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Ponirakis G, Al-Janahi I, Elgassim E, Homssi M, Petropoulos IN, Gad H, Khan A, Zaghloul HB, Ali H, Siddique MA, Mohamed FFS, Ahmed LHM, Dakroury Y, El Shewehy AMM, Saeid R, Mahjoub F, Al-Thani SN, Ahmed F, Hussein R, Mahmoud S, Hadid NH, Al Obaidan A, Salivon I, Mahfoud ZR, Zirie MA, Al-Ansari Y, Atkin SL, Malik RA. Sustained corneal nerve loss predicts the development of diabetic neuropathy in type 2 diabetes. Front Neurosci 2024; 18:1393105. [PMID: 39015377 PMCID: PMC11249546 DOI: 10.3389/fnins.2024.1393105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/05/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction This study was undertaken to investigate whether sustained rather than a single measure of corneal nerve loss was associated with the onset of diabetic peripheral neuropathy (DPN) and the progression of neuropathic symptoms and deficits in individuals with type 2 diabetes (T2D). Methods Participants underwent clinical, metabolic testing and assessment of neuropathic symptoms, vibration perception threshold (VPT), sudomotor function, and corneal confocal microscopy (CCM) at baseline, 1, 2, and 4-7 years. Sustained corneal nerve loss was defined as abnormal corneal nerve fiber density (CNFD, <24 fibers/mm2), corneal nerve branch density (CNBD, <21 branches/mm2), and corneal nerve fiber length (CNFL, <16 mm/mm2) persisting for ≥50% of the study duration. Results A total of 107 participants with a mean duration of T2D of 13.3 ± 7.3 years, aged 54.8 ± 8.5 years, underwent baseline and follow-up assessments over a median duration of 4 years, ranging from 1 to 7 years. The DPN prevalence at baseline was 18/107 (16.8%), and of the 89 participants without DPN at baseline, 13 (14.6%) developed DPN during follow-up. Approximately half of the cohort had sustained corneal nerve damage, and corneal nerve measures were significantly lower in this group than those without sustained damage (p < 0.0001). Sustained corneal nerve damage was associated with the development of DPN (p < 0.0001), a progressive loss of vibration perception (p ≤ 0.05), an increased incidence of burning pain, numbness, or a combination of both (p = 0.01-0.001), and a borderline association with progressive sudomotor dysfunction (p = 0.07). Sustained abnormal CNFL effectively distinguished between participants who developed DPN and those who did not (AUC: 76.3, 95% CI: 65.9-86.8%, p < 0.0001), while baseline and other sustained measures did not predict DPN onset. Conclusion Sustained abnormal CCM is associated with more severe corneal nerve damage, DPN development, and the progression of neuropathic symptoms and deficits. Regular CCM monitoring may enable the identification of those at greater risk of developing and worsening DPN who may benefit from more aggressive risk factor reduction.
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Affiliation(s)
- Georgios Ponirakis
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Ibrahim Al-Janahi
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Einas Elgassim
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Moayad Homssi
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | - Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Hadeel B. Zaghloul
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Hamda Ali
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mashhood A. Siddique
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fatima F. S. Mohamed
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Lina H. M. Ahmed
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Youssra Dakroury
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | - Ruba Saeid
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Fadwa Mahjoub
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Shaikha N. Al-Thani
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Farheen Ahmed
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Rawan Hussein
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Salah Mahmoud
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Nebras H. Hadid
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Aisha Al Obaidan
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Iuliia Salivon
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad R. Mahfoud
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Mahmoud A. Zirie
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Yousuf Al-Ansari
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Rayaz A. Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
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Elafros MA, Reynolds EL, Callaghan BC. Obesity-related neuropathy: the new epidemic. Curr Opin Neurol 2024:00019052-990000000-00172. [PMID: 38864534 DOI: 10.1097/wco.0000000000001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
PURPOSE OF REVIEW To examine the evidence evaluating the association between obesity and neuropathy as well as potential interventions. RECENT FINDINGS Although diabetes has long been associated with neuropathy, additional metabolic syndrome components, including obesity, are increasingly linked to neuropathy development, regardless of glycemic status. Preclinical rodent models as well as clinical studies are shedding light on the mechanisms of obesity-related neuropathy as well as challenges associated with slowing progression. Dietary and surgical weight loss and exercise interventions are promising, but more data is needed. SUMMARY High-fat-diet rodent models have shown that obesity-related neuropathy is a product of excess glucose and lipid accumulation leading to inflammation and cell death. Clinical studies consistently demonstrate obesity is independently associated with neuropathy; therefore, likely a causal risk factor. Dietary weight loss improves neuropathy symptoms but not examination scores. Bariatric surgery and exercise are promising interventions, but larger, more rigorous studies are needed. Further research is also needed to determine the utility of weight loss medications and ideal timing for obesity interventions to prevent neuropathy.
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Affiliation(s)
| | - Evan Lee Reynolds
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
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Liu Y, Wu D, Zheng H, Ni Y, Zhu L, Jiang Y, Dai J, Sun Q, Zhao Y, Zhang Q, Yang Y, Liu R. Serum Spexin Level Is Negatively Associated With Peripheral Neuropathy and Sensory Pain in Type 2 Diabetes. J Diabetes Res 2024; 2024:4538199. [PMID: 38919263 PMCID: PMC11199070 DOI: 10.1155/2024/4538199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 06/27/2024] Open
Abstract
Background: Spexin is a novel peptide hormone and has shown antinociceptive effects in experimental mice. This study is aimed at evaluating the association of serum spexin level with diabetic peripheral neuropathy (DPN) and related pain in a Chinese population. Methods: We enrolled 167 type 2 diabetes mellitus (T2DM) including 56 patients without DPN (non-DPN), 67 painless DPN, and 44 painful DPN. Serum spexin was measured using ELISA. Logistic regression models were performed to analyze the independent effects of spexin on prevalence of DPN and painful DPN. In streptozotocin (STZ)-induced diabetic mice, mechanical pain threshold was measured using electronic von Frey aesthesiometer. Human peripheral blood mononuclear cells (PBMCs) were isolated and further stimulated with lipopolysaccharide without or with spexin. The gene expression was assayed by qPCR. Results: Compared with non-DPN, serum spexin level decreased in painless DPN and further decreased in painful DPN. The odds of DPN was associated with low spexin level in T2DM, which was similar by age, sex, BMI, and diabetes duration, but attenuated in smokers. The odds of having pain was associated with decreased spexin level in DPN, which was similar by age, sex, smoking status, and diabetes duration, but attenuated in normal weight. Furthermore, we observed that mechanical pain threshold increased in spexin-treated diabetic mice. We also found that lipopolysaccharide treatment increased the mRNA level of TNF-α, IL-6, and MCP-1 in human PBMCs, while spexin treatment prevented this increase. Conclusions: These results suggested that spexin might serve as a protective factor for diabetes against neuropathology and pain-related pathogenesis.
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Affiliation(s)
- Ying Liu
- Department of Endocrinology and MetabolismHuashan HospitalFudan University, Shanghai 200040, China
- Institute of Endocrinology and DiabetesFudan University, Shanghai 200040, China
| | - Di Wu
- Department of Endocrinology and MetabolismHuashan HospitalFudan University, Shanghai 200040, China
- Institute of Endocrinology and DiabetesFudan University, Shanghai 200040, China
| | - Hangping Zheng
- Department of Endocrinology and MetabolismHuashan HospitalFudan University, Shanghai 200040, China
- Institute of Endocrinology and DiabetesFudan University, Shanghai 200040, China
| | - Yunzhi Ni
- Department of Endocrinology and MetabolismHuashan HospitalFudan University, Shanghai 200040, China
- Institute of Endocrinology and DiabetesFudan University, Shanghai 200040, China
| | - Lu Zhu
- Institute of Endocrinology and DiabetesFudan University, Shanghai 200040, China
| | - Yaojing Jiang
- Department of Endocrinology and MetabolismHuashan HospitalFudan University, Shanghai 200040, China
- Institute of Endocrinology and DiabetesFudan University, Shanghai 200040, China
| | - Jiarong Dai
- Department of Endocrinology and MetabolismHuashan HospitalFudan University, Shanghai 200040, China
- Institute of Endocrinology and DiabetesFudan University, Shanghai 200040, China
| | - Quanya Sun
- Department of Endocrinology and MetabolismHuashan HospitalFudan University, Shanghai 200040, China
- Institute of Endocrinology and DiabetesFudan University, Shanghai 200040, China
| | - Ying Zhao
- Department of Endocrinology and MetabolismHuashan HospitalFudan University, Shanghai 200040, China
- Institute of Endocrinology and DiabetesFudan University, Shanghai 200040, China
| | - Qi Zhang
- Department of Endocrinology and MetabolismHuashan HospitalFudan University, Shanghai 200040, China
- Institute of Endocrinology and DiabetesFudan University, Shanghai 200040, China
| | - Yehong Yang
- Department of Endocrinology and MetabolismHuashan HospitalFudan University, Shanghai 200040, China
- Institute of Endocrinology and DiabetesFudan University, Shanghai 200040, China
| | - Rui Liu
- Department of Endocrinology and MetabolismHuashan HospitalFudan University, Shanghai 200040, China
- Institute of Endocrinology and DiabetesFudan University, Shanghai 200040, China
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Gad H, Kalra S, Pinzon R, Gracia RAN, Yotsombut K, Coetzee A, Nafach J, Lim LL, Fletcher PE, Lim V, Malik RA. Earlier diagnosis of peripheral neuropathy in primary care: A call to action. J Peripher Nerv Syst 2024; 29:28-37. [PMID: 38268316 DOI: 10.1111/jns.12613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/26/2024]
Abstract
Peripheral neuropathy (PN) often remains undiagnosed (~80%). Earlier diagnosis of PN may reduce morbidity and enable earlier risk factor reduction to limit disease progression. Diabetic peripheral neuropathy (DPN) is the most common PN and the 10 g monofilament is endorsed as an inexpensive and easily performed test for DPN. However, it only detects patients with advanced neuropathy at high risk of foot ulceration. There are many validated questionnaires to diagnose PN, but they can be time-consuming and have complex scoring systems. Primary care physicians (PCPs) have busy clinics and lack access to a readily available screening method to diagnose PN. They would prefer a short, simple, and accurate tool to screen for PN. Involving the patient in the screening process would not only reduce the time a physician requires to make a diagnosis but would also empower the patient. Following an expert meeting of diabetologists and neurologists from the Middle East, South East Asia and Latin America, a consensus was formulated to help improve the diagnosis of PN in primary care using a simple tool for patients to screen themselves for PN followed by a consultation with the physician to confirm the diagnosis.
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Affiliation(s)
- Hoda Gad
- Research Department, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - Rizaldy Pinzon
- Neurology Department of the Bethesda, General Hospital Yogyakarta, Yogyakarta, Indonesia
| | - Rey-An Nino Gracia
- College of Medicine, De LA Salle, Health Medical and Science Institute College of Medicine, Manila, Philippines
| | - Kitiyot Yotsombut
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Ankia Coetzee
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jalal Nafach
- Dubai Diabetes Center, Dubai Academic Health Corporation, Dubai, UAE
| | - Lee-Ling Lim
- Department of Medicine, Diabetes Care Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Pablo E Fletcher
- Endocrinology Department, Medical School, University of Panama, Panama, Panama
| | - Vivien Lim
- Endocrinology Department, Gleneagles Hospital, Singapore, Singapore
| | - Rayaz A Malik
- Research Department, Weill Cornell Medicine-Qatar, Doha, Qatar
- Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK
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Elliott J, Sloan G, Stevens L, Selvarajah D, Cruccu G, Gandhi RA, Kempler P, Fuller JH, Chaturvedi N, Tesfaye S. Female sex is a risk factor for painful diabetic peripheral neuropathy: the EURODIAB prospective diabetes complications study. Diabetologia 2024; 67:190-198. [PMID: 37870649 PMCID: PMC10709240 DOI: 10.1007/s00125-023-06025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/05/2023] [Indexed: 10/24/2023]
Abstract
AIMS/HYPOTHESIS While the risk factors for diabetic peripheral neuropathy (DPN) are now well recognised, the risk factors for painful DPN remain unknown. We performed analysis of the EURODIAB Prospective Complications Study data to elucidate the incidence and risk factors of painful DPN. METHODS The EURODIAB Prospective Complications Study recruited 3250 participants with type 1 diabetes who were followed up for 7.3±0.6 (mean ± SD) years. To evaluate DPN, a standardised protocol was used, including clinical assessment, quantitative sensory testing and autonomic function tests. Painful DPN (defined as painful neuropathic symptoms in the legs in participants with confirmed DPN) was assessed at baseline and follow-up. RESULTS At baseline, 234 (25.2%) out of 927 participants with DPN had painful DPN. At follow-up, incident DPN developed in 276 (23.5%) of 1172 participants. Of these, 41 (14.9%) had incident painful DPN. Most of the participants who developed incident painful DPN were female (73% vs 48% painless DPN p=0.003) and this remained significant after adjustment for duration of diabetes and HbA1c (OR 2.69 [95% CI 1.41, 6.23], p=0.004). The proportion of participants with macro- or microalbuminuria was lower in those with painful DPN compared with painless DPN (15% vs 34%, p=0.02), and this association remained after adjusting for HbA1c, diabetes duration and sex (p=0.03). CONCLUSIONS/INTERPRETATION In this first prospective study to investigate the risk factors for painful DPN, we definitively demonstrate that female sex is a risk factor for painful DPN. Additionally, there is less evidence of diabetic nephropathy in incident painful, compared with painless, DPN. Thus, painful DPN is not driven by cardiometabolic factors traditionally associated with microvascular disease. Sex differences may therefore play an important role in the pathophysiology of neuropathic pain in diabetes. Future studies need to look at psychosocial, genetic and other factors in the development of painful DPN.
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Affiliation(s)
- Jackie Elliott
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Gordon Sloan
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Lynda Stevens
- Department of Epidemiology and Public Health, University College, London, UK
| | - Dinesh Selvarajah
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Giorgio Cruccu
- Department of Neurological Sciences, La Sapienza University, Rome, Italy
| | - Rajiv A Gandhi
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Peter Kempler
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - John H Fuller
- Epidemiology and Public Health, Imperial College of Science, Technology & Medicine, London, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCL, Institute of Cardiovascular Sciences, University College London, London, UK
| | - Solomon Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield, UK.
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
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Qutob RA, Hakami OA, Aldosari L, Alharfi M, Alnader RY, Alomar A, Alaryni A, Alghamdi A, Alsolamy E, Al Harbi K, Alammari Y, Alotay AA, Alhajery MA, Alanazi A. Foot Care Prioritization Among Health Care Providers Treating Diabetic Patients in Saudi Arabia: A Survey-Based Study. Cureus 2023; 15:e50798. [PMID: 38239532 PMCID: PMC10796156 DOI: 10.7759/cureus.50798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Diabetic foot disease (DFD) is a significant complication associated with diabetes, characterized by the potential for progressive amputation of specific foot segments or the entire lower limb in the absence of timely identification of infection and intervention. The aim of our research is to evaluate the degree of importance given to foot care by healthcare professionals who are responsible for treating individuals with diabetes in Riyadh, Saudi Arabia. METHODS This cross-sectional study utilized an online survey previously validated in Australia. The mean foot care prioritization score was used to identify the dummy variable for binary logistic regression analysis, which was used to identify predictors of foot care prioritization. RESULTS A total of 222 participants were involved in this study. Assessing for the risk of developing foot complications, visually inspecting feet for wounds, and providing or recommending footwear to prevent foot complications were the most commonly reported practices, accounting for 80.60% (n = 178), 76.10% (n = 169), and 75.20% (n = 167), respectively. The most commonly referred patients to a specialist tertiary multi-disciplinary foot care team were patients with ulcers in patients with absent foot pulses, ulcers with ascending cellulitis, and diabetic ulceration, accounting for 73.50% (n = 163), 71.60% (n = 159), and 66.70% (n = 148), respectively. The mean foot care prioritization score for the study participants was 54.1 (standard deviation: 11.7) out of 78 (69.4%), which demonstrates a moderately high level of foot care prioritization. Binary logistic regression analysis identified that healthcare professionals who are aged 35-44 years, those who have 5-10 years of experience, those who work at private hospitals, those who have a higher number of practice clinics per week, and those who have to manage a higher number of patients with diabetes in each clinic were more likely to prioritize foot care in their practices (p < 0.05). CONCLUSION Our study found that healthcare professionals in Saudi Arabia place a moderate degree of emphasis on foot care. Healthcare professionals falling within the age range of 35-44 years, possessing 5-10 years of experience, employed at private hospitals, overseeing a greater number of practice clinics weekly, and managing a greater number of patients with diabetes per clinic exhibited a greater propensity to prioritize foot care within their respective practices. Policymakers should consider the integration of continuous glucose monitoring technologies, the establishment of standardized foot screening protocols, and the implementation of targeted educational programs for healthcare professionals.
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Affiliation(s)
- Rayan A Qutob
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Osamah A Hakami
- Department of Internal Medicine, King Abdullah Medical City in Holy Capital (KAMC-HC), Makkah, SAU
| | - Layan Aldosari
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Mohammad Alharfi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Raghad Y Alnader
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdulaziz Alomar
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdullah Alaryni
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdullah Alghamdi
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Eysa Alsolamy
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Khalid Al Harbi
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Yousef Alammari
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdulwahed Abdulaziz Alotay
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Mohammad A Alhajery
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdulrahman Alanazi
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Malik RA. Is the 10 g monofilament fit for purpose for diagnosing DPN? BMJ Open Diabetes Res Care 2023; 11:e003773. [PMID: 37989348 PMCID: PMC10660155 DOI: 10.1136/bmjdrc-2023-003773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Affiliation(s)
- Rayaz A Malik
- Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
- Division of Cardiovascular Sciences, University of Manchester-The Victoria University of Manchester Campus, Manchester, UK
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Sempere‐Bigorra M, Brognara L, Julian‐Rochina I, Mazzotti A, Cauli O. Relationship between deep and superficial sensitivity assessments and gait analysis in diabetic foot patients. Int Wound J 2023; 20:3023-3034. [PMID: 37057818 PMCID: PMC10502296 DOI: 10.1111/iwj.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/27/2023] [Indexed: 04/15/2023] Open
Abstract
Peripheral neuropathy is a prevalent complication of diabetes that can lead to gait impairment and its adverse consequences. This study explored the potential utility of different parameters of gait analysis using a single sensor unit as a simple tool to detect peripheral neuropathy in 85 diabetic patients (DP) with diabetic foot in whom different somato-sensitivity tests in the feet were performed. Gait spatiotemporal parameters were examined by sensor inertial measurement placed in the lumbar area, while the superficial sensitivity pathway was assessed by nociception tests and deep sensitivity was examined by light touch-pressure and vibration sensitivity tests. Correlations between each sensory test and gait parameters were analysed in a logistic regression model in order to assess if gait parameters are associated with two different sensory pathways. Impaired deep sensory pathways were significantly (P < .05) correlated with lower gait speed, reduced cadence, smaller stride length, longer stance periods, and a higher risk of falling on the Tinetti Scale, while all gait parameters were significantly (P < .01) correlated with the superficial sensory pathway. Type 2 diabetics have significantly (P < .05) higher impairment in vibratory sensitivity than type 1 diabetics, and the years with diabetes mellitus (DM) diagnosis have a significant (P < .05) association with reduced vibration sensitivity. These findings indicate relationships between the deep sensory pathway and gait impairments in DP measured by inertial sensors, which could be a useful tool to diagnose gait alterations in DP and to evaluate the effect of treatments to improve gait and thus the risk of falls in diabetic patients.
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Affiliation(s)
- Mar Sempere‐Bigorra
- Nursing Department, Faculty of Nursing and PodiatryUniversity of ValenciaValenciaSpain
| | - Lorenzo Brognara
- Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum University of BolognaBolognaItaly
| | - Iván Julian‐Rochina
- Nursing Department, Faculty of Nursing and PodiatryUniversity of ValenciaValenciaSpain
- Frailty Research Organized Group, Faculty of Nursing and PodiatryUniversity of ValenciaValenciaSpain
| | - Antonio Mazzotti
- Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum University of BolognaBolognaItaly
| | - Omar Cauli
- Nursing Department, Faculty of Nursing and PodiatryUniversity of ValenciaValenciaSpain
- Frailty Research Organized Group, Faculty of Nursing and PodiatryUniversity of ValenciaValenciaSpain
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Ma F, Wang G, Wu Y, Xie B, Zhang W. Improving Effects of Peripheral Nerve Decompression Microsurgery of Lower Limbs in Patients with Diabetic Peripheral Neuropathy. Brain Sci 2023; 13:brainsci13040558. [PMID: 37190523 DOI: 10.3390/brainsci13040558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Peripheral nerve decompression microsurgery can relieve nerve entrapment and improve the symptoms of DPN. However, postoperative tissue adhesion will produce new pressure on the nerves, affecting the surgical efficacy. In this study, a nerve conduit was used in the peripheral nerve decompression microsurgery to prevent postoperative adhesions, and the role of the nerve conduit in surgical nerve decompression was explored. Methods: A total of 69 patients with DPN were recruited and randomly divided into three groups: the nerve conduit group, conventional surgery group, and control group. Two weeks before surgery and 6 months after surgery, patients in each group were clinically tested using the visual analog scale (VAS) score, neurophysiological test, Toronto clinical scoring system (TCSS) score, and two-point discrimination (2-PD) test. Results: The patients’ symptoms in the nerve conduit group were relieved to varying degrees, and the relief rate reached 90.9%; the treatment efficacy was higher than that in the other groups. The postoperative nerve conduction velocity (NCV) in the two surgical groups was significantly higher than that before the surgery, and the difference between the nerve conduit group and the conventional surgery group was statistically significant (p < 0.05). For the 2-PD test, there was a statistically significant difference between the two surgical groups (p < 0.05). The TCSS score in the two surgical groups was significantly higher than that in the control group (p < 0.01). There was a significant difference in the TCSS scores between the nerve conduit group and the conventional surgery group (p < 0.05). Conclusions: The nerve conduit could further improve the efficacy of peripheral nerve decompression microsurgery in the treatment of DPN.
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Sabaghan M, Ataee S, Ataee M, Tebyanian M, Afrashteh S, Daneshi N. Diabetic peripheral neuropathy screening and the related risk factors to its prevalence in people with type 2 diabetes. Int J Diabetes Dev Ctries 2023. [DOI: 10.1007/s13410-022-01165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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