Clinical characteristics of patients with diabetic polyneuropathy: the role of clinical and electromyographic evaluation and the effect of the various types on the quality of life

The Predictors of Painful Diabetic Neuropathy and Its Effect on Quality of Life

BACKGROUND

Knowing the prevalence and predictors of neuropathic pain and its impacts on the quality of life (QoL) using measurement tools is important for good diabetes management. In Turkish society, neuropathic pain, its predictors and its impact on the quality of life of diabetics are not considered enough.

OBJECTIVES

This study examined the prevalence and predictors of neuropathic pain and its impacts on the quality of life in diabetics in Rize Province, Turkey.

DESIGN

This study was designed as a cross-sectional, correlational study.

SETTING

Data collected through face-to-face interviews. The sample size was determined using the formula [n= N t²pq / d² (N-1) + t²pq].

PARTICIPANT

The sample of the study consisted of 122 people with diabetes who visited the diabetes outpatient clinic of the hospital.

METHODS

A Personal Information Form, Douleur Neuropathique en 4 questions (DN4), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used to collect data. Pain intensity was measured using Visual Analogue Scale (VAS) RESULTS: The prevalence of the diagnosed painful diabetic polyneuropathy (PDPN) was found to be 22.9%. On the other hand, the prevalence of the undiagnosed PDPN was found to be 44.3% according to DN4 and 27.9% according to LANSS. The VAS pain score was determined as 1.99±1.20 (range: 1-5). In the people with PDPN, nephropathy was seen 4.514 times more frequently according to DN4 and 7.217 times more frequently according to LANSS. Painful diabetic peripheral neuropathy had negative effects on all dimensions of QoL except for social function and mental health (p <0.05).

CONCLUSIONS

It is important for nurses to determine the prevalence and predictive factors of PDPN in their region and to evaluate the effect of pain on the quality of life of diabetics. Nurses should attempt to increase the quality of life of people with diabetes by reducing the predictors affecting pain.

Turkish version of the Michigan Neuropathy Screening Instrument in the assessment of diabetic peripheral neuropathy: a validity and reliability study

Background/aim

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus (DM). The Michigan Neuropathy Screening Instrument (MNSI) is a simple, brief, and useful screening tool that was designed to assess DPN. The aim of this study was to develop a Turkish version of the MNSI and assess its reliability and validity.

Materials and methods

Eighty-three patients with DM who were divided into two groups according the results of nerve conduction studies (NCS) as having DPN or without DPN were enrolled in this cross-sectional study. The Toronto clinical scoring system, pain detect questionnaire, and NCS were assessed along with the MNSI.

Results

Each section of the MNSI was internally consistent (Cronbach's alpha > 0.70), and the scores of both sections were positively correlated with total MNSI score (r = 0.938; r = 0.908, respectively, p < 0.001). The test-retest reliability of the Turkish version of the MNSI was determined as 0.99 for the total score (intraclass correlation coefficient = 0.996). Using the agreement between MNSI scores and DPN diagnosis by NCS as a gold standard, receiver-operating characteristic (ROC) curve values for section A and section B were estimated as 0.973 and 1.00, respectively. When a cut-off value ≥ 3.0 in section A and a cut-off value ≥ 2.0 in section B were used, we obtained a sensitivity of 97.6% and 100%; a specificity of 63.4% and 97.6%; a positive predictive value of 72.7% and 97.6%; and a negative predictive value of 96.3% and 100%, respectively.

Conclusion

The Turkish version of MNSI is a reliable and valid tool for screening DPN in Turkish patients.

Skin Changes in Patients with Diabetes Melitus Type 2 and their Impact on Quality of Life

Introduction:

Changes in the skin can occur as part of a diabetic, metabolic disorder or diabetic complications. Studies have shown that diabetes has an extremely strong negative impact on quality of life, especially diabetes with complications.

Aim:

Examine the impact of skin changes in patients with type 2 diabetes mellitus on quality of life.

Methods:

A prospective study analysed the quality of life in 200 respondents with type 2 diabetes mellitus which had diabetes-related skin changes. Subjects were divided into four groups according to the type of skin changes associated with diabetes mellitus. Group 1 consisted of patients which had skin changes with a greater or lesser association with diabetes mellitus, group 2 patients with infections, group 3 patients with cutaneous manifestations of diabetic complications and group 4 patients with allergic reactions to antidiabetic therapy. Quality of life assessment was performed using the Skindex-29 questionnaire, and the Nijsten categorization was used to assess the impact of skin changes in patients with type 2 diabetes mellitus on quality of life.

Results:

There were (51.95%) respondents in group 1, group 2 (24.02%), group 3 (22.22%) and group 4 (1.8%) respondents. In the scale of emotions in 84 respondents (43.0%) the impact on quality of life was serious, in the scale of symptoms in 96 (48%) was moderate, and in the scale of social and physical functioning 106 (55%) also had a moderate impact on quality of life, as well as in the total score of 94 respondents (47%). There was a statistically significant difference in the scale of social and physical functioning in the presence of skin changes in group 1 (x2 = 7.95; df = 3, p = 0.045) and group 3 (x2 = 12.48, df = 3; p = 0.006), and in the total score of Skindex-29 when it comes to changes in the skin of group 3 (x2 = 7.26, df = 3, p = 0.05).

Conclusion:

the quality of life in patients with type 2 diabetes mellitus which have skin changes is significantly reduced.

Do we underestimate influences of diabetic mononeuropathy or polyneuropathy on hand functional performance and life quality?

Aims/Introduction

The purpose of the present study was to identify whether there are differences in hand dexterity, hand functional performance and quality of life between diabetes patients with mononeuropathy and polyneuropathy of their hands to further present the importance regarding the impacts of diabetic neuropathic deficits on patients’ functional capacity.

Materials and Methods

The neurological deficits of 127 patients with type 2 diabetes were examined by electrophysiological tests for the median and ulnar nerves, and were stratified into the diabetic mononeuropathy, diabetic polyneuropathy and non‐diabetic neuropathy groups by sensory amplitude of these nerves. The Purdue pegboard test, Michigan Hand Outcomes Questionnaire, and Diabetes‐39 were carried out to understand patients’ hand dexterity, functional hand performance and quality of life, respectively.

Results

The results showed significant differences in all subtests of the Purdue pegboard test among the three groups. Furthermore, aesthetics, patient's satisfaction of the Michigan Hand Outcomes Questionnaire and diabetes control, sexual functioning, energy, and mobility of the Diabetes‐39 also showed significant differences among the three groups.

Conclusions

The present study shows the patients with polyneuropathy suffer from more negative impacts on hand functional performance and quality of life than those with mononeuropathy and without neuropathy. These findings might assist both patients and clinicians in better realizing the impacts of neuropathic hands, and planning suitable strategies of intervention or health education to prevent declines in hand functions.

Topical Citrullus colocynthis (bitter apple) extract oil in painful diabetic neuropathy: A double-blind randomized placebo-controlled clinical trial

BACKGROUND

The aim of the present study was to examine the safety and efficacy of a topical formulation of Citrullus colocynthis in patients with painful diabetic polyneuropathy (PDPN).

METHODS

The study was designed as a two-arm double-blind randomized placebo-controlled clinical trial using a parallel design. Sixty patients with PDPN were randomly allocated to receive either a topical formulation of C. colocynthis or placebo (1:1 allocation ratio) for 3 months. Patients were evaluated before and after the intervention using the neuropathic pain scale, electrodiagnostic findings, World Health Organization Biomedical Research and Education Foundation (BREF) quality of life (WHOQOL-BREF) scores, and reported adverse events.

RESULTS

There was a significantly greater decrease in mean pain score after 3 months in the C. colocynthis (-3.89; 95% confidence interval [CI] -3.19, -4.60) than placebo (-2.28; 95% CI -1.66, -2.90) group (P < 0.001). Mean changes in nerve conduction velocity of the tibial nerve, distal latency of the superficial peroneal nerve and sural nerve, and sensory amplitude of the sural nerve were significantly higher in the intervention than placebo group (P < 0.001) in favour of the intervention. In the different domains of WHOQOL-BREF, there was a significant improvement only for the mean score in the physical domain.

CONCLUSIONS

Application of a topical formulation of C. colocynthis fruit extract can decrease pain in patients with PDPN. It also may have some uncertain effects on nerve function and the physical domain of quality of life, which require further investigation in studies with larger sample sizes and of longer duration.

The effect of lower extremity nerve decompression on health-related quality of life and perception of pain in patients with painful diabetic polyneuropathy: a prospective randomized trial

AIMS

The aim of this study was to assess whether surgical decompression of nerves in the lower extremity in people with painful diabetic polyneuropathy would have an effect on health-related quality of life and to determine minimal clinically important differences in pain and quality of life scores.

METHODS

The design was a randomized controlled trial in which 42 participants with painful diabetic painful neuroapthy underwent unilateral decompression of nerves in their left or right leg, using the other leg as a control, with 12 months follow-up. Surgical decompression was performed at the tibial, superficial, deep and common peroneal nerves. Preoperatively, and at 6 and 12 months post operatively, a visual analogue scale for pain and the 36 item short-form health survey and EuroQual 5 Dimensions questionnaires were completed.

RESULTS

At 12 months follow-up, the visual analogue scale was significantly reduced, but decompression surgery did not significantly alter health-related quality of life scores. The minimal clinically important difference for visual analogue scale reduction was determined at 2.9 points decrease, a threshold reached by 42.5% of the study population.

CONCLUSIONS

Although decompression surgery does not influence health-related quality of life, it achieves a clinically relevant reduction of pain in ~42.5% of people with diabetic peripheral neuropathy. It can therefore be considered for patients who do not adequately respond to pain medication.

Assessment of Diabetic Polyneuropathy in Inpatient Care: Fasting Blood Glucose, HbA1c, Electroneuromyography and Diabetes Risk Factors

CONFLICT OF INTEREST: NONE DECLARED

Associations between complications and health-related quality of life in individuals with diabetes

OBJECTIVE

Type 2 diabetes and associated complications adversely affect health-related quality of life (HRQoL). However, it is unclear whether different complications have the same or different associations with HRQoL. We examined associations between retinopathy, nephropathy, peripheral neuropathy (microvascular), coronary heart disease, stroke and peripheral arterial disease (macrovascular) in diabetes and HRQoL.

DESIGN

This study was a follow-up examination between 2004 and 2007 of participants from four previous cross-sectional population-based studies in Singapore.

METHODS

Health-related quality of life was assessed through self-administered SF-36 health survey version 2. Diabetes and complications status were assessed through self-report, clinical and laboratory examinations. About 2601 individuals, 2205 healthy and 396 with diabetes, were studied.

RESULTS

Lower physical component scores (PCS) were associated with microvascular (2.96 points, P < 0.001) and both macro- and microvascular complications (4.67 points, P < 0.001), but not diabetes alone. Coronary heart disease (3.86 points, P = 0.007), peripheral neuropathy (11.46 points, P < 0.001) and severe retinopathy (4.46 points, P < 0.001) were associated with lower PCS. The greatest reduction in scores was seen in peripheral neuropathy.

CONCLUSIONS

Quality of life in patients with diabetes is affected mainly by presence of complications, and not diabetes per se. Peripheral neuropathy was associated with the greatest reduction in quality of life. Improved management to prevent or delay onset of complications may reduce the effect on quality of life in patients with diabetes.

Median nerve conduction impairment in patients with diabetes and its impact on patients' perception of health condition: a quantitative study

INTRODUCTION

Impaired mobility and compromised manual dexterity leading to difficulties with the activities of daily living (ADL) are an inherent part of the clinical picture in diabetes. Hand function in diabetes is influenced by a variety of pathologies: the median nerve, the most important nerve of the hand, can suffer from metabolic disturbances, ischemia and/or entrapment neuropathies. The resulting deterioration in functional capacity is likely to have significant consequences for the ability to perform ADL, influencing adjustment to diabetes and affecting quality of life. The aim of the present study was to examine the influence of hand function as measured by median motor nerve conduction on quality of life, taking into account various aspects of functioning in patients with diabetes, including activities of daily living, psychological status and acceptance of illness.

PATIENTS AND METHODS

Seventy one hospital patients with diabetes participated in the study. Electrophysiological recordings of conductance in the median nerve were obtained for both hands and the relationship between hand function and functional status (BI), depression and anxiety (HADS), adjustment to illness (AIS) and their effect on quality of life (SF-36v2 and QLI) was studied.

RESULTS

Damage to the median nerve of the left hand was associated with significant differences in functioning in the physical, but not the mental component of the SF-36v2, p = 0.03 and in functional status (p = 0.006). QOL was associated with depression, patient age, acceptance of illness, functional ability and to a small, but significant extent with median nerve damage to the right hand on the measure of conduction velocities (R2 =0.726).

CONCLUSIONS

Nerve conductance studies demonstrated a small, but significant effect of hand function on quality of life. Impairment of the median nerve in the left hand was associated with functional difficulties in the activities of daily living and a diminished quality of life in the area of physical functioning. No dependencies of this kind were found for the right hand, which may reflect the greater compensatory capacity of the right hand resulting from improved efficiency due to practice.

Relationship between diabetes mellitus, hypertension and obesity, and health-related quality of life in Gaziantep, a central south-eastern city in Turkey

AIMS AND OBJECTIVES

The main goal of nursing care should be to increase health-related quality of life as well as improve the medical status of patients with chronic disease. For this reason, this study aims to evaluate and compare the health-related quality of life of patients with diabetes mellitus, hypertension and obesity in Gaziantep, a south-eastern city in Turkey.

BACKGROUND

Diabetes mellitus, hypertension and obesity are the most decisive factors in terms of adversely affecting health-related quality of life.

DESIGN

A cross-sectional, descriptive design was used.

METHOD

In this study, the research population included a total of 1601 diabetes mellitus, hypertension and obesity patients. To evaluate health-related quality of life of patients, Short Form-36 (SF-36) was used. Student's t-test, one-way anova and chi-square analyses were used for comparisons between groups.

RESULTS

In total, 18·1% of patients had combined obesity, hypertension and diabetes mellitus; 16·1% had hypertension and diabetes mellitus. Approximately 16·1% had only hypertension; 15·4% had obesity and hypertension; 13·3% had diabetes mellitus; 12·7% had obesity and diabetes mellitus; and 8·4% had obesity. The health-related quality of life physical component mean scores of patients with combined obesity and hypertension were lower than that of the other groups (p < 0·05). Health-related quality of life physical component mean scores were determined as 34·5 (SD 0·4), and mental component mean scores were determined as 43·9 (SD 4·4). Health-related quality of life physical component mean scores of moderately active patients were higher, while older age and lower educational and income levels had a negative effect on health-related quality of life (p < 0·05).

CONCLUSION

Diabetes, hypertension and obesity decrease patient health-related quality of life while physical activity increases it. The coexistence of obesity and hypertension, in particular, has a more negative effect on health-related quality of life.

RELEVANCE TO CLINICAL PRACTICE

Patients with hypertension, obesity and diabetes mellitus need professional support from nurse. Frequent health-related quality of life evaluation and support is required for chronic patients, especially for those who are older, have lower educational and income levels and those with more than one chronic disease.

[Depressive symptoms and quality of life in type 2 diabetic patients with diabetic distal polyneuropathy]

OBJECTIVE

To investigate the impact of depressive symptoms and neuropathic pain in the quality of life (QL) of diabetic patients with diabetic distal polyneuropathy (DDP).

METHODS

Two hundred and four patients with type 2 diabetes mellitus were evaluated. The diagnosis of DDP was achieved using the Neuropathy Disability Score and Neuropathy Symptom Score questionnaires. The severity of neuropathic pain was assessed by means of a Visual Analogue Scale (VAS); the severity of depression, by means of the Beck Depression Inventory (BDI); and QL was assessed by means of the World Health Organization Quality of Life Instrument-bref (WHOQOLbref).

RESULTS

Patients with DDP presented significant higher scores in BDI (12.6 +/- 7.2 versus 9.9 +/- 7.3; p = 0.018) and in VAS (5.0 +/- 2.4 versus 2.6 +/- 2.9; p < 0.001). They also presented significant lower scores in the physical (52.8 +/- 15.5 versus 59.2 +/- 17.0; p = 0.027) and environmental domains (56.6 +/- 12.3 versus 59.6 +/- 13.6; p = 0,045).

CONCLUSIONS

Diabetic patients with DDP presented a worse QL in the physical and environmental domains of the WHOQOL-bref, probably due to more depressive symptoms and the severity of pain.

A questionnaire for determining prevalence of diabetes related foot disease (Q-DFD): construction and validation

BACKGROUND

Community based prevalence for diabetes related foot disease (DRFD) has been poorly quantified in Australian populations. The aim of this study was to develop and validate a survey tool to facilitate collection of community based prevalence data for individuals with DRFD via telephone interview.

METHODS

Agreed components of DRFD were identified through an electronic literature search. Expert feedback and feedback from a population based construction sample were sought on the initial draft. Survey reliability was tested using a cohort recruited through a general practice, a hospital outpatient clinic and an outpatient podiatry clinic. Level of agreement between survey findings and either medical record or clinical assessment was evaluated.

RESULTS

The Questionnaire for Diabetes Related Foot Disease (Q-DFD) comprised 12 questions aimed at determining presence of peripheral sensory neuropathy (PN) and peripheral vascular disease (PVD), based on self report of symptoms and/or clinical history, and self report of foot ulceration, amputation and foot deformity. Survey results for 38 from 46 participants demonstrated agreement with either clinical assessment or medical record (kappa 0.65, sensitivity 89.0%, and specificity 77.8%). Correlation for individual survey components was moderate to excellent. Inter and intrarater reliability and test re-test reliability was moderate to high for all survey domains.

CONCLUSION

The development of the Q-DFD provides an opportunity for ongoing collection of prevalence estimates for DRFD across Australia.

Gait alterations of diabetic patients while walking on different surfaces

Patients with diabetes have been shown to suffer from increased fall risk. However, authors disagree as to whether only diabetic patients with neuropathy, or also those without neuropathy, present gait alterations. Existing studies evaluate gait indoors, i.e. in specialized gait laboratories. This study evaluates gait parameters in diabetic patients under various real life conditions and compares them to those recorded for healthy controls.

METHODS

We conducted a clinical observation study. Forty-five subjects' gait was assessed on three different surfaces (tar, grass and stones) with a Physilog system (BioAGM, CH), consisting of accelerometers and gyroscopes. Temporal and spatial gait parameters as well as stride-to-stride variability of 30 patients with type 2 diabetes, 15 with and 15 without neuropathy were compared to 15 healthy controls. The three groups were comparable for age, height and body weight (p>0.05).

RESULTS

Diabetic patients' gait parameters differed significantly from those of healthy controls. Post hoc analysis revealed a significant difference between healthy individuals and patients with neuropathy, and between healthy individuals and patients without neuropathy. No difference was observed between patients with and without neuropathy. The highest surface effect was found in patients with diabetic neuropathy, followed by patients without neuropathy and healthy controls.

CONCLUSIONS

Walking in real life conditions revealed gait difficulties in patients with type 2 diabetes before neuropathy was clinically detectable. Clinicians should be aware that diabetic individuals' gait capacity decreases and fall risk increases at an early stage of the disease.