathy (DPN) and neuropathic pain, yet the association between glycemic variability and painful DPN remains insufficiently evidenced. To address this, we conducted a prospective longitudinal cohort study involving adult type 2 diabetes patients at a medical center. DPN was identified using the Michigan Neuropathy Screening Instrument (MNSI), and neuropathic pain was assessed with the Taiwan version of the Douleur Neuropathique 4 (DN4-T) questionnaire. At baseline in 2013, all participants were free of DPN and were re-evaluated in 2019 for the development of painful DPN. We measured visit-to-visit glycemic fluctuations using the coefficient of variation (CV) of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c). Patients were stratified into tertiles according to their FPG-CV and HbA1c-CV. Among the 622 participants, 267 developed DPN during the six-year follow-up. Following matching of age and sex, 210 patients without DPN and 210 with DPN (including 26 with neuropathic pain) were identified. Our findings revealed a significant association between high FPG-CV and painful DPN, with the highest tertile showing an adjusted odds ratio of 2.82 (95% confidence interval 1.04-7.64) compared to the lowest tertile. On the contrary, HbA1c-CV did not show a significant association with the risk of painful DPN. Our study indicates that higher FPG-CV is associated with an increased risk of painful DPN, supporting the role of glycemic variability in the development of painful DPN.

Establishment and external validation of an early warning model of diabetic peripheral neuropathy based on random forest and logistic regression

OBJECTIVE

The primary objective of this study was to investigate the risk factors for diabetic peripheral neuropathy (DPN) and to establish an early diagnostic prediction model for its onset, based on clinical data and biochemical indices.

METHODS

Retrospective data were collected from 1,446 diabetic patients at the First Affiliated Hospital of Anhui University of Chinese Medicine and were split into training and internal validation sets in a 7:3 ratio. Additionally, 360 diabetic patients from the Second Affiliated Hospital were used as an external validation cohort. Feature selection was conducted within the training set, where univariate logistic regression identified variables with a p-value < 0.05, followed by backward elimination to construct the logistic regression model. Concurrently, the random forest algorithm was applied to the training set to identify the top 10 most important features, with hyperparameter optimization performed via grid search combined with cross-validation. Model performance was evaluated using ROC curves, decision curve analysis, and calibration curves. Model fit was assessed using the Hosmer-Lemeshow test, followed by Brier Score evaluation for the random forest model. Ten-fold cross-validation was employed for further validation, and SHAP analysis was conducted to enhance model interpretability.

RESULTS

A nomogram model was developed using logistic regression with key features: limb numbness, limb pain, diabetic retinopathy, diabetic kidney disease, urinary protein, diastolic blood pressure, white blood cell count, HbA1c, and high-density lipoprotein cholesterol. The model achieved AUCs of 0.91, 0.88, and 0.88 for the training, validation, and test sets, respectively, with a mean AUC of 0.902 across 10-fold cross-validation. Hosmer-Lemeshow test results showed p-values of 0.595, 0.418, and 0.126 for the training, validation, and test sets, respectively. The random forest model demonstrated AUCs of 0.95, 0.88, and 0.88 for the training, validation, and test sets, respectively, with a mean AUC of 0.886 across 10-fold cross-validation. The Brier score indicates a good calibration level, with values of 0.104, 0.143, and 0.142 for the training, validation, and test sets, respectively.

CONCLUSION

The developed nomogram exhibits promise as an effective tool for the diagnosis of diabetic peripheral neuropathy in clinical settings.

Efficacy and Safety of the Combination of Palmitoylethanolamide, Superoxide Dismutase, Alpha Lipoic Acid, Vitamins B12, B1, B6, E, Mg, Zn and Nicotinamide for 6 Months in People with Diabetic Neuropathy

AIM

To investigate the efficacy of Palmitoylethanolamide (PEA, 300 mg), Superoxide Dismutase (SOD, 70 UI), Alpha Lipoic Acid (ALA, 300 mg), vitamins B6 (1.5 mg), B1 (1.1 mg), B12 (2.5 mcg), E (7.5 mg), nicotinamide (9 mg), and minerals (Mg 30 mg, Zn 2.5 mg) in one tablet in people with Diabetic Neuropathy (DN).

PATIENTS-METHODS

In the present pilot study, 73 people (age 63.0 ± 9.9 years, 37 women) with type 2 Diabetes Mellitus (DMT2) (duration 17.5 ± 7.3 years) and DN were randomly assigned to receive either the combination of ten elements (2 tablets/24 h) in the active group (n = 36) or the placebo (n = 37) for 6 months. We used the Michigan Neuropathy Screening Instrument Questionnaire and Examination (MNSIQ and MNSIE), measured vibration perception threshold (VPT) with biothesiometer, and Cardiovascular Autonomic Reflex Tests (CARTs). Nerve function was assessed by DPN Check [sural nerve conduction velocity (SNCV) and amplitude (SNAP)]. Sudomotor function was assessed with SUDOSCAN, which measures electrochemical skin conductance in hands and feet (ESCH and ESCF). Pain score (PS) was assessed with Pain DETECT questionnaire. Quality of life was assessed by questionnaire.

RESULTS

In the active group, there was a large improvement of pain (PS from 20.9 to 13.9, p < 0.001). There was also a significant improvement of vitamin B12 (B12) levels, MNSIQ, SNCV, VPT, and ESCF (222.1 vs. 576.3 pg/ mL, p < 0.001; 6.1 vs. 5.9, p = 0.017; 28.8 vs. 30.4, p = 0.001; 32.1 vs. 26.7, p = 0.001; and 72.2 vs. 74.8, p < 0.001 respectively). In the placebo group, neither pain (21.6 vs. 21.7, p = 0.870) or any other aforementioned parameters changed significantly, and MNSIE worsened (2.9 vs. 3.4, p < 0.001). As a result, changes from baseline to follow-up in pain, B12 levels, VPT, and MNSIQ differed significantly between the two groups (p < 0.001, 0.025, 0.009, and <0.001, respectively). CARTs, SNAP, ESCH did not significantly change in either of the two groups.

CONCLUSIONS

The combination of the ten elements in one tablet for 6 months at a daily dose of two tablets in people with DN significantly improves pain, vibration perception threshold, and B12 levels.

Neuropathic Pain With and Without Diabetic Peripheral Neuropathy in Type 1 Diabetes

OBJECTIVE

Diabetic peripheral neuropathy (DPN) is common; however, the features and burden of neuropathic pain (NP) in type 1 diabetes (T1D) are poorly understood. We evaluated the incidence of first occurrence, annual prevalence, remission, and risk factors for NP during long-term follow-up of participants with T1D.

RESEARCH DESIGN AND METHODS

The Michigan Neuropathy Screening Instrument (MNSI) was administered annually (1994-2020) for 1,324 participants in the Epidemiology of Diabetes Interventions and Complications (EDIC) study. NP with clinical signs of DPN (NP DPN+) was defined according to self-reported NP plus an examination score >2, while NP without clinical signs of DPN (NP DPN-) was defined according to self-reported NP and an examination score ≤2.

RESULTS

At EDIC year 1, median age for participants was 36 years (interquartile range 30, 41), diabetes duration 13 years (10, 18), and HbA1c 7.9% (7.2, 8.9). At year 26 (median diabetes duration 39 years), cumulative incidence of NP was 57%, regardless of concomitant clinical signs of DPN (36% NP DPN+ vs. 46% NP DPN-). NP prevalence was 20% at 26 years (11% NP DPN+ and 9% NP DPN-), suggesting frequent remission. Annualized remission rates were similar regardless of pain medication use. In addition to HbA1c, female sex was associated with NP DPN-.

CONCLUSIONS

NP incidence in T1D was high and frequently occurred in the absence of clinical signs of neuropathy, as assessed with the MNSI. Pain remission was not explained by pain medication use. Effective clinical strategies for identification and management are needed.

Comparison of the effect of separate and simultaneous application of Tecar therapy and low-level laser therapy on the neurological symptoms of type 2 diabetic patients with peripheral neuropathy of lower limbs

Objectives

The study aimed to compare the effects of separate and simultaneous application of Tecar therapy and low-level laser therapy on neurological symptoms of type 2 diabetic patients.

Patients and methods

In this randomized control trial conducted between November 2021 and February 2022, 45 patients (30 females, 15 males; mean age: 65.7±7.6 years; range, 51 to 76 years) with type 2 diabetes and peripheral sensory neuropathy of the lower limbs were randomly divided into three groups: Tecar + sham laser (n=15), Tecar + laser (n=15), and laser + sham Tecar (n=15). Outcome measures for both right and left limbs included tibial motor nerve conduction velocity (MNCV), sural nerve amplitude, sole sensation, and ankle-brachial index (ABI) measured before and after 10 sessions and after a three-month follow-up.

Results

In intergroup comparison, the Tecar + laser group significantly improved compared to the laser + sham Tecar group in terms of tibial MNCV in both limbs after 10 sessions and all measured outcomes after three months (p<0.05). In addition, comparison between the Tecar + laser and Tecar + sham laser groups for tibial MNCV (p=0.021 for the right limb and p=0.002 for the left limb) and ABI (p=0.001 for the right limb and p=0.002 for the left limb) in both limbs after three months was significant. In the intragroup comparison, a significant improvement was found in the laser + sham Tecar group for sole sensation (p<0.001) and ABI (p<0.001) of both limbs after three months compared to before the interventions, whereas in the other two groups, significant improvements were found in all four outcomes.

Conclusion

A significant increase was found in neurological outcomes in all three groups after 10 sessions. Moreover, the use of combined Tecar therapy and laser compared to Tecar or laser alone could lead to a more lasting effect in improving the sensory symptoms of type 2 diabetic patients with peripheral neuropathy of the lower limbs.

Peripheral neuropathy and associated factors among type 2 diabetic patients attending referral hospitals in the Amhara region, a multi-center cross-sectional study in Ethiopia

Diabetic peripheral neuropathy is one of the diabetes most common microvascular complications. It is very prevalent in Sub-Saharan Africa due to a combination of causes, including rising diabetes prevalence, limited healthcare resources, and a lack of access to competent medical care. However, just a few studies have been undertaken in the study area. Institution-based cross-sectional study was conducted in the Amhara region referral hospitals, in 2022. By using a systematic random sampling technique, a total of 627 respondents were included. The data was entered into EPI Data version 4.6 and exported to SPSS version 25 for further analysis. A binary logistic regression was used to determine the relationship between the dependent and predictor variables. The association between predictor variables and the dependent variable was determined using multivariate logistic regression [p value < 0.05, 95% confidence interval]. The overall prevalence of diabetic peripheral neuropathy among the study participants was 48.2% (95% CI; 44.2, 52.1). Aged between 40 and 60 years (AOR = 4:27; 95% CI 2.62, 6.94), and 60 years and older (AOR = 4:47; 95% CI 2.40, 8.35), participants who have lived alone (AOR = 2:14; 95% CI 1.21, 3.79), patients with comorbidity (AOR = 1:83; 95% CI 1.22, 2.76), and being physically inactive (AOR = 1:69; 95% CI 1.14, 2.49) were significantly associated with Diabetic peripheral neuropathy. Diabetic peripheral neuropathy was high among diabetic patients. Healthcare providers should prioritize regular screening and early intervention for individuals at higher risk, particularly those aged 40 and above, those living alone, patients with comorbid conditions, and those who are physically inactive. Implementing community-based support programs, encouraging physical activity, and providing comprehensive management plans for diabetes and associated comorbidities can help mitigate the risk and improve the quality of life for these patients.

Cardiac Autonomic Neuropathy in Diabetic Peripheral Neuropathy

Background Cardiac autonomic neuropathy (CAN) is the most underdiagnosed consequence of diabetes because standard hospital settings do not provide consistent diagnostic criteria or testing resources. It is still unclear how diabetic peripheral neuropathy (DPN) and CAN are related. Therefore, this study aimed to determine the prevalence of CAN in individuals with type 2 diabetes mellitus who had isolated DPN without other microvascular or macrovascular complications. Methodology A total of 35 type 2 diabetes mellitus patients with isolated DPN (group 1) and an equal number of sex- and age-matched patients without DPN (group 2) underwent CAN testing. Results were compared between the two groups. Results A significantly higher prevalence of isolated parasympathetic (28.57 vs. 11.42%), isolated sympathetic (22.85 vs. 8.57%), and combined autonomic dysfunction (37.14 vs. 2.85%) was found in the neuropathic group compared to the non-neuropathic group. Group 1 exhibited more abnormal parasympathetic nervous system test results and increased diastolic pressure during sustained handgrip compared to group 2 (all p-values <0.05). Conclusions A significantly higher prevalence of cardiac autonomic dysfunction is seen in patients with DPN without other microvascular or macrovascular complications, irrespective of age, sex, or duration of diabetes mellitus. Patients with a higher body mass index were found to have significantly increased cardiac autonomic dysfunction.

Association Between Microvascular Disease and Cardiorespiratory Fitness Among Adults With Type 2 Diabetes

OBJECTIVE

Little is known about the extent to which microvascular disease is associated with cardiorespiratory fitness (CRF) among individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS

A total of 4,766 participants with type 2 diabetes underwent maximal exercise testing in the Look AHEAD (Action for Health in Diabetes) study at baseline. Low CRF was defined based on the Aerobics Center Longitudinal Study reference standards. Microvascular disease was defined as having one or more of diabetes-related kidney disease (DKD), retinopathy, and neuropathy. The burden of microvascular disease was defined as the number of microvascular beds affected.

RESULTS

Of the 4,766 participants (mean age 58.9 ± 6.7 years, 58.5% women, 66.1% White individuals), 1,761 (37%) had microvascular disease. Participants with microvascular complications in three vascular territories had a lower CFR than those without any microvascular disease (mean adjusted metabolic equivalent of task [MET] 6.58 vs. 7.26, P = 0.001). Participants with any microvascular disease had higher odds of low CRF than those without microvascular disease (adjusted odds ratio [OR] 1.45, 95% CI 1.24-1.71). An increasing burden of microvascular disease was associated with higher odds of low CRF (for microvascular disease in three vascular territories, adjusted OR 2.82, 95% CI 1.36-5.85). Adjusted ORs for low CRF were 1.24 (95% CI 0.99-1.55), 1.34 (95% CI 1.02-1.76), and 1.44 (95% CI 1.20-1.73) for neuropathy, retinopathy, and DKD associations, respectively.

CONCLUSIONS

In a large cohort of adults with type 2 diabetes, the presence of microvascular disease and its burden were independently associated with lower CRF.

Evaluation of Microvascular Complications in Kidney Recipients With Posttransplant Diabetes Mellitus

CONTEXT

The paucity of data on microvascular complications in patients with posttransplant diabetes (PTDM) is an obstacle to developing follow-up algorithms.

OBJECTIVE

To evaluate diabetic microvascular complications in patients with long-standing PTDM.

METHODS

In patients with ≥5-year history of PTDM and age-matched renal transplant recipients without PTDM (NDM), diabetic peripheral neuropathy was evaluated using the Michigan Neuropathy Screening Instrument, the CASE IV device, and in vivo corneal confocal microscopy (CCM). Cardiac autonomic neuropathy tests were performed using heart rate variability. Nephropathy screening was assessed using spot urine albumin/creatinine ratio and eGFR calculation. Diabetic retinopathy was evaluated by fundus examination and photography, and optical coherence tomography.

RESULTS

This study included 41 patients with PTDM and 45 NDM patients. The median follow-up was 107.5 months in the PTDM group. Peripheral neuropathy was significantly higher in the PTDM group than in the NDM group (P = .02). In the PTDM patients with peripheral neuropathy, corneal nerve fiber density examined by CCM was significantly lower than in PTDM patients without neuropathy (P = .001). Parasympathetic involvement was observed in 58.5% of the PTDM group and 22% of the NDM group (P = .001). Sympathetic involvement was present in 65.9% of the PTDM group and 29.3% of the NDM group (P = .001). Retinopathy was observed in 19.5% of patients in the PTDM group and in none of the NDM patients (P < .001). Renal functions were similar between the study groups.

CONCLUSION

Cardiac autonomic neuropathy and diabetic retinopathy can affect patients with PTDM at a high rate. Diabetic retinopathy is a threat to the vision of PTDM patients. Diabetic peripheral neuropathy can be detected early in PTDM patients by CCM.

Lipid Levels and Risk of Diabetic Polyneuropathy in 2 Danish Type 2 Diabetes Cohorts

BACKGROUND AND OBJECTIVES

Reduction of blood lipids may aid in preventing diabetic polyneuropathy (DPN), but evidence remains conflicting. We investigated the association between lipid parameters and DPN risk in individuals with type 2 diabetes mellitus (T2DM).

METHODS

We conducted a population-based cohort study of individuals with newly diagnosed T2DM and a cross-sectional study using a clinically recruited T2DM cohort. Triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and non-HDL cholesterol were measured in routine diabetes care. Each lipid parameter was categorized according to the latest cutoffs in clinical guidelines on dyslipidemia. DPN was assessed with validated hospital diagnosis codes in the population-based cohort and with the Michigan Neuropathy Screening Instrument questionnaire in the clinical cohort. We calculated hazard ratios (HRs) using Cox regression and prevalence ratios (PRs) using Poisson regression.

RESULTS

We included 61,853 individuals in the population-based cohort (median age 63 [quartiles 54-72] years) and 4,823 in the clinical cohort (median age 65 [quartiles 57-72] years). The incidence rate of hospital-diagnosed DPN in the population-based cohort was 3.6 per 1000 person-years during a median follow-up of 7.3 years. Achieving guideline targets for HDL, LDL, and non-HDL cholesterol showed no association with DPN risk. By contrast, adjusted HRs (95% CI) for DPN were 1.02 (0.89-1.18) for triglyceride levels between 150 and 204 mg/dL (1.7-2.3 mmol/L) and 1.28 (1.13-1.45) for levels >204 mg/dL (2.3 mmol/L). In the clinical cohort with a DPN prevalence of 18%, DPN associated strongly with triglycerides >204 mg/dL (2.3 mmol/L) with an adjusted PR (95% CI) of 1.40 (1.21-1.62). The prevalence of DPN was modestly elevated for individuals with HDL cholesterol <39 mg/dL (1.0/1.3 mmol/L) in men and <50 mg/dL (1.3 mmol/L) in women (PR 1.13 [0.99-1.28]) and for individuals with non-HDL cholesterol >131 mg/dL (3.4 mmol/L) (PR 1.27 [1.05-1.52]). In both cohorts, spline models showed an increasing risk of DPN starting from triglyceride levels >124 mg/dL (1.4 mmol/L). All results were similar among statin users.

DISCUSSION

High triglyceride levels are a strong DPN risk factor. Future intervention studies shall determine whether triglyceride reduction is more important for DPN prevention than reduction of other lipids.

Residual β-Cell Function Is Associated With Longer Time in Range in Individuals With Type 1 Diabetes

OBJECTIVE

Little is known about the influence of residual islet function on glycemic control in type 1 diabetes (T1D). We investigated the associations between residual β-cell function and metrics of continuous glucose monitoring (CGM) in individuals with T1D.

RESEARCH DESIGN AND METHODS

In this cross-sectional cohort comprising 489 individuals (64% female, age 41.0 ± 14.0 years), T1D duration was 15.0 (interquartile range [IQR] 6.0-29.0) years. Individuals had a time in range (TIR) of 66% (IQR 52-80%) and a urinary C-peptide-to-creatinine ratio (UCPCR) of 0.01 (IQR 0.00-0.41) nmol/mmol. To assess β-cell function, we measured UCPCR (detectable >0.01 nmol/mmol), and to assess α-cell function, fasting plasma glucagon/glucose ratios were measured. CGM was used to record TIR (3.9-10 mmol/L), time below range (TBR) (<3.9 mmol/L), time above range (TAR) (>10 mmol/L), and glucose coefficient of variance (CV). For CGM, 74.7% used FreeStyle Libre 2, 13.8% Medtronic Guardian, and 11.5% Dexcom G6 as their device.

RESULTS

The percentage of patients with T1D who had a detectable UCPCR was 49.4%. A higher UCPCR correlated with higher TIR (r = 0.330, P < 0.05), lower TBR (r = -0.237, P < 0.05), lower TAR (r = -0.302, P < 0.05), and lower glucose CV (r = -0.356, P < 0.05). A higher UCPCR correlated negatively with HbA1c levels (r = -0.183, P < 0.05) and total daily insulin dose (r = -0.183, P < 0.05). Glucagon/glucose ratios correlated with longer TIR (r = 0.234, P < 0.05).

CONCLUSIONS

Significantly longer TIR, shorter TBR and TAR, and lower CV were observed in individuals with greater UCPCR-assessed β-cell function. Therefore, better CGM-derived metrics in individuals with preserved β-cell function may be a contributor to a lower risk of developing long-term complications.

Prevalence of peripheral neuropathy, amputation, and quality of life in patients with diabetes mellitus

Peripheral neuropathy and amputation are common complications of diabetes mellitus (DM) that significantly impact the quality of life of the affected individuals. This study aims to investigate the prevalence of peripheral neuropathy, the level of amputation, and the quality of life in patients with DM. This cross-sectional study was conducted after approval of the synopsis involving 225 diagnosed patients with DM on pre-defined eligibility criteria, selected from public sector OPDs, specialized diabetes centres, and centres manufacturing orthotics and prosthetics. Data were collected through interviews, observations, and the administration of the Michigan Neuropathy Screening Instrument and the Asian Diabetes Quality of Life Questionnaire. The level of amputation was recorded for each participant. Data was entered into SPSS, and results were synthesized. Pearson correlation is applied to find an association between gender and the quality of life of the participants, while P ≤ 0.05 will be considered significant. The prevalence of peripheral neuropathy in a sample of 225, based on a self-administered questionnaire, was (44.4%), and in terms of foot examination was (51.1%). As people progressed in age, the prevalence increased to 20.0% in patients above 60 years and 8.9% in ≤ 35 years of age. The majority of participants (56.0%) have had DM for less than five years. Females were 57.8% of the study population, while 97.8% of participants had type II DM. Below-knee amputation of the right limb was observed in 22(9.8%) of the participants. The QoL was poor in the majority of the participants (96.9%) patients with DM (P = 0.638 and T = -0.471). This cross-sectional study highlights a high prevalence of peripheral neuropathy and amputation and poor QoL in patients with diabetic mellitus.

Contemporary prevalence of diabetic neuropathies in individuals with type 1 and type 2 diabetes in a Danish tertiary outpatient clinic

BACKGROUND

Population-based prevalence estimates of distal symmetric polyneuropathy (DPN) and diabetic autonomic neuropathy (DAN) are scares. Here we present neuropathy estimates and describe their overlap in a large cohort of people with type 1 and type 2 diabetes.

METHODS

In a large population of outpatient participants, DPN was assessed using vibration perception threshold, sural nerve function, touch, pain and thermal sensation. Definite DPN was defined by the Toronto Consensus Criteria. Painful DPN was defined by Douleur Neuropathique 4 Questions. DAN measures were: cardiovascular reflex tests, electrochemical skin conductance, and gastroparesis cardinal symptom index.

RESULTS

We included 822 individuals with type 1 (mean age (±SD) 54 ± 16 years, median [IQR] diabetes duration 26 [15-40] years) and 899 with type 2 diabetes (mean age 67 ± 11 years, median diabetes duration 16 [11-22] years). Definite DPN was prevalent in 54 % and 68 %, and painful DPN was in 5 % and 15 % of type 1 and type 2 participants, respectively. The prevalence of DAN varied between 6 and 39 % for type 1 and 9-49 % for type 2 diabetes. DPN without other neuropathy was present in 45 % with T1D and 50 % with T2D.

CONCLUSION

The prevalence of DPN and DAN was high. DPN and DAN co-existed in only 50 % of cases.

Umbrella review protocol: Global burden and risk factors of erectile dysfunction in diabetic population

Background

Erectile dysfunction (ED) is no longer a whisper in the shadows; it's a rising tide threatening the sexual health of millions of men in different regions. This worrying trend shows no signs of slowing down, with projections claiming a staggering 322 million men globally could be affected in the near future. In the cases of diabetes, the condition worsens and has a potent cocktail of physical and psychological distress, chipping away at men's confidence, self-esteem, and mental health. This urgent issue demands immediate attention and action. Thus, this umbrella review intended to estimate the current burden of ED and associated risk factors among diabetic patients in the global context.

Methods

Following PRISMA guidelines will be searched for relevant Systematic Review and Meta-analysis studies in PubMed, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. The quality of the included studies will be assessed using the new regress tool, the Assessment of Multiple Systematic Reviews 2 tool. To estimate the pooled prevalence of ED, we will employ a weighted inverse variance random-effects model. We will further conduct subgroup analyses, assess heterogeneity and publication bias, and perform sensitivity analyses to strengthen the robustness of our findings. Prediction intervals will also calculated to estimate the range within which future observations will likely fall. In all statistical analyses, the statistical significance will be declared at p value < 0.05.

Discussion

This umbrella review of systemic review and meta-analysis will be the first to systematically explore and integrate evidence regarding the burden of ED and associated risk factors in the diabetic population in a global context. By estimating the worldwide burden and identifying risk factors of ED in this population, the study will contribute to uncovering the hidden burden. Thereby, the issue will get international attention to reduce its consequences on the sexual health of the diabetic population. Besides, it will also provide input and direction for future research outlook.

Prevalence and Risk Factors of Distal Symmetric Polyneuropathy Among Predominantly Non-Hispanic Black, Low-Income Patients

BACKGROUND AND OBJECTIVES

Distal symmetric polyneuropathy (DSP) is a disabling, often painful condition associated with falls and reduced quality of life. Non-Hispanic Black people and people with low income are underrepresented in existing DSP studies; therefore, it is unknown whether data accurately reflect the prevalence, risk factors, and burden of disease in these populations.

METHODS

Patients older than 40 years presenting to an outpatient internal medicine clinic predominantly serving Medicaid patients in Flint, Michigan, were enrolled in a cross-sectional study. Demographics, clinical characteristics, including medication use, anthropomorphic measurements, fasting lipids, and hemoglobin A1c were collected. DSP was defined using the modified Toronto Clinical Neuropathy Score (mTCNS). Multivariable logistic regression was performed to model DSP and undiagnosed DSP as a function of potential risk factors age, metabolic syndrome, and race. DSP burden was measured using Peripheral Neuropathy Quality of Life Instrument-97.

RESULTS

Two hundred participants were enrolled, and 169 (85%) completed all data collection. The population was 55% female of mean age (SD) 58.2 years (10.4) and 69% non-Hispanic Black. Among the population, 50% had diabetes, 67% had metabolic syndrome, and 47% had a household income <$20,000. DSP was present in 73% of the population, of which 75% were previously undiagnosed. Neuropathic pain was documented in 57% of participants with DSP. DSP based on mTCNS criteria was associated with older age (odds ratio [OR] 1.1 [95% confidence interval (CI) 1.03-1.2]) and metabolic syndrome (OR 4.4 [1.1-18.1]). Non-Hispanic Black participants had lower odds of DSP (OR 0.1 [0.01-0.4]) than non-Hispanic White and Hispanic participants. DSP burden was high, including increased pain, health-related worry, and poorer quality of life (all p < 0.001).

DISCUSSION

DSP is extremely common and often underrecognized in this predominantly non-Hispanic Black, low-income population and leads to substantial disease burden. Metabolic syndrome is a highly prevalent, modifiable risk factor in this population that should be managed to lower DSP prevalence.

Prevalence and disease burden of peripheral neuropathy in the general population in Mexico city: a cross-sectional epidemiological study

OBJECTIVE

Peripheral neuropathy (PN) is one of the most common diseases of the peripheral nervous system. Symptoms range from mild sensory signs to severe neuropathic pain. Untreated PN is progressive and can lead to complications and impair quality of life (QoL). However, PN prevalence is underestimated in the general population and affected individuals often remain undiagnosed. This study aimed to contribute to the global generation of prevalence data and determine sociodemographic and disease-related characteristics of PN sufferers.

METHODS

This cross-sectional study collected information on PN prevalence and associated factors in the adult population (40-65 years) of the Mexico City area. Participants were recruited in public places and screened for PN using the Michigan Neuropathy Screening Instrument (MNSI). Subjects with PN answered the Neuropathy Total Symptom Score-6 (NTSS-6), the Short Form-36 Health Survey (SF-36), and the QoL Pharmacoeconomic Questionnaire. Statistical analysis included descriptive methods and calculation of PN prevalence with 95% confidence intervals.

RESULTS

Of 3066 participants, 448 had PN based on the MNSI physical examination. The overall PN prevalence was 14.6%, with the highest (18.9%) seen in subjects aged 61-65 years. PN was undiagnosed in 82.6%, and 62.9% had never heard of PN. Although half of all subjects had only mild PN symptoms, QoL was impacted in 91.8%.

CONCLUSIONS

The results confirm that PN prevalence in the general population is high. Despite the disease burden, most affected persons are undiagnosed and unaware of the disease. Almost all felt their QoL was impacted. The data highlight the need to raise awareness and identify undiagnosed individuals to prevent complications.

Balance performance, falls-efficacy and social participation in patients with type 2 diabetes mellitus with and without vestibular dysfunction

Background

The performance of balance is an important factor to perform activities. The complications of type 2 diabetes mellitus (T2DM), especially vestibular dysfunction (VD), could decrease balance performance and falls-efficacy (FE) which consequently impacts social participation and quality of life (QoL).

Purpose

This study aimed to compare balance performance, FE, social participation and QoL between individuals with T2DM with and without VD.

Methods

The participants comprised 161 T2DM with VD and 161 without VD. Three clinical tests used for confirming VD included the Head Impulse Test (HIT), the Dix Hallpike Test (DHT) and the Supine Roll Test (SRT). The scores of static and dynamic balances, FE, social participation and QoL were compared between groups.

Results

The balance performance, FE, social participation and QoL were lower in the group with VD. The number of patients who had severe social restriction was higher in T2DM with VD than without VD (58.4% vs 48.4%). Moreover, all domains of QoL (physical, psychological, social relationships and environmental) were lower in T2DM with VD than without VD.

Conclusion

The presence of VD in T2DM patients was associated with decreased physical balance performances and increased social and QoL disengagement. Comprehensive management related to balance and FE, as well as the monitoring to support social participation and QoL, should be emphasized in patients with T2DM with VD.

Neurological dysfunction screening in a cohort of adolescents with type 1 diabetes: a six-year follow-up

Aims

Diabetic neuropathy (DN) is one of the most insidious microvascular complications in patients with type 1 diabetes (T1DM) and initial signs may appear during childhood. The aim of this study is to evaluate associations between the Nerve Conduction Studies (NCS) outcomes at enrollment with neuropathy screening questionnaires performed six years later in a cohort of asymptomatic adolescents followed up until early adulthood, affected by T1DM.

Methods

We performed NCS in a cohort of seventy-two adolescents with T1DM and eighteen healthy controls. Six years later, screening questionnaires for DN were proposed: Michigan Neuropathy Screening Instrument (MNSI, specific for symptoms of somatic dysfunction), Composite Autonomic Symptom Score 31 (COMPASS 31, specific for abnormalities of the autonomic component) and Clarke questionnaire (perception of hypoglycemia). Thirty-two TD1M subjects agreed to participate in the follow-up; main clinical-metabolic parameters, including the number of episodes of hypoglycemia in the past twelve months, were collected.

Results

11.8% of subjects showed changes compatible with DN through the MNSI questionnaire, while 41% declared a reduced perception of hypoglycemia on the Clarke questionnaire. No significant correlation was observed between the clinical-metabolic parameters or altered response to NCS and scores of MNSI and COMPASS 31 questionnaires. On the other hand, an association was observed between NCS abnormalities and a high number of hypoglycemic events after six years (97-fold increased risk, p = 0.009).

Conclusion

The frequency of somatic alterations in the study population is 11.8%, whereas the frequency of symptoms correlated with autonomic damage is about 41%. An autonomic impairment recorded at NCS may represent a six-year risk factor for increased hypoglycemic episodes, even if more extensive studies are needed to investigate this possible relationship further.

Prevalence and predictive features of metabolic dysfunction-associated steatotic liver disease in type 1 diabetes

AIMS/HYPOTHESIS

The prevalence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in type 1 diabetes remain unclear. Therefore, we investigated the prevalence and severity of MASLD in type 1 diabetes and assessed which clinical features are most important in predicting MASLD severity.

METHODS

A total of 453 individuals with type 1 diabetes (41.6 ± 15.0 years, 64% female, body mass index [BMI] 25.4 ± 4.2 kg/m2, and HbA1c 55.6 ± 12 mmol/mol) underwent vibration-controlled transient elastography (VCTE), with a controlled attenuation parameter (CAP) score for steatosis (≥280.0 dB/m) and a liver stiffness measurement (LMS) for fibrosis (≥8.0 kPa). A machine learning Extra-Trees classification model was performed to assess the predictive power of the clinical features associated with type 1 diabetes with respect to steatosis and fibrosis.

RESULTS

The prevalence of hepatic steatosis and fibrosis was 9.5% (95% CI, 6.8-12.2) and 3.5% (95% CI, 1.8-5.2). Higher LMS was associated with a longer duration of type 1 diabetes (median 30.5 [IQR 18.0-39.3] years vs 15.0 [IQR 6.0-27.0] years), and individuals were older, had a higher BMI (mean 27.8 ± 5.2 vs 25.3 ± 4.1 kg/m2), and a higher CAP score (mean 211.4 ± 51.7 dB/m vs 241.4 ± 75.6 dB/m). The most important predictive features of fibrosis were duration of type 1 diabetes, age, and systolic blood pressure, with a mean ± SD area under the curve of 0.73 ± 0.03.

CONCLUSION

Individuals with type 1 diabetes and high blood pressure, older age, higher BMI, and longer duration of disease could be considered at high-risk for developing MASLD.

Neuromuscular electrical stimulation for the treatment of diabetic sensorimotor polyneuropathy: A prospective, cohort, proof-of-concept study

OBJECTIVE

To assess a potential efficacy signal, safety and feasibility of neuromuscular electrical stimulation (NMES) therapy as an adjunct to standard care in patients with diabetic sensorimotor polyneuropathy (DSPN).

METHODS

In this single-centre, prospective, cohort, proof-of-concept study, 25 patients with DSPN consented to at least one daily 30-minute NMES therapy session (Revitive® IX) for 10 weeks, with 20 patients completing the study. The primary outcome measure was nerve conductivity assessed using a nerve conduction study of the sural, superficial peroneal, common peroneal and tibial nerves at 10 weeks compared to baseline. Secondary outcomes included superficial femoral artery (SFA) haemodynamics during NMES therapy compared to rest and quality-of-life at 10 weeks compared to baseline.

RESULTS

At 10 weeks, there were significant increases in sural sensory nerve action potential amplitude and conduction velocity (p < 0.001), superficial peroneal sensory nerve action potential amplitude (p = 0.001) and conduction velocity (p = 0.002), common peroneal nerve conduction velocity (p = 0.004) and tibial nerve compound muscle action potential amplitude (p = 0.002) compared to baseline. SFA volume flow and time-averaged mean velocity significantly increased (p ≤ 0.003) during NMES compared to rest. Patient-reported Michigan Neuropathy Screening Instrument scores significantly decreased (p = 0.028) at 10 weeks compared to baseline. Three unrelated adverse events occurred, and 15 participants adhered to treatment.

CONCLUSIONS

NMES therapy as an adjunct to standard care for 10 weeks significantly increased lower limb nerve conductivity in patients with DSPN and may be beneficial in the treatment of DSPN.

Estimated glucose disposal rate predicts the risk of diabetic peripheral neuropathy in type 2 diabetes: A 5-year follow-up study

BACKGROUND

Insulin resistance is associated with chronic complications of diabetes, including diabetic peripheral neuropathy (DPN). Estimated glucose disposal rate (eGDR), calculated by the common available clinical factors, was proved to be an excellent tool to measure insulin resistance in large patient population. Few studies have explored the association between eGDR and DPN longitudinally. Therefore, we performed the current study to analyze whether eGDR could predict the risk of DPN.

METHODS

In this prospective study, 366 type 2 diabetes (T2DM) subjects without DPN were enrolled from six communities in Shanghai in 2011-2014 and followed up until 2019-2020. Neuropathy was assessed by Michigan Neuropathy Screening Instrument (MSNI) at baseline and at the end of follow-up.

FINDINGS

After 5.91 years, 198 of 366 participants progressed to DPN according to MNSI examination scores. The incidence of DPN in the low baseline eGDR (eGDR < 9.15) group was significantly higher than in the high baseline eGDR (eGDR ≥ 9.15) group (62.37% vs. 45.56%, p = .0013). The incidence of DPN was significantly higher in patients with sustained lower eGDR level (63.69%) compared with those with sustained higher eGDR level (35.80%). Subjects with low baseline eGDR (eGDR < 9.15) had significantly higher risk of DPN at the end of follow-up (odds ratio = 1.75), even after adjusting for other known DPN risk factors.

CONCLUSIONS

The 5-year follow-up study highlights the importance of insulin resistance represented by eGDR in the development of DPN in T2DM. Diabetic patients with low eGDR are more prone to DPN and, therefore, require more intensive screening and more attention.