Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes

Coffee intake, plasma caffeine levels, and diabetic microvascular complications: A Mendelian randomization study

BACKGROUND AND AIM

Diabetic microvascular complications pose significant health challenges for individuals. The influence of modifiable lifestyle factors, such as coffee intake, on these complications has not been conclusively determined, highlighting the need for a causality assessment.

METHODS AND RESULTS

Utilizing Mendelian randomization (MR), this study explored the causal links between coffee intake, plasma caffeine levels, and diabetic microvascular complications using data from FinnGen. Single nucleotide polymorphisms associated with coffee intake and plasma caffeine levels were identified through genome-wide association study meta-analyses. The univariable MR analysis indicated a slightly increased risk for diabetic retinopathy (OR 1.006; 95 % CI: 1.002-1.010; P = 0.003) and a suggestively elevated risk for nephropathy (OR 1.011; 95 % CI: 1.001-1.022; P = 0.036) associated with genetically predicted higher coffee intake, while no significant effect on neuropathy was observed. Multivariable MR analysis, adjusted for smoking, revealed a significant protective effect of coffee intake on diabetic retinopathy (OR 0.895; 95 % CI: 0.856-0.936; P = 9.468 × 10-7) and a suggestive reduction in risk for diabetic nephropathy (OR 0.828; 95 % CI: 0.712-0.963; P = 0.014). Higher plasma caffeine levels were also suggestively protective against these complications.

CONCLUSIONS

Our findings suggest that genetically predicted higher coffee intake and plasma caffeine levels are protective for diabetic retinopathy and nephropathy. Further research is necessary to substantiate these findings and to investigate their potential impact on diabetes management strategies.

Low-intensity pulsed ultrasound relieved the diabetic peripheral neuropathy in mice via anti-oxidative stress mechanism

Diabetic peripheral neuropathy (DPN), as one of the most prevalent complications of diabetes, leads to significant pain and financial burden to patients. Currently, there was no effective treatment for DPN since the glucose control was just a prevention and the drug therapy only relieved the DPN pain. As a non-invasive physical therapy, low-intensity pulsed ultrasound (LIPUS) is utilized in the musculoskeletal and nerve injuries therapy. Studies revealed that LIPUS could regenerate nerves by the mechanical stimulation via oxidative stress pathway, which was thought as the important factor for DPN, and might have potential in the DPN therapy. This study aimed to identify a new therapeutic strategy for DPN using LIPUS. We analyzed the therapy effect and explored the therapeutic mechanism of LIPUS on DPN in mice. This study involved animal experiments and C57BL/6J mice were randomly assigned to DPN model and Sham groups. The DPN model group was fed a high-fat chow diet and injected with streptozotocin (STZ) for 3 consecutive days (40 mg/kg/d), whereas the Sham group was fed a normal diet and injected with an equal volume of sodium citrate buffer. After the DPN model confirmed with the 84-day modeling process, the DPN mice were randomly allocated into the DPN group and the LIPUS group. The LIPUS group underwent ultrasound treatments with a center frequency of 1 MHz, a duty cycle of 20 %, and a spatial average temporal average intensity (ISATA) of 200 mW/cm2 for 20 min/d, 5 d/w. After the 56-day treatment, all mice were euthanized. LIPUS therapeutic effects were evaluated through measurements of fasting blood glucose (FBG), behavioral tests, oxidative stress tests, morphological analysis, immunofluorescence, and western blot analysis. The results indicated that DPN mice had significantly higher FBG levels (28.77 ± 2.95 mmol/L) compared with sham mice (10.31 ± 1.49 mmol/L). Additionally, DPN mice had significantly lower mechanical threshold (4.13 ± 0.92 g) and higher thermal latency (16.20 ± 2.39 s) compared with the sham mice (7.31 ± 0.83 g, 11.67 ± 1.21 s). After receiving LIPUS treatment, the glucose tolerance tests (GTT) suggested that LIPUS treatment improved glucose tolerance, which was shown by a decrease in the area under the curve (AUC) for glucose in the LIPUS group (AUC = 2452 ± 459.33 min*mmol/L) compared with the DPN group (AUC = 3271 ± 420.90 min*mmol/L). Behavioral tests showed that LIPUS treatment significantly alleviated DPN-induced abnormalities by improving the mechanical threshold from 2.79 ± 0.79 g in the DPN group to 5.50 ± 1.00 g in the LIPUS group, and significantly decreasing thermal latency from 12.38 ± 1.88 s in the DPN group to 9.49 ± 2.31 s in the LIPUS group. Morphological observations revealed that DPN mice had a thinning and irregularly shaped myelin sheath, with 61.04 ± 5.60 % of abnormal nerve fibers in the sciatic nerve in LIPUS group, compared with 49.76 ± 4.88 % of abnormal nerve fibers in the LIPUS-treated group. Additionally, LIPUS treatment increased the mean fluorescence intensity of the associated nerve regeneration protein (i.e., Nf200) from 27.81 ± 0.32 arbitrary units in the DPN group to 37.62 ± 0.36 arbitrary units in the LIPUS group. Western blot and immunofluorescence analysis showed that LIPUS treatment significantly reduced Keap1 expression to 0.04 ± 0.06 relative units, compared with 0.17 ± 0.30 in the DPN group. Furthermore, immunofluorescence analysis revealed that LIPUS treatment promoted the production of its downstream antioxidant protein, heme oxygenase-1 (HO-1), with an increase in the fluorescence intensity from 27.81 ± 0.32 arbitrary units in the DPN group to 37.62 ± 0.36 arbitrary units in the LIPUS-treated group. The fluorescence intensity of Nrf2 was significantly higher in the LIPUS group, increasing from 4.90 ± 0.25 arbitrary units in the DPN group to 15.18 ± 2.13 arbitrary units in the LIPUS-treated group. Additionally, the malondialdehyde (MDA) levels, an indicator of oxidative stress, were significantly reduced in the serum, from 5.40 ± 0.48 nmol/ml in the DPN group to 4.64 ± 0.16 nmol/ml in the LIPUS-treated group, and in the sciatic nerve, from 16.17 ± 5.88 nmol/mg protein to 4.67 ± 2.10 nmol/mg protein, suggesting the oxidative stress was inhibited by LIPUS. This study demonstrated for the first time that LIPUS could relive DPN through anti-oxidative stress process. This study suggests that LIPUS might be a new therapy strategy for DPN.

Activation of NR2A-Wnt-TLR2 Signaling Axis in Satellite Glial Cells of the Dorsal Root Ganglion Contributes to Neuropathic Pain Induced by Nerve Injury in Diabetic Mice

Diabetic peripheral neuropathic pain (DPNP), a common diabetic mellitus (DM) complication, may result from the activation of satellite glial cells (SGCs) in the dorsal root ganglion (DRG), potentially enhancing peripheral sensitization. The N-methyl-D-aspartate receptor (NMDAR) subtype NR2A and Toll-like receptor (TLR)2 play key roles in neuroimmune interactions. However, their roles in SGCs of DRG and the precise mechanisms mediating peripheral sensitization in DPNP remain unclear. Here, we found that the expression of glial fibrillary acidic protein (GFAP), NR2A, and TLR2 in SGCs from DRG significantly increased under increased glucose and NMDA stimulation in vitro. Additionally, upregulation of interleukin (IL)-6 and nerve growth factor (NGF) was observed. Notably, lentivirus-induced NR2A knockdown (KD) and C29 (TLR2 inhibitor) significantly blocked the above SGCs changes induced by NMDA and increased glucose. Behavior tests showed mechanical and thermal sensitivities induced by sciatic nerve ligation (SNL) were more obvious in DM background related to streptozotocin (STZ) injection than non-DM background mice, which were significantly alleviated by NR2A conditional knockout (CKO) in SGCs and TLR2 KO. Moreover, immunofluorescence (IF) results revealed the co-expression of NR2A and TLR2 in neurons and SGCs in the DRG. Following SNL in DM mice, the upregulation of NR2A, TLR2, GFAP, β-catenin, p-GSK-3β, p-nuclear factor kappa (NF-κ)-B, IL-6, NGF, Bcl-2-associated X protein (Bax), and Caspase 3, and the significant downregulation of Bcl-2 were consistent with the changes observed after increased glucose and NMDA treatment. The upregulation of TLR2 was blocked by NR2A CKO and Wnt signal pathway inhibition. Additionally, the activation of SGCs, upregulated IL-6 as well as NGF secretion and increased apoptosis, associated with nerve injury in DM background were altered by TLR2 KO and NF-κB pathway inhibition. In conclusion, the activation of the NR2A-Wnt-TLR2 signaling axis mediated peripheral sensitization in the DRG by influencing SGCs' activation, and the synthesis and secretion of pro-inflammatory cytokines and NGF, promoting SGCs' apoptosis, thus exacerbating a peripheral nerve injury related-NP in DM background. Our study provided insights into the role of NR2A-Wnt-TLR2 signaling axis of SGCs in mediating the generation and maintenance of DPNP and suggested targeting this signaling axis may be a promising therapeutic approach for DPNP.

Long-term efficacy of 10 kHz spinal cord stimulation in managing painful diabetic neuropathy: A post-study survey

OBJECTIVE

To evaluate the longer-term efficacy of 10 kHz spinal cord stimulation (SCS) in managing painful diabetic neuropathy (PDN) in a routine clinical setting after the transition from the 24-month SENZA-PDN study.

METHODS

We contacted 142 participants who completed 24 months of postimplantation follow-up in the former randomized controlled trial (SENZA-PDN). Of these, 57 consented and responded to this longer-term post-study survey. Outcomes assessed included pain relief, health-related quality of life (HRQoL) measured using the EuroQol 5-Dimensional 5-Level (EQ-5D-5L) instrument, Patient Global Impression of Change (PGIC), HbA1c, and weight.

RESULTS

Our survey captured patient-reported outcomes at a median of 4.1 years after implantation of a permanent 10 kHz SCS system. Among the surveyed participants, 76.8% (43 of 56) reported clinically meaningful pain relief (≥2 points), and 84.6% (44 of 52) achieved a clinically meaningful improvement in their EQ-5D-5L index score, with a final mean EQ-5D-5L index score of 0.825. Additionally, 74.5% (38 of 51) reported being "Better" or "A great deal better" on the PGIC scale. The surveyed participants reported a mean HbA1c level decrease of 0.4% (p = 0.027), with a more substantial improvement of 1.6% (p < 0.001) among those with type 2 diabetes (T2D) and a higher preimplantation HbA1c (>8%). Significant weight loss was also observed, with a mean reduction of 7.0 kg (p < 0.001) in the overall cohort and 8.7 kg (p < 0.001) in the subgroup with T2D and a higher BMI at preimplantation (≥35 kg/m2).

CONCLUSIONS

High-frequency SCS at 10 kHz provided sustained and clinically meaningful improvements in pain and HRQoL for PDN patients at 4.1 years postimplantation, with no explants in the cohort due to inefficacy. Alongside these benefits, participants experienced metabolic changes that included reductions in body weight and HbA1c beyond that achieved at 24 months, although changes in lifestyle and medication were not accounted for in this analysis. Notably, the cohort's final mean EQ-5D-5L index score was comparable to the US norm. These findings support 10 kHz SCS as a durable and effective treatment option for PDN in routine clinical practice.

The Therapeutic Potential of Dipeptidyl Peptidase 4 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists in Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) is one of the commonest complications of diabetes mellitus (DM). Current therapeutic approaches largely focus on pain management. However, less evidence is available on the clinical potential of two widely prescribed drug categories in DM management: dipeptidyl peptidase 4 inhibitors (DPP-4is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs). In this review, we discuss evidence from both experimental and clinical studies on the potential utility of these drugs in the management of DPN. Immunohistochemical data indicate that agents in both categories promote neurite outgrowth, ion conduction, neuronal survival and Schwann cell function. Furthermore, intra-epidermal nerve fibre density has been reported to increase with DPP-4is or GLP-1RAs treatment. Moreover, electrophysiological studies have indicated a diverse, but mostly beneficial, effect on motor or sensory nerve conduction velocity. Clinical tests, such as the muscular grip or paw jumping control resembling neuropathic symptoms, have also confirmed the advantageous effect of DPP-4is and GLP-1RAs. Finally, limited but promising clinical data have shown improved somatosensory-evoked potentials and vibration perception threshold, as well as restored excitability and nerve size parameters. Nevertheless, further clinical studies are required to elucidate the exact role of DPP-4is and GLP-1RAs in DPN.

Foot screening and customized health education program for patients with diabetic peripheral neuropathy: A nurse-led, real-world observational study

Background

Research has shown that DPN affects 50 % of individuals with diabetes and, in severe cases, can lead to amputation or death. Interventions led by doctors for DPN have demonstrated limited effectiveness in delaying its onset and progression. Nevertheless, there is an increasing recognition of the significance of nurse-led screening and health education in the early detection and slowing down of DPN.

Method

The present study conducted a retrospective analysis of medical records of 10,191 diabetic patients from 2019 to 2023, who also regularly attended outpatient clinics. Patients with incomplete medical data, transfers, critical conditions or death, existing foot ulcers or amputations, bedridden or uncooperative individuals (5,470 individuals) were excluded, and a total of 4,721 individuals were selected for analysis. The screening and intervention components of the FSCHE program were all led by nurses. A total of 2022 participants received foot screening and customized health education (FSCHE) program, while 2699 participants recevied regular care. The primary outcome is on determining the prevalence rate of DPN among all the included diabetic patients. The data was collected through experimental tests and nurse-led foot screening. Prevalence rates were reported as the number of cases per 1000 individuals. Odds Ratios were calculated to approximate Risk Ratios to determine the effectiveness of the FSCHE program.

Results

The prevalence of DPN in diabetic patients who received the FSCHE program decreased from 557 cases per 1000 individuals in 2019 to 199 cases per 1000 individuals in 2023. The hospitalization duration decreased from 11.2 days to 7.59 days. The risk of DPN in diabetic patients participating in the FSCHE program was 0.741 times higher than that of regular diabetes care (RR [95 % CI]: 0.741 [0.654, 0.840], p < 0.001). The DPN-related risk factors showed promising control results as well.

Conclusions

In this observational study conducted among Chinese patients with diabetes, it was found that the nurse-led FSCHE program effectively manages DPN and its associated risk factors. These results highlight the importance of employing objective screening tools to detect DPN at an early stage, as well as the significance of nurse-led interventions in promoting healthy behaviors and preventing the development and progression of DPN.

The antidiabetic properties of lignans: a comprehensive review

BACKGROUND

Diabetes mellitus (DM) is a chronic metabolic disease with a high global prevalence. Lignans, a class of plant natural compounds found in commonly consumed foods, are well-tolerated by humans and have demonstrated promising potential in the management of DM. Consumption of lignan-rich foods has been associated with improved overall health and quality of life.

PURPOSE

The clinical and preclinical evidence on the role of lignans in managing DM are critically examined.

METHODS

A thorough literature search was conducted across major scientific databases, focusing on studies that reported the effects of individual lignans on key diabetes indicators, such as glucose utilisation and insulin sensitivity, in both human and animal models, as well as in cell-based studies.

RESULTS

A total of 180 lignans were included in the review. Out of these, only three were investigated in randomised clinical trials in humans and 31 in animal models. The reviewed evidence suggests some beneficial effects of lignans in preventing the development of obesity-related diabetes. Their therapeutic benefits in preventing diabetes-related complications, particularly diabetic nephropathy, in both type 1 and type 2 diabetes, are also supported. Metabolites of various lignans, produced by microbial metabolism in the gut and serum enzymes, appear to be key bioactive forms, highlighting the need for detailed pharmacodynamic studies, optimised dosage designs, and the use of the appropriate lignan molecules for cell-based screening.

CONCLUSION

Lignans and their microbial metabolites show promise in preventing obesity-related diabetes and mitigating diabetes-related complications such as diabetic nephropathy, though further clinical studies are needed to optimize their therapeutic potential.

A comprehensive review of scientifically reported phytochemicals to manage allodynia in chronic diabetes complications

BACKGROUND

The global prevalence of diabetes mellitus and its associated complications is increasing, impacting both developed and developing nations. One common complication is neuropathy and neuropathic pain, which often manifests as symptoms such as allodynia-a condition where patients experience pain from non-painful stimuli.

OBJECTIVE

This review seeks to explore scientifically validated medicinal plants and phytochemicals, presenting the findings in an organized format based on published literature.

METHODOLOGY

Data were searched in pubmed literature and only the scientifically reported phytochemicals were considered to include in this review.

KEY FINDINGS

The U.S. Food and Drug Administration (FDA) has not approved many medications targeting the root causes of neuropathy. Instead, various strategies are employed to manage the symptoms of allodynia. Research on plant-based ethno-pharmaceuticals aims to address the symptoms without affecting the disease's progression, which involves the gradual loss of nerve fibres from the extremities. This article delves into allodynia's different forms, implications, and underlying signalling mechanisms.

CONCLUSION

The hope is that further research on phytochemicals could lead to the development of therapies for managing various forms of allodynia in diabetic patients.

Effects of evening primrose oil on treating painful diabetic neuropathy: a randomized, double-blind, clinical trial

OBJECTIVES

Diabetic neuropathy results in chronic pain. Traditional treatments often offer limited relief, prompting the exploration of alternative therapies like Evening Primrose Oil (EPO). This study aimed to assess the efficacy of EPO in the treatment of painful diabetic neuropathy.

METHODS

In this interventional clinical trial, Patients were randomly assigned to three groups. Group A, consisted of 24 patients, received 1,000 mg of EPO soft gel capsules every 12 h. Group B, consisted of 21 patients, received 1,000 mg of EPO soft gel capsules daily. Group C, also with 21 patients, was divided so that half of the patients received placebo capsules daily and the other half every 12 h. After 4 weeks, patients returned, and questionnaires were completed. Statistical analysis of the data was conducted using SPSS version 25.

RESULTS

Groups A and B showed significant reductions in visual analog scale (VAS) pain scores, with Group A achieving the most improvement (mean pre-test: 5.96; post-test: 4.63). Analysis of covariance (ANCOVA) revealed significant differences in post-intervention scores (p<0.001) for VAS and Neuropathy total symptom score-6 (NTSS-6), indicating effective interventions. Treatment A was more effective than Treatment B for reducing pain (VAS mean difference= -0.52; p=0.044) and McGill Pain Questionnaire (MPQ) scores (mean difference= -9.56; p<0.001).

CONCLUSIONS

EPO could serve as a valuable alternative therapy for managing painful diabetic neuropathy with fewer side effects than traditional treatments. Further research is warranted to validate these results and explore EPO treatment long-term efficacy and safety.

Integrating exosome wide associations study and Mendelian randomization identified causal miRNAs for type 2 diabetes mellitus and its complications

BACKGROUND

Type 2 diabetes mellitus (T2DM) and its complications, including diabetic lower extremity arterial disease (DLEAD) and diabetic foot (DF), impose significant health burdens worldwide. However, the differential expression of microRNAs (miRNAs) between T2DM and its complications and its causal effects remain poorly understood.

METHODS

We conducted an exosome-wide association study (EWAS) comparing miRNA profiles between T2DM and its complications, including DLEAD and DF, without healthy controls. The significant miRNAs identified between DM and its complications were further validated by integrating cis-miRNA expression quantitative trait loci (cis-miR-eQTLs) and genome-wide association study (GWAS) summary data of T2DM and peripheral arterial disease (PAD) through two-sample Mendelian randomization (MR) analysis.

RESULTS

We identified several differential expressions of miRNAs between T2DM, DLEAD, and DF, such as hsa-miR-409-3p between T2DM and DLEAD, hsa-miR-543 between T2DM and DF and hsa-miR-206 between DLEAD and DF. The two sample MR analysis revealed potential causal relationships between dysregulated miRNAs and T2DM and its complications, such as hsa-miR-30b-3p and hsa-miR-30b-5p showed causal associations with T2DM and PAD respectively.

CONCLUSIONS

Our study elucidates the miRNA signatures associated with T2DM and its complications. These findings provide insights into the pathogenesis of T2DM and its complications and suggest potential therapeutic targets for intervention.

The frequency of neuropathy and predictive parameters in prediabetic cases from Turkiye

INTRODUCTION

Diabetic sensorimotor peripheral neuropathy causes patients to have foot injuries without realizing it. This condition may progress to diabetic foot ulcer; infections can include osteomyelitis and lower limb amputations. Managing diabetes and screening diabetic neuropathy is crucial to reducing patient mortality, quality of life, functionality, and the cost burden of complications to the healthcare system. We aim to contribute to the literature by comparing diagnostic methods and examining parameters that can predict neuropathy early.

MATERIAL AND METHODS

A total of 108 patients with a neuropathy score Douleur Neuropathique-4 (DN-4) above 4, 54 with known diabetes, and 54 with prediabetes were included. Fasting plasma glucose, oral glucose tolerance test, hemoglobin A1c (HbA1c), LDL-cholesterol, HDL-cholesterol, triglyceride, uric acid, vitamin B12, folic acid, creatinine, and complete urinalysis was performed on 108 patients included. Afterward, a monofilament test, tuning fork test, and electromyography were performed by the neurologist to prove neuropathy.

RESULTS

The frequency of neuropathy in the prediabetes group was found to be 0.40 ± 0.49 % using EMG. This rate is 0.71 ± 0.45 % for diabetic neuropathy. The difference is statistically significant (p = 0.001) in the prediabetic group, the neuropathy score (DN-4 score) was 5.1 ± 0.9, the tuning fork test positivity was 0.18 ± 0.39, and p = 0.001 was statistically significant compared to the diabetic group. Also, in the monofilament test, the rate of neuropathy in the prediabetes group was again statistically significant with 0.68 ± 0.47 (p = 0.027). Total cholesterol (185.1 ± 21.8, p = 0.003), high uric acid (5.11 ± 1.27, p = 0.003), and low folic acid (4.5 ± 1.05, p = 0.026) are found to be statistically significant between diabetic and prediabetic groups.

DISCUSSION AND CONCLUSION

In diagnosing neuropathy, monofilament, and diapason testing can be used in the clinical setting, and they have been found to be successful tests in the diagnosis of neuropathy. Also, our analysis indicates the relationship between low folic acid, high total cholesterol/uric acid levels, and prediabetic neuropathy. The role of intervening blood levels of those factors with medications in preventing neuropathy is unclear. We recommend further investigating all the patient's dietary habits to find possible risk factors, as well as investigating patients with low folic acid and high total cholesterol/ uric acid levels much more cautiously.

RECOMMENDATION

Neuropathy should be screened in prediabetic and diabetic patients, and possible risk factors should be assessed periodically.

Network Meta-analysis of Randomized Controlled Trials Assessing Neuromodulation Therapies for Painful Diabetic Neuropathy

INTRODUCTION

Neuromodulation therapies (including non-invasive and invasive neuromodulation) are being used to treat painful diabetic neuropathy (PDN).

METHODS

A systematic search of the PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases was conducted, from their inception until 1 October 2024, to identify randomized controlled trials (RCTs) on neuromodulation therapies for PDN. Data were collected on pain intensity of various adjunctive therapies for PDN, including transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation, repetitive transcranial magnetic stimulation, pulsed electromagnetic field therapy, spinal cord stimulation (SCS), transcranial direct current stimulation, frequency rhythmic electrical modulation system, mesodiencephalic modulation, and sham.

RESULTS

The data from an aggregate of 12 separate studies, comprising a total sample size of 922 participants, was subject to analysis. All seven neuromodulation therapies exhibited better outcomes in pain intensity compared to the Sham intervention, with TENS achieving the highest ranking, followed by SCS. At the final follow-up time point, statistically significant reductions in pain intensity (vs. Sham) was only observed for SCS.

CONCLUSION

The results of this network meta-analysis should facilitate the development of clinical guidance and enhance the decision-making process for both patients and healthcare professionals, thereby identifying the most appropriate PDN treatment options.

TRIAL REGISTRATION

PROSPERO: CRD42024597208.

Significance of high-resolution ultrasound imaging and elastography as early predictors of diabetic peripheral neuropathy

To evaluate the significance of high-resolution ultrasound (HRUS) and shear wave elastography (SWE) in the diagnosis of diabetic peripheral neuropathy (DPN) to clarify their possible roles as early predictors of the occurrence of this important complication.The study included 90 patients with diabetes mellitus with different clinical stages of DPN as well as 30 healthy controls. A full history, clinical examination, and assessment of both the Toronto Clinical Neuropathy Score (TCNS) and HbA1c were performed, followed by real-time HRUS and SWE examinations of their right and left tibial and median nerves to assess their cross-sectional area (CSA) and nerve stiffness, respectively.The CSA and stiffness of tibial and median nerves were significantly increased in patients with diabetes compared to controls, with higher values associated with the severity of their DPN. Both parameters were correlated with each other and with the duration of the disease, TCNS, and HbA1c. The CSA cut-off value of both tibial and median nerves to detect DPN in patients was 13.5 mm2, meanwhile, the SWE cut-off values were 68.5 and 61.5 KPa, respectively. SWE showed a higher AUC than CSA for the prediction of DPN.Measurement of the CSA and stiffness of the peripheral nerves could be a reliable tool for early detection of DPN. Therefore, we recommend adding these noninvasive diagnostic parameters as complementary diagnostic tools to the routine follow-up schedule of diabetic complications, especially in long-standing cases.

Diabetic foot in the context of rheumatic diseases: pathogenesis and treatment approaches

Diabetic foot is a frequent and debilitating complication of diabetes mellitus that significantly impairs quality of life and increases the risk of disability and amputation. This review examines the multifactorial pathogenesis of diabetic foot, focusing on its increased incidence and severity in patients with rheumatic diseases. The development of diabetic foot is driven by diabetic neuropathy, peripheral vascular disease, and infection. In patients with rheumatic diseases, chronic systemic inflammation and vascular dysfunction further accelerate tissue damage and impair wound healing. Long-term use of pharmacologic agents such as glucocorticoids and nonsteroidal anti-inflammatory drugs also contributes to metabolic imbalance, immune suppression, and vascular complications, increasing the risk of ulceration and infection. Rheumatic disease-related joint deformities and altered foot biomechanics add mechanical stress, exacerbating the condition. Effective management of diabetic foot in patients with rheumatic diseases requires a multidisciplinary approach. This includes early diagnosis, strict glycemic control, modulation of systemic inflammation, optimization of vascular health, and preventive foot care strategies. Addressing both metabolic and rheumatologic components is essential to reduce the risk of severe outcomes such as chronic infection and limb amputation. Understanding the interplay between diabetes and rheumatic diseases is crucial for improving clinical outcomes. Targeted, integrated interventions are key to preventing complications and enhancing the quality of life for affected patients.

Indole metabolism and its role in diabetic macrovascular and microvascular complications

Tryptophan (Trp), an essential amino acid obtained through dietary sources, plays a crucial role in various physiological processes. The metabolism of Trp branches into three principal pathways: the serotonin pathway, the kynurenine pathway, and the indole pathway. The kynurenine and serotonin pathways are host pathways while the indole pathway is solely the result of bacterial metabolism. Trp metabolites extend their influence beyond protein biosynthesis to affect a spectrum of pathophysiological mechanisms including, but not limited to, neuronal function, immune modulation, inflammatory responses, oxidative stress regulation, and maintenance of intestinal health. This review focuses on indole derivatives and their impact on vascular health. Trp-containing dipeptides are highlighted as a targeted nutraceutical approach to modulate Trp metabolism, enhance beneficial metabolite production, and mitigate risk factors for vascular diseases. The importance of optimizing Trp intake and dietary strategies to harness the benefits of Trp-derived metabolites for vascular health is underscored, bringing to light the need for further research to refine these therapeutic approaches.

A customized partitioned microneedle array based on functionalized glycol chitosan for prolonged blood glucose regulation and prevention of diabetic neuropathy

Efficient glycemic control serves as the cornerstone of diabetes and its complication treatments, necessitating additional symptomatic medications or nutritional supplements tailored to various complications. However, different diseases and medications require specific treatment regimens and drug delivery methods. For instance, conventional subcutaneous insulin injections suffer from uncontrollable release rates and onset times. This study has developed a segmented microneedle array that integrates two controlled-release mechanisms within a single array. Different drugs are loaded into distinct regions, allowing for modular and simultaneous timed-release therapies. The posterior segment of the microneedle tip releases insulin via a glucose-sensitive mechanism, enabling real-time intelligent glycemic regulation and effective glycemic control for up to 43.7 h, which is nearly 8 times longer than subcutaneous injections. The anterior segment releases vitamin B9 via a sustained-release mechanism, which has potential preventive and reparative effects on diabetic neuropathy, providing a gentler and more sustained nutrient supply. The regionalized design of the microneedles significantly enhances drug delivery efficiency and the intelligent customization of drug release, especially in managing diabetic neuropathy.

Content and effects of balance training in people with diabetic peripheral neuropathy - a systematic review and meta-analysis

BACKGROUND

Diabetic Peripheral Neuropathy (DPN) impairs balance due to sensory loss, proprioceptive deficits, muscle weakness, altered gait, and delayed reflexes. Targeted aerobic and balance training seem promising to mitigate these issues. However, the exact content of a recommended training regime is yet to be determined.

OBJECTIVE

To delineate and synthesise balance training content and efficacy for people with DPN.

METHODS

The literature search was conducted on PubMed and Embase in accordance with the PRISMA-checklist. Last search was performed on April 29, 2024. Inclusion criteria were established using the PICO-framework. Methodological quality was assessed using the TESTEX Scale. Meta-analyses were exclusively applied to studies featuring a passive control group.

RESULTS

A total of 2007 articles were identified. Twelve studies were included in the qualitative synthesis. Seven studies were included in the meta-analyses. Two studies were of high quality. Most studies reported the frequency, session time, duration, and setting of balance training, while none reported the intensity. The meta-analyses showed a standardized mean difference in favor of balance training compared to passive control for One-Legged Stance (openeyes) (0.89[0.5,1.28]), One-Legged Stance (closed eyes) (1.48[0.36, 2.60]), Postural sway (-0.71[-1.04, -0,37]), Timed Up and Go(-0.94[-1.78, -0.10]), and Berg Balance Scale (2.26[0.48, 4.05]), respectively.

CONCLUSION

Studies are few and generally of low methodological quality. The content of balance training interventions is minimally described, especially concerning the applied intensity. However, balance training does seem to improve balance outcomes in people with DPN, but given the methodological limitations, interpretation must be cautious.

MoSeq based 3D behavioral profiling uncovers neuropathic behavior changes in diabetic mouse model

Diabetic neuropathy (DN) is a prevalent and debilitating complication of diabetes, significantly impairing quality of life through chronic pain, sensory deficits, and motor dysfunction. Despite its widespread impact, current rodent behavioral assessments using 2D tracking methods primarily quantify basic locomotion, such as distance and speed, but lack resolution to detect subtle, pattern-based motor impairments characteristic of DN. This study employed MoSeq-based 3D behavioral profiling combined with unsupervised machine learning to identify subtle yet significant alterations in nicotinamide (NA)- and streptozotocin (STZ)-induced DN mouse models. Our analysis identified 22 distinct behavioral syllables, with DN mice exhibiting increased stress-associated behaviors such as head weaving, wall jumping, and nasal hesitancy, while displaying decreased locomotor activities including walking and rearing. These alterations were accompanied by heightened mechanical sensitivity indicative of neuropathic pain and a more predictable, less exploratory behavioral transition pattern, suggesting a restricted behavioral repertoire rather than improved motor coordination. Additionally, MoSeq-based profiling enabled detailed analysis of movement organization and temporal transitions, highlighting stereotyped behavioral sequences and notably decreased exploratory behaviors in DN mice. These behavioral patterns indicate that DN-associated pain is more strongly related to impairments in behavioral adaptability and higher-order motor planning than to simple reductions in movement, suggesting underlying dysfunctions in sensorimotor or cognitive control circuits. These findings indicate that MoSeq can be used as a valuable tool for high-resolution behavioral quantification in diabetic neuropathic animal pain model, enabling refined evaluation of neuropathic phenotypes and therapeutic efficacy in preclinical studies.

Diabetic neuropathy: cutting-edge research and future directions

Diabetic neuropathy (DN) is a prevalent and debilitating complication of diabetes mellitus, significantly impacting patient quality of life and contributing to morbidity and mortality. Affecting approximately 50% of patients with diabetes, DN is predominantly characterized by distal symmetric polyneuropathy, leading to sensory loss, pain, and motor dysfunction, often resulting in diabetic foot ulcers and lower-limb amputations. The pathogenesis of DN is multifaceted, involving hyperglycemia, dyslipidemia, oxidative stress, mitochondrial dysfunction, and inflammation, which collectively damage peripheral nerves. Despite extensive research, disease-modifying treatments remain elusive, with current management primarily focusing on symptom control. This review explores the complex mechanisms underlying DN and highlights recent advances in diagnostic and therapeutic strategies. Emerging insights into the molecular and cellular pathways have unveiled potential targets for intervention, including neuroprotective agents, gene and stem cell therapies, and innovative pharmacological approaches. Additionally, novel diagnostic tools, such as corneal confocal microscopy and biomarker-based tests, have improved early detection and intervention. Lifestyle modifications and multidisciplinary care strategies can enhance patient outcomes. While significant progress has been made, further research is required to develop therapies that can effectively halt or reverse disease progression, ultimately improving the lives of individuals with DN. This review provides a comprehensive overview of current understanding and future directions in DN research and management.

DNA methylation and 28 year incidence of two neuropathy phenotypes in type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications cohort study

AIMS/HYPOTHESIS

Diabetic peripheral neuropathy (DPN) and neuropathic pain (NP) are common complications of type 1 diabetes that can greatly affect quality of life. Studying DNA methylation (DNAm) may help identify potential therapeutic targets; however, epigenome-wide association studies (EWAS) of DPN and NP are lacking. We thus performed prospective EWAS of 28 year DPN and NP incidence in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset (<17 years) type 1 diabetes.

METHODS

DPN was defined as two or more of the following criteria: symptoms consistent with DPN; decreased tendon reflexes; or abnormal sensory examination. NP was reported as burning, aching or stabbing pain in the feet during an EDC examination or on the Michigan Neuropathy Screening Instrument (MNSI). The time of the first available blood-derived DNA specimen collected between 1988-1998 was considered the analytic 'baseline' (mean age 27 years; diabetes duration 19 years). After quality control, DNAm (EPIC array) at 683,597 CpGs was analysed in Cox models for time-to-DPN in 282 individuals free of DPN at baseline and time to NP in 365 individuals free of NP at baseline. False discovery rate (FDR) <0.05 was considered statistically significant. We also identified differentially methylated regions (DMRs), functional interaction networks and genetic variants associated with DNAm (methylation quantitative trait loci [meQTLs]), and performed Mendelian randomisation (MR) to assess evidence of causality.

RESULTS

Over 28 years, 154 individuals (54.6%) developed DPN and 148 (40.5%) developed NP. Greater methylation at three CpGs was significantly associated (FDR≤0.05) with reduced hazard of DPN: cg06163904 (CHMP6); cg10835127 (CACNA1B); and cg18945945 (PKNOX1). CpG associations with DPN remained similar after adjustment for clinical risk factors. We identified 75 meQTLs for cg18945945 in the PKNOX1 region, 59 of which were validated in an external diabetes cohort. One-sample MR provided nominal evidence for a potentially causal association between cg18945945 and DPN (p=0.01). While no individual CpGs were significantly associated with NP, there were 49 NP-associated DMRs.

CONCLUSIONS/INTERPRETATION

Our study identified associations between DNAm and 28 year incidence of DPN and NP at several biologically plausible loci. Most notably, we identified a novel association between DNAm of PKNOX1 and future DPN, including evidence of a genetic influence on PKNOX1 methylation that was validated in an external diabetes cohort. PKNOX1 has previously been implicated in drug-induced neuropathy; our results provide strong evidence that epigenetic regulation of PKNOX1 may also play a functional role in the development of diabetic neuropathy. Our results suggest that epigenetic modification of the identified loci warrants further study to inform potential targets for prevention of DPN.

Neuroinflammation in diabetic peripheral neuropathy and therapeutic implications

Diabetic peripheral neuropathy (DPN) is a serious complication of diabetes mellitus, which is a common cause of disability in individuals with diabetes mellitus. Multiple mechanisms may be involved in the development of DPN. Neuroinflammation is a critical factor contributing to nerve damage during diabetes. Inflammation can induce the development of diabetes mellitus, and long-term hyperglycemia also causes increased oxidative stress and promotes the release of inflammatory cytokines. After reading through the literature, the association of inflammation with the induction of diabetes and DPN was discussed in the review. Inflammation induces nerve damage and nerve conduction impairment. The neuropathic pain in diabetes-induced DPN is also closely associated with the inflammatory response. Given the important roles of inflammation in diabetes-induced DPN, explicit elucidation of neuroinflammation during diabetes mellitus and DPN should hold the potential for developing novel therapeutic strategies for DPN. Experimental studies and limited clinical trials support the value of anti-inflammatory reagents in treating DPN, and the positive outcomes of these investigations warrant further clinical trials.

Understanding the Impact of Diabetic Peripheral Neuropathy and Neuropathic Pain on Quality of Life and Mental Health in 6,960 People With Diabetes

OBJECTIVE

Diabetic peripheral neuropathy (DPN) and neuropathic pain impacts quality of life (QoL) and mental health negatively. This cross-sectional survey study aimed to 1) elucidate the associations between painful and painless DPN and QoL, mental health, and socioeconomic factors, 2) assess the prevalence of sensory pain descriptors, and 3) evaluate the association between descriptors and the above factors.

RESEARCH DESIGN AND METHODS

Participants were grouped into people with (n = 1,601) and without (n = 5,359) DPN based on the Michigan Neuropathy Screening Instrument questionnaire. Participants with DPN were subsequently divided into people with (n = 1,085) and without (n = 516) concomitant neuropathic pain based on the modified Douleur Neuropathique en 4 Questions-interview.

RESULTS

The study showed diminished QoL (36-item Short Form Health Survey [SF-36]: 55.1 [interquartile range 36.7, 73.6], 82.2 [63.6, 90.9]) and poorer mental health (Hospital Anxiety and Depression Scale, subscale for anxiety [HADS-A]: 5.00 [2, 9], 2.00 [1, 5]; HADS-subscale for depression [HADS-D]: 4.00 [1, 8], 1.00 [0, 3]) in participants with DPN compared with participants without DPN. The addition of pain diminished QoL (SF-36: 50.7 [34.8, 69.8]) and mental health (HADS-A: 6 [3, 10], HADS-D: 4 [1, 8]) further. The most prevalent pain descriptor in participants with painful DPN were burning pain (73%), while the most prevalent sensory descriptor was pins-and-needles (93%). An interesting finding is the high prevalence of itch (44%). Weak associations with mental health and QoL were present for cold pain, electric pain, and itch.

CONCLUSIONS

An increased focus on differences in QoL, mental health, and pain phenotypes is of importance to move the field forward toward more interdisciplinary, personalized treatment.

The impact of diabetes mellitus on the management and outcome of ankle fractures

Diabetes mellitus is a chronic condition which disrupts bone homeostasis leading to impaired healing and profound complications in ankle fractures. Hyperglycaemia and chronic inflammation cause increased generation of advanced glycation end products and reactive oxygen species which ultimately drive osteoclastogenesis and increase bone resorption. Together with a lack of insulin signalling, these mechanisms compromise bone metabolism and increase the risk of complications in fracture healing. Diabetes is associated with comorbidities such as vasculopathy and neuropathy which further contribute to the risk of complications. The complications identified in diabetic patients with ankle fractures include non-union, malunion, infection, amputation, and mortality. Thus, careful consideration is needed when deciding between surgical and conservative treatment. This narrative review provides a synthesis of the literature covering the impact of diabetes on ankle fractures, considering their high prevalence in the UK.

Can Spinal Cord Stimulation be Considered as a Frontier for Chronic Pain in Diabetic Foot?

Chronic pain in the diabetic foot (DF) is a common complication of diabetes, bringing a significant burden to patients, their families, and even society. There is no very effective treatment for it, traditional treatments such as medication, lumbar sympathetic nerve block, and alternative therapies are often not very effective and have more adverse effects. The emergence of neuromodulation technology has brought new hope for the treatment of DF, among which spinal cord stimulation (SCS) is a hotspot in current research and has achieved remarkable efficacy in the study of DF treatment by blocking pain signaling and improving circulation and other mechanisms. This article reviews the SCS technique and clinical trails of SCS for chronic DF pain, and describes the prospects and current challenges of SCS.

A single blinded randomized controlled trial assessing the effect of photobiomodulation therapy on neuron specific biomarkers in type II diabetes mellitus patients with peripheral neuropathy

BACKGROUND

Diabetic peripheral neuropathy is one of the most devastating complications of long-term diabetes mellitus, associated with functional limitations and poor quality of life.

MATERIALS AND METHODS

Two hundred subjects were randomized into intervention and control group, with one hundred in each arm. The intervention arm received photobiomodulation therapy for ten days, with Low -Level Helium-Neon Laser at a wavelength of 632.8 nm of dosage 3.1 J/cm2 for 9 min on both the dorsal and plantar surfaces of the foot, while the control group received sham laser. Patients were assessed at day 0 of treatment and four weeks after treatment for all the clinical and neuropathy-specific biomarkers. Serum levels of Neuron specific enolase (NSE), Calcitonin gene related peptide (CGRP) Nerve Growth Factor (NGF) for monitoring neuronal changes and monofilament test, Biothesiometer, Numeric Pain Rating Scale (NPRS) to analyze vibration sensation, and pain score. The neuropathic quality of life was assessed using the Norfolk Quality of Life Questionnaire- Diabetic Neuropathy (Norfolk QOL-DN).

RESULT

Trial found significant changes in serum NSE (p < 0.001), CGRP(p < 0.001), MNSI(p < 0.001), VPT(p < 0.001), NPRS(p < 0.001), and NQL(p < 0.001) in the intervention group four weeks after receiving photobiomodulation therapy, whereas no changes in NGF levels(p = 0.937). This was in correlation with improved neuropathic pain and quality of life.

CONCLUSION

Serum levels of NSE and CGRP may be good indicators of effectiveness of photobiomodulation in reducing neuropathic pain and other symptoms in individuals with DPN. Reduced neuropathic symptoms, improved protective sensation of foot and quality of life, and reduced neuropathic pain was observed in intervention group.

The impact of pancreas transplantation on diabetic complications: A systematic review

BACKGROUND

Pancreas Transplantation (PT) provides optimal treatment for patients with severe complicated Type 1 Diabetes Mellitus (T1DM). Restoration of beta-cell mass allows return to euglycaemia and insulin independence. We aimed to examine its impact on the secondary complications associated with severe T1DM including diabetic eye disease, neuropathy and cardiovascular disease.

METHODS

A database search using MedLINE to identify publications to April 2023 was conducted. Searches were performed using MeSH terms 'Pancreas Transplantation' AND 'Diabetes Mellitus, Type 1' 'Diabetic Retinopathy' OR 'Heart Disease' OR 'Cardiovascular Diseases' OR 'Peripheral Vascular Disease' OR "Amputation' OR 'Neuropathy."

RESULTS

All articles were retrospective with 51.1 % (n = 23) case control studies and 48.9 % (n = 22) cohort studies. 82.2 % (n = 37) examined simultaneous pancreas and kidney (SPK) transplantation and 17.8 % (n = 8) analysed pancreas transplant alone (PTA). Heterogenous outcomes metrics were employed. 15 studies examined diabetic retinopathy (DR) with 53.3 % (n = 8) demonstrated improvements after PT, while the remainder (n = 7) exhibited stabilisation. 16 studies assessed neuropathy and 87.5 % (n = 14) demonstrated beneficial effects of PT on nerve conduction studies, vibration perception threshold or corneal confocal microscopy. There was a positive effect on cardiovascular disease by reduction in the incidence of cardiac events, improvement in metabolic profile and increased left ventricular ejection fraction. 14 studies examined cardiovascular disease (71.4 % (n = 10) improvement; 14.2 % (n = 2) stabilisation; 14.2 % (n = 2) progression).

CONCLUSION

SPK and PTA have beneficial effects in ameliorating or stabilising diabetes complications. Future work should seek to reduce heterogeneity of outcome metrics assessing T1DM complication profile to facilitate robust comparison of beta-cell replacement interventions.

Role of Mitochondrial Dysfunction in Neuropathy

Diabetes mellitus is characterized by a state of hyperglycemia, which can lead to severe complications if left untreated or poorly managed. Diabetic peripheral neuropathy (DPN) is one common complication. This condition is characterized by damage to the nerves that supply the legs and feet as well as problems with blood vessels, the heart, or urinary tract. To alleviate pain for patients, clinicians resort to long-term treatment regimens of nerve pain medications, which are usually either anticonvulsants or antidepressants. However, little is understood about the underlying mechanisms of DPN. Many pathogenic pathways have been proposed, one of which is mitochondrial dysfunction. Mitochondrial dysfunction includes a range of possible deficiencies given the number of functions controlled by or located in mitochondria, including their core function of bioenergetics. This review focuses on mitochondrial bioenergetics, including respiration/ATP synthesis and reactive oxygen species (ROS) production, as well as calcium homeostasis and apoptosis, and their potential as targets for the effective treatment of diabetic peripheral neuropathy.

Development of a Body-Worn Textile-Based Strain Sensor: Application to Diabetic Foot Assessment

Diabetic Foot Ulcers (DFUs) are a significant health and economic burden, potentially leading to limb amputation, with a severe impact on a person's quality of life. During active movements like gait, the monitoring of shear has been suggested as an important factor for effective prevention of DFUs. It is proposed that, in textiles, strain can be measured as a proxy for shear stress at the skin. This paper presents the conceptualisation and development of a novel strain-sensing approach that can be unobtrusively integrated within sock textiles and worn within the shoe. Working with close clinical and patient engagement, a sensor specification was identified, and 12 load-sensing approaches for the prevention of DFU were evaluated. A lead concept using a conductive adhesive was selected for further development. The method was developed using a Lycra sample, before being translated onto a knitted 'sock' substrate. The resultant strain sensor can be integrated within mass-produced textiles fabricated using industrial knitting machines. A case-study was used to demonstrate a proof-of-concept version of the strain sensor, which changes resistance with applied mechanical strain. A range of static and dynamic laboratory testing was used to assess the sensor's performance, which demonstrated a resolution of 0.013 Ω across a range of 0-430 Ω and a range of interest of 0-20 Ω. In cyclic testing, the sensor exhibited a cyclic strain threshold of 6% and a sensitivity gradient of 0.3 ± 0.02, with a low dynamic drift of 0.039 to 0.045% of the total range. Overall, this work demonstrates a viable textile-based strain sensor capable of integration within worn knitted structures. It provides a promising first step towards developing a sock-based strain sensor for the prevention of DFU formation.

Impact of Selective Peroxisome Proliferator-Activated Receptor (PPAR)-α Modulators and Fibrates on Microvascular Disease: Is There Still Room?

PURPOSE OF REVIEW

This review examines the role of fibrates and the selective PPAR-alpha modulators (SPPARM-α), pemafibrate, in diabetic microvascular disease. It reviews their potential to mitigate residual risk in retinopathy, nephropathy, neuropathy and peripheral vascular disease.

RECENT FINDINGS

These pharmacotherapies, beyond their lipid-lowering effects, may exert anti-inflammatory, antioxidant, and endothelial-protective actions. Secondary analyses of large clinical trials supports their efficacy in slowing retinopathy progression, reducing albuminuria, and preventing minor amputations. Recent analyses suggest that pemafibrate offers an enhanced efficacy and safety profile compared to conventional fibrate and may lower the incidence of diabetic foot ulcers and gangrene. Fibrates and SPPARM-α agonists represent promising therapies to prevent diabetic microvascular complications. Their benefits in reducing microvascular damage support their broader adoption in clinical practice. However, additional dedicated randomized trials are essential to validate the efficacy of those agents in contemporary diabetes care era and to address the growing burden of diabetes-related microvascular complications.

Comprehensive review on diabetic foot ulcers and neuropathy: Treatment, prevention and management

Diabetic foot (DF) is a major public health concern. As evident from numerous previous studies, supervision of DF ulcer (DFU) is crucial, and a specific quality check-up is needed. Patients should be educated about glycaemic management, DFUs, foot lesions, proper care for injuries, diet, and surgery. Certain reasonably priced treatments, such as hyperbaric oxygen and vacuum-assisted closure therapy, are also available for DFUs, along with modern wound care products and techniques. Nonetheless, DF care (cleaning, applying antimicrobial cream when wounded, and foot reflexology), blood glucose monitoring to control diabetes, and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs. Between 50% and 80% of DF infections are preventable. Regardless of the intensity of the lesion, it needs to be treated carefully and checked daily during infection. Tissue regeneration can be aided by cleaning, dressing, and application of topical medicines. The choice of shoes is also important because it affects blood circulation and nerve impulses. In general, regular check-ups, monitoring of the patient's condition, measuring blood glucose levels, and providing frequent guidance regarding DFU care are crucial. Finally, this important clinical problem requires involvement of multiple professionals to properly manage it.

Research trends of acupuncture therapy for painful peripheral nervous system diseases from 2004 to 2023: a bibliometric and meta-analysis

Background

Peripheral nervous system diseases (PNSD) have represented a major global health burden, leading to significant economic impacts and diminished productivity. This bibliometric analysis was performed to summarize the current research trends and hotspots over the past two decades, aiming to provide a comprehensive perspective for future research.

Methods

All data were sourced from the Web of Science Core Collection (WoSCC) on March 1, 2024, for publications between January 1, 2004, and December 31, 2023. Data visualization and analyses, including descriptive statistics, co-occurrence mapping, and cluster analysis, were performed using CiteSpace (Version 6.1.R6) and Excel 2021.

Results

Our search yielded 678 references, with the annual publication count demonstrating an increasing trend over the past 20 years. The most productive country and institution were China and Kyung Hee University, respectively. Fang Jianqiao, was the most prolific author with the highest publications. Among journals, "Pain," was the most frequently cited, while the top-cited reference was a randomized controlled pilot trial by Lu Weidong in 2020. "Acupuncture" emerged as the keyword with the highest frequency. The meta-analysis indicated that acupuncture was more effective than standard care for pain associated with Diabetic Peripheral Neuropathy [MD = -2.03, 95% CI (-2.86, -1.21), 2 RCTs, 102 participants, p < 0.0001].

Conclusion

Our bibliometric review revealed key insights into the focal areas of PNSD research, underscoring the urgent need for continued and targeted high-quality investigations.

Polymorphic variants and risk of diabetic peripheral neuropathy in patients with type 2 diabetes mellitus: systematic review and meta-analysis

BACKGROUND

Neuropathy is a frequent complication of diabetes mellitus, a disease that is growing exponentially worldwide. Genetic research has emerged as an important tool for better understanding its predisposition, although a systematic synthesis of existing evidence is needed to better comprehend its association. The objective of this review was to determine the association between polymorphic variants identified through massive genomic testing and the risk of peripheral diabetic neuropathy in patients with type 2 diabetes mellitus.

METHODS

Inclusion criteria were case-control, cohort, and cross-sectional studies examining polymorphic variants and diabetic neuropathy (DNP) risk in type 2 diabetes, studies using GWAS, EWAS, or microarray for identifying genetic polymorphisms, studies involving adults, and articles in English or Spanish. Exclusion criteria included case reports, case series, ecological studies, editor letters, reviews, or secondary studies and conference abstracts. Exhaustive search in PubMed, Scopus, and Web of Science databases, using keywords. Risk of bias was determined through Newcastle-Ottawa scale. A qualitative synthesis of the results was performed (frequency), including meta-analysis where applicable (forest plot and funnel plot).

RESULTS

The searching strategy identified 370 studies, from which 7 were chosen for the systematic review, included 9478 participants. The quality of the studies was mostly good, but a significant heterogeneity in methods was found. We identify a significant association between peripheral neuropathy and plenty of single nucleotide variants (SNVs). Just the SNV rs10555080 in the gene THEG5 showed a higher likelihood of neuropathy (OR:1,34; IC 95%: 1,19 - 1,49).

DISCUSSION

This study faced limitations due to heterogeneity in DNP definitions, genotyping methods, and a focus on white and Arab populations, limiting generalization. Only English and Spanish articles were included, potentially excluding relevant research in other languages. Multiple SNVs were identified through genomic testing that were associated with peripheral diabetic neuropathy in patients with type 2 diabetes mellitus; however, the SNVs were not similar between studies.

TRIAL REGISTRATION

This research received no funding and was registered in PROSPERO (ID CRD42024505256).

Plasma Fetuin-B Levels are Associated with Nervous Symptoms and Conduction Velocity in Patients with Painful DPN

Aim

To assess the plasma concentrations of the novel hepatokine fetuin-B in individuals with type 2 diabetes with or without diabetic peripheral neuropathy (DPN), and to evaluate the relationship among fetuin-B levels, nervous function, and metabolic parameters.

Methods

A total of 333 participants were recruited and divided into three groups: DPN, painful DPN (pDPN), and non-DPN. Metabolic parameters, peripheral neuropathy-associated indices, and general biochemical parameters were also measured.

Results

Compared with the non-DPN group, general parameters, including age, SBP, BUN, Cr, and ALT, were significantly higher in the DPN and pDPN groups, and FPG, HbA1c, TC, TG, LDL, BUN, Cr, and UA levels were higher in the pDPN group. The neuropathy symptom score (NSS), neuropathy disability score (NDS), and Douleur Neuropathique en 4 Questions (DN4) were highest in the pDPN group, followed by the DPN group, and lowest in the non-DPN group. Moreover, fetuin B levels showed the same trends as peripheral neuropathy indices. Additionally, oxidative stress markers showed a decrease in total antioxidant capacity (TAC) and an increase in malondialdehyde (MDA) across all groups, with the most pronounced changes observed in pDPN patients. Bivariate correlation analysis showed that fetuin B levels were positively correlated with FPG, TC, LDL, NSS, NDS, DN4, and MDA levels, and negatively associated with TAC after adjusting for age and sex. Furthermore, nerve conduction velocity, including MLT, MRT, SRS, and SLT, showed decreasing trends among tertiles of fetuin B levels.

Conclusion

The current study suggests that circulating fetuin-B levels may be associated with the progression of pDPN and highlights the effects of hepatokine-mediated liver-to-peripheral nervous system crosstalk in DPN.

Levels of DEFA1, Progranulin, and NRG4 in Patients with Autonomic Neuropathy: Potential Biomarkers for Diagnosis and Prognosis

BACKGROUND

Diabetic autonomic neuropathy (DAN) is a severe complication of diabetes that affects the autonomic nervous system, impacting cardiovascular, gastrointestinal, genitourinary, and other systems. This study examines the levels of three potential biomarkers-DEFA1, progranulin, and NRG4-to assess their diagnostic and prognostic value in DAN patients.

METHODS

This observational, single-center study included 80 patients with type 2 diabetes. Clinical data and laboratory results were collected, and serum levels of DEFA1, progranulin, and NRG4 were measured using ELISA. The presence of DAN was assessed using Ewing's tests. Statistical analyses included t-tests, Pearson's correlations, and ROC analysis to explore associations and the predictive values of the biomarkers.

RESULTS

Progranulin levels were significantly elevated in patients with DAN compared to those without (p < 0.05), showing a positive correlation with diabetes duration (r = 0.375; p = 0.01) and a significant predictive value for DAN (AUC = 0.666; p = 0.013). DEFA1 and NRG4 levels did not differ significantly between the groups. Progranulin was also higher in patients who were treated with sulfonylureas and GLP-1 receptor agonists and in those with coronary artery disease.

CONCLUSIONS

Progranulin emerges as a potential biomarker for the presence and severity of DAN, correlating with disease duration and autonomic dysfunction. While DEFA1 and NRG4 showed no significant association, the findings underscore the importance of further exploring the inflammatory pathways in DAN. Progranulin measurement could enhance early diagnosis and personalized management of autonomic neuropathy in diabetes.

Neuropathy and the metabolic syndrome

Obesity and the metabolic syndrome (MetS) are major global health challenges that contribute significantly to the rising prevalence of type 2 diabetes (T2D) and neuropathy. Neuropathy, a common and disabling complication of T2D, is characterized by progressive distal-to-proximal axonal degeneration, driven in part by mitochondrial dysfunction in both neurons and axons. Recent evidence points to the toxic effects of saturated fatty acids on peripheral nerve health, with studies demonstrating that these fats impair mitochondrial function and bioenergetics, leading to distal axonal loss. Conversely, monounsaturated fatty acids are found to be neuroprotective, restoring mitochondrial function and preventing neuropathy. These findings suggest that dietary factors play a crucial role in the pathogenesis of neuropathy associated with metabolic dysregulation and emphasize the need for lifestyle interventions and therapies that target these newly identified mechanisms.

Diabetes Complications and Comorbidities as Risk Factors for MACE in People With Type 2 Diabetes and Their Development Over Time: A Danish Registry-Based Case-Control Study

AIM

This study aimed to investigate the association between cardiovascular risk factors and major adverse cardiovascular events (MACE) in people with type 2 diabetes, while assessing potential changes over time.

METHODS

Utilizing data from Danish registries, this study identified people with type 2 diabetes between 2002 and 2021 (n = 372 328) and subdivided them into two 10-year time periods: TP1: 2002-2011 and TP2: 2012-2021, and further categorized into cases and controls. Cases were defined as having suffered a first-time three-point MACE (nTP1 = 12 713, nTP2 = 8981) and matched 1:1 with controls on age, sex, and type 2 diabetes duration. Exposures were preselected diabetes complications and comorbidities.

RESULTS

Fewer were affected by MACE during TP2 compared to TP1 (p < 0.001). Diabetes complications associated with MACE were nephropathy (ORTP1 = 1.54, 95% CI 1.30-1.83, ORTP2 = 1.47, 95% CI 1.20-1.79), neuropathy (ORTP1 = 2.02, 95% CI 1.84-2.21 ORTP2 = 1.58, 95% CI 1.44-1.73) and retinopathy (ORTP1 = 1.10, 95% CI 0.98-1.23, ORTP2 = 1.38, 95% CI 1.17-1.63). Comorbidities associated with MACE included hypertension (ORTP1 = 1.30, 95% CI 1.22-1.38 ORTP2 = 1.31, 95% CI 1.22-1.41), atrial flutter or fibrillation (ORTP1 = 1.46, 95% CI 1.35-1.58, ORTP2 = 1.37, 95% CI 1.26-1.50), heart failure (ORTP1 = 1.53, 95% CI 1.401.67-, ORTP2 = 1.37, 95% CI 1.23-1.54) and hypercholesterolemia (ORTP1 = 1.13, 95% CI 1.07-1.20, ORTP2 = 1.02, 95% CI 0.96-1.10). Hypercholesterolemia (p = 0.038) and neuropathy (p = 0.038) exhibited a significant decrease in association with MACE between the time periods.

CONCLUSIONS

The prevalence of first-time MACE decreased over time, despite a relatively stable prevalence of type 2 diabetes. Several diabetes-related complications and comorbidities were significantly associated with MACE. The associations of neuropathy and hypercholesterolemia with MACE lessened over time, suggesting potential improvements in risk management or treatment strategies.

The Role of Inflammation in the Pathogenesis of Diabetic Peripheral Neuropathy: New Lessons from Experimental Studies and Clinical Implications

Diabetic peripheral neuropathy (DPN) is one of the most frequent complications of diabetes mellitus (DM). Its pathogenesis is still not entirely clear. Inflammation is increasingly being appreciated as a key factor in its development and progression. The aim of this review was to outline current evidence from experimental research on the role of inflammation in the pathogenesis of DPN and to suggest emerging clinical implications. Beyond commonly assessed interleukins, chemokines and tumour necrosis factor alpha (TNFα), several novel underlying mechanisms and potential therapeutic targets have been unravelled. Pathogenesis is also influenced by dietary patterns, such as iron supplementation. Furthermore, the impact of the inflammasome nucleotide-binding oligomerisation domain-like receptor pyrin domain-containing protein 3 (NLPR3) is gaining importance. The same holds true for inflammatory pathways, such as the Toll-like receptor (TLR)-associated pathways or the phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) pathway. SIRTuins are also of importance. DPN is associated with changes in macrophage polarisation. In addition, several metalloproteinases are emerging as contributors, although data is still limited. Finally, miRNAs (e.g. miR146a) are strongly linked with DPN by acting in several inflammatory pathways. However, we still need confirmation of preliminary research findings. It is hoped that new knowledge will lead to new therapeutic approaches, including stem cell-based or exosome-based therapies.

siRNA targeting PARP-1 alleviates diabetic peripheral neuropathy in a streptozotocin-induced rat model

Diabetic peripheral neuropathy (DPN) is a debilitating complication of diabetes mellitus, affecting nearly 50% of diabetic patients and leading to chronic pain, numbness and progressive sensory and motor function loss. This study investigates the potential of siRNA-mediated silencing of poly(ADP-ribose) polymerase 1 (PARP1) to alleviate DPN in a rat model. PARP1 overactivation, driven by hyperglycaemia-induced oxidative stress, exacerbates neuronal damage in DPN. Using chitosan nanoparticles (ChNPs) to deliver PARP1-targeting siRNA intrathecally in diabetic rats induced with streptozotocin (STZ) 55 mg/kg intraperitoneally, we conducted behavioural and physiological assessments, including Sciatic Functional Index (SFI), motor nerve conduction velocity (MNCV), grip strength and pain sensitivity tests, alongside qRT-PCR analyses, to evaluate therapeutic outcomes. Our findings indicate statistically significant improvements, with siRNA ChNPs-mediated PARP1 silencing alleviating neuropathic symptoms in DPN rats (p < .001 for SFI and MNCV improvements). Biochemical analyses revealed reductions in oxidative stress markers, such as MDA, and increased antioxidant levels, including GSH, CAT and SOD (p < .001). Pro-inflammatory cytokines and apoptotic markers, including NF-κB, IL6, IL1β, TNFa, TGF-β, CAS3, CAS9, BAK and BAX, also showed significant reductions (p < .01), confirming the neuroprotective effects of PARP1 inhibition. These results highlight the potential of siRNA-based therapies targeting PARP1 as a promising therapeutic approach for DPN, paving the way for future research with clinical applications.

Electrospinning strategies targeting fibroblast for wound healing of diabetic foot ulcers

The high incidence and prevalence of diabetic foot ulcers (DFUs) present a substantial clinical and economic burden, necessitating innovative therapeutic approaches. Fibroblasts, characterized by their intrinsic cellular plasticity and multifunctional capabilities, play key roles in the pathophysiological processes underlying DFUs. Hyperglycemic conditions lead to a cascade of biochemical alterations that culminate in the dysregulation of fibroblast phenotype and function, which is the primary cause of impaired wound healing in DFUs. Biomaterials, particularly those engineered at the nanoscale, hold significant promise for enhancing DFU treatment outcomes. Electrospun nanofiber scaffolds, with their structural and compositional similarities to the natural extracellular matrix, serve as an effective substrate for fibroblast adhesion, proliferation, and migration. This review comprehensively summarizes the biological behavior of fibroblasts in DFUs and the mechanism mediating wound healing. At the same time, the mechanism of biological materials, especially electrospun nanofiber scaffolds, to improve the therapeutic effect by regulating the activity of fibroblasts was also discussed. By highlighting the latest advancements and clinical applications, we aim to provide a clear perspective on the future direction of DFU treatment strategies centered on fibroblast-targeted therapies.

Efficacy of Frequency Rhythmic Electrical Modulated System (FREMS) in the treatment of diabetic neuropathy: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Painful diabetic peripheral neuropathy (DPN) is a debilitating complication of diabetes with limited treatment options. Frequency Rhythmic Electrical Modulated System (FREMS), a non-invasive electrotherapy, has shown promise in symptom management.

METHODS

Databases, including PubMed, Scopus, and Embase were searched until October 2024. Randomized controlled trials (RCTs) involving adults with DPN comparing FREMS with control were included. Data on Visual Analog Scale (VAS) scores and nerve conduction were extracted. Standardized mean differences (SMDs) with 95 % confidence intervals (CIs) were pooled using random-effects models. Risk of bias was assessed using RoB 2. Heterogeneity was quantified via I2 statistics, with sensitivity analyses and publication bias evaluation.

RESULTS

Five RCTs (333 participants) were included. Meta-analysis indicated that FREMS significantly reduced daytime VAS pain scores post-treatment (SMD -0.56, 95 % CI -0.82 to -0.29, I2 = 4 %) and at follow-up (SMD -0.47, 95 % CI -0.73 to -0.21, I2 = 0 %). Night-time VAS pain scores also improved post-treatment (SMD -0.54, 95 % CI -0.80 to -0.27, I2 = 44 %) and at follow-up (SMD -0.38, 95 % CI -0.65 to -0.12, I2 = 1 %). FREMS improved motor nerve conduction but showed no effect on sensory conduction or microvascular blood flow.

CONCLUSION

FREMS effectively reduces DPN pain with sustained benefits and a favorable safety profile. Further research should standardize treatment protocols and assess long-term outcomes for clinical integration.

Intervention effects of low-level laser therapy (LLLT) on grade I-II ulcers in diabetic foot patients: A meta-analysis

This study aims to systematically evaluate the effect of low-level laser therapy on grade I-II diabetic foot ulcers. We conducted a systematic search of the PubMed, Embase, Web of Science, EBSCO, Cochrane, ClinicalKey, Ovid Medline, Sinomed, CNKI, and WANFANG databases for studies assessing the efficacy of low-level laser therapy for diabetic foot ulcers, with a cutoff date of 15 September 2024. Two researchers independently selected relevant studies and extracted data, utilising RevMan 5.4 software to perform a meta-analysis. A total of 11 studies involving 657 participants with grade I-II diabetic foot ulcers were included. In patients with grade I-II diabetic foot ulcers, low-level laser therapy significantly increased the complete healing rate (RR = 4.97, 95% CI: 2.65-9.32, p < 0.00001), the wound shrinkage area (MD = 7.76, 95% CI: 6.51-9.0, p <0.00001), and the wound bacterial clearance rate (RR = 3.72, 95% CI: 2.16-6.39, p <0.00001) compared to the control group, while also reducing the infection rate (RR = 0.11, 95% CI: 0.01-0.8, p <0.03). Low-level laser therapy is an effective adjuvant therapy that accelerates wound healing in patients with grade I-II diabetic foot ulcers. However, further research is necessary to validate its effects on wound area reduction rate and healing time.

Outcomes of Hallux Amputation Versus Partial First Ray Resection in People with Non-Healing Diabetic Foot Ulcers: A Pragmatic Observational Cohort Study

There are few data comparing outcomes after hallux amputation or partial first ray resection after diabetic foot ulcer (DFU). In a similar context, the choice to perform one of these two surgeries is attributable to clinician preference based on experience and characteristics of the patient and the DFU. Therefore, the purpose of this study was to determine the more definitive surgery between hallux amputation and partial first ray resection. We abstracted data from a cohort of 70 patients followed for a 1-year postoperative period to support clinical practice. We also attempted to identify patient characteristics leading to these outcomes. Our results suggested no statistical difference between the type of surgery and outcomes such as recurrence of DFU and amputation at 3, 6, and 12 months or death. However, there was a statistically significantly increased likelihood of re-ulceration for patients with CAD who underwent hallux amputation (p = 0.02). There was also a significantly increased likelihood of re-ulceration for people with depression or a history when the partial ray resection was performed (p = 0.02). Patients with prior amputation showed a higher probability of undergoing another re-amputation with partial ray resection (p = 0.01). Although the trends that emerge from this project are limited to what is observed in this statistical context, where the number of patients included and the number of total observations per outcome were limited, it highlights interesting data for future research to inform clinical decisions to support best practices for the benefit of patients.

Rodent Models of Diabetic Neuropathy, Role of Calcium Homeostasis in Pain and KB-R7943 as a Potential Therapeutic

Diabetic neuropathy (DN) is characterized by nerve damage as a consequence of diabetes mellitus. Diabetes causes high blood glucose and triglyceride levels, which destroy the nerve blood vessels over time and trigger DN. Peripheral neuropathy is the most common type of DN, which encompasses a broad range of symptoms. One fourth of patients with diabetes suffer from neuropathic pain, which decreases their quality of life and puts them at high risk for emotional disturbances and depression. Finding an adequate therapy is an essential element in the cure of painful DN (PDN). Since the pathophysiology of this disease still needs to be elucidated, this has led to the development of various in vivo diabetic models. Animal models of DN not only provide insights into this disease but also are significant drivers for treatment assessment and improvement. In this review, we present the major features of the most commonly used chemically and diet-induced models of PDN in rodents and their progress to date, which are utilized for a better understanding of the disease mechanism for finding novel therapeutics. Considering the role of Ca2+ homeostasis in pain, we also review our recent research data on the Na+/Ca2+ exchanger blocker KB-R7943, which is a potential neuropathic pain reliever in a rodent model of DN.

Analysis of risk factors for foot ulcers in diabetes patients with neurovascular complications

BACKGROUND

Diabetic foot ulcers (DFU), characterized by open sores or wounds primarily occurring on the feet of diabetes patients, are a serious and highly morbid complication of long-standing diabetes, accounting for significant morbidity and mortality. These ulcers develop when diabetes damages both nerves and blood vessels, a combination known as neurovascular complications. Neurovascular disease is a well-established risk factor. While studies have extensively examined risk factors for DFU, few have specifically focused on patients with diabetic neurovascular disease. Therefore, we assess the prevalence and risk factors for DFU in diabetic patients with established neurovascular complications.

METHODS

This study analyzed data from 6722 patients with diabetic neurovascular disease aged over 18 years old from the Southern Medical University Nanfang Hospital (SMUNFH) database (2018-2023) and 2689 patients with the same condition and age range from the National Institutes of Health (NIH) Integrated Surveillance System (NIS) database (2017-2019). The incidence of DFU was determined using information from the NIS database and SMUNFH databases. A binary logistic regression model was employed to explore the risk factors for DFU.

RESULTS

The incidence of DFU among neurovascular disease patients was 13.4% at SMUNH and 25.9% in the NIS Asian population. Multiple regression analysis identified several factors associated with DFU in the SMUNH database, including diabetic retinopathy, diabetic nephropathy, osteomyelitis, coronary heart disease, tinea pedis (fungal foot infection), sepsis, ability to sense a 128 Hz tuning fork (both left and right sides), C-reactive protein (CRP) levels, and urinary albumin-to-creatinine ratio (ACR). Analysis of NIS data revealed that in the broader Asian population, peripheral vascular disorders and osteomyelitis were associated with DFU.

CONCLUSION

The prevalence of DFU is higher in Asia than in China. Focusing on peripheral vascular disorders and osteomyelitis can effectively reduce the prevalence of DFU in the Asian population while addressing diabetic retinopathy, diabetic nephropathy, osteomyelitis, coronary heart disease, tinea pedis, ability to sense a 128 Hz tuning fork, CRP levels, and urinary ACR can be effective in China.

Plantar Thermogram Analysis Using Deep Learning for Diabetic Foot Risk Classification

AIMS

Thermography is a noninvasive method to identify patients at risk of diabetic foot ulcers. In this study, we employed thermography and deep learning to stratify patients with diabetes at risk of developing foot ulcers.

METHODS

We prospectively recorded clinical data and plantar thermograms for adult patients with diabetes who underwent diabetic foot screening. A total of 153 thermal images were analyzed using a deep learning algorithm to determine the risk of diabetic foot ulcers. The neural network was trained using a balanced dataset consisting of 98 thermal images (49 normal and 49 abnormal), with 80% allocated for training and 20% for validation. The trained model was then validated on a separate testing dataset consisting of 55 thermal images (42 normal and 13 abnormal). The neural network was trained to prioritize higher sensitivity in identifying at-risk feet for screening purposes.

RESULTS

Participants had a mean age of 63.1 ± 12.6 years (52.3% female), and 62.1% had been diagnosed with diabetes for more than 10 years. The average body mass index was 27.5 ± 5.6 kg/m2. Of the thermal images, 91 were classified as category 0 and 62 as categories 1 to 3, according to the diabetic foot risk classification system of the International Working Group on the Diabetic Foot. Using five-fold cross-validation, the neural network model achieved an overall accuracy of 71.8 ± 4.9%, a sensitivity of 81.2 ± 10.0%, and a specificity of 64.0 ± 7.4%. Additionally, the Matthews correlation coefficient was 0.46 ± 0.08.

CONCLUSIONS

These results suggest that thermography combined with deep learning could be developed for screening purposes to stratify patients at risk of developing diabetic foot ulcers.

Alpha-Lipoic Acid Treatment Reduces the Levels of Advanced End Glycation Products in Type 2 Diabetes Patients with Neuropathy

Background/Objectives: Type 2 diabetes mellitus (T2DM) and its macro- and microvascular complications are major health concerns with multiple factors, like advanced end glycation products (AGEs), in the background. AGEs induce long-lasting functional modification of the proteins and collagen in the vascular wall and nerve tissue. We investigated the effect of alpha-lipoic acid (ALA) treatment on AGEs, soluble AGE receptor (sRAGE), the AGE/sRAGE ratio, and the parameters of endothelial dysfunction and their correlations. Methods: In our 6-month intervention study, 54 T2DM patients with neuropathy treated according to the actual therapeutic guidelines with unchanged oral antidiabetic drugs were included and treated by daily oral administration of 600 mg ALA. A total of 24 gender and age-matched T2DM patients without neuropathy served as controls. Results: In our work, we first demonstrated the attenuating effect of alpha lipoic acid therapy on AGEs in humans (11.89 (9.44-12.88) to 10.95 (9.81-12.82) AU/μg (p = 0.017)). sRAGE levels or the AGEs/sRAGE ratio were not affected by ALA treatment or by the presence of neuropathy. We found a correlation between the changes of AGEs and the improvement of current perception threshold and progranulin levels, and an inverse correlation with the change of asymmetric dimethylarginine. Conclusions: According to our results, ALA decreases AGEs, which may contribute to the clinically well-known beneficial effect in diabetic neuropathy and improvement of endothelial function.

Physiological mechanisms of neuromuscular impairment in diabetes-related complications: Can physical exercise help prevent it?

Diabetes mellitus is a chronic disorder that progressively induces complications, compromising daily independence. Among these, diabetic neuropathy is particularly prevalent and contributes to substantial neuromuscular impairments in both types 1 and 2 diabetes. This condition leads to structural damage affecting both the central and peripheral nervous systems, resulting in a significant decline in sensorimotor functions. Alongside neuropathy, diabetic myopathy also contributes to muscle impairment and reduced motor performance, intensifying the neuromuscular decline. Diabetic neuropathy typically implicates neurogenic muscle atrophy, motoneuron loss and clustering of muscle fibres as a result of aberrant denervation-reinervation processes. These complications are associated with compromised neuromuscular junctions, where alterations occur in pre-synaptic vesicles, mitochondrial content and post-synaptic signalling. Neural damage is intensified by chronic hyperglycaemia and oxidative stress, exacerbating vascular dysfunction and reducing oxygen delivery. These complications imply a severe decline in neuromuscular performance, evidenced by reductions in maximal force and power output, rate of force development and muscle endurance. Furthermore, diabetes-related complications are compounded by age-related degenerative changes in long-term patients. Aerobic and resistance training offer promising approaches for managing blood glucose levels and neuromuscular function. Aerobic exercise promotes mitochondrial biogenesis and angiogenesis, supporting metabolic and cardiovascular health. Resistance training primarily enhances neural plasticity, muscle strength and hypertrophy, which are crucial factors for mitigating sarcopenia and preserving functional independence. This topical review examines current evidence on the physiological mechanisms underlying diabetic neuropathy and the potential impact of physical activity in counteracting this decline.

The irreversible, towards fatalic neuropathy: from the genesis of diabetes

Diabetic neuropathy is the most prevalent diabetes-associated complication that negatively impacts the quality of life of the patients. The extensive complications of diabetic peoples in the world are the leading cause of neuropathic pain, and over-activation of different biochemical signalling process induces the pathogenic progression and are also corresponding the epidemic painful symptom of diabetic neuropathy. The main prevalent abnormality is neuropathy, which further causing distal symmetric polyneuropathy and focal neuropathy. The exact pathological complication of diabetes associated neuropathic algesia is still unclear, but the alteration in micro-angiopathy associated nerve fibre loss, hyper polyol formation, MAPK signalling, WNT signalling, tau-derived insulin signalling processes are well known. Furthermore, the post-translational modification of different ion channels, oxidative and nitrosative stress, brain plasticity and microvascular changes can contributes the development of neuropathic pain. However, in the current review we discussed about these pathogenic development of neuropathic pain from the genesis of diabetes, and how diabetes affects the physiological and psychological health, and quality of life of the patients. Furthermore, the treatment of diabetic neuropathy with conventional monotherapy and emerging therapy are discussed. In addition, the treatment with phytochemical constituents their mechanisms and clinical evidences are also reported. The future investigation is required on pathological alteration occurs in neuropathic individuals, and on molecular mechanisms as well as the adverse effect of phytochemicals to determine all aspects of neuropathic algesia including effective treatments, which will prevents the sympathetic pain in patients.

Correlation between lipoprotein-associated phospholipase A2 and diabetic peripheral neuropathy in patients with type 2 diabetes mellitus: A cross-sectional study

BACKGROUND

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an enzyme implicated in inflammation and oxidative stress, and has been associated with cardiovascular conditions and adverse outcomes, particularly in diabetes and its complications. However, no prior studies have examined the relationship between Lp-PLA2 and diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM). This research aims to explore the potential association between Lp-PLA2 and DPN.

METHODS

This retrospective study included 880 hospitalized patients with T2DM treated between March 2024 and August 2024 at Nanjing First Hospital. To assess the relationship between Lp-PLA2 and DPN, multiple logistic regression models were applied. The study also utilized restricted cubic spline (RCS) modeling, segmented regression, stratified analysis, and receiver operating characteristic (ROC) curve assessments.

RESULTS

Patients diagnosed with DPN exhibited elevated Lp-PLA2 levels compared to those without DPN. Even after adjusting for multiple variables, Lp-PLA2 was independently associated with a higher likelihood of DPN (odds ratio [OR] 1.011, 95 % confidence interval [CI] 1.008-1.014, P < 0.001). The RCS analysis revealed a nonlinear association, with an inflection point at 215.8 ng/mL. In ROC curve analysis, the area under the curve (AUC) for Lp-PLA2 was 0.664, while the combined indicator AUC was 0.739.

CONCLUSIONS

Serum Lp-PLA2 levels show a significant correlation with the presence of DPN in patients with T2DM. These findings suggest that Lp-PLA2 could serve as a valuable biomarker for identifying patients at risk for DPN, emphasizing the need for close monitoring of T2DM individuals with elevated Lp-PLA2 to mitigate the risk of developing DPN and associated adverse health outcomes.