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Karlsson P, Sjogaard MB, Schousboe K, Mizrak HI, Kufaishi H, Staehelin Jensen T, Randel Nyengaard J, Hansen CS, Yderstræde KB, Buhl CS. Assessment of neuropathy subtypes in type 1 diabetes. BMJ Open Diabetes Res Care 2024; 12:e004289. [PMID: 39025795 PMCID: PMC11261698 DOI: 10.1136/bmjdrc-2024-004289] [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: 04/23/2024] [Accepted: 06/27/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION Diabetic polyneuropathy (DPN), a common complication of diabetes, can manifest as small, large, or mixed fiber neuropathy (SFN, LFN, and MFN, respectively), depending on the type of fibers involved. Despite evidence indicating small fiber involvement prior to large fiber involvement in type 1 diabetes mellitus (T1DM)-associated DPN, no evidence has been produced to determine the more prevalent subtype. We aim to determine the more prevalent type of nerve fiber damage-SFN, LFN, and MFN-in T1DM-associated DPN, both with and without pain. RESEARCH DESIGN AND METHODS In this cross-sectional study, participants (n=216) were divided into controls; T1DM; T1DM with non-painful DPN (NP-DPN); and T1DM with painful DPN (P-DPN). DPN was further subgrouped based on neuropathy severity. The more prevalent type of fiber damage was determined applying small and large fiber-specific tests and three diagnostic models: model 1 (≥1 abnormal test); model 2 (≥2 abnormal tests); and model 3 (≥3 abnormal tests). RESULTS MFN showed the highest prevalence in T1DM-associated DPN. No differences in neuropathy subtype were found between NP-DPN and P-DPN. DPN, with prevalent SFN plateaus between models 2 and 3. All models showed increased prevalence of MFN according to DPN severity. Model 3 showed increased DPN with prevalent LFN in early neuropathy. DPN with prevalent SFN demonstrated a similar, but non-significant pattern. CONCLUSIONS DPN primarily manifests as MFN in T1DM, with no differentiation between NP-DPN and P-DPN. Additionally, we propose model 2 as an initial criterion for diagnosing DPN with a more prevalent SFN subtype in T1DM. Lastly, the study suggests that in mild stages of DPN, one type of nerve fiber (either small or large) is more susceptible to damage.
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Affiliation(s)
- Pall Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Core Center for Molecular Morphology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Marie Balle Sjogaard
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Karoline Schousboe
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | | | | | - Troels Staehelin Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Randel Nyengaard
- Core Center for Molecular Morphology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
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Nakabayashi M, Tanabe J, Ogura Y, Ichinose M, Shibagaki Y, Kamijo-Ikemori A, Ono Y. Correlation of diabetic renal hypoperfusion with microvascular responses of the skeletal muscle: a rat model study using diffuse correlation spectroscopy. BIOMEDICAL OPTICS EXPRESS 2024; 15:3900-3913. [PMID: 38867789 PMCID: PMC11166419 DOI: 10.1364/boe.522385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/10/2024] [Accepted: 05/12/2024] [Indexed: 06/14/2024]
Abstract
Using diffuse correlation spectroscopy, we assessed the renal blood flow and thigh muscle microvascular responses in a rat model of type 2 diabetes. The blood flow index at the renal surface decreased significantly with arterial clamping, cardiac extirpation, and the progression of diabetic endothelial dysfunction. Renal blood flow measured in diabetic and nondiabetic rats also showed a significant correlation with the reactive hyperemic response of the thigh muscle. These results suggest shared microcirculatory dysfunction in the kidney and skeletal muscle and support endothelial responses in the skeletal muscle as a potential noninvasive biomarker of renal hypoperfusion.
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Affiliation(s)
- Mikie Nakabayashi
- Electrical Engineering Program, Graduate School of Science and Technology, Meiji University, 1-1-1 Higashi-Mita, Tama-ku, Kawasaki, Kanagawa 2148571, Japan
| | - Jun Tanabe
- Division of Nephrology and hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 2168511, Japan
| | - Yuji Ogura
- Department of Physiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 2168511, Japan
| | - Masashi Ichinose
- Human Integrative Physiology Laboratory, School of Business Administration, Meiji University, 1-1 Surugadai, Kanda, Chiyoda-ku Tokyo 1018301, Japan
| | - Yugo Shibagaki
- Division of Nephrology and hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 2168511, Japan
| | - Atsuko Kamijo-Ikemori
- Division of Nephrology and hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 2168511, Japan
- Department of Anatomy, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 2168511, Japan
| | - Yumie Ono
- Department of Electronics and Bioinformatics, School of Science and Technology, Meiji University, 1-1-1 Higashi-Mita, Tama-ku, Kawasaki, Kanagawa 2148571, Japan
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3
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Staehelin Jensen T. The pathogenesis of painful diabetic neuropathy and clinical presentation. Diabetes Res Clin Pract 2023; 206 Suppl 1:110753. [PMID: 38245319 DOI: 10.1016/j.diabres.2023.110753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/30/2023] [Indexed: 01/22/2024]
Abstract
Diabetic neuropathy is a common complication of diabetes that affects up to 50% of patients during the course of the disease; 20-30% of the patients also develop neuropathic pain. The mechanisms underlying neuropathy are not known in detail, but both metabolic and vascular factors may contribute to the development of neuropathy. The development of the most common type of neuropathy is insidious, often starting distally in the toes and feet and gradually ascending up the leg and later also involving fingers and hands. The symptoms are mainly sensory with either sensory loss or positive symptoms with different types of paresthesia or painful sensations. In more advanced cases motor dysfunction may occur, causing gait disturbances and falls. The diagnosis of neuropathy is based on history and a careful examination, which includes a sensory examination of both large and small sensory nerve fiber function, as well as an examination of motor function and deep tendon reflexes of the lower limbs. Attention needs to be paid to the feet including examination of the skin, joints, and vascular supply. Nerve conduction studies are rarely needed to make a diagnosis of neuropathy. In patients with clear motor deficit or with an asymmetrical presentation, additional electrophysiological examination may be necessary. Early detection of diabetic neuropathy is important to avoid further irreversible injury to the peripheral nerves.
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Affiliation(s)
- Troels Staehelin Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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4
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Maalmi H, Strom A, Petrera A, Hauck SM, Strassburger K, Kuss O, Zaharia OP, Bönhof GJ, Rathmann W, Trenkamp S, Burkart V, Szendroedi J, Ziegler D, Roden M, Herder C. Serum neurofilament light chain: a novel biomarker for early diabetic sensorimotor polyneuropathy. Diabetologia 2023; 66:579-589. [PMID: 36472640 PMCID: PMC9892145 DOI: 10.1007/s00125-022-05846-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/19/2022] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS No established blood-based biomarker exists to monitor diabetic sensorimotor polyneuropathy (DSPN) and evaluate treatment response. The neurofilament light chain (NFL), a blood biomarker of neuroaxonal damage in several neurodegenerative diseases, represents a potential biomarker for DSPN. We hypothesised that higher serum NFL levels are associated with prevalent DSPN and nerve dysfunction in individuals recently diagnosed with diabetes. METHODS This cross-sectional study included 423 adults with type 1 and type 2 diabetes and known diabetes duration of less than 1 year from the prospective observational German Diabetes Study cohort. NFL was measured in serum samples of fasting participants in a multiplex approach using proximity extension assay technology. DSPN was assessed by neurological examination, nerve conduction studies and quantitative sensory testing. Associations of serum NFL with DSPN (defined according to the Toronto Consensus criteria) were estimated using Poisson regression, while multivariable linear and quantile regression models were used to assess associations with nerve function measures. In exploratory analyses, other biomarkers in the multiplex panel were also analysed similarly to NFL. RESULTS DSPN was found in 16% of the study sample. Serum NFL levels increased with age. After adjustment for age, sex, waist circumference, height, HbA1c, known diabetes duration, diabetes type, cholesterol, eGFR, hypertension, CVD, use of lipid-lowering drugs and use of non-steroidal anti-inflammatory drugs, higher serum NFL levels were associated with DSPN (RR [95% CI] per 1-normalised protein expression increase, 1.92 [1.50, 2.45], p<0.0001), slower motor (all p<0.0001) and sensory (all p≤0.03) nerve conduction velocities, lower sural sensory nerve action potential (p=0.0004) and higher thermal detection threshold to warm stimuli (p=0.023 and p=0.004 for hand and foot, respectively). There was no evidence for associations between other neurological biomarkers and DSPN or nerve function measures. CONCLUSIONS/INTERPRETATION Our findings in individuals recently diagnosed with diabetes provide new evidence associating higher serum NFL levels with DSPN and peripheral nerve dysfunction. The present study advocates NFL as a potential biomarker for DSPN.
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Affiliation(s)
- Haifa Maalmi
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Agnese Petrera
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Metabolomics and Proteomics Core, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Stefanie M Hauck
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Metabolomics and Proteomics Core, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Klaus Strassburger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Düsseldorf, Germany
| | - Oliver Kuss
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Düsseldorf, Germany
- Centre for Health and Society, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Oana-Patricia Zaharia
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Gidon J Bönhof
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Düsseldorf, Germany
| | - Sandra Trenkamp
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Volker Burkart
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology, Diabetology, Metabolism and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
- Institute for Diabetes and Cancer (IDC) & Joint Heidelberg-IDC Translational Diabetes Program, Helmholtz Center Munich, München-Neuherberg, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Rasmussen VF, Jensen TS, Tankisi H, Karlsson P, Vestergaard ET, Kristensen K, Nyengaard JR, Terkelsen AJ. Large fibre, small fibre and autonomic neuropathy in adolescents with type 1 diabetes: A systematic review. J Diabetes Complications 2021; 35:108027. [PMID: 34429229 DOI: 10.1016/j.jdiacomp.2021.108027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/27/2021] [Accepted: 08/14/2021] [Indexed: 01/23/2023]
Abstract
AIMS To estimate the prevalence of neuropathy in adolescents with type 1 diabetes. METHODS Systematic collection of published studies exploring the prevalence of large fibre neuropathy (LFN), small fibre neuropathy (SFN), and autonomic neuropathy in adolescents with type 1 diabetes. Following prospective registration (Prospero CRD42020206093), PubMed, EMBASE, and Cochrane Library were searched for studies from 2000 to 2020. PICO framework was used in the selection process (Population: adolescents aged 10-19 years with type 1 diabetes; Intervention: diagnostic methods for neuropathy; Comparison: reference data; Outcome: data on prevalence or comparison). Data were extracted concerning study quality based on available data and established methods for determining and diagnosing various neuropathy types. RESULTS From 2,017 initial citations, 27 studies (7589 participants) fulfilled eligibility criteria. The study population (47% males) had a diabetes duration between 4.0 and 10.6 years, and HbA1c level between 7.3 and 10.8%, 56-95 mmol/mol. The prevalence of LFN, based on nerve conduction studies, was 10-57%. Based on other tests for neuropathy, the prevalence of LFN and SFN was 12-62%, and that of cardiac autonomic neuropathy was 12-75%. CONCLUSION The described prevalence of neuropathy in adolescents with type 1 diabetes varied, which can be methodological due to different screening methods and classifications of neuropathy.
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Affiliation(s)
- Vinni Faber Rasmussen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Paediatrics, Randers Regional Hospital, Randers, Denmark.
| | - Troels Staehelin Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; International Diabetic Neuropathy Consortium, Aarhus University, Denmark
| | - Hatice Tankisi
- Department of Neurophysiology, Department of Clinical Medicine, Aarhus University, Denmark
| | - Páll Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Esben Thyssen Vestergaard
- Department of Paediatrics, Randers Regional Hospital, Randers, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | - Jens Randel Nyengaard
- Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Juhl Terkelsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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6
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Zhao N, Xu J, Zhou Q, Li X, Chen J, Zhou J, Zhou F, Liang J. Application of the Ipswich Touch Test for diabetic peripheral neuropathy screening: a systematic review and meta-analysis. BMJ Open 2021; 11:e046966. [PMID: 34607858 PMCID: PMC8491285 DOI: 10.1136/bmjopen-2020-046966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Diabetic peripheral neuropathy (DPN) is one of the most important risk factors of diabetic foot ulcers, and early screening and treatment of DPN are crucial. The Ipswich Touch Test (IPTT) is a new method for screening for DPN and, compared with traditional methods, is more simple to operate and requires no equipment. However, the screening accuracy of IPTT in patients with DPN has not been well characterised. We aim to conduct a systematic review and meta-analysis to characterise the sensitivity and specificity of IPTT compared with traditional methods and to understand the potential screening value of IPTT. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature Database up to 16 April 2020. METHODS Stata V.15.1 software was used for analysis, and the screening value of IPTT in DPN was described using 10 g monofilament (10g-MF), neuropathy disability scores (NDS), Pin prick, 128 Hz tuning fork, and ankle reflex as reference standards. Sensitivity, specificity and other measures of accuracy of IPTT for screening DPN were pooled based on a quality effects model. The protocol was registered with PROSPERO (42020168420). RESULTS Of the 441 records retrieved, 7 studies were evaluated for the screening value of IPTT. Five studies with 10g-MF as the reference standard were included in the meta-analysis, and the pooled sensitivity and specificity were 0.77 (95%CI 0.69-0.84) and 0.96(95%CI 0.93-0.98), respectively, and the area under curve was 0.897. Compared with vibration perception threshold, IPTT showed a sensitivity between 0.76 and 1, and a specificity between 0.90 and 0.97. Compared with NDS, IPTT showed a sensitivity between 0.53 and 1, and a specificity between 0.90 and 0.97. Compared with Pin prick, IPTT showed a sensitivity and specificity of 0.8 and 0.88, respectively. Compared with 128 Hz tuning fork, IPTT showed a sensitivity and specificity of 0.4 and 0.27, respectively. Compared with ankle reflex, IPTT had a sensitivity of 0.2 and a specificity of 0.97. CONCLUSIONS IPTT shows a high degree of agreement with other commonly used screening tools for DPN screening. It can be used clinically, especially in remote areas and in primary medical institutions, and by self-monitoring patients. More high-quality studies are needed to assess and promote more effective screening practices. PROSPERO REGISTRATION NUMBER Registration Number is CRD (42020168420).
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Affiliation(s)
- Nan Zhao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya center for Evidence-Based Practice & Healthcare Innovation: A Joanna Briggs Institute Affiliated Group, Changsha, Hunan, China
| | - Jingcan Xu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya center for Evidence-Based Practice & Healthcare Innovation: A Joanna Briggs Institute Affiliated Group, Changsha, Hunan, China
- Diabetic Foot Prevention Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiuhong Zhou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Diabetic Foot Prevention Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinyi Li
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Jiarui Chen
- Xiangya center for Evidence-Based Practice & Healthcare Innovation: A Joanna Briggs Institute Affiliated Group, Changsha, Hunan, China
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Jing Zhou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Feng Zhou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Department of Emergency, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Jinghong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
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7
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Jensen TS, Karlsson P, Gylfadottir SS, Andersen ST, Bennett DL, Tankisi H, Finnerup NB, Terkelsen AJ, Khan K, Themistocleous AC, Kristensen AG, Itani M, Sindrup SH, Andersen H, Charles M, Feldman EL, Callaghan BC. Painful and non-painful diabetic neuropathy, diagnostic challenges and implications for future management. Brain 2021; 144:1632-1645. [PMID: 33711103 DOI: 10.1093/brain/awab079] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 12/12/2022] Open
Abstract
Peripheral neuropathy is one of the most common complications of both type 1 and type 2 diabetes. Up to half of patients with diabetes develop neuropathy during the course of their disease, which is accompanied by neuropathic pain in 30-40% of cases. Peripheral nerve injury in diabetes can manifest as progressive distal symmetric polyneuropathy, autonomic neuropathy, radiculo-plexopathies, and mononeuropathies. The most common diabetic neuropathy is distal symmetric polyneuropathy, which we will refer to as DN, with its characteristic glove and stocking like presentation of distal sensory or motor function loss. DN or its painful counterpart, painful DN, are associated with increased mortality and morbidity; thus, early recognition and preventive measures are essential. Nevertheless, it is not easy to diagnose DN or painful DN, particularly in patients with early and mild neuropathy, and there is currently no single established diagnostic gold standard. The most common diagnostic approach in research is a hierarchical system, which combines symptoms, signs, and a series of confirmatory tests. The general lack of long-term prospective studies has limited the evaluation of the sensitivity and specificity of new morphometric and neurophysiological techniques. Thus, the best paradigm for screening DN and painful DN both in research and in clinical practice remains uncertain. Herein, we review the diagnostic challenges from both clinical and research perspectives and their implications for managing patients with DN. There is no established DN treatment, apart from improved glycaemic control, which is more effective in type 1 than in type 2 diabetes, and only symptomatic management is available for painful DN. Currently, less than one-third of patients with painful DN derive sufficient pain relief with existing pharmacotherapies. A more precise and distinct sensory profile from patients with DN and painful DN may help identify responsive patients to one treatment versus another. Detailed sensory profiles will lead to tailored treatment for patient subgroups with painful DN by matching to novel or established DN pathomechanisms and also for improved clinical trials stratification. Large randomized clinical trials are needed to identify the interventions, i.e. pharmacological, physical, cognitive, educational, etc., which lead to the best therapeutic outcomes.
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Affiliation(s)
- Troels S Jensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Pall Karlsson
- Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Sandra S Gylfadottir
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Signe T Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, Oxford University, Oxford, UK
| | - Hatice Tankisi
- Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Astrid J Terkelsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Karolina Khan
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Mustapha Itani
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Søren H Sindrup
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Charles
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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8
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Avendaño-Valencia LD, Yderstræde KB, Nadimi ES, Blanes-Vidal V. Video-based eye tracking performance for computer-assisted diagnostic support of diabetic neuropathy. Artif Intell Med 2021; 114:102050. [PMID: 33875161 DOI: 10.1016/j.artmed.2021.102050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/16/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
Diabetes is currently one of the major public health threats. The essential components for effective treatment of diabetes include early diagnosis and regular monitoring. However, health-care providers are often short of human resources to closely monitor populations at risk. In this work, a video-based eye-tracking method is proposed as a low-cost alternative for detection of diabetic neuropathy. The method is based on the tracking of the eye-trajectories recorded on videos while the subject follows a target on a screen, forcing saccadic movements. Upon extraction of the eye trajectories, representation of the obtained time-series is made with the help of heteroscedastic ARX (H-ARX) models, which capture the dynamics and latency on the subject's response, while features based on the H-ARX model's predictive ability are subsequently used for classification. The methodology is evaluated on a population constituted by 11 control and 20 insulin-treated diabetic individuals suffering from diverse diabetic complications including neuropathy and retinopathy. Results show significant differences on latency and eye movement precision between the populations of control subjects and diabetics, while simultaneously demonstrating that both groups can be classified with an accuracy of 95%. Although this study is limited by the small sample size, the results align with other findings in the literature and encourage further research.
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Affiliation(s)
- Luis David Avendaño-Valencia
- Group of Applied AI and Data Science, Maersk-McKinney-Moller Institute, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Knud B Yderstræde
- Steno Diabetes Center and Center for Innovative Medical Technology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
| | - Esmaeil S Nadimi
- Group of Applied AI and Data Science, Maersk-McKinney-Moller Institute, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Victoria Blanes-Vidal
- Group of Applied AI and Data Science, Maersk-McKinney-Moller Institute, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
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9
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Itani M, Gylfadottir SS, Krøigård T, Kristensen AG, Christensen DH, Karlsson P, Möller S, Andersen H, Tankisi H, Nielsen JS, Jensen TS, Thomsen RW, Finnerup NB, Sindrup SH. Small and large fiber sensory polyneuropathy in type 2 diabetes: Influence of diagnostic criteria on neuropathy subtypes. J Peripher Nerv Syst 2020; 26:55-65. [PMID: 33295647 DOI: 10.1111/jns.12424] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/16/2020] [Accepted: 12/01/2020] [Indexed: 12/24/2022]
Abstract
Diabetic polyneuropathy (DPN) can be classified based on fiber diameter into three subtypes: small fiber neuropathy (SFN), large fiber neuropathy (LFN), and mixed fiber neuropathy (MFN). We examined the effect of different diagnostic models on the frequency of polyneuropathy subtypes in type 2 diabetes patients with DPN. This study was based on patients from the Danish Center for Strategic Research in Type 2 Diabetes cohort. We defined DPN as probable or definite DPN according to the Toronto Consensus Criteria. DPN was then subtyped according to four distinct diagnostic models. A total of 277 diabetes patients (214 with DPN and 63 with no DPN) were included in the study. We found a considerable variation in polyneuropathy subtypes by applying different diagnostic models independent of the degree of certainty of DPN diagnosis. For probable and definite DPN, the frequency of subtypes across diagnostic models varied from: 1.4% to 13.1% for SFN, 9.3% to 21.5% for LFN, 51.4% to 83.2% for MFN, and 0.5% to 14.5% for non-classifiable neuropathy (NCN). For the definite DPN group, the frequency of subtypes varied from: 1.6% to 13.5% for SFN, 5.6% to 20.6% for LFN, 61.9% to 89.7% for MFN, and 0.0% to 6.3% for NCN. The frequency of polyneuropathy subtypes depends on the type and number of criteria applied in a diagnostic model. Future consensus criteria should clearly define sensory functions to be tested, methods of testing, and how findings should be interpreted for both clinical practice and research purpose.
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Affiliation(s)
- Mustapha Itani
- Research Unit for Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sandra Sif Gylfadottir
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Krøigård
- Research Unit for Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Pall Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Denmark
| | - Sören Möller
- OPEN-Open Patient data Explorative Network, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Steen Nielsen
- Danish Center for Strategic Research in Type 2 Diabetes, Steno Diabetes Center Odense, Odense, Denmark
| | - Troels Staehelin Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Hein Sindrup
- Research Unit for Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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10
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Corneal nerves in diabetes-The role of the in vivo corneal confocal microscopy of the subbasal nerve plexus in the assessment of peripheral small fiber neuropathy. Surv Ophthalmol 2020; 66:493-513. [PMID: 32961210 DOI: 10.1016/j.survophthal.2020.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
The cornea's intense innervation is responsible for corneal trophism and ocular surface hemostasis maintenance. Corneal diabetic neuropathy affects subbasal nerve plexus, with progressive alteration of nerves' morphology and density. The quantitative analysis of nerve fibers can be performed with in vivo corneal confocal microscopy considering the main parameters such as corneal nerve fibers length, corneal nerve fibers density, corneal nerve branching density, tortuosity coefficient, and beadings frequency. As the nerve examination permits the detection of early changes occurring in diabetes, the invivo corneal confocal microscopy becomes, over time, an important tool for diabetic polyneuropathy assessment and follow-up. In this review, we summarize the actual evidence about corneal nerve changes in diabetes and the relationship between the grade of alterations and the duration and severity of the disease. We aim at understanding how diabetes impacts corneal nerves and how it correlates with sensorimotor peripheral polyneuropathy and retinal complications. We also attempt to analyze the safety of the most common surgical procedures such as cataract and refractive surgery in diabetic patients and to highlight the specific risk factors. We believe that information about the corneal nerve fibers' condition obtained from the in vivo subbasal nerve plexus investigation may be crucial in monitoring peripheral small fiber polyneuropathy and that it will help with decision-making in ophthalmic surgery in diabetic patients.
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11
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Li YP, Yan ZQ, Han LP, Yin AL, Xu JY, Zhai YR, Hao S, Zhang L, Xie Y. The Association Between Phosphorylated Neurofilament Heavy Chain (pNF-H) and Small Fiber Neuropathy (SFN) in Patients with Impaired Glucose Tolerance. Diabetes Ther 2020; 11:71-81. [PMID: 31673971 PMCID: PMC6965567 DOI: 10.1007/s13300-019-00716-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Small fiber neuropathy (SFN)-the early stage of diabetic peripheral neuropathy (DPN)-progresses gradually and is difficult to diagnose using neurophysiological tests. To facilitate the early diagnosis of SFN, biomarkers for SFN must be identified. The purpose of this study was to investigate the characteristics of SFN in prediabetic patients and the relationship between pNF-H and SFN. METHODS 44 IGT patients (inpatients and outpatients) were selected at random. 33 healthy subjects served as controls. Data on clinical characteristics and laboratory parameters were collected. Quantitative sensory testing (QST), electromyography (EMG), and Sudoscan were performed, and pNF-H was measured by ELISA. RESULTS 24 of the 44 patients with impaired glucose tolerance (IGT) were diagnosed with SFN according to the modified Toronto Diabetic Neuropathy Expert Group consensus criteria. The thermal sensory thresholds of the IGT-SFN group were significantly different from those of the CTRL group (p < 0.05), except for the heat pain threshold. The sensory nerve action potential (SNAP) of the sural nerve was 12.39 in the IGT-SFN group, which was significantly lower than those in the other groups. No significant difference in nerve conduction velocity (NCV) was observed among the three groups. The electrochemical skin conductance (ESC) in the IGT-SFN group was 69.78 ± 14.03uS, which was significantly lower than that in the CTRL group. The pNF-H in the IGT-SFN group was 170.6 (140.0, 223.6) pg/ml, which was significantly higher than those in the CTRL and IGT-non-SFN groups (76.55 and 64.7 pg/ml, respectively). Multivariate regression analysis demonstrated that pNF-H and 2h plasma glucose were independently correlated with SFN; the ORs (95% CI) were 1.429 (1.315, 1.924) and 2.375 (1.157, 4.837), respectively. CONCLUSIONS Serum pNF-H may be associated with SFN in IGT patients, and serum pNF-H could therefore serve as a sensitive biomarker for the detection of SFN.
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Affiliation(s)
- Yu-Peng Li
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China.
- Tianjin Institute of Endocrinology, Tianjin, China.
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China.
| | - Zhong-Qing Yan
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Li-Ping Han
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Ai-Li Yin
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Jin-Yong Xu
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Ya-Ran Zhai
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Sai Hao
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Lin Zhang
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China
| | - Yun Xie
- Tianjin Medical University Metabolic Diseases Hospital & Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China.
- Tianjin Institute of Endocrinology, Tianjin, China.
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin, China.
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12
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Gylfadottir SS, Weeracharoenkul D, Andersen ST, Niruthisard S, Suwanwalaikorn S, Jensen TS. Painful and non-painful diabetic polyneuropathy: Clinical characteristics and diagnostic issues. J Diabetes Investig 2019; 10:1148-1157. [PMID: 31222961 PMCID: PMC6717899 DOI: 10.1111/jdi.13105] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/06/2019] [Accepted: 06/17/2019] [Indexed: 12/17/2022] Open
Abstract
Diabetic neuropathy (DN) is a common complication of diabetes and can be either painful or non-painful. It is challenging to diagnose this complication, as no biomarker or clear consensus on the clinical definition of either painful or non-painful DN exists. Hence, a hierarchical classification has been developed categorizing the probability of the diagnosis into: possible, probable or definite, based on the clinical presentation of symptoms and signs. Pain is a warning signal of tissue damage, and non-painful DN therefore represents a clinical and diagnostic challenge because it often goes unnoticed until irreversible nerve damage has occurred. Simple clinical tests seem to be the best for evaluation of DN in the general care for diabetes. Screening programs at regular intervals might be the most optimal strategy for early detection and interventions to possibly prevent further neuronal damage and to lower the economic burden of this complication.
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Affiliation(s)
| | - Danita Weeracharoenkul
- Pain Management Research UnitDepartment of AnesthesiologyFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkokThailand
| | - Signe Toft Andersen
- Danish Pain Research CenterAarhus UniversityAarhusDenmark
- Department of Public HealthAarhus UniversityAarhusDenmark
| | - Supranee Niruthisard
- Pain Management Research UnitDepartment of AnesthesiologyFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkokThailand
| | - Sompongse Suwanwalaikorn
- Department of MedicineFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkokThailand
| | - Troels Staehelin Jensen
- Danish Pain Research CenterAarhus UniversityAarhusDenmark
- Department of NeurologyAarhus University HospitalAarhusDenmark
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13
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Mao F, Zhu X, Liu S, Qiao X, Zheng H, Lu B, Li Y. Age as an Independent Risk Factor for Diabetic Peripheral Neuropathy in Chinese Patients with Type 2 Diabetes. Aging Dis 2019; 10:592-600. [PMID: 31165003 PMCID: PMC6538210 DOI: 10.14336/ad.2018.0618] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/18/2018] [Indexed: 12/22/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is more prevalent in aging populations. Older adults with diabetes have higher rates of macro and micro vascular complications. Our study assessed whether age is an independent factor for both large and small nerve dysfunctions in Chinese patients with T2DM. This cross-sectional study involved a total of 950 patients with type 2 diabetes (mean age: 60.01±12.30 years). Diabetic peripheral neuropathy (DPN) was assessed according to clinical symptoms and physical examinations by using neuropathy symptom score (NSS), the neuropathy disability score (NDS), Michigan Neuropathy Screening Instrument (MNSI score), vibration perception threshold (VPT) and SUDOSCAN test. By using independent logistic regression model, we showed that age was an independent risk factor of DPN (odds ratio [OR] = 1.036, 95% confidence interval [CI] 1.018-1.054, P< 0.01). T2DM patients over 71 years had a higher risk of DPN determined by using NSS/NDS (OR= 2.087; 95% CI 1.112-3.918; P <0.05), MNSI (OR=1.922; 95% CI 1.136-3.252; P<0.05), VPT (OR=3.452; 95%CI 1.052-11.332; P<0.05) and SUDOSCAN (OR=1.922; 95%CI 1.136-3.252; P<0.05) as diagnostic criteria respectively. The results of spline analysis showed a non-linearly positive association between age and OR of DPN. Individuals with 40, 50, 60, and 70 years old had LnOR of 1.22 (95%CI: 0.44- 2.00), 1.79(95%CI: 0.67- 2.91), 2.29 (95% CI: 0.98- 3.59), and 2.67(95% CI: 1.38-3.96) in DPN risk compared to T2DM patients with 19 years old, respectively. All of the above results in our study suggested age as an independent risk factor for the development of diabetic neuropathy in T2DM patients is significantly associated with the occurrence of both small and large nerve dysfunction, independent of other risk factors.
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Affiliation(s)
- Fei Mao
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoming Zhu
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Siying Liu
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaona Qiao
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Hangping Zheng
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Lu
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiming Li
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.,2Department of Endocrinology and Metabolism, Jing'an District Center Hospital of Shanghai, China
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14
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Shillo P, Sloan G, Greig M, Hunt L, Selvarajah D, Elliott J, Gandhi R, Wilkinson ID, Tesfaye S. Painful and Painless Diabetic Neuropathies: What Is the Difference? Curr Diab Rep 2019; 19:32. [PMID: 31065863 PMCID: PMC6505492 DOI: 10.1007/s11892-019-1150-5] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The prevalence of diabetes mellitus and its chronic complications are increasing to epidemic proportions. This will unfortunately result in massive increases in diabetic distal symmetrical polyneuropathy (DPN) and its troublesome sequelae, including disabling neuropathic pain (painful-DPN), which affects around 25% of patients with diabetes. Why these patients develop neuropathic pain, while others with a similar degree of neuropathy do not, is not clearly understood. This review will look at recent advances that may shed some light on the differences between painful and painless-DPN. RECENT FINDINGS Gender, clinical pain phenotyping, serum biomarkers, brain imaging, genetics, and skin biopsy findings have been reported to differentiate painful- from painless-DPN. Painful-DPN seems to be associated with female gender and small fiber dysfunction. Moreover, recent brain imaging studies have found neuropathic pain signatures within the central nervous system; however, whether this is the cause or effect of the pain is yet to be determined. Further research is urgently required to develop our understanding of the pathogenesis of pain in DPN in order to develop new and effective mechanistic treatments for painful-DPN.
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Affiliation(s)
- Pallai Shillo
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF UK
| | - Gordon Sloan
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF UK
| | - Marni Greig
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF UK
| | - Leanne Hunt
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF UK
| | - Dinesh Selvarajah
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK
| | - Jackie Elliott
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK
| | - Rajiv Gandhi
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF UK
| | | | - Solomon Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF UK
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK
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15
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Ono Y, Esaki K, Takahashi Y, Nakabayashi M, Ichinose M, Lee K. Muscular blood flow responses as an early predictor of the severity of diabetic neuropathy at a later stage in streptozotocin-induced type I diabetic rats: a diffuse correlation spectroscopy study. BIOMEDICAL OPTICS EXPRESS 2018; 9:4539-4551. [PMID: 30615744 PMCID: PMC6157794 DOI: 10.1364/boe.9.004539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/10/2018] [Accepted: 08/16/2018] [Indexed: 06/09/2023]
Abstract
We propose a novel application of diffuse correlation spectroscopy to evaluate microvascular malfunctions of muscle tissue affected by hyperglycemia and determine their correlation with the severity of diabetic neuropathy at a later stage. Microvascular responses of the thigh muscle and the mechanical pain threshold of the hind paw of streptozotocin-induced type I diabetic rats were continuously monitored once per week for 70 days. Significantly decreased baseline blood flow and reactive hyperemia responses were observed as early as 1 week after hyperglycemia induction. The reactive hyperemia response at 2 weeks of hyperglycemia was highly correlated with the mechanical pain threshold at 8 weeks, at which time a decreased pain threshold was statistically confirmed in hyperglycemic rats relative to controls.
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Affiliation(s)
- Yumie Ono
- Department of Electronics and Bioinformatics, School of Science and Technology, Meiji University, 1-1-1 Higashi-Mita, Tama-ku, Kawasaki, Kanagawa 2148571, Japan
| | - Kimiya Esaki
- Electrical Engineering Program, Graduate School of Science and Technology, Meiji University, 1-1-1 Higashi-Mita, Tama-ku, Kawasaki, Kanagawa 2148571, Japan
| | - Yuta Takahashi
- Electrical Engineering Program, Graduate School of Science and Technology, Meiji University, 1-1-1 Higashi-Mita, Tama-ku, Kawasaki, Kanagawa 2148571, Japan
| | - Mikie Nakabayashi
- Department of Electronics and Bioinformatics, School of Science and Technology, Meiji University, 1-1-1 Higashi-Mita, Tama-ku, Kawasaki, Kanagawa 2148571, Japan
- Electrical Engineering Program, Graduate School of Science and Technology, Meiji University, 1-1-1 Higashi-Mita, Tama-ku, Kawasaki, Kanagawa 2148571, Japan
| | - Masashi Ichinose
- Human Integrative Physiology Laboratory, School of Business Administration, Meiji University, 1-1 Surugadai, Kanda, Chiyoda-ku, Tokyo 1018301, Japan
| | - Kijoon Lee
- College of Transdisciplinary Studies, Daegu Gyeongbuk Institute of Science and Technology, 333 Techno Jungang-daero, Hyeonpung-myeon, Dalseong-gun, Daegu, South Korea
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16
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Goddard K, Vas P, Purves A, McMillan V, Langford T, Reid F, Edmonds M. Comparing the Diagnostic Accuracy of Simple Tests to Screen for Diabetic Peripheral Neuropathy: Protocol for a Cross-Sectional Study. JMIR Res Protoc 2018; 7:e72. [PMID: 29625948 PMCID: PMC5910530 DOI: 10.2196/resprot.7438] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 01/05/2018] [Accepted: 01/26/2018] [Indexed: 01/06/2023] Open
Abstract
Background Various tests are used to detect diabetic peripheral neuropathy by assessing sense perception in the feet. Tests vary in terms of time and resources required. Simple tests are those that can be conducted quickly and easily in primary care without laboratory equipment. There are some limitations to these simple tests, an example being the variable amplitude of the 128 Hz tuning fork. A new test, VibraTip (McCallan Medical, UK), might be a valuable alternative as it emits a consistent amplitude and may offer improved diagnostic accuracy. Objective The aims of this study are to estimate the diagnostic accuracy of the VibraTip device for diabetic peripheral neuropathy against the reference standard of sural nerve conduction velocity measurement, and to assess whether the VibraTip offers superior diagnostic accuracy to other routine tests based on vibration or touch. Methods The study will prospectively recruit adults with type 2 diabetes who are due to attend a routine follow-up clinic. A cross-sectional study design will be employed to assess the diagnostic accuracy of 5 standard index tests for peripheral neuropathy, including VibraTip. The reference test will be sural nerve conduction velocity measurement. Results Funding is being sought to conduct this research. The outcomes assessed will be the diagnostic accuracy of the 5 index tests against sural nerve conduction velocity measurement, including sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio. Receiver operating characteristic curves will be constructed and compared for each test. Conclusions This study will be the first within-study comparison of 5 simple tests for screening diabetic peripheral neuropathy and will address uncertainties in the potential benefits of using VibraTip in comparison with the other tests.
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Affiliation(s)
- Kate Goddard
- King's Technology Evaluation Centre, King's College London, London, United Kingdom
| | - Prashanth Vas
- King's College London Hospital NHS Trust, London, United Kingdom
| | - Alistair Purves
- King's College London Hospital NHS Trust, London, United Kingdom
| | - Viktoria McMillan
- King's Technology Evaluation Centre, King's College London, London, United Kingdom
| | - Thomas Langford
- King's Technology Evaluation Centre, King's College London, London, United Kingdom
| | - Fiona Reid
- King's Technology Evaluation Centre, King's College London, London, United Kingdom
| | - Michael Edmonds
- King's College London Hospital NHS Trust, London, United Kingdom
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17
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Vas PRJ, Edmonds ME. Early recognition of diabetic peripheral neuropathy and the need for one-stop microvascular assessment. Lancet Diabetes Endocrinol 2016; 4:723-725. [PMID: 27180137 DOI: 10.1016/s2213-8587(16)30063-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Prashanth R J Vas
- Department of Diabetes and Diabetes Foot Medicine, King's College Hospital, London SE5 9RS, UK.
| | - Michael E Edmonds
- Department of Diabetes and Diabetes Foot Medicine, King's College Hospital, London SE5 9RS, UK
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