Association of Diabetic Neuropathy with Duration of Type 2 Diabetes and Glycemic Control

Diabetic peripheral neuropathy among adult type 2 diabetes patients in Adama, Ethiopia: health facility-based study

Diabetic peripheral neuropathy is the most prominent microvascular complication of diabetes mellitus and the leading cause of ulceration, amputation, and extended hospitalization. Evidence regarding the magnitude and factors associated with diabetic peripheral neuropathy is not well documented in Ethiopia, particularly in the study area. A facility-based cross-sectional study was conducted among 293 adult type 2 diabetic patients who were on treatment and follow-up from May to June 31, 2023. To select participants in the study, a systematic random sampling method was utilized. Data were collected using semi-structured questionnaires and medical record reviews. The Michigan Neuropathy Screening Instrument (MNSI) was employed to assess diabetic peripheral neuropathy. To model the association between diabetic peripheral neuropathy and independent variables, binary logistic regression model was used. An adjusted odds ratio with a 95% confidence interval was used to estimate the association and statistical significance was proclaimed at a p-value < 0.05. The magnitude of diabetic peripheral neuropathy was 14.3% (95% CI 10.4-18.0). It was 13.4% (95% CI 8.4-19.1) among males and 15.4% (95% CI 10.1-22.2) among females. Age above 60 years (AOR = 5.06, 95% CI 1.60-15.96), being rural resident (AOR = 2.41; 95% CI 1.15-5.06), duration of diabetes above 5 years (AOR = 2.48, 95% CI 1.16-5.27) and having comorbid hypertension (AOR = 2.56, 95% CI 1.24-5.28) were independently associated with diabetic peripheral neuropathy. One in seven adult type 2 diabetes patients in the study area had diabetic peripheral neuropathy. Factors such as age, place of residence, duration of diabetes, and comorbid hypertension showed positive associations with diabetic peripheral neuropathy. Thus, it is imperative to give special consideration to diabetic patients who are elderly, living in rural areas, experiencing a prolonged duration of diabetes, or dealing with comorbid hypertension.

Do Serum Nesfatin-1 Levels have A Predictive Role in Type-2 Diabetes Mellitus and its Microvascular Complications? A Case-Control Study

Background Type 2 diabetes mellitus (T2DM) is a chronic disease with macrovascular and microvascular complications. Nesfatin-1 is a neuropeptide that develops from a more substantial intermediate compound known as nucleobindin 2 (NUCB2). Nesfatin-1 is known to play a role in regulating various physiological processes related to appetite, energy balance, and body weight. The purpose of the current study was to investigate the serum levels of nesfatin-1 in Egyptian patients with type 2 diabetes mellitus (T2DM) in comparison to healthy subjects and to assess the association of serum nesfatin-1 levels with the occurrence of diabetic microvascular complications in those patients. Methods This matched case-control study was conducted on 90 subjects 40-80 years old, with normal hepatic, cardiac, and respiratory functions, and 60 of them had T2DM. The included participants were divided into two groups: group 1, which was the control group and included 30 healthy subjects, and group 2, which included 60 subjects with T2DM. Group 2 was subdivided according to the presence or absence of microvascular complications into group 2a, which included 30 patients having T2DM with no microvascular complications, and group 2b, which included 30 patients having T2DM with one or more microvascular complications. Results T2DM patients had significantly lower serum nesfatin-1 levels (5.07±1.78 versus 9.05±2.1 mmol/L, <0.001) compared to healthy controls. Also, T2DM patients with microvascular complications had lower serum nesfatin-1 levels (4.32±1.72 versus 5.83±1.51 mmol/L, <0.001) compared to T2DM patients without microvascular complications. Serum nesfatin-1 level at a cutoff value of <8.09 mmol/L can be a marker for the detection of diabetes mellitus (DM) with the area under the curve (AUC) of 94.3%, 95% sensitivity, 74.3% specificity, 77.9% positive predictive value (PPV), and 65.7% negative predictive value (NPV), and at a cutoff value of <5.87 mmol/L can be a marker for the detection of microvascular complications of diabetes mellitus at AUC of 75.5%, 76.7% sensitivity, 67.3% specificity, 77.1% PPV, and 62.9% NPV. Conclusions Serum Nesfatin-1 may play a potential protective role in diabetes mellitus (DM) and its microvascular complications, as it decreases in individuals with diabetes and those with diabetic microvascular complications compared to controls. Additionally, serum Nesfatin-1 levels may have predictive value for the early detection of Type 2 diabetes mellitus (T2DM) patients, diabetic microvascular complications, and diabetic kidney disease (DKD) at cut-off values of < 8.09 (mmol/L), < 5.87 (mmol/L), and < 5.46 (mmol/L), respectively. Therefore, targeted Nesfatin-1 drug therapy may be tried to reduce morbidity and mortality caused by microvascular complications of diabetes.

"Knowing It Before Blocking It," the ABCD of the Peripheral Nerves: Part B (Nerve Injury Types, Mechanisms, and Pathogenesis)

Selander emphatically said, "Handle these nerves with care," and those words still echo, conveying a loud and clear message that, however rare, peripheral nerve injury (PNI) remains a perturbing possibility that cannot be ignored. The unprecedented nerve injuries associated with peripheral nerve blocks (PNBs) can be most tormenting for the unfortunate patient and a nightmare for the anesthetist. Possible justifications for the seemingly infrequent occurrences of PNB-related PNIs include a lack of documentation/reporting, improper aftercare, or associated legal implications. Although they make up only a small portion of medicolegal claims, they are sometimes difficult to defend. The most common allegations are attributed to insufficient informed consent; preventable damage to a nerve(s); delay in diagnosis, referral, or treatment; misdiagnosis, and inappropriate treatment and follow-up care. Also, sufficient prospective studies or randomized trials have not been conducted, as exploring such nerve injuries (PNB-related) in living patients or volunteers may be impractical or unethical. Understanding the pathophysiology of various types of nerve injury is vital to dealing with them further. Processes like degeneration, regeneration, remyelination, and reinnervation can influence the findings of electrophysiological studies. Events occurring in such a process and their impact during the assessment determine the prognosis and the need for further interventions. This educational review describes various types of PNB-related nerve injuries and their associated pathophysiology.

Efficacy of prokinetic agents in diabetic gastroparesis comparing symptomatology and scintigraphy - An open-label trial

Background

It is pertinent to objectively assess the severity of diabetic gastroparesis and tailor treatment accordingly. The current study was planned to document gastroparesis by gastric emptying scintigraphy (GES) objectively and see the effect of medications and diet control on clinical and GES after four weeks.

Methods

A prospective, open-label randomized trial was conducted in the Department of Internal Medicine at a tertiary care teaching hospital over twelve months. Type 2 diabetic patients aged 18-65 years diagnosed with a case of delayed gastric emptying by gastric scintigraphy were included. All baseline GSCI was recorded, and then they were allotted to 3 groups - Group-1 (Levosulpiride 25mg once daily), group-2 (Cinitapride 1mg thrice daily), and Group-3 (Waitlisted control) by block randomization and followed-up weekly till four weeks. After four weeks duration, if not improved clinically, then Group-3 on diet and diabetic control only, were randomized into Levosulpiride 25mg once daily (Group 1), and Cinitapride 1mg Thrice daily (Group 2) for the next four weeks.

Results

Forty confirmed cases with diabetic gastroparesis documented by Gastroparesis Symptom Cardinal Index (GCSI) scoring and later by Scintigraphy (GES) were included in this study. However, there was no statistically significant difference between the Levosulpiride and Cinitapride groups when all symptoms were taken into account. Levosulpiride was significantly more effective than Cinitapride in improving individual symptoms like nausea, vomiting, stomach fullness, and early satiety.

Conclusion

Levosulpiride is better than Cinitapride in improving the symptoms of diabetic gastroparesis but no significant effect on gastric scintigraphy.

Pharmacist-lead screening for diabetic peripheral neuropathy using Michigan Neuropathy Screening Instrument (MNSI)

BACKGROUND

Diabetic peripheral neuropathy (DPN) is highly prevalent among Jordanian patients, mostly are asymptomatic. Early recognition and appropriate management of neuropathy is important to improve symptoms, reduce sequelae, and improve quality of life. This study aims at exploring the role of pharmacists in the early recognition of DPN and providing quick screening for the presence of it among diabetic patients.

MATERIAL AND METHODS

A cross-sectional study was conducted at multi-pharmacy settings, in Irbid, Jordan. Twenty trained pharmacists who had bachelor's degrees in pharmacy participated in data collection. A total of 400 patients with confirmed diagnosis of type 2 diabetes mellitus (DM) according to the World Health Organization diagnostic criteria were recruited. DPN was assessed using the translated Arabic version of Michigan Neuropathy Screening Instrument (MNSI) history version.

RESULTS

The mean MNSI questionnaire score for all participants was 4.40 ± 3.00. Mean age of the patients was 62.6 ± 10.7 years old and duration of diabetes was 8.25 ± 6.9. DN was present in 23.7% of the population. Diabetic patients with neuropathy were older than patients without neuropathy (p < 0.05) and had had diabetes longer (p < 0.05). Poor glycemic control, hypertension and gender, were significantly risk factors for DN (p < 0.05).

CONCLUSIONS

In addition to delivering medications, this study suggests that pharmacists can have a role in screening and counseling about diabetic peripheral neuropathy using a simple objective, and non-invasive tool and also can determine level of damage and risk.

Diabetic Polyneuropathy in Type 1 and Type 2 Diabetes Mellitus: A Cross-Sectional Study

BACKGROUND

Diabetes mellitus (DM) is one of the three most common chronic diseases worldwide. This study aimed to determine the prevalence of diabetic polyneuropathy (DPN) among patients with diabetes.

METHOD

This cross-sectional study was carried out on DM patients who visited King Abdulaziz University Hospital (KAUH) between August 2021 and February 2022. We used the Michigan Neuropathy Screening Instrument (MNSI) questionnaire to determine if the patients had DN. In addition, we used the Global Physical Activity Questionnaire (GPAQ) to assess the level of physical activity (PA) in these DM patients.

RESULTS

A total of 336 patients consented to participate in the study. We found a DN prevalence of 23.8% amongst DM patients treated at the KAUH. In addition, the prevalence of DN amongst T1DM and T2DM patients was found to be 16% and 24.4%, respectively. Furthermore, we found that 65% of DM patients developed complications, with a significant correlation observed between the duration of DM and the development of complications. However, patient age and sex were non-statistically significantly correlated with the development of complications. Analysis of the GPAQ showed that among the 249 patients who completed the questionnaire, none had a high physical activity level, while 4% and 96% had moderate and low physical activity levels, respectively. No association was found between physical activity and patients' age, sex, type of DM, duration of DM, and development of complications.

CONCLUSION

DN prevalence amongst DM patients treated at KAUH was 23.8%. The duration of diabetes was found to be a risk factor for DN. However, patient age and sex were non-statistically significantly associated with DN.

Neuroepigenetic Changes in DNA Methylation Affecting Diabetes-Induced Cognitive Impairment

Chronic diabetic conditions have been associated with certain cerebral complications, that include neurobehavioral dysfunctional patterns and morphological alterations of neurons, especially the hippocampus. Neuroanatomical studies done by the authors have shown decreased total dendritic length, intersections, dendritic length per branch order and nodes in the CA1 hippocampal region of the diabetic brain as compared to its normal control group, indicating reduced dendritic arborization of the hippocampal CA1 neurons. Epigenetic alterations in the brain are well known to affect age-associated disorders, however its association with the evolving diabetes-induced damage in the brain is still not fully understood. DNA hypermethylation within the neurons, tend to silent the gene expression of several regulatory proteins. The findings in the study have shown an increase in global DNA methylation in palmitic acid-induced lipotoxic Neuro-2a cells as well as within the diabetic mice brain. Inhibiting DNA methylation, restored the levels of HSF1 and certain HSPs, suggesting plausible effect of DNMTs in maintaining the proteostasis and synaptic fidelity. Neuroinflammation, as exhibited by the astrocyte activation (GFAP), were further significantly decreased in the 5-azadeoxycytidine group (DNMT inhibitor). This was further evidenced by decrease in proinflammatory cytokines TNF⍺, IL-6, and mediators iNOS and Phospho-NFkB. Our results suggest that changes in DNA methylation advocate epigenetic dysregulation and its involvement in disrupting the synaptic exactitude in the hippocampus of diabetic mice model, providing an insight into the pathophysiology of diabetes-induced neuroepigenetic changes.

Comparison of the Response to Pulpal Sensibility Tests in Well-Controlled and Uncontrolled Type II Diabetes Mellitus Patients: A Cross-Sectional Study

Introduction

Diabetes mellitus is a metabolic disorder in which impairment of sensory fibers would be anticipated. The present study would assess the dental pulp response to cold and EPT sensibility tests in patients with type 2 diabetes, both well-controlled and uncontrolled.

Materials and Methods

One hundred two maxillary central incisors, belonging to participants aged 35–67 years, were included in this survey. At last, 51 diabetic patients were allocated to each group of well-controlled (HbA1C < 7) and uncontrolled (HbA1C ≥ 7). Electric and cold pulpal vitality tests were conducted for all teeth. Statistical analysis was performed with Student's t-test, the chi-square test, and the multiple linear regression model. A P value less than 0.05 was considered significant.

Results

Based on the results of this study, the mean value of response to EPT was 4.51 ± 2.06 and 4.41 ± 1.85 in well-controlled and uncontrolled diabetic patients, respectively. Also, the pulpal responses to cold and EPT tests had no significant differences between the two groups (P > 0.05).

Conclusion

Tooth responses to the cold and EPT sensibility tests were not different in well-controlled and uncontrolled diabetic patients. Despite no statistically significant correlation, male diabetic patients in the uncontrolled group showed a lower sensory response threshold to EPT compared to a well-controlled group.

Association Between HbA1c Levels and Diabetic Peripheral Neuropathy: A Case-Control Study of Patients with Type 2 Diabetes Using Claims Data

BACKGROUND

Evidence on the efficacy of glycemic control for diabetic peripheral neuropathy (DPN) is limited in patients with type 2 diabetes mellitus. Despite the known relationship between hemoglobin A1c (HbA1c) and DPN, the parameters (e.g., mean values or variability) that play an important role have not been elucidated.

OBJECTIVE

The objective of this study was to explore factors associated with DPN, including long-term HbA1c parameters, among patients with type 2 diabetes, in a large-scale longitudinal study.

METHODS

We conducted a case-control study using a medical claims database. We extracted data of patients with type 2 diabetes and disease records of DPN (indicating that they received treatment for DPN) and those without DPN records (controls), and matched for age, sex, index year, and duration since the first type 2 diabetes record. A logistic regression analysis was performed to explore factors associated with DPN, and a receiver-operating characteristic analysis to estimate the optimal mean HbA1c target.

RESULTS

Of 1,792,037 patients with type 2 diabetes, data from 1632 patients (816 per group) were analyzed. The mean HbA1c levels in the 3-year observation period were 7.2 ± 1.0% in the DPN group and 6.9 ± 1.1% in the control group. Elevated 3-year mean HbA1c levels were significantly associated with DPN records (adjusted odds ratio: 1.23, 95% confidence interval 1.06-1.42), while HbA1c variability was not significantly associated. The mean HbA1c levels that discriminated between patients with and without DPN records were 6.5% (unadjusted) and 7.1% (adjusted).

CONCLUSIONS

The development or progression of DPN in patients with type 2 diabetes was associated with the 3-year mean HbA1c level in real-world data.

Vitamin B12 Deficiency and Clinical Neuropathy with Metformin Use in Type 2 Diabetes

Introduction: Type 2 diabetes (T2DM), which is more prevalent (more than 90% of all diabetes cases) and the main driver of the diabetes epidemic, now affects 5.9% of the world’s adult population, with almost 80% of the total in developing countries. At present, 537 million adults (20−79 years) are living with diabetes—1 in 10. This number is predicted to rise to 643 million by 2030 and 783 million by 2045. In India, reports show that 69.2 million people are living with diabetes (8.7%) as per 2015 data. Long-term metformin treatment is a known pharmacological cause of vitamin B12 (Vit B12) deficiency, as was evident within the first 10−12 years after it started to be used. Methods: This was a cross-sectional study conducted in the Postgraduate Department of Medicine in one of the tertiary hospitals in Kashmir. A total of 1600 consecutive patients with T2DM were taken for the study. Out of which 700 patients met the inclusion criteria. These 700 patients were divided into two groups: those taking metformin, and those who were not on metformin. Cumulative metformin doses were recorded in patients taking metformin, using history of dose and duration of treatment. Serum Vit B12 levels were taken for all patients. Based on the results of Vit B12 levels, patients were classified into normal levels (20 pmol/L), possible B12 deficiency (150−220 pmol/l), and definite deficiency (<150 pmol/L). Results: Our results depicted that patients on prolonged metformin therapy showed an increase in Vit B12 deficiency by 11.16%. The prevalence of clinical neuropathy in the metformin-exposed group was 45%, whereas, a prevalence of 31.8% was found in the non-metformin group. The mean age of patients with neuropathy was higher than those without neuropathy (59.01 ± 7.14 vs. 49.95 ± 7.47) (p-value < 0.514, statistically insignificant). Conclusions: In our study, we found that metformin use is associated with Vit B12 deficiency, which is dependent upon the cumulative dose of metformin. Importantly, prolonged metformin use is also associated with an increase in the prevalence of clinical neuropathy.

The Effectiveness of Massage Therapy on Healing of Diabetic Neuropathy in Diabetes Mellitus Patients

BACKGROUND: Diabetic neuropathy reduces the patient’s quality of life and the quality of diabetes management itself and, as a result, worsens the prognosis of other diabetic complications. Various complaints that are often felt by diabetes mellitus (DM) patients due to neuropathy include pain in the legs, numbness, and weakness in the affected leg, paresthesia, or numbness, and the absence of tendon reflexes in the affected leg. AIM: This study aimed to determine the effectiveness of electric massage therapy on neuropathy healing in DM patients. METHODS: The pre-test and post-test experimental design without a control group was employed. Patients with neuropathy diabetic were recruited as the subject of the study. The total number of participants in the study was 30 people. All the subjects were assessed for neuropathy using the neuropathy assessment instrument and the monofilament test. The Kolmogorov–Smirnov test was employed to analyze the normality of the data. The Wilcoxon signed-rank test was employed for non-normally distributed data. The study used a 95% confidence interval, and significance was assessed at alpha <0.05. RESULTS: Mean difference test resulted that the Z value was −4.791; (p < 0.01). These results indicate that there was a statistically significant difference in the level of neuropathy before and after the massage therapy intervention. CONCLUSIONS: Foot massage therapy has a significant effect in reducing the complaints of diabetic peripheral neuropathy (DPN). It is recommended for the DPN patients to conduct foot massage independently regularly as an alternative treatment in-home care treatment.

Racial Differences in Pain, Nutrition, and Oxidative Stress

Investigating the disproportionate rates of chronic pain and their related comorbidities between Black and non-Hispanic White (White) individuals is a growing area of interest, both in the healthcare community and in general society. Researchers have identified racial differences in chronic pain prevalence and severity, but still very little is known about the mechanisms underlying them. Current explanations for these differences have primarily focused on socioeconomic status and unequal healthcare between races as causal factors. Whereas these factors are informative, a racial gap still exists between Black and White individuals when these factors are controlled for. One potential cause of this racial gap in chronic pain is the differences in nutrition and dietary intake between groups. Certain foods play a key role in the inflammatory and oxidative stress pathways in the human body and could potentially influence the severity of the pain experience. Here, we review the previous literature on the surrounding topics and propose a potential mechanism to explain racial differences in the chronic pain population, based on established racial differences in diet and oxidative stress.

Local plantar vibration for the treatment of diabetic neuropathy: a case report

PURPOSE

One of the most common and debilitating complications of diabetes is peripheral neuropathy. Physical modalities such as whole-body vibration are used to treat diabetic peripheral neuropathy (DPN), but there are limted studies on the effectiveness of local vibration for the treatment of PDN. In this study, we aimed to evaluate the effectiveness of local vibration in treating a patient with DPN.

METHODS

The local vibration was applied on the plantar side of both feet. The patient received 10 min of local vibration with 62.5 Hz frequency for five sessions. We used brief BESTest for balance evaluation, Numerical Pain Rating Scale (NPRS) for pain assessment, monofilament examination score for protective sensation evaluation, vibration threshold, and skin temperature to evaluate the effects of local vibration, which were measured before the treatment, after one session  of treatment, and after 5th session of treatment.

RESULTS

There was a 62.5% reduction in pain severity after five sessions of treatment. Vibration threshold of both patient's feet and protective sensation of right foot returned to normal after treatment. Skin temperature was increased in all evaluated points of both patient's feet, brief BESTest score increased by six points after five treatment sessions, indicating improvements in the blood flow of feet and balance, respectively.

CONCLUSIONS

Local plantar vibration was effective in improving the symptoms of DPN.

Tocotrienol-Rich Vitamin E (Tocovid) Improved Nerve Conduction Velocity in Type 2 Diabetes Mellitus Patients in a Phase II Double-Blind, Randomized Controlled Clinical Trial

Diabetic peripheral neuropathy (DPN) is the most common microvascular complication of diabetes that affects approximately half of the diabetic population. Up to 53% of DPN patients experience neuropathic pain, which leads to a reduction in the quality of life and work productivity. Tocotrienols have been shown to possess antioxidant, anti-inflammatory, and neuroprotective properties in preclinical and clinical studies. This study aimed to investigate the effects of tocotrienol-rich vitamin E (Tocovid Suprabio^TM) on nerve conduction parameters and serum biomarkers among patients with type 2 diabetes mellitus (T2DM). A total of 88 patients were randomized to receive 200 mg of Tocovid twice daily, or a matching placebo for 12 months. Fasting blood samples were collected for measurements of HbA1c, renal profile, lipid profile, and biomarkers. A nerve conduction study (NCS) was performed on all patients at baseline and subsequently at 2, 6, 12 months. Patients were reassessed after 6 months of washout. After 12 months of supplementation, patients in the Tocovid group exhibited highly significant improvements in conduction velocity (CV) of both median and sural sensory nerves as compared to those in the placebo group. The between-intervention-group differences (treatment effects) in CV were 1.60 m/s (95% CI: 0.70, 2.40) for the median nerve and 2.10 m/s (95% CI: 1.50, 2.90) for the sural nerve. A significant difference in peak velocity (PV) was also observed in the sural nerve (2.10 m/s; 95% CI: 1.00, 3.20) after 12 months. Significant improvements in CV were only observed up to 6 months in the tibial motor nerve, 1.30 m/s (95% CI: 0.60, 2.20). There were no significant changes in serum biomarkers, transforming growth factor beta-1 (TGFβ-1), or vascular endothelial growth factor A (VEGF-A). After 6 months of washout, there were no significant differences from baseline between groups in nerve conduction parameters of all three nerves. Tocovid at 400 mg/day significantly improve tibial motor nerve CV up to 6 months, but median and sural sensory nerve CV in up to 12 months of supplementation. All improvements diminished after 6 months of washout.

Association of serum calprotectin with peripheral neuropathy in patients with type 2 diabetes mellitus

Introduction

Peripheral neuropathy is a common microvascular complication in patients with type 2 diabetes mellitus with a prevalence of around 50%.

Objectives

This prospective observational cross-sectional study was done to assess serum calprotectin levels among diabetic patients with peripheral neuropathy as compared to those without neuropathy.

Methods

This cross-sectional study was conducted in 126 diabetic patients attending the out-patient department of JIPMER Hospital, Pondicherry from July 2017 to January 2019. The subjects were divided into two groups (with and without peripheral neuropathy) and underwent nerve conduction study of both the lower limbs. Blood samples were collected and stored at -80°C for estimation of serum calprotectin. Serum calprotectin levels were compared between diabetic patients with and without peripheral neuropathy.

Results

Serum calprotectin levels were increased in patients with diabetic peripheral neuropathy (DPN) as compared to those without DPN. However, there was no significant difference in the mean value of serum calprotectin among the various sub-groups of DPN.

Conclusion

Serum calprotectin, an inflammatory biomarker is elevated in patients with diabetic peripheral neuropathy as compared to those without neuropathy.

Prevalence and Determinants of Peripheral Neuropathy Among Adult Type II Diabetes Mellitus Patients Attending a Non-communicable Disease Clinic in Rural South India

Background

Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of diabetes. Almost half of the diabetic patients develop foot ulcer as a complication of DPN during their lifetime. The aim was to estimate the prevalence and identify the risk factors of diabetic peripheral neuropathy among adult diabetes mellitus (DM) patients.

Methods

A cross-sectional study was conducted among 421 type 2 DM patients attending Non-Communicable Disease (NCD) clinic in rural Puducherry through systematic random sampling. The study instruments used for data collection were a pre-tested semi-structured questionnaire, Michigan Neuropathy Screening Instrument (MNSI), Morisky Green Levine Scale (MGLS), physical measurements and recent laboratory results. The data was captured using Epicollect5 and analyzed using SPSS version 20.

Results

The prevalence of DPN was 31.1% (95% confidence interval (CI): 27.1%-35.1%). The mean age, duration of diabetes, and duration of foot symptoms were 57.91±10.61, 7.00±6.23, 5.56±5.26 years. Smoking (adjusted odds ratio (AOR) 3.14; 95% CI 1.73-5.69), mean duration of diabetes>5years (AOR 2.74; 95% CI 1.71-4.40), hyperglycemic status(>200mg/dl) (AOR 2.24; 95% CI 1.08-4.64) and unemployment (AOR 2.05; 95% CI 1.11-3.76) were found to be statistically significant determinants of DPN on binary logistic regression analysis.

Conclusions

A considerable proportion of diabetics are at risk of developing DPN among rural DM patients. More diligent screening in a primary health care setting and addressing the modifiable risk factors like smoking, obesity, physical inactivity, and uncontrolled hyperglycemia will delay or hamper DPN development among diabetic patients.

Determinants of peripheral neuropathy among diabetic patients under follow-up in chronic care clinics of public hospitals at Gamo and Gofa zones, southern Ethiopia

BACKGROUND

Peripheral neuropathy is a leading cause of morbidity and increased mortality among diabetic patients. It is characterized by significant deficits in vibration and tactile sensation. With an annual incidence of 2%, it affects as many as 110 million people worldwide. The aim of this study was to assess factors associated with peripheral neuropathy among diabetic patients in chronic care clinic in Gamo and Gofa zone, South Ethiopia.

METHODS

An institution- based unmatched case control study was employed among 528 randomly selected participants using a pre-tested, interviewer-administered, and structured questionnaire. Bivariate and multivariable logistic regression analysis was conducted to identifiy determinants of peripheral neuropathy using IBM SPSS version 25.

RESULT

The odds of being an urban dweller was 2.67 times higher among cases than controls [AOR = 2.67 (1.27, 5.63)]. The likelihood of fasting blood glucose level between 203 and 282 and 282 and above was 2.55 and 3.88 times higher among cases than controls [AOR = 2.55 (1.91, 7.16)] and [AOR = 3.88 (1.42, 10.60)] respectively. The probability of living with diabetes mellitus for 10 and more years was 3.88 times higher among cases than controls [AOR = 3.88 (1.42, 10.60)]. The odds of controlling glucose level after developing symptom was 5.33 times higher among cases than controls [AOR = 5.33 (1.28, 12.24)]. The probability of having high blood pressure was 2.36 times higher among cases than controls [AOR = 2.36 (1.26, 4.43)]. The likelihood of having a family history of complication from diabetes mellitus was 5.60 times higher among cases than controls [AOR = 5.60 (2.03, 15.43)]. The odds of exercising 3 times per week for 15 to 30 minutes and for less than 15 minutes were 2.96 and 4.92 times higher among cases than controls respectively [AOR = 2.96 (1.32, 6.61)] and AOR = 4.92, 95% CI (1.85, 13.04) respectively. The likelihood of having a waist circumference greater than or equal to 40 inch was 2.72 times higher among cases than controls [AOR = 2.72 (1.07, 6.94)].

CONCLUSION

This study showed that residence, duration of diabetic mellitus, family history of complication from diabetic mellitus, level of fasting blood glucose, method of glycemic control, having a high blood pressure/hypertension/, frequency and duration of physical activity and waist circumference were found to be determinants of peripheral neuropathy. Thus, the concerned health authorities and health professionals should target on these factors in their efforts to prevent peripheral neuropathy among diabetics in the study area.

Prevalence of peripheral neuropathy and associated pain in patients with diabetes mellitus: Evidence from a cross-sectional study

Background

Diabetic peripheral neuropathy (DPN) is the most common and troublesome complication of diabetes mellitus. It affects almost half the population with diabetes and worsens quality of life of the patient. This study was aimed to determine the prevalence of peripheral neuropathy and associated pain in patients with diabetes mellitus.

Methods

This was a cross-sectional study conducted over a period of six months. Patient's ≥ 18 years with confirmed diagnosis of diabetes mellitus were included in the study. Patients with hypothyroidism, medical illness such as cancer, liver or renal disease, cervical or lumbar spondylosis, pregnant patients with diabetes and patients receiving any treatment that might influence nerve function (e.g., cytotoxic or antiepileptic agents) were excluded from the study. DPN was diagnosed using 10 g monofilament test. The S-LANSS questionnaire was used to assess the associated painful symptoms. Association was calculated using chi-square test. A p- value of ≤0.05 was considered statistically significant. All the statistical analysis was performed using SPSS v22.

Result

The overall prevalence of DPN was found to be 28.85% from which 88% patients were found to have painful symptoms. A significant association of DPN was observed with the duration of diabetes (p = 0.004), poor glycaemic control (p = 0.03) and other diabetic complications such as nephropathy (p = 0.002). No association of neuropathy was found with retinopathy and hypertension. Duration of diabetes (>15 years), and HbA1c (>9%) was found to be positively associated the painful DPN.

Conclusion

The current study found a high prevalence of DPN and it was found to be significantly associated with duration of diabetes, poor glycaemic control and nephropathy.

Peripheral Neuropathy and All-Cause and Cardiovascular Mortality in U.S. Adults : A Prospective Cohort Study

BACKGROUND

Growing evidence indicates that peripheral neuropathy (PN) is common even in the absence of diabetes. However, the clinical sequelae of PN have not been quantified in the general population.

OBJECTIVE

To assess the associations of PN with all-cause and cardiovascular mortality in the general adult population of the United States.

DESIGN

Prospective cohort study.

SETTING

NHANES (National Health and Nutrition Examination Survey), 1999 to 2004.

PARTICIPANTS

7116 adults aged 40 years or older who had standardized monofilament testing for PN.

MEASUREMENTS

Cox regression to evaluate the associations of PN with all-cause and cardiovascular mortality after adjustment for demographic and cardiovascular risk factors, overall and stratified by diabetes status.

RESULTS

The overall prevalence of PN (±SE) was 13.5% ± 0.5% (27.0% ± 1.4% in adults with diabetes and 11.6% ± 0.5% in adults without diabetes). During a median follow-up of 13 years, 2128 participants died, including 488 of cardiovascular causes. Incidence rates (per 1000 person-years) of all-cause mortality were 57.6 (95% CI, 48.4 to 68.7) in adults with diabetes and PN, 34.3 (CI, 30.3 to 38.8) in adults with PN but no diabetes, 27.1 (CI, 23.4 to 31.5) in adults with diabetes but no PN, and 13.0 (CI, 12.1 to 14.0) in adults with no diabetes and no PN. In adjusted models, PN was significantly associated with all-cause mortality (hazard ratio [HR], 1.49 [CI, 1.15 to 1.94]) and cardiovascular mortality (HR, 1.66 [CI, 1.07 to 2.57]) in participants with diabetes. In those without diabetes, PN was significantly associated with all-cause mortality (HR, 1.31 [CI, 1.15 to 1.50]), but the association between PN and cardiovascular mortality was not statistically significant after adjustment (HR, 1.27 [CI, 0.98 to 1.66]).

LIMITATION

Prevalent cardiovascular disease was self-reported, and PN was defined by monofilament testing only.

CONCLUSION

Peripheral neuropathy was common and was independently associated with mortality in the U.S. population, even in the absence of diabetes. These findings suggest that decreased sensation in the foot may be an underrecognized risk factor for death in the general population.

PRIMARY FUNDING SOURCE

National Institute of Diabetes and Digestive and Kidney Diseases and National Heart, Lung, and Blood Institute of the National Institutes of Health.

Comparison of Fingertip vs Palm Site Sampling on Pain Perception, and Variation in Capillary Blood Glucose Level among Patients with Diabetes Mellitus

Introduction: Glycaemic status of the patient is often monitored using capillary blood glucose test which is fairly accurate. Traditional finger stick sampling is done to obtain sample, which can be painful and may be a barrier for repeated testing. The current study was conducted to compare fingertip and palm site sampling on pain perception, and variation in capillary blood glucose level. Methods: This study was conducted among 284 diabetic patients, who were selected by convenience sampling method. The data was collected by measuring capillary blood glucose levels from fingertip and palm site of the left hand at an interval of 10 minutes using a standard glucometer. The level of pain perceptions was measured with a numerical rating pain scale. Data analysis was accomplished using descriptive analysis, Mann-Whitney U test and Kruskal- Wallis test. Results: The level of pain perception at the palm site (2) was lesser than fingertip (3) which was significant at P < 0.001. 223 (78.52%) of the participants experienced more pain at fingertip than palm site, the difference in the measured capillary blood glucose level between fingertip [mean (SD): 226.65 (87.86)] and palm site [mean (SD): 225.65(92.13)] was minimum. The agreement of palm site was 90.7% in single measurement and 95.1% in average measurement. Conclusion: The present study concludes that, majority of the participants experienced less pain perception at the palm site sampling (alternate site sampling) than fingertip sampling with very minimal variation in the blood glucose level.

Telemedicine to deliver diabetes care in low- and middle-income countries: a systematic review and meta-analysis

Objective

To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries.

Methods

We searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. We extracted data on the study characteristics, primary end-points and effect sizes of outcomes. Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties.

Findings

We included 31 interventions in our meta-analysis. We observed significant standardized mean differences of −0.38 for glycated haemoglobin (95% confidence interval, CI: −0.52 to −0.23; I² = 86.70%), −0.20 for fasting blood sugar (95% CI: −0.32 to −0.08; I² = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I² = 93.75%), 0.55 for diabetes knowledge (95% CI: −0.10 to 1.20; I² = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I² = 97.15%). We observed no significant treatment effects for other outcomes, with standardized mean differences of −0.04 for body mass index (95% CI: −0.13 to 0.05; I² = 35.94%), −0.06 for total cholesterol (95% CI: −0.16 to 0.04; I² = 59.93%) and −0.02 for triglycerides (95% CI: −0.12 to 0.09; I² = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications.

Conclusion

Although we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias.

Prevalence of diabetic peripheral neuropathy among type II diabetic patients in King Fahd University Hospital, Khobar, Kingdom of Saudi Arabia

Background: Diabetic peripheral neuropathies (DPN) are a common complication of diabetes mellitus (DM). DPN can be either painless or painful.General objective: To determine the prevalence of DPN among DM type II patients at King Fahd University Hospital (KFUH), Al-Khobar, Kingdom of Saudi Arabia (KSA).Specific objectives: To see the association between the prevalence of DPN and patient demographics and body mass index (BMI).To assess the relationship between the prevalence of DPN and DM type II and duration of disease.To provide awareness and education of DPN by pamphlets to the recruited diabetic patients at KFUH, Al-Khobar, KSA.Methods: questionnaire-based cross-sectional study, recruited DM type II patients from the internal medicine outpatient clinics at KFUH, Khobar, KSA. The investigators recorded patients' demographics (age, sex, and nationality), height, weight, and BMI, diabetes duration in years and laboratory results of fasting blood glucose (FBG), Hemoglobin A1C and the Michigan Neuropathy Screening Instrument (MNSI) has been applied.Results: among 187 recruited patients with type II DM, the prevalence of DPN was 37.4%. The mean age range of the sample was 56.4 ± 11.2 years. Females to males were 62.6% vs 37.4%. Saudis represented a great proportion of the participants constituting nearly 95.2%. The mean BMI of patients was 33.6 ± 7.08 kg/m². The mean FBG was 161.4 ± 62.9 mg/dL while the mean value of HbA1c was 8.11%±1.63%. HbA1c levels were significantly associated with DPN. Duration of DM of more than 1 year and FBG levels were significant predictors for patients to have DPN. Other socio-demographic variables such as age, gender, nationality, and BMI levels were not significantly associated with DPN.Conclusion: DPN affects 37.4% of type II diabetic patients at King Fahd University Hospital in Saudi Arabia. Approximately 60% of patients were not aware of the importance of daily foot care. Thus, foot care pamphlets were distributed to patients.

Thermal Perception Abnormalities Can Predict Diabetic Kidney Disease in Type 2 Diabetes Mellitus Patients

BACKGROUND

Previous studies have illustrated clinical associations between diabetic peripheral neuropathy (DPN) and diabetic kidney disease (DKD). Quantitative sensory testing (QST) can accurately detect thermal perception abnormalities and aid in the early diagnosis of asymptomatic small-fiber DPN in patients with type 2 diabetes. The aim of this study was to determine the predictive value of thermal perception abnormalities by QST to detect DKD.

METHODS

We prospectively enrolled 432 patients with type 2 diabetes (50.2% male, mean age 57.2 years, and average duration of diabetes 9.9 years) at our hospital between 2016 and 2017. Demographic and clinical data of the patients were recorded and analyzed. Diagnosis and staging of DKD were determined by urinary albumin excretion rate and estimated glomerular filtration rate. The presence of thermal perception abnormalities was determined by QST. Multiple logistic regression and receiver operating characteristic (ROC) analyses were performed to investigate the relationships between thermal perception abnormalities and DKD in these patients.

RESULTS

In multiple regression analysis, abnormal cold perception in the lower limbs was associated with an increased risk of advanced DKD. Area under the ROC curve analysis revealed that four-limb cold perception abnormalities had the best discriminatory power (0.741 ± 0.053) to predict advanced DKD.

CONCLUSIONS

Our results demonstrate the value of using thermal perception abnormalities to identify patients with type 2 diabetes also at risk of DKD.

Deterioration of Sleep Quality According to Glycemic Status

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a progressive disease with multiple complications. The present study aimed to determine the effects of glycemic status on sleep quality in individuals with T2DM, prediabetes, and normal glucose tolerance (NGT).

METHODS

A total of 90 participants were categorized into three groups, T2DM (n=30), prediabetes (n=30), and NGT (n=30). Objective sleep quality was measured with the actigraph wrist-worn device over 3 nights and subjective sleep quality was evaluated with a questionnaire.

RESULTS

The duration of diabetes in the T2DM group was 2.23 years and the glycosylated hemoglobin (HbA1c) levels in the T2DM, prediabetes, and NGT groups were 7.83%, 5.80%, and 5.31%, respectively. Sleep efficiency decreased across the T2DM, prediabetes, and NGT groups (86.25%, 87.99%, and 90.22%, respectively; P=0.047). Additionally, HbA1c levels revealed a significant negative correlation with sleep efficiency (r=-0.348, P=0.001). The sleep quality questionnaire results were similar among the three groups.

CONCLUSION

Although the participants in the present study were not necessarily conscious of their sleep disturbances, deterioration in sleep quality progressed according to glycemic status.

Diabetic neuropathy is associated with increased pain perception, low serum beta-endorphin and increase insulin resistance among Nigerian cohorts in Ekiti State

INTRODUCTION

There has been an increase in the global prevalence of diabetic polyneuropathy and research evidence suggests that insulin resistance plays an important role in its development and prognosis. However, there seem to be a dearth of information in understanding the likely interplay between beta endorphin, insulin resistance and pain perception especially in the setting of painful diabetic neuropathy.

METHOD

This study recruited 120 volunteers divided into four groups (30 per group): group 1 healthy volunteer (control); group 2 DM type 2 without neuropathy (DM group); group 3 DM type 2 with painful neuropathy (DPN group); group 4 DM type 2 without painful neuropathy (DN). All subjects were evaluated for pain threshold and neuropathy using an ischemia-induced pain model and biothesiometer respectively. Their beta-endorphin, glycated hemoglobin, fasting plasma insulin, and HOMA values were determined and means compared using ANOVA.

RESULT

Serum beta-endorphin is significantly reduced in DN and DPN (∗p < 0.001) compared with the control and DM group. Also, DPN and DN patients have significantly increased insulin resistance compared to those without neuropathy (∗p < 0.001; ∗p < 0.0001 respectively). There is a significant positive correlation between the pain threshold and beta-endorphin in all the groups except DN group. The correlation between beta-endorphin and insulin resistance was negative and significant in control and DM groups only. Suggestive that the fact that insulin resistance plays an important role in diabetes polyneuropathy, does not alone explain the chronic pain perception noticed in the DPN patients.

CONCLUSION

The present study demonstrates that diabetic neuropathy patients have a poor endogenous opioid peptide system which is associated with increased pain perception and high insulin resistance. However, insulin resistance alone does not explain the chronic pain perception noticed in the DPN patients. Thus, further study is required.

Diabetic Peripheral Neuropathy Increases Electrical Stimulation Threshold of Sciatic Nerve: A Prospective Parallel Cohort Study

PURPOSE

To investigate the impact of diabetic peripheral neuropathy and its severity on the threshold of sciatic nerve electrical stimulation in diabetic patients.

PATIENTS AND METHODS

The case-control study included 60 patients that were divided into non-diabetic patients (control group, n = 26) and diabetic patients (diabetes group, n = 34). All the patients who were scheduled for lower leg, foot, and ankle surgery received a popliteal sciatic nerve block. We recorded the minimum current required to produce motor activity of the sciatic nerve during ultrasound-guided popliteal sciatic nerve block.

RESULTS

Among the 60 patients, the sciatic nerve innervated muscle contractile response was successfully elicited in 57 patients (dorsiflexion of foot, plantar flexion, foot valgus or adduction, toe flexion, etc.) under electric stimulation. We failed to elicit the motor response in three patients with diabetic peripheral neuropathy, even when the stimulation current was 3 mA. The average electrical stimulation threshold (1.0 ± 0.7 mA) in the diabetes group was significantly higher than that of the control group (0.4 ± 0.1 mA). Diabetic patients with peripheral neuropathy had a higher electrical stimulation threshold (1.2 ± 0.7 mA) than patients without peripheral neuropathy (0.4 ± 0.1 mA). Furthermore, the electrical stimulation threshold of the sciatic nerve in diabetic patients had a linear dependence on the Toronto Clinical Scoring System (TCSS) peripheral neuropathy score (electrical stimulation threshold [in mA] = 0.125 TCSS score) (P < 0.001).

CONCLUSION

The threshold of electrical stimulation to elicit a motor response of the sciatic nerve was increased in diabetic patients, and the threshold of electrical stimulation of the sciatic nerve increased with the severity of diabetic nerve dysfunction.

Predictive Model of Diabetic Polyneuropathy Severity Based on Vitamin D Level

BACKGROUND:

Type 2 Diabetes Mellitus is one of the most common metabolic diseases worldwide. The most common complication of DM is diabetic neuropathy (DN), especially diabetic polyneuropathy (DPN). Vitamin D plays an important role in the pathogenesis of DN, thus affecting its severity which can be assessed using nerve conduction study (NCS).

AIM:

This study aimed to develop a predictive model of DPN severity based on vitamin D level.

METHODS:

This was a prospective cohort study involving 50 subjects with DM which was conducted in Haji Adam Malik General Hospital Medan. All subjects were fulfilling inclusion criteria underwent laboratory examination to determine HbA1c and 25 (OH) D levels. Predictive variables were sex, age, duration of DM, smoking status, type and number of anti-diabetic drugs, the presence of metabolic syndrome, HbA1c and vitamin D levels. A scoring system was developed to determine a predictive model. The DPN severity was assessed using NCS and was re-evaluated after 3 months.

RESULTS:

Most of the subjects were female (60%), belonged to ≥ 50 years old age-group (88%), with DM duration < 5 years (56%), were non-smoker (90%), we’re using one anti-diabetic drug (60%), were using insulin (50%), had metabolic syndrome (68%), had HbA1c level > 6.5% (94%), and had vitamin D level < 20 ng/ml (56%). A score of > 4 on this predictive model of DPN severity had a relative risk (RR) of 2.70. The predictive model had a sensitivity of 82.8% and specificity of 61.9%.

CONCLUSION:

A score of higher than 4 on this predictive model showed a 2.7 times higher risk of severe DPN. A predictive model of DPN severity based on vitamin D level had high sensitivity and specificity.

HbA1C Variability Is Strongly Associated With the Severity of Peripheral Neuropathy in Patients With Type 2 Diabetes

Variability in HbA1c is associated with a higher risk of cardiovascular disease and microvascular complications in patients with type 2 diabetes. The present study evaluated the severity of somatic nerve dysfunction at different stages of chronic glycemic impairment, and its correlation with different cardio-metabolic parameters. The study was conducted on 223 patients with type 2 diabetes. We calculated the intrapersonal mean, standard deviation (SD), and coefficient of variation of HbA1c for each patient using all measurements obtained for 3 years prior to the study. Patients were divided into quartiles according to the SD of HbA1c, and we constructed composite scores of nerve conduction as the severity of peripheral neuropathy. Linear regression analysis was performed to evaluate the influence of independent variables on mean composite scores. Those with higher SD-HbA1c had a higher body mass index, mean and index HbA1c, triglyceride and uric acid level, urinary albumin excretion and albumin-creatinine ratio, proportion of insulin therapy, and prevalence of hypertension as the underlying diseases, but lower estimate glomerular filtration rate (eGFR). In addition, those with higher SD-HbA1c showed lower amplitudes and reduced motor nerve conduction velocity in tested nerves, and lower sensory nerve conduction velocity in the sural nerve. Furthermore, those with higher SD-HbA1c had higher composite scores of low extremities. Multiple linear regression analysis revealed that diabetes duration, SD-HbA1c, and eGFR were independently associated with mean composite scores. Based on our results, HbA1c variability plus chronic glycemic impairment is strongly associated with the severity of peripheral neuropathy in patients with type 2 diabetes. Aggressively control blood glucose to an acceptable range and avoid blood glucose fluctuations by individualized treatment to prevent further nerve damage.

Evaluation of safety tool for ambulatory leprosy patients at risk of adverse outcome

BACKGROUND

Leprosy is a potentially debilitating disease of the skin and nerves that requires a complex management approach consisting of laboratory monitoring, screening for factors that will adversely affect outcome with corticosteroids, engagement of allied health services, and prolonged follow-up. Given the complexities of leprosy management, a safety tool was developed and implemented in the Tropical Disease Unit at Toronto General Hospital. Our objective was to evaluate the utility of the tool using a retrospective chart review.

METHODS

We reviewed the charts of patients with leprosy treated over a 3.5-year period: up to 3 years prior to tool implementation, and 6-months following implementation. Pre-determined outcomes of interest included: loss to follow-up; monitoring of laboratory parameters; allied health services engagement; baseline ophthalmologic assessment; and risk mitigation interventions.

RESULTS

Of 17 patients enrolled, 8 were treated pre-implementation, and 9 post-implementation. Five (29.4%) pre-implementation patients were lost to follow-up compared to none post-implementation (p = 0.009). One (12.5%) pre-implementation patient was sent for baseline ophthalmologic assessment versus 8 (88.9%) post-implementation (p = 0.0034). Only post-implementation patients received referrals for occupational therapy and social work, with 77.8% (n = 7) receiving occupational therapy (p = 0.0023) and 33.3% (n = 3) social work (p = 0.2059). Laboratory parameters such as hemoglobin, hepatic transaminases, and methemoglobin were routinely monitored for patients on dapsone irrespective of tool implementation.

CONCLUSIONS

Implementation of a leprosy-specific safety tool has established a user-friendly method for systemizing all elements of care, and ensuring the involvement of allied health services necessary for optimizing health outcomes.

Randomized, Double-Blinded, Double-Dummy, Active-Controlled, and Multiple-Dose Clinical Study Comparing the Efficacy and Safety of Mulberry Twig (Ramulus Mori, Sangzhi) Alkaloid Tablet and Acarbose in Individuals with Type 2 Diabetes Mellitus

Aims. To evaluate the efficacy and safety of mulberry twig alkaloid (SZ-A) tablet compared with acarbose in patients with type 2 diabetes. Methods. This clinical trial enrolled 38 patients who were randomized into two groups (SZ-A: 23; acarbose: 15) and were treated for 24 weeks. Patients and clinical trial staffs were masked to treatment assignment throughout the study. The primary outcome measures were glycated hemoglobin (HbA1c) and 1-hour and 2-hour postprandial and fasting plasma glucose levels from baseline to the end of treatment. Analysis included all patients who completed this study. Results. By the end of this study, HbA1c level in SZ-A group was decreased from baseline significantly (P < 0.001). No significant difference was found when compared with acarbose group (P = 0.652). Similarly, 1-hour and 2-hour postprandial plasma glucose levels in SZ-A group were decreased from baseline statistically (P < 0.05), without any significant differences compared with acarbose group (P = 0.748 and 0.558, resp.). The fasting plasma glucose levels were not significantly changed in both groups. One of 23 patients in SZ-A group (4.76%) and 5 of 15 patients in acarbose group (33.33%) suffered from gastrointestinal adverse events. Conclusions. Compared with acarbose, SZ-A tablet was effective and safe in glycemic control in patients with type 2 diabetes.

Impact of neuropathy on the adherence to diabetes-related self-care activities: a cross-sectional study

PURPOSE

The purpose of this study was to evaluate the impact of the presence and severity of neuropathy and depression on the patient's adherence to diabetes-related self-care activities (DRSCA) in a cohort of patients with type 2 diabetes mellitus (T2DM).

PATIENTS AND METHODS

In this cross-sectional, noninterventional study, 198 patients with T2DM were enrolled according to a population-based, consecutive-case enrollment principle. In all patients, the adherence to DRSCA was evaluated using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire; a higher SDSCA score is associated with a better adherence. The presence and severity of neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI) and the severity of depression using the Patient Health Questionnaire-9 (PHQ-9).

RESULTS

The presence of neuropathy was associated with a decreased SDSCA score (26 points vs 37 points; P<0.001), an increased severe depression prevalence (24.7% vs 4.3%; P<0.001), and an increased PHQ-9 score (12 points vs 7 points; P<0.001). The MNSI score was reverse correlated with SDSCA score (r=-0.527; P<0.001) and positively correlated with PHQ-9 score (r=0.495; P<0.001). The reverse correlation between MNSI score and SDSCA score was present for all the subcomponents of SDSCA questionnaire (diet, exercise, glycemic monitoring, and foot care).

CONCLUSION

The presence of neuropathy is associated with decreases in the quality of adherence to DRSCA in patients with T2DM and with increases in the symptomatology of depression. The significant, negative association between the severity of T2DM and the quality of disease self-management points to a possible loop-type relationship between these two components, being possible a reciprocal augmentation with negative consequences on the global management of the disease.