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Kempler P, Körei A. [Diabetic cardiovascular autonomic neuropathy: clinical significance, diagnosis and therapy]. Orv Hetil 2024; 165:602-612. [PMID: 38643475 DOI: 10.1556/650.2024.33027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/29/2024] [Indexed: 04/23/2024]
Abstract
Az autonóm neuropathia a cukorbetegség igen gyakori szövődménye, mely a diabetes
kórfejlődése során már korán kialakul, sőt már a csökkent glükóztolerancia
stádiumában is jelen lehet. A betegek életminőségére, a cardiovascularis
morbiditásra és mortalitásra gyakorolt prognosztikus jelentősége, a többi
szövődménnyel mutatott összefüggései miatt a cardiovascularis autonóm funkció
károsodása a cukorbetegség szövődményei között kiemelt jelentőségű. A
cardiovascularis autonóm neuropathia klinikai manifesztációi mint a nyugalmi
tachycardia, az orthostaticus hypotonia, a néma myocardialis ischaemia és
infarktus vagy éppen a QT-távolság megnyúlása miatt kialakuló ritmuszavarok mind
hozzájárulnak a cardiovascularis autonóm neuropathia rossz prognózisához. Ezek a
betegek gyakrabban szenvednek el hirtelen szívhalált, és a perioperatív
légzés-keringésleállás kockázata is nagyobb. A szövődmény irányában végzett
szűrővizsgálatok így alapvető jelentőségűek. A diagnosztikában a mai napig a
hagyományos cardiovascularis reflextesztek tekinthetők arany standardnak, melyek
egyszerű, noninvazív, jól reprodukálható, megfelelő szenzitivitással és
specificitással rendelkező eszközös vizsgálatok. Az egyéb vizsgálati lehetőségek
közül a szívfrekvencia-variabilitás és baroreflex-szenzitivitás a prognózis
pontosabb megítélésére, illetve elsősorban klinikai tanulmányokban végpontokként
használatosak. Az összefoglaló kitér emellett a betegek előszűrését szolgáló
kérdőíves módszerekre és a diagnosztika egyszerűsítését célzó újabb
lehetőségekkel kapcsolatos legfrissebb eredményekre. A cardiovascularis autonóm
neuropathia kezelésének sarokkövét a megfelelő glykaemiás kontroll és a
cardiovascularis kockázati tényezők kontrollja jelenti. További oki terápiás
lehetőség az alfa-liponsav alkalmazása, melynek az autonóm funkcióra gyakorolt
kedvező hatásait klinikai vizsgálat igazolta. A hagyományos értelemben vett
glykaemiás kontrollon túl újabban a glykaemiás variabilitás és egyes
antidiabetikumok idegi funkciókra gyakorolt pleiotrop hatásai kerültek előtérbe.
A testsúlycsökkentés nemcsak a diabetes, de az autonóm neuropathia tekintetében
is jótékony hatású, ugyanakkor az életmód-terápia további összetevőivel
kapcsolatban nem egyértelműek az adatok. Orv Hetil. 2024; 165(16): 602–612.
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Affiliation(s)
- Péter Kempler
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Onkológiai Klinika Budapest, Korányi Sándor u. 2/A, 1083 Magyarország
| | - Anna Körei
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Onkológiai Klinika Budapest, Korányi Sándor u. 2/A, 1083 Magyarország
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2
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Zhuang R, Xiong Z, Yan S, Zhang H, Dong Q, Liu W, Miao J, Zhuo Y, Fan X, Zhang W, Wang X, Liu L, Cao J, Zhang T, Hao C, Huang X, Jiang L. Efficacy of electro-acupuncture versus sham acupuncture for diabetic peripheral neuropathy: study protocol for a three-armed randomised controlled trial. BMJ Open 2024; 14:e079354. [PMID: 38569706 PMCID: PMC10989182 DOI: 10.1136/bmjopen-2023-079354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Specific treatment for diabetic peripheral neuropathy (DPN) is still lacking, and acupuncture may relieve the symptoms. We intend to investigate the efficacy and safety of electro-acupuncture (EA) in alleviating symptoms associated with DPN in diabetes. METHODS AND ANALYSIS This multicentre, three-armed, participant- and assessor-blind, randomised, sham-controlled trial will recruit 240 eligible participants from four hospitals in China and will randomly assign (1:1:1) them to EA, sham acupuncture (SA) or usual care (UC) group. Participants in the EA and SA groups willl receive either 24-session EA or SA treatment over 8 weeks, followed by an 8-week follow-up period, while participants in the UC group will be followed up for 16 weeks. The primary outcome of this trial is the change in DPN symptoms from baseline to week 8, as rated by using the Total Symptom Score. The scale assesses four symptoms: pain, burning, paraesthesia and numbness, by evaluating the frequency and severity of each. All results will be analysed with the intention-to-treat population. ETHICS AND DISSEMINATION The protocol has been approved by the Ethics Committee of the Beijing University of Chinese Medicine (Identifier: 2022BZYLL0509). Every participant will be informed of detailed information about the study before signing informed consent. The results of this trial will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ChiCTR2200061408.
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Affiliation(s)
- Rong Zhuang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiyi Xiong
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Shiyan Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Haoran Zhang
- College of Preschool Education, Beijing Youth Politics College, Beijing, China
| | - Qi Dong
- Department of Metabolic Diseases, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Weiai Liu
- Department of Acupuncture and Massage Rehabilitation, The Second Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Jinling Miao
- Acupuncture and Moxibustion Department, Shanxi Provincial Acupuncture and Moxibustion Hospital, Taiyuan, Shanxi, China
| | - Yuanyuan Zhuo
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong, China
| | - Xiaohong Fan
- Department of Metabolic Diseases, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Weiliang Zhang
- Department of Metabolic Diseases, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Xiaomei Wang
- Department of Metabolic Diseases, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, Shanxi, China
| | - Lian Liu
- Department of Acupuncture and Massage Rehabilitation, The Second Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Jianan Cao
- Department of Acupuncture and Massage Rehabilitation, The Second Hospital of Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Tiansheng Zhang
- Acupuncture and Moxibustion Department, Shanxi Provincial Acupuncture and Moxibustion Hospital, Taiyuan, Shanxi, China
| | - Chongyao Hao
- Acupuncture and Moxibustion Department, Shanxi Provincial Acupuncture and Moxibustion Hospital, Taiyuan, Shanxi, China
| | - Xingxian Huang
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong, China
| | - Lijiao Jiang
- The fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
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3
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Grünerbel A, Voll L. [How to prescribe therapeutic footwear for people with diabetic neuropathy?]. MMW Fortschr Med 2024; 166:43-45. [PMID: 38637391 DOI: 10.1007/s15006-024-3770-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Arthur Grünerbel
- Diabeteszentrum München Süd, Stockmannstr. 47, 81477, München, Deutschland.
| | - Lukas Voll
- Seeßle Orthopädieschuhtechnik und Sanitätshaus, München, Deutschland
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4
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Cheng Y, Chen Y, Li K, Liu S, Pang C, Gao L, Xie J, Wenjing LV, Yu H, Deng B. How inflammation dictates diabetic peripheral neuropathy: An enlightening review. CNS Neurosci Ther 2024; 30:e14477. [PMID: 37795833 PMCID: PMC11017439 DOI: 10.1111/cns.14477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) constitutes a debilitating complication associated with diabetes. Although, the past decade has seen rapid developments in understanding the complex etiology of DPN, there are no approved therapies that can halt the development of DPN, or target the damaged nerve. Therefore, clarifying the pathogenesis of DPN and finding effective treatment are the crucial issues for the clinical management of DPN. AIMS This review is aiming to summary the current knowledge on the pathogenesis of DPN, especially the mechanism and application of inflammatory response. METHODS We systematically summarized the latest studies on the pathogenesis and therapeutic strategies of diabetic neuropathy in PubMed. RESULTS In this seminal review, the underappreciated role of immune activation in the progression of DPN is scrutinized. Novel insights into the inflammatory regulatory mechanisms of DPN have been unearthed, illuminating potential therapeutic strategies of notable clinical significance. Additionally, a nuanced examination of DPN's complex etiology, including aberrations in glycemic control and insulin signaling pathways, is presented. Crucially, an emphasis has been placed on translating these novel understandings into tangible clinical interventions to ameliorate patient outcomes. CONCLUSIONS This review is distinguished by synthesizing cutting-edge mechanisms linking inflammation to DPN and identifying innovative, inflammation-targeted therapeutic approaches.
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Affiliation(s)
- Yifan Cheng
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's HospitalAffiliated People's Hospital, Hangzhou Medical CollegeHangzhouChina
| | - Yinuo Chen
- Department of NeurologyFirst Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvinceChina
- First School of Clinical MedicineWenzhou Medical UniversityWenzhouZhejiang ProvinceChina
| | - Kezheng Li
- Department of NeurologyFirst Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvinceChina
- First School of Clinical MedicineWenzhou Medical UniversityWenzhouZhejiang ProvinceChina
| | - Shuwei Liu
- First School of Clinical MedicineWenzhou Medical UniversityWenzhouZhejiang ProvinceChina
| | - Chunyang Pang
- Department of NeurologyFirst Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvinceChina
| | - Lingfei Gao
- Department of NeurologyFirst Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvinceChina
| | - Jiali Xie
- Department of Neurology, Shanghai East HospitalTongji UniversityShanghaiP.R. China
| | - L. V. Wenjing
- Department of GeriatricsThe Affiliated Hospital of Qingdao UniversityQingdaoShandong ProvinceChina
| | - Huan Yu
- Department of PediatricsSecond Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Binbin Deng
- Department of NeurologyFirst Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvinceChina
- First School of Clinical MedicineWenzhou Medical UniversityWenzhouZhejiang ProvinceChina
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5
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Gholami F, Naderi A, Saeidpour A, Lefaucheur JP. Effect of exercise training on glycemic control in diabetic peripheral neuropathy: A GRADE assessed systematic review and meta-analysis of randomized-controlled trials. Prim Care Diabetes 2024; 18:109-118. [PMID: 38286719 DOI: 10.1016/j.pcd.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/03/2024] [Accepted: 01/20/2024] [Indexed: 01/31/2024]
Abstract
AIMS We conducted a systematic review and meta-analysis to investigate the effect of exercise training on HbA1c, and on fasting and postprandial plasma glucose concentrations in patients with diabetic peripheral neuropathy (DPN). METHODS Two independent researchers performed a systematic search in the electronic databases of PubMed, Web of Science and Scopus. Studies investigating the effect of exercise training on patients diagnosed with DPN using a randomized-controlled design were included in the meta-analysis. RESULTS Of 1254 retrieved studies, 68 studies were identified to undergo full-text review; out of these a total of 13 randomized trials met the inclusion criteria. Eleven studies assessed HbA1c, 8 fasting plasma-glucose concentration, and 3 postprandial plasma-glucose concentration. Overall, exercise training significantly decreased HbA1c [-0.54% (95% CI -0.78 to -0.31%)], fasting plasma glucose [-32.6 mg/dl [-1.8 mmol/L] (-44.2 to -20.9 mg/dl [-2.4 to -1.1 mmol/L])] and postprandial plasma glucose [-67.5 mg/dl [-3.7 mmol/L] (-129.5 to -5.4 mg/dl [-7.1 to -0.3 mmol/L])]. Studies with aerobic training intervention yielded the largest significant mean reduction in HbA1c (-0.75%) and fasting plasma glucose concertation (34.0 mg/dl). CONCLUSIONS aerobic training is the most effective modality to reduces HbA1c, fasting and postprandial plasma glucose concentration in patients with DPN. From a metabolic perspective, the magnitude precision range of the reduction in HbA1c is of clinical importance for patients with DPN. This area of research warrants further attention to investigate the impact of various exercise modalities on glycemic control. Registration number CRD42023413687.
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Affiliation(s)
- Farhad Gholami
- Department of Physical Education and Sport Sciences, Faculty of Physical Education, Shahrood University of Technology, Shahrood, Iran.
| | - Aynollah Naderi
- Department of Physical Education and Sport Sciences, Faculty of Physical Education, Shahrood University of Technology, Shahrood, Iran
| | - Asal Saeidpour
- Department of Physical Education and Sport Sciences, Faculty of Physical Education, Shahrood University of Technology, Shahrood, Iran
| | - Jean Pascal Lefaucheur
- ENT Team, EA4391, Faculty of Medicine, Paris Est Créteil University, Créteil, France; Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France
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6
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Li S, Zheng Y, Kang Y, He X, Zheng Y, Jiang M, Xu X, Ma L, Wang X, Zhang K, Shao X, Fang J, Jiang Y. Electroacupuncture alleviates streptozotocin-induced diabetic neuropathic pain via suppressing phosphorylated CaMKIIα in rats. Neuroreport 2024; 35:258-268. [PMID: 38305135 PMCID: PMC10852042 DOI: 10.1097/wnr.0000000000002000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Diabetic neuropathic pain (DNP) is a frequent complication of diabetes. Calcium/calmodulin-dependent protein kinase II α (CaMKIIα), a multi-functional serine/threonine kinase subunit, is mainly located in the surface layer of the spinal cord dorsal horn (SCDH) and the primary sensory neurons in dorsal root ganglion (DRG). Numerous studies have indicated electroacupuncture (EA) takes effect in various kinds of pain. In this research, we explored whether CaMKIIα on rats' SCDH and DRG participated in DNP and further explored the mechanisms underlying the analgesic effects of EA. The DNP model in rats was successfully established by intraperitoneal injection of streptozotocin. Certain DNP rats were treated with intrathecal injections of KN93, a CaMKII antagonist, and some of the DNP rats received EA intervention. The general conditions, behaviors, the expressions of CaMKIIα and phosphorylated CaMKIIα (p-CaMKIIα) were evaluated. DNP rats' paw withdrawal threshold was reduced and the expressions of p-CaMKIIα in SCDH and DRG were upregulated compared with the Normal group, while the level of CaMKIIα showed no significance. KN93 attenuated DNP rats' hyperalgesia and reduced the expressions of p-CaMKIIα. We also found EA attenuated the hyperalgesia of DNP rats and reduced the expressions of p-CaMKIIα. The above findings suggest that p-CaMKIIα in SCDH and DRG is involved in DNP. The analgesic effect of EA in DNP might be related to the downregulation of p-CaMKIIα expression level. Our study further supports that EA can be an effective clinical treatment for DNP.
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Affiliation(s)
- Siyi Li
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yinmu Zheng
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yurong Kang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiaofen He
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yu Zheng
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Minjian Jiang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xinnan Xu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Liqian Ma
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiaoxiang Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Kunlong Zhang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiaomei Shao
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jianqiao Fang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yongliang Jiang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
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7
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Pérez Hernández MF, Calderón Vallejo A, Aguilar Castillo SDJ, Gómez Jiménez DC, Rodríguez Guerrero E, Aguilar Morales F, Moreno Tovar MG, Zurita Muñóz MA, Bautista Cortéz AE, Calzada Mendoza CC, De Nova Ocampo MA, Ordóñez Rodríguez JM, Gómez Esquivel ML, García Méndez A, Flores Gil O, Macías Zaragoza VM, Cortés Moreno GY, Salinas Lara C, Velázquez García G, Saldivar Cerón HI, Pérez Navarro LM, Ávila Jiménez L, Gómez Zamudio JH, Díaz Flores M, Cruz López M, Ocharan Hernández ME, Peralta Romero JDJ. Electroacupuncture efficacy in diabetic polyneuropathy: Study protocol for a double-blinded randomized controlled multicenter clinical trial. BMC Complement Med Ther 2024; 24:90. [PMID: 38360684 PMCID: PMC10868023 DOI: 10.1186/s12906-024-04375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is the most common complication of type 2 diabetes mellitus (T2DM); its diagnosis and treatment are based on symptomatic improvement. However, as pharmacological therapy causes multiple adverse effects, the implementation of acupunctural techniques, such as electroacupuncture (EA) has been suggested as an alternative treatment. Nonetheless, there is a lack of scientific evidence, and its mechanisms are still unclear. We present the design and methodology of a new clinical randomized trial, that investigates the effectiveness of EA for the treatment of DPN. METHODS This study is a four-armed, randomized, controlled, multicenter clinical trial (20-week intervention period, plus 12 weeks of follow-up after concluding intervention). A total of 48 T2DM patients with clinical signs and symptoms of DPN; and electrophysiological signs in the Nerve Conduction Study (NCS); will be treated by acupuncture specialists in outpatient units in Mexico City. Patients will be randomized in a 1:1 ratio to one of the following four groups: (a) short fibre DPN with EA, (b) short fibre DPN with sham EA, (c) axonal DPN with EA and (d) axonal DPN with sham EA treatment. The intervention will consist of 32 sessions, 20 min each, per patient over two cycles of intervention of 8 weeks each and a mid-term rest period of 4 weeks. The primary outcome will be NCS parameters, and secondary outcomes will include DPN-related symptoms and pain by Michigan Neuropathy Screening Instrument (MNSI), Michigan Diabetic Neuropathy Score (MDNS), Dolour Neuropatique Score (DN-4), Semmes-Westein monofilament, Numerical Rating Scale (NRS) for pain assessment, and the 36-item Short Form Health Survey (SF-36). To measure quality of life and improve oxidative stress, the inflammatory response; and genetic expression; will be analysed at the beginning and at the end of treatment. DISCUSSION This study will be conducted to compare the efficacy of EA versus sham EA combined with conventional diabetic and neuropathic treatments if needed. EA may improve NCS, neuropathic pain and symptoms, oxidative stress, inflammatory response, and genetic expression, and it could be considered a potential coadjutant treatment for the management of DPN with a possible remyelinating effect. TRIAL REGISTRATION ClinicalTrials.gov. NCT05521737 Registered on 30 August 2022. International Clinical Trials Registry Platform (ICTRP) ISRCTN97391213 Registered on 26 September 2022 [2b].
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Affiliation(s)
- María Fernanda Pérez Hernández
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Mexico City, 06720, Mexico
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, 11340, Mexico
- Red MEDICI. Carrera de Médico Cirujano. FES Iztacala, UNAM, Estado de México, State of Mexico, 54090, Mexico
| | - Alejandra Calderón Vallejo
- Departamento de Neurología de la Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Mexico City, 06720, Mexico
| | - Sergio de Jesús Aguilar Castillo
- Departamento de Neurofisiología de la Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Mexico City, 06720, Mexico
| | - Daniel Cuauhtémoc Gómez Jiménez
- Sección de Estudios de Posgrado e Investigación, Especialidad en Acupuntura Humana, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Mexico City, 07320, Mexico
| | - Eduardo Rodríguez Guerrero
- Sección de Estudios de Posgrado e Investigación, Especialidad en Acupuntura Humana, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Mexico City, 07320, Mexico
| | | | | | | | | | - Claudia Camelia Calzada Mendoza
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, 11340, Mexico
| | - Mónica Ascención De Nova Ocampo
- Sección de Estudios de Posgrado e Investigación, Escuela Nacional de Medicina y Homeopatía del Instituto Politécnico Nacional. Maestría en Ciencias en Biomedicina Molecular, Mexico City, 07320, Mexico
| | - Juan Manuel Ordóñez Rodríguez
- Sección de Estudios de Posgrado e Investigación, Especialidad en Acupuntura Humana, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Mexico City, 07320, Mexico
| | - Mónica Luz Gómez Esquivel
- Sección de Estudios de Posgrado e Investigación, Especialidad en Acupuntura Humana, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Mexico City, 07320, Mexico
| | | | - Octavio Flores Gil
- Coordinación de Internado y Servicio Social, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Mexico City, 07320, Mexico
| | | | | | - Citlaltepetl Salinas Lara
- Red MEDICI. Carrera de Médico Cirujano. FES Iztacala, UNAM, Estado de México, State of Mexico, 54090, Mexico
- Departamento de Neuropatología, Instituto Nacional de Neurología y Neurocirugía, Mexico City, 14269, Mexico
| | - Germán Velázquez García
- Red MEDICI. Carrera de Médico Cirujano. FES Iztacala, UNAM, Estado de México, State of Mexico, 54090, Mexico
- Carrera de Médico Cirujano Facultad de Estudios Superiores Zaragoza, UNAM, Mexico City, 09239, Mexico
- Universidad Intercultural del Estado de México Plantel Tepetlixpa, Tepetlixpa, Estado de México, 56880, México
| | - Héctor Iván Saldivar Cerón
- Red MEDICI. Carrera de Médico Cirujano. FES Iztacala, UNAM, Estado de México, State of Mexico, 54090, Mexico
- Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla, State of Mexico, 54090, Mexico
- Unidad de Biomedicina (UBIMED), Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla, State of Mexico, 54090, Mexico
| | | | - Laura Ávila Jiménez
- Coordinación Auxiliar Médica de Investigación en Salud, Jefatura de Servicios de Prestaciones Médicas, Delegación Estatal Morelos, IMSS, Cuernavaca, Morelos, 62000, Mexico
| | - Jaime Héctor Gómez Zamudio
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Mexico City, 06720, Mexico
| | - Margarita Díaz Flores
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Mexico City, 06720, Mexico
| | - Miguel Cruz López
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Mexico City, 06720, Mexico
| | - María Esther Ocharan Hernández
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, 11340, Mexico
| | - José de Jesús Peralta Romero
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Mexico City, 06720, Mexico.
- Sección de Estudios de Posgrado e Investigación, Especialidad en Acupuntura Humana, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Mexico City, 07320, Mexico.
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8
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Zuidema X, de Galan B, Brouwer B, Cohen SP, Eldabe S, Argoff CE, Huygen F, Van Zundert J. 4. Painful diabetic polyneuropathy. Pain Pract 2024; 24:308-320. [PMID: 37859565 DOI: 10.1111/papr.13308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Pain as a symptom of diabetic polyneuropathy (DPN) significantly lowers quality of life, increases mortality and is the main reason for patients with diabetes to seek medical attention. The number of people suffering from painful diabetic polyneuropathy (PDPN) has increased significantly over the past decades. METHODS The literature on the diagnosis and treatment of diabetic polyneuropathy was retrieved and summarized. RESULTS The etiology of PDPN is complex, with primary damage to peripheral nociceptors and altered spinal and supra-spinal modulation. To achieve better patient outcomes, the mode of diagnosis and treatment of PDPN evolves toward more precise pain-phenotyping and genotyping based on patient-specific characteristics, new diagnostic tools, and prior response to pharmacological treatments. According to the Toronto Diabetic Neuropathy Expert Group, a presumptive diagnosis of "probable PDPN" is sufficient to initiate treatment. Proper control of plasma glucose levels, and prevention of risk factors are essential in the treatment of PDPN. Mechanism-based pharmacological treatment should be initiated as early as possible. If symptomatic pharmacologic treatment fails, spinal cord stimulation (SCS) should be considered. In isolated cases, where symptomatic pharmacologic treatment and SCS are unsuccessful or cannot be used, sympathetic lumbar chain neurolysis and/or radiofrequency ablation (SLCN/SLCRF), dorsal root ganglion stimulation (DRGs) or posterior tibial nerve stimulation (PTNS) may be considered. However, it is recommended that these treatments be applied only in a study setting in a center of expertise. CONCLUSIONS The diagnosis of PDPN evolves toward pheno-and genotyping and treatment should be mechanism-based.
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Affiliation(s)
- Xander Zuidema
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Anesthesiology and Pain Management, Diakonessenhuis Utrecht/Zeist, Utrecht, The Netherlands
| | - Bastiaan de Galan
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Brigitte Brouwer
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Steven P Cohen
- Department of Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sam Eldabe
- Department of Pain Medicine and Anesthesiology, Durham University, Durham, UK
| | - Charles E Argoff
- Department of Neurology, New York University School of Medicine, and Pain Management Center, North Shore University Hospital, Manhasset, New York, USA
| | - Frank Huygen
- Department of Anesthesiology and Pain Management, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Anesthesiology and Pain Management, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Van Zundert
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Belgium
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9
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Zhou PB, Sun HT. Letter to the Editor Regarding: "Long-Term Evaluation of Spinal Cord Stimulation in Patients With Painful Diabetic Polyneuropathy: An Eight-to-Ten-Year Prospective Cohort Study". Neuromodulation 2024; 27:399-400. [PMID: 38325955 DOI: 10.1016/j.neurom.2023.10.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Peng-Bo Zhou
- The First School of Clinical Medical, Lanzhou University, Lanzhou, Gansu, People's Republic of China; Tianjin Key Laboratory of Neurotrauma Repair, Characteristic Medical Center of People's Armed Police Forces, Tianjin, People's Republic of China
| | - Hong-Tao Sun
- The First School of Clinical Medical, Lanzhou University, Lanzhou, Gansu, People's Republic of China; Tianjin Key Laboratory of Neurotrauma Repair, Characteristic Medical Center of People's Armed Police Forces, Tianjin, People's Republic of China.
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10
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Dillon BR, Ang L, Pop-Busui R. Spectrum of Diabetic Neuropathy: New Insights in Diagnosis and Treatment. Annu Rev Med 2024; 75:293-306. [PMID: 38285516 DOI: 10.1146/annurev-med-043021-033114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Diabetic neuropathy is a highly prevalent complication of diabetes. It consists of a broad range of neuropathic conditions, such as distal symmetric polyneuropathy and various forms of autonomic neuropathies involving the cardiovascular, gastrointestinal, and urogenital systems. Prevention or diagnosis in early stages of disease is crucial to prevent symptomatic onset and progression, particularly in the absence of current disease-modifying therapies. In this review, we describe the four main types of diabetic neuropathy. We review current understanding with respect to diagnosis and treatment while highlighting knowledge gaps and future directions.
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Affiliation(s)
- Brendan R Dillon
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA;
| | - Lynn Ang
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, Ann Arbor, Michigan, USA; ,
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, Ann Arbor, Michigan, USA; ,
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11
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Elshinnawy AM, Eraky ZS, Abdelaziz SS, Abd-Elrahman NAF. Effect of cold application versus transcutaneous nerve stimulation on chemotherapy induced diabetic peripheral neuropathy post mastectomy. Physiother Res Int 2024; 29:e2051. [PMID: 37814489 DOI: 10.1002/pri.2051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND The adverse effects of chemotherapy-induced diabetic peripheral neuropathy (CIDPN) are rather prevalent. There is no known pharmaceutical treatment that can stop CIDPN. OBJECTIVE This study compared the effects of cold application and transcutaneous nerve stimulation (Transcutaneous electrical nerve stimulation (TENS)) on individuals who had undergone mastectomy following CIDPN. SUBJECTS AND METHODS Between Mars 2021 and September 2021, a randomised controlled experiment was carried out at physical therapy clinics at the Modern University for Technology and Information. 30 patients were randomly split into two equal groups (A and B). Both lower limbs received cold application (Group A) three times per week for 12 weeks and TENS application (Group B) three times each week for 12 weeks. The Visual Analogue Scale and nerve conduction velocity for the sural nerve were used to assess patients before and after 12 weeks of therapy. RESULTS The results showed that Group A significantly (p < 0.05) decreased pain intensity after treatment by 70.83% compared with Group B by 55.17%. Moreover, Group A improved significantly (p < 0.05) the sural nerve amplitude by 44.12% compared with group B which recorded 26.87%. After treatment, both pain intensity and sural nerve amplitude significantly (p < 0.05) changed between Group A versus Group B. CONCLUSION Cold application has a better effect on pain in CIDPN post mastectomy.
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Affiliation(s)
- Ahmed M Elshinnawy
- Department of Physical Therapy for Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, Horus University, New Damietta, Egypt
| | - Zeezy S Eraky
- Department of Physical Therapy for Internal Medicine and Elderly, Faculty of Physical Therapy, Modern University for Technology and Information, Cairo, Egypt
| | - Sarah Sami Abdelaziz
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Modern University for Technology and Information, Cairo, Egypt
| | - Noha A F Abd-Elrahman
- Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Badr University, Badr, Egypt
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12
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Yeung AM, Huang J, Nguyen KT, Xu NY, Hughes LT, Agrawal BK, Ejskjaer N, Klonoff DC. Painful Diabetic Neuropathy: The Need for New Approaches. J Diabetes Sci Technol 2024; 18:159-167. [PMID: 36305521 PMCID: PMC10899841 DOI: 10.1177/19322968221132252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Painful diabetic neuropathy is a common vexing problem for people with diabetes and a costly problem for society. The pathophysiology is not well understood, and no safe and effective mechanistically-based treatment has been identified. Poor glycemic control is a risk factor for painful diabetic neuropathy. Excessive intraneuronal glucose in people with diabetes can be shunted away from physiological glycolysis into multiple pathological pathways associated with neuropathy and pain. The first three treatments that are traditionally offered consist of risk factor reduction, lifestyle modifications, and pharmacological therapy, which includes only three drugs that are approved for this indication by the United States Food and Drug Administration. All of these traditional treatments are often inadequate for relieving neuropathic pain, and thus, new approaches are needed. Modern devices based on neuromodulation technology, which act directly on the nervous system, have been recently cleared by the United States Food and Drug Administration for painful diabetic neuropathy and offer promise as next-in-line therapy when traditional therapies fail.
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Affiliation(s)
| | | | | | - Nicole Y. Xu
- Diabetes Technology Society, Burlingame, CA, USA
| | - Lorenzo T. Hughes
- Balance Health, San Francisco, CA, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | | | - Niels Ejskjaer
- Steno Diabetes Center North Denmark and Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - David C. Klonoff
- Diabetes Technology Society, Burlingame, CA, USA
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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13
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Yeung AM, Huang J, Nguyen KT, Xu NY, Hughes LT, Agrawal BK, Ejskjaer N, Klonoff DC. Spinal Cord Stimulation for Painful Diabetic Neuropathy. J Diabetes Sci Technol 2024; 18:168-192. [PMID: 36384312 PMCID: PMC10899837 DOI: 10.1177/19322968221133795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Spinal cord stimulation (SCS) technology has been recently approved by the US Food and Drug Administration (FDA) for painful diabetic neuropathy (PDN). The treatment involves surgical implantation of electrodes and a power source that delivers electrical current to the spinal cord. This treatment decreases the perception of pain in many chronic pain conditions, such as PDN. The number of patients with PDN treated with SCS and the amount of data describing their outcomes is expected to increase given four factors: (1) the large number of patients with this diagnosis, (2) the poor results that have been obtained for pain relief with pharmacotherapy and noninvasive non-pharmacotherapy, (3) the results to date with investigational SCS technology, and (4) the recent FDA approval of systems that deliver this treatment. Whereas traditional SCS replaces pain with paresthesias, a new form of SCS, called high-frequency 10-kHz SCS, first used for pain in 2015, can relieve PDN pain without causing paresthesias, although not all patients experience pain relief by SCS. This article describes (1) an overview of SCS technology, (2) the use of SCS for diseases other than diabetes, (3) the use of SCS for PDN, (4) a comparison of high-frequency 10-kHz and traditional SCS for PDN, (5) other SCS technology for PDN, (6) deployment of SCS systems, (7) barriers to the use of SCS for PDN, (8) risks of SCS technology, (9) current recommendations for using SCS for PDN, and (10) future developments in SCS.
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Affiliation(s)
| | | | | | - Nicole Y. Xu
- Diabetes Technology Society, Burlingame, CA, USA
| | - Lorenzo T. Hughes
- Balance Health, San Francisco, CA, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | | | - Niels Ejskjaer
- Steno Diabetes Center North Denmark and Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - David C. Klonoff
- Diabetes Technology Society, Burlingame, CA, USA
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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14
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Santos SS, de Souza MB, Lauria PSS, Juiz PJL, Villarreal CF, Viana MDM. Technological Trends Involving Probiotics in the Treatment of Diabetic Neuropathy: A Patent Review (2009-2022). Curr Diabetes Rev 2024; 20:e220523217168. [PMID: 37221688 DOI: 10.2174/1573399820666230522121707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Diabetic neuropathy (DN) causes neuropathic pain, and current treatments are unsatisfactory. Recently studies have demonstrated an assertive correlation between gut microbiota and pain modulation. OBJECTIVE Considering the emerging search for new therapies for the control of DN and the growing commercial interest in the probiotics market, this study aimed to provide patents on the use of probiotics in the control of DN. METHODS This is a patent prospection performed in the Espacenet Patent database, using the association of keywords and IPC related to probiotics in medical preparations and foods, from 2009 to December 2022. RESULTS Results have shown that in 2020, there was a boom in patent filing in the area. Asian countries accounted for more than 50% of all 48 inventions (n = 48), with Japan as the only applicant in 2021. Products being developed in recent years point to effects that may represent an advancement in DN treatment, such as reduced concentration of pro-inflammatory mediators, metabolites and neurotransmitters release, and hypoglycemic potential. All effects were more related to the Lactobacillus and Bifidobacterium genera, associated with more than one property mentioned. CONCLUSION The mechanisms attributed to the microorganisms suggest the therapeutic potential of probiotics in the non-pharmacological treatment of pain. New applications for probiotics have resulted from great research interest by academia, but also reflect commercial interests despite the paucity of clinical trials. Thus, the present work supports the evolution of research to explore the benefits of probiotics and their clinical use in DN.
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Affiliation(s)
- Sthefane Silva Santos
- Laboratory of Pharmacology and Experimental Therapeutics, Pharmacy College, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Mariana Bastos de Souza
- Laboratory of Pharmacology and Experimental Therapeutics, Pharmacy College, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Pedro Santana Sales Lauria
- Laboratory of Pharmacology and Experimental Therapeutics, Pharmacy College, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Cristiane Flora Villarreal
- Laboratory of Pharmacology and Experimental Therapeutics, Pharmacy College, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Max Denisson Maurício Viana
- Laboratory of Pharmacology and Experimental Therapeutics, Pharmacy College, Federal University of Bahia, Salvador, Bahia, Brazil
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15
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Petersen EA. Spinal cord stimulation in painful diabetic neuropathy: An overview. Diabetes Res Clin Pract 2023; 206 Suppl 1:110760. [PMID: 38245324 DOI: 10.1016/j.diabres.2023.110760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/30/2023] [Indexed: 01/22/2024]
Abstract
Up to 25% of people with diabetes develop painful diabetic neuropathy (PDN). The standard of care pharmacotherapies for PDN have limited efficacy with a considerable side effect profile. Spinal cord stimulation (SCS) is a form of electrical neurostimulation that modulates neural function via electrodes implanted into the spinal epidural space. While low frequency SCS has been shown to be potentially effective for treating pain associated with neuropathies, it masks pain perception by inducing paresthesia. Compared to low frequency SCS, high frequency (10 kHz) SCS delivers paresthesia-free therapy. As was shown in a randomized controlled trial, SENZA-PDN (NCT03228420), 10 kHz SCS is safe and effective for the treatment of painful diabetic neuropathy. 10 kHz SCS offered a comprehensive treatment that improved pain levels, sleep, quality of life, and neurological function. These improvements correlated with a high degree of patient satisfaction. 10 kHz SCS provides a safe, durable and effective treatment for PDN with the unique potential to improve neurological function. In patients for whom durable, effective treatments have been limited thus far, the findings of the SENZA-PDN study are encouraging.
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Affiliation(s)
- Erika A Petersen
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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16
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Taylor RS. Health-related quality of life and spinal cord stimulation in painful diabetic neuropathy. Diabetes Res Clin Pract 2023; 206 Suppl 1:110826. [PMID: 38245322 DOI: 10.1016/j.diabres.2023.110826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/07/2023] [Accepted: 07/10/2023] [Indexed: 01/22/2024]
Abstract
Peripheral neuropathic pain, including painful diabetic neuropathy (PDN), is associated with marked negative impact on health-related quality of life (HRQoL). The magnitude of reduction of HRQoL experienced by individual PDN patients appears to be strongly associated with their level of pain and disease severity. In spite of the availability of a range of pharmacotherapy, a substantive proportion of PDN patients continue to experience suboptimal HRQoL. Such patients are potential candidates for spinal cord stimulation (SCS) devices. Three randomised controlled trials in over 300 patients with refractory PDN have shown that the addition of SCS to standard of care therapy results in important health gains, including pain reduction and enhancement of HRQoL. Sham-controlled RCTs that enable blinding of patients, clinicians and researchers are needed to confirm the role of SCS in PDN.
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Affiliation(s)
- Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, School of Health and Well Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom; College of Medicine and Health, University of Exeter, Heavitree Rd, Exeter, United Kingdom; Faculty of Health Sciences & National Institute of Public Health and Department of Psychology, University of South Denmark, Copenhagen, Denmark.
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17
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Shahrjerdi S, Bahrpeyma F, Bagherian SA. Acute short term effects of endurance and resistance training on balance control in patients with diabetic peripheral neuropathy. Int J Neurosci 2023; 133:1017-1023. [PMID: 35109765 DOI: 10.1080/00207454.2022.2033739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/08/2020] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Exercise training have numerous beneficial effects on the complications of diabetic peripheral neuropathy. Exercise training may cause immediate effects on balance control in DPN patients. This study aims to assess the Acute Short Term effects of endurance and resistance exercise training on balance control in DPN patients. METHODS In this study, 11 patients with DPN and 11 healthy subjects participated. Patients and healthy subjects did endurance and resistance training in two separate exercise sessions. Dynamic balance and functional balance test were assessed before and after the interventions. Independent t-test was used to compare balance indices before and after training, the intervention effects were examined using ANOVA repeated measure test. The statistical significance level was set at p < 0.05. RESULTS The results showed that dynamic and functional balance in DPN patients were significantly lower than in healthy subjects. Anterior-posterior stability and total stability indices and functional balance test deteriorated significantly after training. CONCLUSION Endurance or resistance training may lead to acute disturbance of dynamic and functional balance in DPN patients. Hence, immediately after exercise, patients with diabetes are at an increased risk of falling, therefore, preventive considerations are necessary.
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Affiliation(s)
- Samira Shahrjerdi
- Department of physical therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farid Bahrpeyma
- Department of physical therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Seyed Ahmad Bagherian
- Department of physical therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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18
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Boulton AJM. A brief overview of the diabetic neuropathies. Diabetes Res Clin Pract 2023; 206 Suppl 1:110758. [PMID: 38245328 DOI: 10.1016/j.diabres.2023.110758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/30/2023] [Indexed: 01/22/2024]
Abstract
The diabetic neuropathies represent the commonest long-term complications of diabetes, and may be the presenting feature of Type 2 diabetes. In clinical practice, distal symmetrical polyneuropathy (DSPN) and the autonomic neuropathies are the most frequently seen forms of diabetic neuropathy. The 2017 American Diabetes Association classification system for the neuropathies of diabetes are in general use. Treatment challenges remain and the need for revised recommendations and further discussion of management of severely painful DSPN that does not fully respond to conventional medical management is clear, especially in light of the recent opioid crisis in the USA.
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Affiliation(s)
- Andrew J M Boulton
- Professor of Medicine, University of Manchester, Division of Diabetes, Endocrinology and Gastroenterology , Consultant Physician, Manchester Royal Infirmary, Visiting Professor of Medicine, University of Miami, Miami, FL, USA; President, Worldwide Initiative for Diabetes Education Immediate Past-President, International Diabetes Federation Past-President, European Association for the Study of Diabetes, United States.
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19
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Luecke TD. Real world outcomes with spinal cord stimulation. Diabetes Res Clin Pract 2023; 206 Suppl 1:110754. [PMID: 38245320 DOI: 10.1016/j.diabres.2023.110754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/30/2023] [Indexed: 01/22/2024]
Abstract
High frequency spinal cord stimulation (SCS) is a safe and effective treatment option for refractory painful diabetic neuropathy and should be considered for use early in the course of the disease. Raising awareness of this minimally invasive treatment option among physician networks is of major importance.
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Affiliation(s)
- Thorsten D Luecke
- Department of Anesthesia and Intensive Care, Clinical Director, Pain Center, Franziskus Hospital Linz, Linz am Rhein, Gemany.
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20
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Wood H. Tackling the global burden of diabetic neuropathy. Nat Rev Neurol 2023; 19:711. [PMID: 37932439 DOI: 10.1038/s41582-023-00897-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
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21
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Grabowska W, King R, Roll S, Habermann IV, Hörder S, Hahn K, Willich SN, Schröder S, Brinkhaus B, Dietzel J. Reliability of a novel point of care device for monitoring diabetic peripheral neuropathy. Sci Rep 2023; 13:19043. [PMID: 37923763 PMCID: PMC10624654 DOI: 10.1038/s41598-023-45841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023] Open
Abstract
We aimed to assess DPNCheck's reliability for repeated sural nerve conduction (NC) parameters. This post hoc analysis used data from the randomized controlled ACUDPN trial assessing NC of the N. Suralis every eight weeks over a 6-month period in 62 patients receiving acupuncture against diabetic peripheral neuropathy (DPN) symptoms. The reliability of DPNCheck for nerve conduction velocity and amplitude was assessed using intraclass correlation coefficients (ICC) and was calculated using data from single time points and repeated measures design. The results of the NC measurements were correlated with the Total Neuropathy Score clinical (TNSc). Overall, for both nerve velocity and amplitude, the reliability at each measurement time point can be described as moderate to good and the reliability using repeated measures design can be described as moderate. Nerve velocity and amplitude showed weak correlation with TNSc. DPNCheck's reliability results question its suitability for monitoring DPN's progression. Given the limitation of our analysis, a long-term, pre-specified, fully crossed study should be carried out among patients with DPN to fully determine the suitability of the device for DPN progression monitoring. This was the first analysis assessing the reliability of the DPNCheck for DPN progression monitoring using data from multiple collection time points.
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Affiliation(s)
- W Grabowska
- Institute of Social Medicine, Epidemiology and Health Economics, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstr. 57, 10117, Berlin, Germany
| | - R King
- Institute of Social Medicine, Epidemiology and Health Economics, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstr. 57, 10117, Berlin, Germany
| | - S Roll
- Institute of Social Medicine, Epidemiology and Health Economics, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstr. 57, 10117, Berlin, Germany
| | - I V Habermann
- Institute of Social Medicine, Epidemiology and Health Economics, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstr. 57, 10117, Berlin, Germany
| | - S Hörder
- Institute of Social Medicine, Epidemiology and Health Economics, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstr. 57, 10117, Berlin, Germany
| | - K Hahn
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S N Willich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstr. 57, 10117, Berlin, Germany
| | - S Schröder
- Hanse Merkur Center for Traditional Chinese Medicine at the University Medical Center Hamburg-Eppendorf, Martinistrasse 64, 20251, Hamburg, Germany
| | - B Brinkhaus
- Institute of Social Medicine, Epidemiology and Health Economics, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstr. 57, 10117, Berlin, Germany
| | - J Dietzel
- Institute of Social Medicine, Epidemiology and Health Economics, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstr. 57, 10117, Berlin, Germany.
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22
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Li X, Liu Y, Jing Z, Fan B, Pan W, Mao S, Han Y. Effects of acupuncture therapy in diabetic neuropathic pain: A systematic review and meta-analysis. Complement Ther Med 2023; 78:102992. [PMID: 37805054 DOI: 10.1016/j.ctim.2023.102992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/10/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness of acupuncture in relieving diabetic neuropathic pain and to establish a more reliable and efficient foundation for acupuncture practice in diabetes care. METHODS The Chinese National Knowledge Infrastructure, Wanfang database, Chongqing Weipu, Chinese Biomedical Literature Database, PubMed, Embase, and Cochrane Library were all searched for a randomized controlled trial research of acupuncture for DNP. Two researchers independently performed literature screening, quality evaluation, and data extraction. After selecting studies and extracting data, we conducted the data analysis using RevMan 5.4 and Stata 14.0. The quality was assessed using the Cochrane Risk of Bias Assessment Tool. RESULTS An extensive review of 19 studies involving 1276 patients up to April 29, 2023, found that acupuncture was successful in improving pain intensity [MD= -1.09; 95% CI (-1.28, -0.89), P < 0.00001], clinical efficacy indicating pain changes [RR= 1.22; 95% CI (1.15, 1.29), P < 0.00001], and clinical neuropathy [MD= -1.55; 95% CI ( -3.00, -0.09), P = 0.04] in DNP patients. Quality of life was also improved, with few side effects reported. CONCLUSION According to this meta-analysis, acupuncture therapy significantly improved the clinical efficacy of pain intensity, pain changes, and clinical neuropathy in patients with DNP, improved the quality of life of patients to a certain extent, and had lower side effects. This discovery provides evidence-based and practical recommendations for the treatment of DNP patients.
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Affiliation(s)
- Xintong Li
- Department of Rehabilitation Medicine, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Yang Liu
- Medical College, Sias University, Zhengzhou, China
| | - Zheng Jing
- Medical College, Sias University, Zhengzhou, China
| | - Baozhu Fan
- Department of Medical Laboratory, Qingdao West Coast New Area Central Hospital, Qingdao, China
| | - Weimin Pan
- College of Sports and Health Sciences, Xi'an Physical Education University, Xi'an, China
| | - Shigang Mao
- Department of Rehabilitation Medicine, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China.
| | - Yabing Han
- Medical College, Ankang University, Ankang, China.
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23
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Lepesis V, Marsden J, Rickard A, Latour JM, Paton J. Systematic review and meta-analysis of the effects of foot and ankle physical therapy, including mobilisations and exercises, in people with diabetic peripheral neuropathy on range of motion, peak plantar pressures and balance. Diabetes Metab Res Rev 2023; 39:e3692. [PMID: 37431167 DOI: 10.1002/dmrr.3692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/05/2023] [Accepted: 06/17/2023] [Indexed: 07/12/2023]
Abstract
To evaluate the effects of foot and ankle physical therapy on ankle and first metatarsophalangeal joint range of motion (ROM), peak plantar pressures (PPPs) and balance in people with diabetes. MEDLINE, EBSCO, Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database of Systematic Reviews, PROSPERO, EThOS, Web of Science and Google Scholar were searched in April 2022. Randomised Controlled Trials (RCT), quasi-experimental, pre-post experimental design and prospective cohort studies were included. Participants were people with diabetes, neuropathy and joint stiffness. Interventions included physical therapy such as mobilisations, ROM exercises and stretches. Outcome measures focused on ROM, PPPs and balance. Methodological quality was assessed with Critical Appraisal Skills Programme RCT and Risk-of-Bias 2 tool. Meta-analyses used random-effects models and data was analysed using the inverse variance method. In total, 9 studies were included. Across all studies, participant characteristics were similar; however, type and exercise dosage varied greatly. Meta-analysis was performed with four studies. Meta-analysis showed significant effects of combined exercise interventions in increasing total ankle ROM (3 studies: MD, 1.76; 95% CI, 0.78-2.74; p = 0; I2 = 0%); and reducing PPPs in the forefoot area (3 studies; MD, -23.34; 95% CI, -59.80 to 13.13; p = 0.21, I2 = 51%). Combined exercise interventions can increase ROM in the ankle and reduce PPPs in the forefoot. Standardisation of exercise programmes with or without the addition of mobilisations in the foot and ankle joints needs further research.
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Affiliation(s)
- Vasileios Lepesis
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jonathan Marsden
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Alec Rickard
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Joanne Paton
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
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24
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Sher EK, Džidić-Krivić A, Karahmet A, Beća-Zećo M, Farhat EK, Softić A, Sher F. Novel therapeutical approaches based on neurobiological and genetic strategies for diabetic polyneuropathy - A review. Diabetes Metab Syndr 2023; 17:102901. [PMID: 37951098 DOI: 10.1016/j.dsx.2023.102901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Neuropathy is among the most often reported consequences of diabetes and the biggest cause of morbidity and mortality in people suffering from this life-long disease. Although different therapeutic methods are available for diabetic neuropathy, it is still the leading cause of limb amputations, and it significantly decreases patients' quality of life. AIM This study investigates potential novel therapeutic options that could ameliorate symptoms of DN. METHODOLOGY Research and review papers from the last 10 years were taken into consideration. RESULTS There are various traditional drugs and non-pharmacological methods used to treat this health condition. However, the research in the area of pathogenic-oriented drugs in the treatment of DN showed no recent breakthroughs, mostly due to the limited evidence about their effectiveness and safety obtained through clinical trials. Consequently, there is an urgent demand for the development of novel therapeutic options for diabetic neuropathy. CONCLUSION Some of the latest novel diagnostic methods for diagnosing diabetic neuropathy are discussed as well as the new therapeutic approaches, such as the fusion of neuronal cells with stem cells, targeting gene delivery and novel drugs.
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Affiliation(s)
- Emina Karahmet Sher
- Department of Biosciences, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, United Kingdom.
| | - Amina Džidić-Krivić
- International Society of Engineering Science and Technology, Nottingham, United Kingdom; Department of Neurology, Clinical Hospital Zenica, Zenica, 72000, Bosnia and Herzegovina
| | - Alma Karahmet
- International Society of Engineering Science and Technology, Nottingham, United Kingdom
| | - Merima Beća-Zećo
- International Society of Engineering Science and Technology, Nottingham, United Kingdom; Department of Pharmacy, Faculty of Health Sciences, Victoria International University, Mostar, 88000, Bosnia and Herzegovina
| | - Esma Karahmet Farhat
- International Society of Engineering Science and Technology, Nottingham, United Kingdom; Faculty of Food Technology, Juraj Strossmayer University of Osijek, Osijek, 31000, Croatia
| | - Adaleta Softić
- Department of Biochemistry, Faculty of Pharmacy, University of Tuzla, Tuzla, 75000, Bosnia and Herzegovina
| | - Farooq Sher
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, United Kingdom.
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25
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Shahani P, Mahadevan A, Mondal K, Waghmare G, Datta I. Repeat intramuscular transplantation of human dental pulp stromal cells is more effective in sustaining Schwann cell survival and myelination for functional recovery after onset of diabetic neuropathy. Cytotherapy 2023; 25:1200-1211. [PMID: 37642606 DOI: 10.1016/j.jcyt.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/30/2023] [Accepted: 07/30/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AIMS Mesenchymal stromal cell (MSC) therapy for diabetic neuropathy (DN) has been extensively researched in vitro and in pre-clinical studies; however, the clinical scenario thus far has been disappointing. Temporary recovery, a common feature of these studies, indicates that either the retention of transplanted cells deteriorates with time or recovery of supportive endogenous cells, such as bone marrow-derived MSCs (BM-MSCs), does not occur, requiring further replenishment. In DN, BM-MSCs are recognized mediators of Schwann cell regeneration, and we have earlier shown that they suffer impairment in the pre-neuropathy stage. In this study, we attempted to further elucidate the mechanisms of functional recovery by focusing on changes occurring at the cellular level in the sciatic nerve, in conjunction with the biodistribution and movement patterns of the transplanted cells, to define the interval between doses. METHOD & RESULTS We found that two doses of 1 × 106 dental pulp stromal cells (DPSCs) transplanted intramuscularly at an interval of 4 weeks effectively improved nerve conduction velocity (NCV) and restored motor coordination through improving sciatic nerve architecture, Schwann cell survival and myelination. Despite very minimal recovery of endogenous BM-MSCs, a temporary restoration of NCV and motor function was achieved with the first dose of DPSC transplantation. However, this did not persist, and a repeat dose was needed to consolidate functional improvement and rehabilitate the sciatic nerve architecture. CONCLUSION Thus, repeat intramuscular transplantation of DPSCs is more effective for maintenance of Schwann cell survival and myelination for functional recovery after onset of DN.
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Affiliation(s)
- Pradnya Shahani
- Department of Biophysics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Kallolika Mondal
- Department of Biophysics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Girish Waghmare
- Department of Biophysics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Indrani Datta
- Department of Biophysics, National Institute of Mental Health and Neurosciences, Bengaluru, India.
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26
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Coombes BK, Bisset LM, Sierra-Silvestre E, Ware RS, Coppieters MW, Coombes JS, Burton NW. Personal Activity Intelligence eHealth intervention in people with diabetic peripheral neuropathy: A feasibility study. Aust J Gen Pract 2023; 52:771-777. [PMID: 37935148 DOI: 10.31128/ajgp-04-23-6797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND AND OBJECTIVES People with diabetic peripheral neuropathy (DPN) report difficulty exercising. This study tested an innovative intervention to promote physical activity self-management and its impact on foot symptoms. METHOD Ten adults with DPN not meeting exercise guidelines consented to four weekly sessions involving exercise tasters, behaviour change counselling and Physical Activity Intelligence (PAI) self-monitoring, with a goal to maintain daily PAI scores ≥100. Foot symptoms were assessed using repeated mobile phone surveys at 0 and 12 weeks. RESULTS Participants attended a mean 3.5 sessions and achieved 100 PAI on 53% and 15% of days during Weeks 2-4 and 5-12, respectively. No major adverse events and large reductions in aching (P=0.02) and burning pain (P=0.03) in the feet were recorded. DISCUSSION The PAI eHealth intervention was feasible and safe and might reduce foot symptoms. More work is needed to support self-directed exercise maintenance.
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Affiliation(s)
- Brooke K Coombes
- BPhty (Hons), MPhty (Musc), GCertHigherEd, PhD, Lecturer, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld
| | - Leanne M Bisset
- PhD, MPhty (ManipPhty), MPhty (Sports), BPhty, Associate Professor, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld
| | - Eva Sierra-Silvestre
- BSc Physiotherapy, MSc (MT), PhD, Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld
| | - Robert S Ware
- BSc (Hons1), PhD, Professor, School of Medicine and Dentistry, Griffith University, Brisbane, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld
| | - Michel W Coppieters
- BPT, PhD, Professor, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld; Adjunct Professor, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam
| | - Jeff S Coombes
- BAppSci, Bed (Hons), MEd, PhD, Professor, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld
| | - Nicola W Burton
- BSc (Hons), MPsych (Clinical), GCertHigherEd, PhD, Associate Professor, School of Applied Psychology, Griffith University, Brisbane, Qld; Research Fellow, Menzies Health Institute Queensland, Brisbane and Gold Coast, Qld; Research Fellow, Centre for Mental Health, Griffith University, Brisbane, Qld
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27
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Chen J, Frizzi K, Zardouz S, Province-Azalde R, Furnish T, Wallace M, Castellanos J, Tayerani A, Halter K, Lam K, Banducci S, Chieu A, Calcutt N. High-frequency spinal cord stimulation (10 kHz) alters sensory function and nerve fiber density in painful diabetic neuropathy: a pilot prospective open-label study. Pain Med 2023; 24:S33-S40. [PMID: 37833050 DOI: 10.1093/pm/pnad096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/06/2023] [Accepted: 06/29/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE Spinal cord stimulation at 10 kHz has provided effective pain relief and improved function in painful diabetic peripheral neuropathy. This study aims to confirm the clinical outcomes for 10-kHz spinal cord stimulation treatment of painful diabetic peripheral neuropathy and explore its impact on objective quantitative measures of nerve pathology and function. METHODS This single-academic center, prospective, open-label, observational study examined the pain relief success of 10-kHz spinal cord stimulation in patients >18 years of age with diabetic peripheral neuropathy. Patients underwent skin biopsies to measure intra-epidermal nerve fiber densities and corneal confocal microscopy measurements before implantation and at the 3-, 6-, and 12-month follow-up visits. Numerical rating scale for pain, visual analog scale, neuropathy pain scale, Short Form-36, and Neuropen (pin prick and monofilament) assessments were also conducted. RESULTS Eight patients met the criteria and were enrolled in the study. A successful trial was achieved in 7 subjects, and 6 completed the study. Significant pain relief (P < .001) was achieved at all follow-up visits. Neurological assessments showed reduced numbers of "absent" responses and increased "normal" responses from baseline to 12 months. Both proximal and distal intra-epidermal nerve fiber densities were higher at 12 months than at baseline (P < .01). Confocal microscopy measurements showed a steady increase in nerve density from baseline (188.8% increase at 12 months; P = .029). CONCLUSIONS We observed pain relief and improvements in sensory function after stimulation that were accompanied by increases in lower-limb intra-epidermal nerve fiber density and corneal nerve density. Further evaluation with a blinded and controlled study is needed to confirm the preliminary findings in this study.
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Affiliation(s)
- Jeffrey Chen
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego, La Jolla, CA, United States
| | - Katie Frizzi
- Department of Pathology, University of California San Diego, La Jolla, CA, United States
| | - Shawn Zardouz
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego, La Jolla, CA, United States
| | | | - Tim Furnish
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego, La Jolla, CA, United States
| | - Mark Wallace
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego, La Jolla, CA, United States
| | - Joel Castellanos
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego, La Jolla, CA, United States
| | - Alireza Tayerani
- Department of Pathology, University of California San Diego, La Jolla, CA, United States
| | - Kenneth Halter
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego, La Jolla, CA, United States
| | - Katie Lam
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego, La Jolla, CA, United States
| | | | - Alex Chieu
- Nevro Corp, Redwood City, CA, United States
| | - Nigel Calcutt
- Department of Pathology, University of California San Diego, La Jolla, CA, United States
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28
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Kissoon NR, LeMahieu AM, Stoltenberg AD, Bendel MA, Lamer TJ, Watson JC, Sletten DM, Singer W. Quantitative assessment of painful diabetic peripheral neuropathy after high-frequency spinal cord stimulation: a pilot study. Pain Med 2023; 24:S41-S47. [PMID: 37833046 DOI: 10.1093/pm/pnad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/08/2023] [Accepted: 06/22/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE Randomized trials have demonstrated efficacy of spinal cord stimulation (SCS) for treatment of painful diabetic neuropathy (PDN). Preliminary data suggested that treatment of PDN with high-frequency SCS resulted in improvements on neurological examination. The purpose of the present study was to explore whether patients with PDN treated with high-frequency SCS would have improvements in lower-extremity peripheral nerve function. DESIGN Prospective cohort study in an outpatient clinical practice at a tertiary care center. METHODS Patients with PDN were treated with high-frequency SCS and followed up for 12 months after SCS implantation with clinical outcomes assessments of pain intensity, neuropathic symptoms, and neurological function. Small-fiber sudomotor function was assessed with the quantitative sudomotor axon reflex test (QSART), and large-fiber function was assessed with nerve conduction studies (NCS). Lower-extremity perfusion was assessed with laser Doppler flowmetry. RESULTS Nine patients completed 12-month follow-up visits and were observed to have improvements in lower-extremity pain, weakness, and positive sensory symptoms. Neuropathy impairment scores were improved, and 2 patients had recovery of sensory responses on NCS. A reduction in sweat volume on QSART was observed in the proximal leg but not at other sites. No significant differences were noted in lower-extremity perfusion or NCS as compared with baseline. CONCLUSIONS The improvement in pain relief was concordant with improvement in neuropathy symptoms. The findings from this study provide encouraging preliminary data in support of the hypothesis of a positive effect of SCS on peripheral neuropathy, but the findings are based on small numbers and require further evaluation. TRIAL REGISTRATION ClinicalTrials.gov ID NCT03769675.
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Affiliation(s)
- Narayan R Kissoon
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States
| | - Allison M LeMahieu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, United States
| | - Anita D Stoltenberg
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
| | - Markus A Bendel
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
| | - Tim J Lamer
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
| | - James C Watson
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
| | - David M Sletten
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States
| | - Wolfgang Singer
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States
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29
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Elafros MA, Callaghan BC. Diabetic Neuropathies. Continuum (Minneap Minn) 2023; 29:1401-1417. [PMID: 37851036 DOI: 10.1212/con.0000000000001291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This article provides an up-to-date review of the diagnosis and management of the most common neuropathies that occur in patients with diabetes. LATEST DEVELOPMENTS The prevalence of diabetes continues to grow worldwide and, as a result, the burden of diabetic neuropathies is also increasing. Most diabetic neuropathies are caused by hyperglycemic effects on small and large fiber nerves, and glycemic control in individuals with type 1 diabetes reduces neuropathy prevalence. However, among people with type 2 diabetes, additional factors, particularly metabolic syndrome components, play a role and should be addressed. Although length-dependent distal symmetric polyneuropathy is the most common form of neuropathy, autonomic syndromes, particularly cardiovascular autonomic neuropathy, are associated with increased mortality, whereas lumbosacral radiculoplexus neuropathy and treatment-induced neuropathy cause substantial morbidity. Recent evidence-based guidelines have updated the recommended treatment options to manage pain associated with distal symmetric polyneuropathy of diabetes. ESSENTIAL POINTS Identifying and appropriately diagnosing the neuropathies of diabetes is key to preventing progression. Until better disease-modifying therapies are identified, management remains focused on diabetes and metabolic risk factor control and pain management.
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30
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Yoo SH, Kim WJ, Chae JS, Kang BK, Kang MJ, Beak MH. Efficacy of scrambler therapy in patients with painful diabetic peripheral neuropathy: A single-arm, prospective, pilot study. Medicine (Baltimore) 2023; 102:e35357. [PMID: 37773810 PMCID: PMC10545242 DOI: 10.1097/md.0000000000035357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND A variety of medications are available to manage painful diabetic peripheral neuropathy (DPN), but the proper treatment remains challenging. Accordingly, various neuromodulation modalities have been used. However, no prospective clinical trials have evaluated the use of scrambler therapy (ST) in painful DPN. This study aimed to explore the long-term effects of ST in managing painful DPN. METHODS The patients received 10 consecutive STs of 45 minutes every 1 to 2 days. The primary outcome was pain score. We measured the visual analog scale (VAS) pain scores at baseline, during ST, immediately after ST, and at 1, 2, 3, and 6 months after ST. The secondary outcomes were Michigan Neuropathy Screening Instrument (MNSI), Semmes-Weinstein monofilament test, and Leeds Assessment of Neuropathic Symptoms and Signs pain scores, which were measured at baseline, immediately after ST, and at 1, 2, 3, and 6 months after ST. RESULTS VAS scores showed significant improvement at the 8th, 9th, and 10th sessions during ST and 1 month after ST. The MNSI self-report component score was decreased 1 month after the ST. However, all other outcomes did not show significant differences compared to the baseline. CONCLUSION ST may have short-term effects and limited long-term effects on painful DPN.
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Affiliation(s)
- Seung Hee Yoo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Won-joong Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Ji Seon Chae
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Bo Kyung Kang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Min Jeong Kang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Min Hyouk Beak
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
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31
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Armstrong DG, Grunberger G. Stimulating Results Signal a New Treatment Option for People Living With Painful Diabetic Neuropathy. J Diabetes Sci Technol 2023; 17:1387-1391. [PMID: 35770993 PMCID: PMC10563543 DOI: 10.1177/19322968221099542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Painful diabetic neuropathy (PDN) is a progressive condition that deprives many patients of quality of life. With limited treatment options available, successful pain management can be difficult to achieve. METHODS We reviewed results of recent data evaluating high frequency spinal cord stimulation (SCS). RESULTS from the SENZA-PDN randomized clinical trial (NCT03228420), the largest such trial to date, demonstrated 10-kHz spinal cord stimulation substantially reduced PDN refractory to conventional medical management along with improvements in health-related quality-of-life measures that were sustained over 12 months. These data supported the recent U.S. Food & Drug Administration (FDA) approval for 10-kHz SCS in PDN patients and contributed to the body of evidence on SCS available to health care professionals managing the effects of PDN. CONCLUSION High frequency spinal cord simulation appears to hold promise in treatment of painful diabetic neuropathy. We look forward to future works in the literature that will further elucidate these promising findings.
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Affiliation(s)
- David G. Armstrong
- Department of Surgery, Southwestern Academic Limb Salvage Alliance, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - George Grunberger
- Grunberger Diabetes Institute, Bloomfield Hills, MI, USA
- Internal Medicine, Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Taylor RS, Lad SP, White JL, Stauss TG, Healey BE, Sacks NC, McLin R, Patil S, Jaasma MJ, Caraway DL, Petersen EA. Health care resource utilization and costs in patients with painful diabetic neuropathy treated with 10 kHz spinal cord stimulation therapy. J Manag Care Spec Pharm 2023; 29:1021-1029. [PMID: 37610114 PMCID: PMC10508838 DOI: 10.18553/jmcp.2023.29.9.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND: Diabetic peripheral neuropathy, a common comorbidity of diabetes, is a neurodegenerative disorder that targets sensory, autonomic, and motor nerves frequently associated with painful diabetic neuropathy (PDN). PDN carries an economic burden as the result of reduced work and productivity. A recent multicenter randomized controlled trial, SENZA-PDN (NCT03228420), assessed the impact of high-frequency (10 kHz) spinal cord stimulation (SCS) on pain relief. The effects of high-frequency SCS on health care resource utilization and medical costs are not known. OBJECTIVE: To evaluate the effect of high-frequency (10 kHz) SCS on health care resource utilization (HRU) and medical costs in patients with PDN using data from the SENZA-PDN trial. METHODS: Participants with PDN were randomly assigned 1:1 to receive either 10 kHz SCS plus conventional medical management (CMM) (SCS treatment group) or CMM alone (CMM treatment group). Patient outcomes and HRU up to the 6-month follow-up are reported here. Costs (2020 USD) for each service was estimated based on publicly available Medicare fee schedules, Medicare claims data, and literature. HRU metrics of inpatient and outpatient contacts and costs are reported as means and SDs. Univariate and bivariate analyses were used to compare SCS and CMM treatment groups at 6 months. RESULTS: At 6-month follow up, the SCS arm experienced approximately half the mean rate of hospitalizations per patient compared with the CMM treatment group (0.08 vs 0.15; P = 0.066). The CMM treatment group's total health care costs per patient were approximately 51% higher compared with the SCS treatment group (equivalent to mean annual cost per patient of $9,532 vs $6,300). CONCLUSIONS: Our analysis of the SENZA-PDN trial indicates that the addition of 10 kHz SCS therapy results in lower rates of hospitalization and consequently lower health care costs among patients with PDN compared with those receiving conventional management alone.
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Affiliation(s)
- Rod S. Taylor
- MRC/CSO Social and Public Health Sciences Unit, Robertson Centre for Biostatistics, School of Health & Wellbeing, University of Glasgow, UK
| | | | | | | | | | - Naomi C. Sacks
- PRECISIONheor, Boston, MA
- EpidStrategies, A Division of ToxStrategies, LLC, Boston, MA
| | - Ronaé McLin
- PRECISIONheor, New York, NY, now with Case Western Reserve University School of Medicine, Cleveland, OH
| | | | | | | | - Erika A. Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR
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Petersen EA, Stauss TG, Scowcroft JA, Jaasma MJ, Brooks ES, Edgar DR, White JL, Sills SM, Amirdelfan K, Guirguis MN, Xu J, Yu C, Nairizi A, Patterson DG, Tsoulfas KC, Creamer MJ, Galan V, Bundschu RH, Mehta ND, Sayed D, Lad SP, DiBenedetto DJ, Sethi KA, Goree JH, Bennett MT, Harrison NJ, Israel AF, Chang P, Wu PW, Argoff CE, Nasr CE, Taylor RS, Caraway DL, Mekhail NA. Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial. Diabetes Res Clin Pract 2023; 203:110865. [PMID: 37536514 PMCID: PMC10801706 DOI: 10.1016/j.diabres.2023.110865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/30/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
AIMS To evaluate the long-term efficacy of high-frequency (10 kHz) spinal cord stimulation (SCS) for treating refractory painful diabetic neuropathy (PDN). METHODS The SENZA-PDN study was a prospective, multicenter, randomized controlled trial that compared conventional medical management (CMM) alone with 10 kHz SCS plus CMM (10 kHz SCS+CMM) in 216 patients with refractory PDN. After 6 months, participants with insufficient pain relief could cross over to the other treatment. In total, 142 patients with a 10 kHz SCS system were followed for 24 months, including 84 initial 10 kHz SCS+CMM recipients and 58 crossovers from CMM alone. Assessments included pain intensity, health-related quality of life (HRQoL), sleep, and neurological function. Investigators assessed neurological function via sensory, reflex, and motor tests. They identified a clinically meaningful improvement relative to the baseline assessment if there was a significant persistent improvement in neurological function that impacted the participant's well-being and was attributable to a neurological finding. RESULTS At 24 months, 10 kHz SCS reduced pain by a mean of 79.9% compared to baseline, with 90.1% of participants experiencing ≥50% pain relief. Participants had significantly improved HRQoL and sleep, and 65.7% demonstrated clinically meaningful neurological improvement. Five (3.2%) SCS systems were explanted due to infection. CONCLUSIONS Over 24 months, 10 kHz SCS provided durable pain relief and significant improvements in HRQoL and sleep. Furthermore, the majority of participants demonstrated neurological improvement. These long-term data support 10 kHz SCS as a safe and highly effective therapy for PDN. TRIAL REGISTRATION ClincalTrials.gov Identifier, NCT03228420.
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Affiliation(s)
- Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA.
| | - Thomas G Stauss
- Advanced Pain Management, 4131 W Loomis Rd Ste 300, Greenfield, WI 53221, USA
| | - James A Scowcroft
- Pain Management Associates, 200 NE Missouri Rd Ste 103, Lee's Summit, MO 64086, USA
| | | | | | | | - Judith L White
- AES Compass Orlando, 100 W Gore St, Orlando, FL 32806, USA
| | - Shawn M Sills
- Touchstone Interventional Pain Center, 2925 Siskiyou Blvd, Medford, OR 97504, USA
| | | | - Maged N Guirguis
- Ochsner Health System, 2820 Napoleon Ave, New Orleans, LA 70115, USA
| | - Jijun Xu
- Department of Pain Management, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Cong Yu
- Swedish Medical Center, 1101 Madison St, Seattle, WA 98104, USA
| | - Ali Nairizi
- Nevada Advanced Pain Specialists, 5578 Longley Ln, Reno, NV 89511, USA
| | - Denis G Patterson
- Nevada Advanced Pain Specialists, 5578 Longley Ln, Reno, NV 89511, USA
| | | | - Michael J Creamer
- Central Florida Pain Relief Centers, 100 W Gore St #500, Orlando, FL 32806, USA
| | - Vincent Galan
- Pain Care, 1365 Rock Quarry Rd #301, Stockbridge, GA 30281, USA
| | - Richard H Bundschu
- Coastal Orthopedics and Sports Medicine, 8000 SR 64, Bradenton, FL 34212, USA
| | - Neel D Mehta
- Department of Anesthesiology, Weill Cornell Medical College, 240 East 59th Street, 2nd Floor, New York, NY 10022, USA
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University, 40 Duke Medicine Cir, Durham, NC 27710, USA
| | | | - Khalid A Sethi
- Department of Neurosurgery, United Health Services, 46 Harrison St, Johnson City, NY 13790, USA
| | - Johnathan H Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA
| | - Matthew T Bennett
- Department of Neurosurgery, United Health Services, 46 Harrison St, Johnson City, NY 13790, USA
| | - Nathan J Harrison
- Ochsner Health System, 2820 Napoleon Ave, New Orleans, LA 70115, USA
| | - Atef F Israel
- Pain Management Associates, 200 NE Missouri Rd Ste 103, Lee's Summit, MO 64086, USA
| | - Paul Chang
- Pain Care, 1365 Rock Quarry Rd #301, Stockbridge, GA 30281, USA
| | - Paul W Wu
- Holy Cross Hospital, 5601 N Dixie Hwy #209, Fort Lauderdale, FL 33334, USA
| | - Charles E Argoff
- Department of Neurology, Albany Medical Center, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Christian E Nasr
- Division of Endocrinology, Department of Internal Medicine, The University of Arizona College of Medicine - Phoenix, 475 N 5th St, Phoenix, AZ 85004, USA
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit, Robertson Centre for Biostatistics, School of Health and Well Being, Clarice Pears Building, University of Glasgow, Glasgow, Scotland G12 8QQ, UK
| | | | - Nagy A Mekhail
- Evidence-Based Pain Management Research, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
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34
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Zaino B, Goel R, Devaragudi S, Prakash A, Vaghamashi Y, Sethi Y, Patel N, Kaka N. Diabetic neuropathy: Pathogenesis and evolving principles of management. Dis Mon 2023; 69:101582. [PMID: 37164794 DOI: 10.1016/j.disamonth.2023.101582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The global rise of prediabetes and diabetes has spawned an epidemic of complications associated with these conditions. Neuropathy is the most common consequence, with distal symmetric polyneuropathy (DSP) being the most prevalent. Diabetic neuropathy (DN) is a debilitating consequence of diabetes mellitus resulting in the highest morbidity and death, besides imposing a substantial financial burden on the patient. Loss of sensory function commencing distally in the lower limbs, accompanied by discomfort and considerable morbidity, characterizes diabetic neuropathy. The clinical evaluation and therapeutic options for diabetic peripheral neuropathy are multifaceted. At least fifty percent of people with diabetes acquire diabetic neuropathy over time. Good glycemic control halts the evolution in individuals with Type 1 diabetes mellitus. These results have prompted fresh attempts to comprehend the origin and develop new guidelines for prevention and treatment. New recommendations have also been established for the treatment of painful DN using separate classes of medications, with an emphasis on avoiding the use of opioids. Although our comprehension of the intricacies of diabetic neuropathy has progressed significantly over the past decade, the unique processes driving the neuropathy in type 1 and type 2 diabetes remain unexplained. Currently, glycemic control and pain management are the only effective therapies. While glucose management significantly reduces neuropathy development in type 1 diabetics, the effect is considerably lower in type 2 diabetics. Evidence supports the use of anticonvulsants and antidepressants for diabetic peripheral neuropathy pain treatment. However, the absence of disease-modifying medications for diabetic DSP necessitates the identification of unrecognized modifiable risk factors. It is imperative to identify the 'missed' risk factors and targets, allowing comprehensive, individualized care for patients.
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Affiliation(s)
- Basem Zaino
- Tishreen University, Syria; PearResearch, India
| | - Rashika Goel
- Punjab Institute of Medical Sciences, India; PearResearch, India
| | - Sanjana Devaragudi
- Apollo Institute of Medical Sciences and Research, Hyderabad, India; PearResearch, India
| | - Ananya Prakash
- Narayana Institute of Cardiac Sciences, Bangalore, India; PearResearch, India
| | - Yogeshkumar Vaghamashi
- Bicol Christian College of Medicine, Legazpi city, Philippines; Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Yashendra Sethi
- PearResearch, India; Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Neil Patel
- PearResearch, India; GMERS Medical College Himmatnagar, India.
| | - Nirja Kaka
- PearResearch, India; GMERS Medical College Himmatnagar, India
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35
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Leikin JB. Foreword: Pathogenesis and Management of Polyneuropathies: Multiple Sclerosis and Diabetic Neuropathy. Dis Mon 2023; 69:101496. [PMID: 36266117 DOI: 10.1016/j.disamonth.2022.101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jerrold B Leikin
- Adjunct Clinical Professor in the Division of Environmental and Occupational Health Sciences and the Occupational and Environmental Medicine Service of UI Health at the University of Illinois at Chicago, United States.
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36
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Zhu GC, Chen YW, Tsai KL, Wang JJ, Hung CH, Schmid AB. Swimming exercise attenuates mechanical hypersensitivity and mitigates peripheral nerve degeneration in rats with painful diabetic neuropathy (PDN). Neurosci Lett 2023; 812:137406. [PMID: 37480979 DOI: 10.1016/j.neulet.2023.137406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND This study aimed to assess the effectiveness of swimming exercise in alleviating mechanical hypersensitivity and peripheral nerve degeneration associated with a pre-clinical model of painful diabetic neuropathy (PDN). METHODS This study is a pre-clinical study conducted using the streptozocin (STZ)-induced PDN rat model. Rats were randomly allocated to three groups: a vehicle group of non-diabetic rats (Vehicle, n = 9), a group of rats with PDN (PDN, n = 8), and a group of rats with PDN that performed a swimming exercise program (PDN-SW, n = 10). The swimming exercise program included daily 30-minute swimming exercise, 5 days per week for 4 weeks. Von Frey testing was used to monitor hindpaw mechanical sensitivity over 4 weeks. Assessment of cutaneous peripheral nerve fiber integrity was performed after the 4-week study period via immunohistochemistry for protein gene product 9.5-positive (PGP9.5+) intra-epidermal nerve fiber density (IENFD) in hind-paw skin biopsies by a blinded investigator. RESULTS The results showed that swimming exercise mitigated but did not fully reverse mechanical hypersensitivity in rats with PDN. Immunohistochemical testing revealed that the rats in the PDN-SW group retained higher PGP9.5+ IENFD compared to the PDN group but did not reach normal levels of the Vehicle group. CONCLUSIONS The results of this study indicate that swimming exercise can mitigate mechanical hypersensitivity and degeneration of peripheral nerve fibers in rats with experimental PDN.
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Affiliation(s)
- Guan-Cheng Zhu
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Yu-Wen Chen
- Department of Physical Therapy, China Medical University, Taichung, Taiwan, ROC
| | - Kun-Ling Tsai
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan, ROC
| | - Ching-Hsia Hung
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan, ROC.
| | - Annina B Schmid
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
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37
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Yin Y, Wang L, Zhao L, Lin L, Shen X. Effect of 10.6 μm laser moxibustion on inflammation in diabetic peripheral neuropathy rats. Front Endocrinol (Lausanne) 2023; 14:1203677. [PMID: 37593350 PMCID: PMC10427917 DOI: 10.3389/fendo.2023.1203677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/14/2023] [Indexed: 08/19/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the main cause of disability in diabetes patients but the efficacy of available drugs is poor. Moxibustion is an adjunctive treatment for DPN that can reduce symptoms. The peak value of the far infrared wavelength of 10.6 μm laser moxibustion is close to the infrared radiation spectrum of traditional moxibustion. Its effect is similar to that of moxibustion and does not cause pain, infection or produce irritating smoke. Twenty-four male SD rats were divided into control (Con), DPN, laser moxibustion (LM), and pyrrolidine dithiocarbamate (PDTC) groups (n=6/group). The DPN, LM and PDTC group rats were intraperitoneally injected with 1% streptozotocin (STZ) to induce a model of DPN. LM group rats were irradiated with a laser at bilateral ST36 acupoints for 15 min, once every other day, for 14 days. PDTC group rats were intraperitoneally injected with PDTC once a day. Body weight, blood glucose, and paw withdrawal mechanical threshold (PWMT) were measured and laser speckle imaging (LSI) performed before and after modeling and at 1 and 2 weeks after intervention. Two weeks after intervention, changes in serum interleukin 1β (IL1β), interleukin 6 (IL6), tumor necrosis factor α (TNFα) and nerve growth factor (NGF) were analyzed, and the abundance of NF-κB and IκB-α proteins and levels of NF-κB and IκB-α mRNAs in the sciatic nerve were observed. The results showed that 10.6 μm laser moxibustion can relieve pain, improve microcirculation, and alleviate inflammation in DPN rats, possibly via the NF-κB inflammatory pathway.
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Affiliation(s)
- Yue Yin
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lina Wang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ling Zhao
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lin Lin
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xueyong Shen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Laboratory of Systemic Physiology for Acupuncture and Meridian, Shanghai Research Center of Acupuncture and Meridian, Shanghai, China
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Ahmed MSO, Forde H, Smith D. Diabetic gastroparesis: clinical features, diagnosis and management. Ir J Med Sci 2023; 192:1687-1694. [PMID: 36266392 DOI: 10.1007/s11845-022-03191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022]
Abstract
Diabetic gastroparesis carries a heavy burden on people with diabetes and the healthcare system. It remains underdiagnosed and represents challenges to treat. This article reviews the epidemiology, pathophysiology, clinical features, diagnosis and treatment of diabetic gastroparesis. The disorder is characterized by delayed gastric emptying without evidence of mechanical gastric outflow obstruction. It presents with upper gastrointestinal (GI) symptoms such as nausea, vomiting, early satiety, postprandial fullness, upper abdominal discomfort and or bloating. As the prevalence of diabetes has been growing over the last few decades, we would expect an increased incidence of delayed gastric emptying in poorly controlled diabetes and perhaps in line with the increasing use of medications that act on the GI tract such as incretin-based therapy. The disease results from multiple reversible and irreversible mechanisms. Diagnosing diabetic gastroparesis requires careful history, examination and investigations to exclude other disorders that could mimic its clinical presentation. Treatment involves a wide variety of options starting with optimization of glycaemic control, stopping any offending medications and lifestyle modifications followed by the introduction of medical therapeutics such as prokinetics. Then, surgical interventions are considered in refractory cases.
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Affiliation(s)
- Mohammed S O Ahmed
- Academic Department of Diabetes and Endocrinology, Beaumont Hospital, The Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Hannah Forde
- Academic Department of Diabetes and Endocrinology, Beaumont Hospital, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Diarmuid Smith
- Academic Department of Diabetes and Endocrinology, Beaumont Hospital, The Royal College of Surgeons in Ireland, Dublin, Ireland
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Yue Y, Deng M, Liao S, Xiao G, Huang Y. Effects of Mindfulness Training Combined with Tai Chi in Patients with Diabetic Peripheral Neuropathy. J Vis Exp 2023. [PMID: 37522720 DOI: 10.3791/65421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes. One of its crucial therapy approaches is mind-body exercise. Recently, various exercise modalities, including stepping, resistance, aerobics, balance, and whole-body vibration, were investigated to construct the most suitable form of exercise for patients with DPN. The purpose of this study is to describe a standard protocol for mindfulness training combined with Tai Chi. The convenience sampling method was used to select 90 patients with DPN who met the inclusion and exclusion criteria from three communities. The three communities were randomly divided into the control group (CG), the Tai Chi group (TCG), and the mindfulness training combined with the Tai Chi group (MTCG). The CG was given routine health education guidance once a month, a total of three times. Based on the CG, the TCG practiced Tai Chi three times; the MTCG received mindfulness training combined with Tai Chi exercise a week for a total of 12 weeks. Before the intervention and 12 weeks after the intervention, the clinical symptoms, neurological function, attention awareness level, pain, and quality of life of the subjects were evaluated by Toronto Clinical Scoring System (TCSS), Mindful Attention Awareness Scale (MAAS), Visual analog scale (VAS), Diabetes Specificity Quality of life Scale (DSQL) and tumor necrosis factor-α. Overall, the addition of mindfulness training to Tai Chi effectively enhances the exercise effects of Tai Chi. Therefore, mindfulness training combined with Tai Chi is worthy of promotion and application.
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Affiliation(s)
- Yan Yue
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Min Deng
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Shunqi Liao
- Hospital of Chengdu University of Traditional Chinese Medicine;
| | - Guojin Xiao
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Yan Huang
- Hospital of Chengdu University of Traditional Chinese Medicine
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40
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Sharma S, Rayman G. Frontiers in diagnostic and therapeutic approaches in diabetic sensorimotor neuropathy (DSPN). Front Endocrinol (Lausanne) 2023; 14:1165505. [PMID: 37274325 PMCID: PMC10234502 DOI: 10.3389/fendo.2023.1165505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/01/2023] [Indexed: 06/06/2023] Open
Abstract
Diabetes sensory polyneuropathy (DSPN) is a significant complication of diabetes affecting up to 50% of patients in their lifetime and approximately 20% of patients suffer from painful diabetes neuropathic pain. DSPN - both painless and painful - leads to considerable morbidity including reduction of quality of life, increased lower limb amputations and is associated with worsening mortality. Significant progress has been made in the understanding of pathogenesis of DSPN and the last decade has seen newer techniques aimed at its earlier diagnosis. The management of painful DSPN remains a challenge despite advances made in the unravelling the pathogenesis of pain and its transmission. This article discusses the heterogenous clinical presentation of DSPN and the need to exclude key differential diagnoses. Furthermore, it reviews in detail the current diagnostic techniques involving both large and small neural fibres, their limitations and advantages and current place in the diagnosis of DSPN. Finally, the management of DSPN including newer pharmacotherapies are also discussed.
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Affiliation(s)
- Sanjeev Sharma
- Department of Diabetes and Endocrinology, Ipswich Hospital, East Suffolk and North East Essex NHS Foundation Trust (ESNEFT), Ipswich, United Kingdom
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41
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Sharan AD, Hatheway JA, Murphy M, Dann T, Fishman MA, Zuidema X, van Zundert JH, LaRue M, Slangen R. Comment on Duarte et al. Systematic Review and Network Meta-analysis of Neurostimulation for Painful Diabetic Neuropathy. Diabetes Care 2022;45:2466-2475. Diabetes Care 2023; 46:e110-e111. [PMID: 37185683 PMCID: PMC10154651 DOI: 10.2337/dc22-2491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
| | | | | | - Tammy Dann
- Pain Evaluation & Management Center, Dayton, OH
| | | | - Xander Zuidema
- Maastricht University Medical Center+, Maastricht, the Netherlands
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42
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Duarte RV, Nevitt S, Copley S, Maden M, de Vos CC, Taylor RS, Eldabe S. Response to Comment on Duarte et al. Systematic Review and Network Meta-analysis of Neurostimulation for Painful Diabetic Neuropathy. Diabetes Care 2022;45:2466-2475. Diabetes Care 2023; 46:e113-e114. [PMID: 37185686 DOI: 10.2337/dci23-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Rui V Duarte
- 1Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, U.K
- 2Saluda Medical Pty. Ltd., Artarmon, New South Wales, Australia
| | - Sarah Nevitt
- 1Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, U.K
| | - Sue Copley
- 3Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, U.K
| | - Michelle Maden
- 1Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, U.K
| | - Cecile C de Vos
- 4Department of Neurology and Neurosurgery, Medisch Spectrum Twente, Enschede, the Netherlands
- 5Centre for Pain Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Rod S Taylor
- 6Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit and Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, U.K
| | - Sam Eldabe
- 3Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, U.K
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43
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Sadeghirad B, Wang X, Busse JW. Comment on Duarte et al. Systematic Review and Network Meta-analysis of Neurostimulation for Painful Diabetic Neuropathy. Diabetes Care 2022;45:2466-2475. Diabetes Care 2023; 46:e112. [PMID: 37185685 DOI: 10.2337/dc22-2449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Behnam Sadeghirad
- 1Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- 2Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- 3Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Xiaoqin Wang
- 3Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- 1Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- 2Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- 3Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
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44
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Ghoweba RE, Khowailed AA, Aboulhoda BE, Rashed LA, Selmy A. Synergistic role of resveratrol and exercise training in management of diabetic neuropathy and myopathy via SIRT1/NGF/GAP43 linkage. Tissue Cell 2023; 81:102014. [PMID: 36621294 DOI: 10.1016/j.tice.2023.102014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/10/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
AIMS Oxidative stress also plays an important role in the pathogenesis of diabetic neuropathy (DN). Both resveratrol (RES) and exercise (EX) have potent anti-oxidative benefits. Low levels of nerve growth factor (NGF) and SIRT1 (a member of sirtuin family) have been reported in patients with DN. The current study has been designed to investigate the role of serum NGF and SIRT1 on DN-induced hyperalgesia and motor incoordination and to evaluate the possible protective role of RES and/or EX. MAIN METHODS A total of 40 male adult albino rats divided into five groups; control, DN, DN + RES, DN + EX, and DN + RES and EX. DN was confirmed by sensorimotor disturbance and diminished nerve conduction velocity (NCV). NGF and SIRT1 levels were measured by western blot. Calcitonin gene-related peptide (CGRP) was measured by PCR. Myofibrillar degeneration and inflammation scores were revealed via H&E microscopic analysis of the gastrocnemius muscle. Immunohistochemical evaluation of caspase3 and TNF-α was performed in the lumber segment of spinal cord and gastrocnemius muscle sections. Ultrastructural evaluation of sciatic nerve axonal degeneration has also been assessed. KEY FINDINGS DN group showed decreased SIRT1 level, decreased NGF level and correlated with CGRP level and Na+/K+ ATPase. Treatment with RES and/or EX resulted in improvement of sensorimotor disturbance. DN characterized by reduced SOD level, whereas RES and/or EX could limit oxidative damage by up-regulation Bcl2, Akt and GAP-43 and down-regulation of caspase3 and TNF-α. In conclusion, increased level of SIRT1and NGF by incorporation of RES (natural supplementation) and EX (life style modification) could improve the neuroinflammatory state in DN.
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Affiliation(s)
| | | | - Basma Emad Aboulhoda
- Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, Egypt.
| | - Laila Ahmed Rashed
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Egypt
| | - Asmaa Selmy
- Department of Physiology, Faculty of Medicine, Cairo University, Egypt
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Miyashita A, Kobayashi M, Yokota T, Zochodne DW. Diabetic Polyneuropathy: New Strategies to Target Sensory Neurons in Dorsal Root Ganglia. Int J Mol Sci 2023; 24:ijms24065977. [PMID: 36983051 PMCID: PMC10051459 DOI: 10.3390/ijms24065977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/29/2023] Open
Abstract
Diabetic polyneuropathy (DPN) is the most common type of diabetic neuropathy, rendering a slowly progressive, symmetrical, and length-dependent dying-back axonopathy with preferential sensory involvement. Although the pathogenesis of DPN is complex, this review emphasizes the concept that hyperglycemia and metabolic stressors directly target sensory neurons in the dorsal root ganglia (DRG), leading to distal axonal degeneration. In this context, we discuss the role for DRG-targeting gene delivery, specifically oligonucleotide therapeutics for DPN. Molecules including insulin, GLP-1, PTEN, HSP27, RAGE, CWC22, and DUSP1 that impact neurotrophic signal transduction (for example, phosphatidylinositol-3 kinase/phosphorylated protein kinase B [PI3/pAkt] signaling) and other cellular networks may promote regeneration. Regenerative strategies may be essential in maintaining axon integrity during ongoing degeneration in diabetes mellitus (DM). We discuss specific new findings that relate to sensory neuron function in DM associated with abnormal dynamics of nuclear bodies such as Cajal bodies and nuclear speckles in which mRNA transcription and post-transcriptional processing occur. Manipulating noncoding RNAs such as microRNA and long-noncoding RNA (specifically MALAT1) that regulate gene expression through post-transcriptional modification are interesting avenues to consider in supporting neurons during DM. Finally, we present therapeutic possibilities around the use of a novel DNA/RNA heteroduplex oligonucleotide that provides more efficient gene knockdown in DRG than the single-stranded antisense oligonucleotide.
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Affiliation(s)
- Akiko Miyashita
- Department of Neurology, Neurological Science, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
- Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Masaki Kobayashi
- Department of Neurology, Neurological Science, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
- Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
- Department of Neurology, Nissan Tamagawa Hospital, Tokyo 158-0095, Japan
| | - Takanori Yokota
- Department of Neurology, Neurological Science, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
- Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Douglas W. Zochodne
- Division of Neurology and Department of Medicine, Faculty of Medicine and Dentistry, The Neuroscience and Mental Health Institute and The Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2G3, Canada
- Correspondence: ; Tel.: +1-780-248-1928; Fax: +1-780-248-1807
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Frey CB, Park R, Robinson R, Yoder C. Nagging Pain and Foot Ulcers Can be Treated into Remission. Endocrinol Metab Clin North Am 2023; 52:119-133. [PMID: 36754488 DOI: 10.1016/j.ecl.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Lower extremity ulcerations are very common in patients with diabetes. These wounds lead to amputation in a surprisingly large percentage of patients with diabetes. The mortality rate following amputation in a patient with diabetes is alarmingly high. Preventive treatment is pivotal to avoid the numerous complications associated with diabetic ulcerations. However, at the onset of ulceration, early treatment under the supervision and guidance of a specialist can result in remission. Diabetic peripheral neuropathy is also a life-altering and debilitating disease. Although some patients experience numbness, some experience pain that can be sharp, shooting, and tingling. Although treatment is challenging and often requires medication, newer modalities, such as stimulation and physical therapy, have shown promise in reversing the devastating effects of peripheral neuropathy.
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Affiliation(s)
- Craig B Frey
- University Hospitals Podiatric Medicine and Surgery, University Hospitals Advanced Limb Salvage and Reconstruction, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Richard Park
- University Hospitals Podiatric Medicine and Surgery, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Rachel Robinson
- University Hospitals Podiatric Medicine and Surgery, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Courtney Yoder
- University Hospitals Podiatric Medicine and Surgery, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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de Geus TJ, Franken G, Joosten EA. Conventional, high frequency and differential targeted multiplexed spinal cord stimulation in experimental painful diabetic peripheral neuropathy: Pain behavior and role of the central inflammatory balance. Mol Pain 2023; 19:17448069231193368. [PMID: 37488684 PMCID: PMC10504849 DOI: 10.1177/17448069231193368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
Spinal cord stimulation (SCS) is a last resort treatment for pain relief in painful diabetic peripheral neuropathy (PDPN) patients. However, the effectivity of SCS in PDPN is limited. New SCS paradigms such as high frequency (HF) and differential target multiplexed (DTM) might improve responder rates and efficacy of SCS-induced analgesia in PDPN patients, and are suggested to modulate the inflammatory balance and glial response in the spinal dorsal horn. The aim of this study was to research the effects of Con-, HF- and DTM-SCS on pain behavior and the spinal inflammatory balance in an animal model of PDPN. Streptozotocin-induced PDPN animals were stimulated for 48 hours with either Con-SCS (50Hz), HF-SCS (1200Hz) or DTM-SCS (combination of Con- and HF-SCS). Mechanical hypersensitivity was assessed using Von Frey (VF) test and the motivational aspects of pain were assessed using the mechanical conflict avoidance system (MCAS). The inflammatory balance and glial response were analyzed in the dorsal spinal cord based on RNA expression of pro- and anti-inflammatory cytokines (Tnf-α, Il-1ß, Il-4, Il-10), a microglia marker (Itgam), an astrocyte marker (Gfap), a T-cell marker (Cd3d), microglia proliferation markers (Irf8, Adgre1) and P2X4, p13-MAPK, BDNF signaling markers (P2x4, Mapk14, Bdnf). The results show that Con-, HF-, and DTM-SCS significantly decreased hypersensitivity after 48 hours of stimulation compared to Sham-SCS in PDPN animals, but at the same time did not affect escape latency in the MCAS. At the molecular level, Con-SCS resulted in a significant increase in spinal pro-inflammatory cytokine Tnf-α after 48 hours compared to DTM-SCS and Sham-SCS. In summary, Con-SCS showed a shift of the inflammatory balance towards a pro-inflammatory state whilst HF- and DTM-SCS shifted the balance towards an anti-inflammatory state. These findings suggest that the underlying mechanism of Con-SCS induced pain relief in PDPN differs from that induced by HF- and DTM-SCS.
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Affiliation(s)
- Thomas J. de Geus
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Glenn Franken
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Elbert A Joosten
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
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Wang L, Guan B, Li G, Feng L, Sun H, Xu J. The efficacy and safety of traditional Chinese medicine physiotherapy combined with acupoint injection on diabetic peripheral neuropathy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31467. [PMID: 36550907 PMCID: PMC9771249 DOI: 10.1097/md.0000000000031467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The efficacy and safety of traditional Chinese medicine physiotherapy combined with acupoint injection in treating diabetic peripheral neuropathy remains unknown. As a result, we will conduct a systematic review and meta-analysis to assess the evidence. METHODS We will look for pertinent randomized controlled trials in the following databases: China National Knowledge Infrastructure, WanFangData, Chinese biological medical database, Medline, Cochrane Library, PubMed, and Embase up to January 2022. Following the standards of Cochrane Review 6.2, 2 researchers independently evaluated the quality of the evidence in the relevant papers. Data analysis will be conducted by using Review Manager 5.4, including statistical analysis, subgroup analysis, making forest plot and funnel chart. RESULTS The results will be submitted to a peer-reviewed journal. CONCLUSION The research will verify the safety and efficacy of traditional Chinese medicine physiotherapy in combination with acupoint injection for diabetic peripheral neuropathy.
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Affiliation(s)
- Lin Wang
- Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province, China
| | - Bugao Guan
- Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province, China
| | - Guangrun Li
- Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province, China
| | - Liquan Feng
- Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province, China
| | - Hui Sun
- Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province, China
| | - Jin Xu
- Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province, China
- *Correspondence: Jin Xu Department of Rehabilitation Medicine, Jinhu County People’s Hospital, Huai’an, Jiangsu Province 211600, China. (e-mail: )
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Cruvinel-Júnior RH, Ferreira JSSP, Veríssimo JL, Monteiro RL, Suda EY, Silva ÉQ, Sacco ICN. Could an Internet-Based Foot-Ankle Therapeutic Exercise Program Modify Clinical Outcomes and Gait Biomechanics in People with Diabetic Neuropathy? A Clinical Proof-of-Concept Study. Sensors (Basel) 2022; 22:9582. [PMID: 36559949 PMCID: PMC9781221 DOI: 10.3390/s22249582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Previous studies have shown the efficacy of foot-ankle exercises in people with diabetic peripheral neuropathy (DPN), but the quality of evidence is still low. This proof-of-concept study pursues preliminary evidence for potential clinical and gait biomechanical benefits from an internet-based foot-ankle therapeutic exercise program for people with DPN. We randomized 30 individuals with DPN (IWGDF risk category 1 or 2) into either the control group (CG) receiving the usual care or the intervention group (IG) receiving the usual care plus an internet-based foot-ankle exercise program, fully guided by the Sistema de Orientação ao Pé Diabético (SOPeD; translation: Diabetic Foot Guidance System) three times per week for 12 weeks. We assessed face-to-face clinical and biomechanical outcomes at baseline, 12 weeks, and 24 weeks (follow up). Participants had good adherence to the proposed intervention and it led to only mild adverse events. The IG showed improvements in the ankle and first metatarsophalangeal joint motion after 12 and 24 weeks, changed forefoot load absorption during foot rollover during gait after 24 weeks, reduced foot pain after 12 weeks, and improved foot function after 24 weeks. A 12-week internet-based foot-ankle exercise program using the SOPeD software (version 1.0) has the potential to reduce foot pain, improve foot function, and modify some important foot-ankle kinematic outcomes in people with DPN.
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Affiliation(s)
- Ronaldo H. Cruvinel-Júnior
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
| | - Jane S. S. P. Ferreira
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
| | - Jady L. Veríssimo
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
| | - Renan L. Monteiro
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
- . Department of Biological and Health Science, Federal University of Amapá, Rod. Juscelino Kubitschek, km 02—Jardim Marco Zero, Macapá 68903-419, AP, Brazil
| | - Eneida Y. Suda
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
- Postgraduate Program in Physical Therapy, Ibirapuera University, Av. Interlagos, 1329—Chácara Flora, São Paulo 04661-100, SP, Brazil
| | - Érica Q. Silva
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
| | - Isabel C. N. Sacco
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51—Butantã, São Paulo 05360-160, SP, Brazil
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50
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Schnapp WD, Delcroix GJR. Improved Sensation Resulting From Spinal Cord Stimulation for the Treatment of Painful Diabetic Neuropathy: The Possible Role of Stochastic Resonance. Pain Physician 2022; 25:E1399-E1403. [PMID: 36608011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Painful diabetic neuropathy (PDN) is a progressive chronic pain condition that significantly affects the quality of life of patients with long-standing diabetes mellitus. Sensory deficits may result in falls, foot ulceration, and lower limb amputations. Recently, spinal cord stimulation (SCS) was studied for treatment of painful diabetic neuropathy. In addition to pain relief, we were surprised to discover that sensory improvements were also demonstrated. No mechanistic explanation has yet been offered to explain these findings. OBJECTIVES Sensory improvements were observed in patients during the Senza-PDN clinical trial. Our objective was to offer a hypothesis to explain these results. STUDY DESIGN The randomized, prospective, multicenter, open-label Senza-PDN clinical trial was aimed at documenting the value of 10 kHz SCS in addition to conventional medical management alone. We formulated an hypothesis to explain the neurologic improvement observed while using SCS in these study patients. SETTING This work was conducted in a private clinical practice. RESULTS SCS resulted in an overall decrease in pain for the enrolled PDN patients. An unexpected improvement in neurologic outcomes was also noticed at up to 12 months, which had never been reported before. We hypothesized that stochastic resonance mechanism could explain these sensory improvements. We believe that waveforms delivered to the spinal cord may have had the unexpected effect of creating noise-enhanced signal processing. LIMITATIONS Further research will have to be performed to confirm the plausibility of the stochastic resonance hypothesis formulated. CONCLUSIONS SCS might have unexpected benefits in patients with PDN beyond pain reduction. The Senza-PDN trial is the first to describe improved sensation in association with SCS. While the mechanism of action are still unknown, we hypothesize that noise-enhanced signal processing via stochastic resonance may explain these results. Stochastic resonance, or the benefit of additional randomness, should be further studied in the context of spinal cord stimulation. Further, SCS programming that optimizes for stochastic resonance should also be investigated for restoration of sensory and possibly even motor function.
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Affiliation(s)
| | - Gaëtan J-R Delcroix
- NeuroSpine & Pain Center of Key West, Key West, FL; Nova Southeastern University, College of Allopathic Medicine, Fort Lauderdale, FL
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