Diabetic neuropathy

Curcumin nanoparticles loaded in a bioengineering and biodegradable silk-hyaluronan scaffold triggered wound healing by regulating inflammation and accelerating proliferation in a diabetic rat model

The complex causes of diabetic wounds require a combined strategy for effective treatment. Herein we investigated whether bioengineering and biodegradable silk-hyaluronan (SH) scaffold incorporated with curcumin nanoparticles (CN) could promote wound repairing in diabetic rats. Forty-five diabetic animals were randomly divided into the control group, SH group, and CN-incorporated SH (SCN) group. Sampling took place on days 4 and 8 for additional evaluations. Evaluations indicated that the parameters related to regeneration, including wound closure, fibroblasts and blood vessel counts, collagen density, and tensile strength, as well as concentration levels of TGF-β and VEGF in both treatment groups were considerably greater than those of the control group, and these changes were more obvious in the SCN ones. This is while the number of neutrophils and macrophages, and the concentration levels of TNF-α and IL-1β decreased more notably in the SCN group than the other groups. In general, these results indicated that using the complementary or synergistic impacts of curcumin nanoparticles and SH could be a promising approach to accelerate diabetic wound healing.

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.

Impact of Exercise Training in Patients with Diabetic Peripheral Neuropathy: An Umbrella Review

BACKGROUND

Diabetic peripheral neuropathy (DPN) is a common and serious complication of diabetes mellitus, affecting sensory, motor, and autonomic nerves. It increases the risk of foot ulceration and falls. Management typically involves preventive strategies like patient education, risk stratification, and regular foot screenings. Exercise plays a key role in enhancing glycemic control and nerve function, reducing the risk of DPN and related complications. This umbrella review aimed to evaluate the impact of different exercise interventions on patients with DPN.

METHODS

The search was conducted in the following databases: Pubmed, Scopus, Cochrane Library, Embase, and SPORTDiscus, from the establishment of the database up to the search date (September 11, 2023). We included systematic reviews and meta-analyses assessing exercise interventions in adults with type 1 or type 2 diabetes and DPN. Studies were selected based on predefined PICO criteria. The methodological quality of included reviews was assessed using the AMSTAR-2 tool. Results were synthesized narratively and categorized by exercise type and health outcome.

RESULTS

Fourteen reviews were included, examining the effects of various exercise interventions. Duration ranged from one week to 12 months, and studies were conducted in multiple countries. Additionally, we extracted and reanalyzed individual results from 70 primary studies included within the reviews. Some meta-analyses reported significant improvements in fasting glucose and HbA1c (n = 1), neuropathic symptoms (n = 3), physical function (n = 1), static and dynamic balance (n = 2), range of motion (n = 1), and fear of falling (n = 1). No significant effects were found for BMI, ulcer incidence, adverse events, weight-bearing activity, quality of life, or forefoot plantar pressure (n = 1). Outcome assessment tools included the Biodex system (n = 9), single-leg stance (n = 8), Berg Balance Scale (n = 11), and Timed Up and Go (n = 13) for balance; nerve conduction velocity (n = 8), MNSI (n = 6), and Total Symptom Score (n = 3) for nerve function; fasting glucose (n = 3) and HbA1c (n = 5) for glycemic control. Other outcomes included muscle strength (n = 6), functional capacity (n = 6), pain (n = 6), and quality of life (n = 6).

CONCLUSIONS

Exercise training appears to have potential benefits for certain aspects of DPN, neuropathic symptoms, and functional capacity. However, the effects on glycemic control, fall risk reduction, and ulcer prevention remain inconclusive, with significant variability in study outcomes.

Managing surface energy dynamics for enhanced axonal growth: An overview of present and future challenges

To create functional neuronal circuit units during nervous system development and/or regeneration, axons are subjected to guidance signals. Expression of these signals occurs in spatiotemporal variations and is translated by the growth cone into a pathway to reach the connecting target which can be a neuron or a non-neuronal cell such as a muscle cell. This path is generated by interactions with the surrounding environment such as cells or the extracellular matrix, a complex molecular substrate. Understanding the interactions with this last component is essential to stimulate nerve regeneration in the context of motor peripheral nerve trauma, the most common source of disabilities, increasing with aging. The goal is to mimic its composition and specific characteristics using innovative biomaterials and/or implants. This review highlights some aspects of the recent findings in nerve repair. After an introduction to the peripheral nervous system, we present an overview of nerve degeneration and regeneration mechanisms before detailing the strategies used nowadays to optimize nerve (re)growth with a specific focus on the use of electric field. We discuss the advantages and limits of each option in terms of therapeutic applications.

Intradermal Advanced Glycation End-products Relate to Reduced Sciatic Nerve Structural Integrity in Type 2 Diabetes

BACKGROUND

Cardiovascular risk management is beneficial, but stringent glycemic control does not prevent the progression of distal sensorimotor polyneuropathy (DSPN). Persistent hyperglycemia-induced alterations and cardiovascular factors may contribute to diabetes-associated nerve damage. This study aimed to evaluate the correlation between skin auto-fluorescence (sAF), an indicator of dermal advanced glycation end-product (AGE) accumulations, cardiovascular risk, and changes in peripheral nerve integrity.

METHODS

Sixty-two individuals with type 2 diabetes (T2D) (20 women and 42 men), including 29 diagnosed with DSPN (7 women and 22 men), and 10 healthy controls (HC) underwent diffusion tensor MR imaging of the sciatic nerve to assess fractional anisotropy (FA), an indicator of nerve structural integrity. sAF measurements were combined with clinical, serological, and electrophysiological evaluations. Arterial stiffness was assessed via pulse wave velocity (PWV).

RESULTS

sAF (HC 2.1 ± 0.25 AU, nDSPN 2.3 ± 0.47, DSPN 2.6 ± 0.43; p = 0.005) was higher in individuals with DSPN compared to HC (p = 0.010) and individuals without DSPN (p = 0.035). Within the group of T2D FA correlated negatively with sAF (r = -0.49, p < 0.001), PWV (r = -0.40, p = 0.009) and high-sensitivity troponin T (hsTNT), a marker of microvascular damage (r = -0.39, p < 0.001). In DSPN, sAF correlated positively with hsTNT (r = 0.58, p = 0.005) and with PWV (r = 0.52, p = 0.007), the sciatic nerve's FA correlated negatively with PWV (r = -0.47, p = 0.010).

CONCLUSIONS

This study is the first to show close correlations between reduced peripheral nerve integrity and both intradermal AGE deposition and arterial stiffness in individuals with T2D. These findings highlight a mechanistic link between glycation-related vascular injury and neuronal damage emphasizing the importance of cardiovascular risk management in preventing DSPN.

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.

Surface electromyography for characterizing neuromuscular changes in diabetic peripheral neuropathy

PURPOSE

Distal symmetric polyneuropathy (DSP) is the most common diabetic neuropathy (75% of all diabetic neuropathies), potentially leading to plantar ulcers and lower limb amputation. Early detection of at-risk individuals is essential for timely intervention. This study aimed to evaluate different surface EMG (sEMG) parameters from isometric and dynamic exercises as biomarkers for early DSP detection and monitoring.

METHODS

The study involved 61 participants (34 controls and 27 cases with low, moderate and high levels of severity). sEMG signals were recorded from four lower-limb muscles (tibialis anterior, medial gastrocnemius, extensor digitorum brevis, and flexor digitorum brevis) and characterized by their amplitude, frequency, complexity and shape.

RESULTS

Significant sEMG differences were found between controls and diabetic patients at low and moderate/high DSP risk, especially in the extensor digitorum and flexor digitorum muscles during isometric and dynamic exercises. Diabetic patients showed lower amplitude and complexity, with higher frequency, peakedness, and asymmetry.

CONCLUSION

Parameters like root mean square, sample entropy, and central shape distance effectively distinguished between groups, highlighting changes in motor unit recruitment and muscle quality. Dynamic and isometric exercises emphasized their complementary roles in assessing muscle function, supporting sEMG's potential as a non-invasive tool for monitoring neuromuscular changes in diabetes.

N-acetyl-L-cysteine mitigates diabetes-induced impairments in sciatic nerve

Diabetic neuropathy is a consequence of long-term hyperglycemia. The emergence of neuronal condition is a result of hyperglycemia-induced oxidative stress. In the present study, streptozotocin-induced diabetes exhibited notable decrease in the levels of phospholipids, glycolipids, gangliosides, and triglycerides in the sciatic nerve. The alterations in lipids resulted in increase in cholesterol to phospholipid ratio in sciatic nerve of diabetic animals. This ratio is crucial and determines the rheological properties of membranes and resulted in substantial reduction in the activity of membrane-bound enzymes; Ca2 + ATPase and acetylcholinesterase. Histological examination of the cross-section of the sciatic nerve in diabetic mice revealed axonal atrophy and disarrayed myelin sheath. The potential therapeutic impact of N-acetyl Cysteine (NAC), a powerful antioxidant, on a rat model of diabetic neuropathy was evaluated. NAC was administered to rats in drinking water for a period of 8 weeks. The results indicate that administration of NAC restored lipid composition; ratio of cholesterol to phospholipids, the activity of membrane linked enzymes, and improved the structural defects in sciatic nerve. NAC plays protective role against diabetes-induced alterations in lipid composition in sciatic nerve membranes leading to improvement in structure and function of membranes. Overall, the findings suggest NAC as a potential therapeutic strategy in preventing diabetic neuropathy and other diabetic complications.

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.

Empowering Pharmacists in Type 2 Diabetes Care: Opportunities for Prevention, Counseling, and Therapeutic Optimization

Diabetes is a growing chronic disease with complications that impose a significant burden on healthcare systems worldwide. Pharmacists are readily accessible for diabetes management beyond simply dispensing medications. Consequently, they are involved in disease prevention and detection, therapy management, and patient monitoring. However, with the current escalating impact of diabetes, pharmacists must upgrade their strategies by integrating guidelines from sources like the American Diabetes Association (ADA) 2024 with pharmacy expertise. This perspective serves as a guide for pharmacists, identifying key foundations involved in diabetes management, highlighting five crucial steps for optimal disease control, ranging from prevention strategies to pharmacist-led counseling interventions. We employed PubMed, CDC, WHO guidelines, and key reference texts. Searches were performed using combinations of terms such as "pharmacist", "type 2 diabetes", "diabetes prevention", "pharmacist intervention", and "diabetes management", covering publications from January 2010 to March 2025. Studies were included if they focused on pharmacist-led prevention, intervention, or management strategies related to type 2 diabetes (T2D) and were published in English. Studies focusing exclusively on type 1 diabetes were excluded. Generative artificial intelligence was employed to order and structure information as described in the acknowledgments. Conflicting evidence was resolved by giving relevance to recent systematic reviews, randomized trials, and major guidelines. Additional insights were gained through consultations with PharmD professionals experienced in diabetes care. Evidence from selected studies suggests that pharmacist-led care models may enhance and promote the early detection of T2D, improve therapy adherence, enhance glycemic control, and increase overall treatment efficiency. This work suggests that pharmacists must play a key role in diagnosing, preventing, managing, and mitigating the consequences associated with T2D. They must contribute to early treatments with appropriate training and involvement to improve therapeutic outcomes and reduce diabetes-related complications.

A novel fullerene-lysine derivative with noticeable ROS scavenging capabilities for improving type 2 diabetes mellitus

As some of the most promising candidates available, fullerene-derived bioactive agents have been explored as new drugs with high efficacy and safety for biomedical applications. In this study, a fullerene-lysine derivative (C60-Lys) was synthesized successfully and proved to be good at treating type 2 diabetes mellitus (T2DM). C60-Lys could alleviate oxidative stress both in streptozotocin (STZ)-induced MIN6 cells and in STZ-induced T2DM mice subjected to a high-fat diet, and it significantly normalized glucose uptake and reduced blood glucose. In addition, C60-Lys can alleviate insulin resistance, hyperinsulinemia and lipid levels in T2DM mice. It was further confirmed that C60-Lys could alleviate oxidative stress by increasing the activities of antioxidant enzymes and stabilizing the mitochondrial membrane potential (MMP) of pancreatic β-cells to reduce the overproduction of ROS. The results provide compelling evidence that C60-Lys possesses promising applications for T2DM treatment.

Prevalence and determinants of complications of type 2 diabetes in a community screening program in Kerala

Introduction

This study aims to estimate the prevalence and identify the determinants of peripheral neuropathy (PN), retinopathy and peripheral arterial disease (PAD) among persons with type two diabetes mellitus.

Methods

A cross-sectional study with a two-stage cluster sampling was conducted in Kerala in 33 clusters among individuals with type 2 diabetes. The first 85-90 participants who visited the camp with a duration of diabetes of more than a year were enrolled in the study from 33 camps. Thus, a total of 3083 persons with diabetes were enrolled. Mixed effects logistic regression was used to find the factors associated with diabetic retinopathy (DR), PN and PAD.

Results

The prevalence of PN, DR and PAD was found to be 48.5% (95% CI 46.74 to 50.26), 28.9% (95% CI 27.36 to 30.56) and 46.3% (95% CI 42.65 to 49.95) respectively. Increased risk of PN was observed among participants with age >60 years (aOR 1.71; 95% CI 1.41 to 2.03), diabetes duration >15 years (aOR 1.88; 95% CI 1.04 to 3.38), unsatisfactory glycosylated haemoglobin (HbA1c) (aOR 1.29, 95% CI 1.05 to 1.61) and unemployment (aOR 1.3, 95% CI 1.09 to 1.59). Women appeared to have a lower risk of 0.68 (95% CI 0.50 to 0.92) compared with men. PAD was higher among those from urban areas (aOR 1.56, 95% CI 1.08 to 2.27). The independent determinants of retinopathy were increasing duration of diabetes from 1.4 (95% CI 1.01 to 1.97) at 6-10 years to 3.58 (95% CI 2.48 to 5.15) more than 15 years and an unsatisfactory HbA1c had a two times (95% CI 1.50, 2.67) higher risk of retinopathy.

Conclusion

There is a high prevalence of peripheral vascular disease, PN and retinopathy in Kerala. Retinopathy is more likely with longer duration of type two diabetes and high HbA1c levels. Older age and longer diabetes duration increase the risk of neuropathy, while PAD is more common in urban areas. This highlights the need to include regular screening through the public health system.

Corneal microstructural changes, and nephropathy, in participants with diabetes mellitus with and without peripheral neuropathy: a systematic review and meta-analysis

The aim of this review is to evaluate corneal microstructural changes and nephropathy in participants with diabetic peripheral neuropathy (DPN+) and without (DPN-) in each of type 1 (T1DM) and type 2 diabetes (T2DM). A systematic review of primary studies was conducted that quantified corneal sub-basal nerve plexus parameters using laser scanning in vivo corneal confocal microscopy (CCM) and DPN+ in at least five humans with diabetes mellitus. CCM parameters examined were corneal nerve fibre density (NFD), nerve branch density (NBD) and nerve fibre length (NFL). Weighted mean difference (±standard error) is reported. Twenty-six studies were included in this meta-analysis (18 for T1DM, 14 for T2DM). This comprised 1,357 participants with T1DM (573,784; DPN+, DPN-), 1,119 with T2DM (598,521; DPN+, DPN-) and 1,032 non-diabetic controls. Compared to T2DM, T1DM participants had larger differences in NFD (8.54 ± 0.83 vs 3.61 ± 0.41), NBD (11.92 ± 1.93 vs 3.56 ± 1.03) and NFL (4.24 ± 0.41 vs 1.65 ± 0.18) between DPN+ and DPN- groups. T1DM participants also had larger differences than T2DM participants in NBD (-21.26 ± 2.90 vs -6.15 ± 1.69) and NFL (-4.25 ± 0.59 vs -2.65 ± 0.31) between DPN- and non-diabetic controls, but smaller, insignificant difference, in NFD (-5.93 ± 0.90 vs -6.39 ± 0.92). eGFR was significantly different between DPN+ and DPN- in T1DM (p < 0.00001) but not in T2DM (p = 0.46). When comparing DPN- to DPN+, ACR was reduced in T1DM (-2.72 ± 1.14) and T2DM (-20.85 ± 8.91). Corneal sub-basal nerve changes and glomerular nephropathy likely precede peripheral neuropathy in T1DM and T2DM, with greater corneal neuropathy in T1DM. The current evidence suggests that CCM may be useful for monitoring the progression of diabetic neuropathy and nephropathy.

Screening the absorbed active components of Danggui Sini Decoction in the treatment of diabetic peripheral neuropathy by network pharmacology combined with molecular docking and dynamics simulation

Diabetic peripheral neuropathy (DPN) is a prevalent and detrimental condition that can be debilitating and even fatal if not treated; however, there remains a dearth of efficacious pharmaceutical interventions for DPN. The Danggui Sini Decoction (DSD), a renowned traditional Chinese medicine prescription, has been utilized in the clinic for the treatment of DPN because of its efficacy in addressing yang deficiency and cold coagulation. However, the active components and underlying mechanisms of DSD remain unclear. In this study, we devised a conventional approach to screen the absorbed active ingredients in DSD, employing LC-MS to identify the principal active compounds of DSD in the blood of rats and then validating these components using network pharmacology for target prediction and molecular dynamics simulations for further validation. We identified 17 potentially active components in the serum and 47 main targets that might be relevant for treating DPN with DSD. These targets were associated with pathways including neuroactive ligand-receptor interaction, HIF-1, and AGE-RAGE signaling pathways, all of which are implicated in diabetic complications. Through molecular docking, we found that glycyrrhetinic acid and betulonic acid-two active components identified by LC-MS in the DSD-containing serum of rats-exhibited strong binding activities with AKT1 and STAT3. Furthermore, molecular dynamics simulations of the docking results indicated that the AKT1-glycyrrhetinic acid and AKT1-betulonic acid complexes were highly stable throughout the kinetic simulations. These findings suggest that the molecular mechanism underlying DSD treatment of DPN may involve the activation of AKT1 by glycyrrhetinic acid and betulonic acid.

Neuroprotective effect of Bergenin in diabetic neuropathy: modulation of AMPK and NF-κB signaling

AIM AND OBJECTIVES

This study explores the therapeutic potential of Bergenin (BER), a plant-derived bioactive compound, in treating diabetic neuropathy, with a focus on its effects on activated protein kinase (AMPK) signaling pathways.

METHODOLOGY

Diabetic rats were randomly divided into several groups: a control group, an STZ-only group, control groups treated with varying doses of BER (10, 20, and 40 mg/kg), and a group treated with pregabalin (PRE) at 10 mg/kg. After the treatment period, blood samples and sciatic nerve tissues were collected for analysis.

RESULTS

The results showed that BER, particularly at the highest dose, produced a sustained reduction in blood glucose levels, indicating a potential dose-dependent effect. BER also significantly alleviated cold allodynia, mechanical allodynia, and mechanical hyperalgesia, supporting its promise as a pain management option for diabetic neuropathy. Treatment with 40 mg/kg BER notably reduced oxidative stress markers and boosted antioxidant levels. Additionally, BER inhibited NF-kβ activity, reduced neuroinflammation, and suppressed the production of inflammatory cytokines such as TNF-α and NF-kβ. Activation of AMPK, confirmed by elevated P-AMPK levels, suggests that BER may help restore damaged cellular pathways associated with diabetic neuropathy.

CONCLUSION

In conclusion, BER demonstrates strong potential as a therapeutic agent, reducing inflammation and oxidative stress while enhancing nerve function, likely through modulation of AMPK signaling pathways.

Rapid Onset of Pain Relief with Crisugabalin in Patients with Diabetic Peripheral Neuropathic Pain: Findings from a Multicenter, Randomized, Double-Blind, Controlled Study

INTRODUCTION

This study aims to evaluate the efficacy and safety of Crisugabalin in patients with diabetic peripheral neuropathic pain (DPNP), with a focus on its rapid onset of action.

METHODS

All the analyses in this study were based on data from a phase 2/3 adaptive randomized clinical trial that enrolled 596 patients. Participants were categorized into four treatment groups according to the intervention received: Crisugabalin 40 mg/day, Crisugabalin 80 mg/day, placebo, and Pregabalin 300 mg/day. The primary endpoint was the change in the average daily pain score (ADPS) over a 13-week treatment period. Secondary endpoints included changes in the Numeric Rating Scale (NRS) and the daily sleep interference score (DSIS) during the first two weeks of treatment.

RESULTS

Both Crisugabalin treatment groups (40 mg/day and 80 mg/day) demonstrated statistically significant reductions in ADPS compared to the placebo group starting from week 1 and continuing through week 13 (P < 0.05). Significant differences in pain relief for the Pregabalin group were observed only from week 6. Improvements in NRS and DSIS scores were also noted in both Crisugabalin groups, with statistically significant enhancements evident as early as day 2 of administration. Safety assessments indicated that Crisugabalin was well-tolerated, with a low incidence of serious adverse events and no significant increase in dropout rates among participants.

CONCLUSION

The findings suggest that Crisugabalin offers effective pain relief with an acceptable safety profile, highlighting its rapid onset in patients with DPNP.

CLINICAL TRIAL REGISTRATION

Clinical trial registration number derived from our parent project, we have retained the original registration identifier: NCT04647773.

Comparison and evaluation of negative pressure wound therapy versus standard wound care in the treatment of diabetic foot ulcers

BACKGROUND

To explore the efficacy, safety, and cost implications of NPWT versus standard wound care (SWC) for Diabetic Foot Ulcers (DFUs).

METHODS

91 patients with DFUs were included in this retrospective study from May 2017 and February 2024. All patients were divided into NPWT (n = 44) and SWC (n = 47) groups based on the surgery methods. Arterial disease severity was assessed via ankle-brachial index (ABI) and Doppler ultrasound, with subgroups categorized as severe ischemia (ABI < 0.4), moderate ischemia (ABI 0.4-0.7), and normal/mild ischemia (ABI > 0.7). Baseline characteristics, wound parameters, healing progression, adverse events, costs, and subgroup outcomes by arterial disease status were compared between two groups.

RESULTS

At the 4-week assessment, the NPWT group exhibited significantly higher mean percentage reduction in wound area (35.01% vs. 32.53%, P = 0.033) and greater reduction in wound depth (2.74 mm vs. 2.14 mm, P = 0.032) compared to the SWC group. A notably higher proportion of NPWT patients achieved complete wound closure (52.27% vs. 27.66%, P = 0.029), resolution of infection (88.64% vs. 68.09%, P = 0.035), and neuropathy improvement (59.09% vs. 34.04%, P = 0.029). NPWT also showed lower wound infection rates (9.09% vs. 29.79%, P = 0.027) but higher skin irritation (31.82% vs. 10.64%, P = 0.026). Subgroup analysis revealed NPWT's superiority in both PAD-positive (48.0% vs. 20.0%, RR = 2.40, 95% CI: 1.12-5.15, P = 0.042) and PAD-negative subgroups (55.2% vs. 30.4%, RR = 1.82, 95% CI: 1.05-3.15, P = 0.031). Even in severe ischemia (ABI < 0.4), NPWT achieved higher closure rates (36.4% vs. 12.5%, P = 0.038). While total treatment costs were comparable (P = 0.084), NPWT reduced hospitalization days (16.05 vs. 21.38 days, P = 0.028) and drug costs (5229.33 RMB vs. 5915.5 RMB, P = 0.030).

CONCLUSION

NPWT is more superior in safety, cost-efficiency, and long-term wound management compared to SWC.

TRIAL REGISTRATION

Not applicable.

The Parkinson's disease DJ-1/PARK7 gene controls peripheral neuronal excitability and painful neuropathy

Parkinson's disease is a progressive neurodegenerative disease with well-documented motor symptoms and less recognized, but significant, non-motor symptoms. These non-motor symptoms include prodromal pain and peripheral neuropathy, the causes of which are unknown. We investigated the role of DJ-1/PARK7, a Parkinson's disease-associated gene, in prodromal pain and peripheral neuropathy. Using Dj-1-deficient mice, we conducted comprehensive sensory tests, cutaneous staining, molecular analyses and electrophysiological studies on mouse and human primary sensory neurons from dorsal root ganglia. We found that these mice exhibited cold hypersensitivity, oxidative stress, and neuropathy of the cutaneous fibres of primary sensory neurons before any motor impairments were observed. Mechanistically, DJ-1 in primary sensory neurons regulated this hypersensitivity and neuropathy via TRPA1 signalling. Interestingly, we discovered that DJ-1 also plays a role in the progression of chemotherapy-induced peripheral neuropathies. Pain and mechanisms associated with these neuropathies were exacerbated in Dj-1-deficient mice but were significantly reduced by the pharmacological activation of Dj-1. Importantly, we also confirmed the expression of DJ-1 and its therapeutic potential in human primary sensory neurons. Thus, we uncover a peripheral mechanism of DJ-1 and propose that it might serve as a new target for developing therapeutic approaches for Parkinson's disease-linked and other painful neuropathies.

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.

Neuropathic pain in diabetic polyneuropathy: a 5-year prospective study

ABSTRACT

There are few prospective studies on neuropathic pain in diabetic polyneuropathy (P-DPN). We aimed to examine the development of P-DPN over time as well as factors associated with both the development of and relief from pain. In this 5-year follow-up study, we included 102 patients with at least probable DPN at baseline, according to the Toronto consensus criteria, recruited from a nationwide Danish cohort of 5514 patients with newly diagnosed type 2 diabetes between 2016 and 2018. All participants underwent detailed phenotyping of both DPN and pain, consisting of a bedside sensory examination, quantitative sensory testing (QST), skin biopsies, and nerve conduction studies at baseline and follow-up. The estimated prevalence (95% CI) of at least probable P-DPN increased from 11.5% (8.2; 14.9) at baseline to 14.8% (9.2; 20.4) at follow-up, with a median (interquartile range) diabetes duration of 11.0 (9.2, 12.2) years. Among 64 patients with baseline nonpainful DPN, 38.2% developed pain at follow-up, while 28.9% of 38 patients with baseline P-DPN did not have pain at follow-up. A higher proportion of patients with baseline dysesthesia developed pain (42.9%), compared with patients without dysesthesia (27.9%, Χ2-test for trend: P < 0.0001). Development of pain was associated with female sex, lower baseline sensitivity to warm stimuli on QST, and lower baseline sural sensory nerve action potential amplitudes. Relief from pain was associated with lower baseline body mass index and cholesterol, as well as higher sensitivity to cold, mechanical, and vibratory stimuli on QST at baseline. This detailed study identified risk factors for neuropathic pain development and cessation.

Changes of intestinal microbiome and its relationship with painful diabetic neuropathy in rats

OBJECTIVE

To analyze the gut bacterial microbiome in rats with painful diabetic neuropathy (PDN) compared to normal rats.

METHODS

Type 2 diabetes was induced in rats via a high-fat and high-sugar diet combined with a low dose of streptozotocin. Glucose metabolism and insulin sensitivity were evaluated using intraperitoneal glucose tolerance tests and insulin tolerance tests. The progression of peripheral neuropathy was assessed using the mechanical withdrawal threshold and thermal withdrawal latency. Histopathological analysis of rat colon tissues was performed using hematoxylin-eosin staining to observe morphological changes. The expression levels of pro-inflammatory cytokines TNF-α and IL-1β in spinal cord tissues were measured using enzyme-linked immunosorbent assay (ELISA). Fecal samples were then collected for metagenomic sequencing and analysis.

RESULT

Behavioral tests revealed reduced mechanical withdrawal threshold and thermal withdrawal latency in PDN rats. Histological analysis showed significant colonic mucosal damage and inflammatory cell infiltration, suggesting impaired intestinal barrier function. Elevated TNF-α and IL-1β levels in spinal cord tissues further highlight peripheral inflammation's role in PDN. Sequencing analysis revealed significant differences in gut microbiota composition between PDN and control rats, with altered Bacillota/Bacteroidota ratios and increased Lactobacillus abundance. Functional annotation analysis, based on the KEGG, EggNOG, and CAZy databases, indicated significant enrichment of metabolic pathways related to carbohydrate and amino acid metabolism, energy metabolism, and cell structure biogenesis in PDN rats. Cluster analysis identified higher functional clustering in Metabolism and Genetic Information Processing pathways in PDN rats.

CONCLUSION

This study demonstrates that PDN leads to altered gut microbiota composition, disrupted metabolic pathways, and increased inflammation, contributing to the pathological progression of diabetic neuropathy. This study provides new insights into the interplay between gut microbiota and diabetic neuropathy, offering potential avenues for therapeutic interventions targeting microbiome and metabolism.

Intraplantar β-Caryophyllene Alleviates Pain and Inflammation in STZ-Induced Diabetic Peripheral Neuropathy via CB2 Receptor Activation

Diabetic peripheral neuropathy (DPN) is a debilitating complication of diabetes, characterized by mechanical allodynia, neuroinflammation, and oxidative stress. Current treatments offer limited efficacy and are often associated with systemic side effects. Emerging evidence suggests that activation of cannabinoid receptor type 2 (CB2) may represent a promising target for managing neuropathic pain and inflammation. This study investigates the therapeutic potential of intraplantar β-Caryophyllene (BCP), a selective CB2 receptor agonist, administered as a topical intervention in a streptozotocin (STZ)-induced DPN mouse model. Hyperglycemia was induced by STZ injections, and diabetic mice received intraplantar BCP (9, 18, or 27 µg) daily for 21 days. Mechanical allodynia was assessed using von Frey filaments, and levels of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6) and oxidative stress markers (MDA, SOD, CAT) were quantified in hind paw tissues. BCP dose-dependently alleviated STZ-induced mechanical allodynia, with the 27 µg dose producing the most pronounced effect (p < 0.001). The anti-allodynic effects of BCP were mediated through CB2 receptor activation, confirmed by reversal with the CB2 antagonist AM630 (p < 0.001), while the CB1 antagonist AM251 had no significant impact. In addition, BCP significantly reduced pro-inflammatory cytokines (p < 0.01) and oxidative stress markers (p < 0.001) while restoring antioxidant enzyme activities (p < 0.05). A control group treated with a clinically available topical analgesic cream containing capsaicin 0.075% exhibited limited efficacy. These findings position topical BCP administration as a novel therapeutic strategy for DPN, offering sustained pain relief and modulation of neuroinflammatory and oxidative pathways with minimal systemic exposure. Further clinical studies are warranted to validate its potential for translation into therapeutic practice.

Transcutaneous Application of Gaseous CO2 Improves Diabetic Distal Symmetrical Polyneuropathy in Patients with and Without Chronic Wounds

The study explores the effects of non-invasive transcutaneous CO2 therapy on diabetic symmetrical peripheral polyneuropathy (DSPN). Overall, we included 120 patients with diabetes: 40 patients with DSPN (group A) and 40 patients with DSPN and diabetic foot ulceration (DFU) (group B), both receiving 20 sessions of CO2 therapy; 40 DSPN patients not receiving treatment (group C). Outcomes were assessed using the Semmes-Weinstein monofilament test, 128 Hz tuning fork vibration sensation, hallux temperature, wound dimensions, and adverse effects. There was a significant improvement in protective sensation for the CO2-treated groups. Group A exhibited a 53% improvement, while Group B improved by 34% (p = .002). In Groups A, B vibration sensation improvement was 30% and 23%, respectively. Hallux temperature increased more in Group A (5.10 °C) compared with Group B (3.89 °C). Improvement in monofilament sensation was observed in both CO2 treated groups, regardless of ankle-brachial index (ABI), with best results in patients having borderline ABI (67.5% in Group A and 53.1% in Group B). In conclusion, CO2 therapy effectively alleviated DSPN symptoms in patients with/without DFUs, with normal or insufficient circulation, and it was well-tolerated without adverse effects.

Dysregulated mast cell activation induced by diabetic milieu exacerbates the progression of diabetic peripheral neuropathy in mice

Diabetic peripheral neuropathy (DPN), a common disorder in diabetes, is associated with severe microenvironment imbalance due to immunometabolic stress. However, the underlying mechanistic drivers remain unclear. Here, we generate a single-cell atlas of human peripheral nerves and identify cell-specific transcriptional changes in DPN as well as aberrant amplification of mast cells. Using streptozotocin-induced mouse diabetes models, we further find that glucose uptake mediated by GLUT3 in high-glucose (HG) diabetic milieu upregulates ERK1/2 phosphorylation in mouse mast cells. Sustained HG stimulation also induces aberrant mTOR hyperactivity, resulting in endoplasmic reticulum stress and mitochondrial oxidative stress, thereby impairing mitochondrial functions of mast cells. Dysregulated mast cells then degranulate and release histamine, tryptase and inflammatory factors into neural microenvironment to cause neuropathy in diabetic mice. Lastly, mice with mast cell deficiency are protected from the immune imbalance in nerves and progression of neuropathy. Our findings thus implicate dysregulated activation of mast cells as a potential driver in the progression of DPN.

Imaging for inflammatory neuropathies

Inflammatory neuropathies comprise a heterogeneous group of conditions united by inflammation-mediated damage to peripheral nerves and their vasa nervorum. Although classification, diagnosis and management are largely based on clinical features, electrodiagnostic and laboratory examinations, imaging studies play an important supporting role. Ultrasound and MRI are the two modalities used for imaging peripheral nerves. The two techniques differ in the clinical context of application, the information provided and the diagnostic performance. This narrative review aims to provide guidance on when and how to use ultrasound or MRI in patients with inflammatory neuropathies, highlighting their respective strengths and pitfalls, and how to combine these imaging modalities to enhance their usefulness in the diagnostic-therapeutic management of these far from rare conditions.

CASPAR: a retrospective cohort study of the high-concentration capsaicin topical system in patients with painful diabetic peripheral neuropathy of the feet

INTRODUCTION

Painful diabetic peripheral neuropathy (pDPN), a common complication of diabetes, is challenging to treat and negatively impacts quality of life (QoL). Many patients either fail to achieve adequate pain relief with current treatments or suffer from systemic side effects with oral options. This study used data from the German Pain e-Registry (GPeR) to evaluate the high-concentration capsaicin topical system (HCCTS) for treating pDPN of the feet.

RESEARCH DESIGN AND METHODS

This retrospective, non-interventional cohort study (CASPAR) included patients with pDPN of the feet who received ≥1 HCCTS treatment (~3-month treatment intervals) and contributed data to the GPeR for ≥12 months. Data were collected on pain intensity, QoL, sleep, mood, concomitant medication, and tolerability.

RESULTS

Overall, 365 patients with pDPN of the feet were included. Significant reductions in 24-hour average pain intensity (API) were observed from baseline to month 3 (following one HCCTS treatment). Further reductions in mean API score were seen over 12 months with ongoing treatments, whereas API increased in patients who discontinued treatment (baseline to month 12 mean API scores: 61.4 to 8.8 for four HCCTS [∆ -52.6], 59.3 to 16.7 for three HCCTS [∆ -42.6], 56.3 to 31.9 for two HCCTS [∆ -24.4], 57.5 to 51.4 for one HCCTS [∆ -6.1]). Similar trends were seen for sleep, mood, and QoL outcomes. There was a significant reduction in concomitant pain medication use in patients receiving ongoing HCCTS treatments. The most common adverse events were local application-site reactions.

CONCLUSIONS

This real-world study in patients with pDPN of the feet demonstrates that ongoing HCCTS treatments continue to improve pain intensity, mood, and QoL, while concomitant medication use decreases. Benefits from treatment were lost following HCCTS discontinuation. These findings emphasize the importance of ongoing treatments to achieve the potential of HCCTS in improving outcomes for patients with pDPN.

Improving HbA1c Levels by Methylcobalamin Vitamin in Diabetic Volunteers, Combined with Dapagliflozin as Type 2 Diabetes Mellitus Routine Treatment: A Controlled Randomized, Double-blind Trial

Background

Diabetes mellitus is predominantly a growing global problem interconnected proportionally with obesity escalation. The current study evaluated the prognostic implications of vitamin B12 administration on Body Mass Index (BMI) and glycosylated hemoglobin (HbA1c) levels in type 2 diabetic patients treated with dapagliflozin.

Methods

In this controlled randomized, double-blind trial, 160 patients for each arm were enrolled from July 2022 to June 2023 in Amman, Jordan.; 76 females and 84 males with inclusion criteria of vitamin B12 less than 233 ng/ml, age between 19-76 years, HbA1c range between 6.8-9.1%, and BMI less than 35. Group I received only dapagliflozin 10 mg/daily for a period of 12 months, whereas, group II received vitamin B12 supplements, methylcobalamin 500 µg, once daily with dapagliflozin 10 mg/day. HbA1c, Vitamin B12, and BMI were measured at time intervals of 0, 6, and 12 months. Using SPSS version 23, P values<0.05 were considered statistically significant. The continuous variables were reported as median and IQR. Mann-Whitney-u test and Correlations Spearman's rho were used for continuous variables.

Results

The co-administration of vitamin B12 significantly decreased the levels of HbA1c in group II (54 participants) to 6.66±0.643 by 0.6 %, F(2,78)=172, P<0.001, compared to the subjects in group I (6.92±0.434). A significant impact of vitamin B12 administration on BMI lowering was observed at different time intervals during the study (P=0.002).

Conclusion

The co-administration of vitamin B12 as a supplement for diabetic patients improved BMI and HbA1c levels.Trial Registration Number: NCT06241638.

SP1 activates AKT3 to facilitate the development of diabetic nephropathy

BACKGROUND

Diabetic nephropathy (DN) is a severe complication of diabetes mellitus and has the complex pathogenesis. The previous study reported that protein kinase Bγ (AKT3) was involved in DN progression. Our aim was to explore the detailed mechanisms of AKT3 in DN development.

METHODS

RT-qPCR was performed to measure the levels of specificity protein 1 (SP1) and AKT3. Mesangial cells were treated with high glucose (30 mM) to form DN cell model in vitro. Western blot was conducted to detect the protein expression of AKT3, SP1, fibrosis-related proteins, and AKT/mTOR pathway-related proteins. Cell proliferation and inflammation were evaluated via MTT, EdU staining, and ELISA assays, respectively. Oxidative stress was determined via measuring ROS and MDA levels. ChIP and dual-luciferase reporter assays were carried out to verify the relationship between SP1 and AKT3. C57BL/6 mice-treated with streptozotocin for 5 days were used to establish DN mouse model in vivo, and HE and Masson staining were conducted to evaluate pathological changes of mouse kidney tissues.

RESULTS

AKT3 and SP1 were highly expressed in DN kidney tissues and HG-induced mesangial cells. AKT3 depletion could relieve HG treatment-caused cell damage of mesangial cells through repressing cell proliferation, fibrosis, inflammation and oxidative stress. SP1 can bind to the promoter of AKT3 and serve as a translation regulation factor of AKT3. SP1 overexpression worsened HG treatment-caused cell damage of mesangial cells. Moreover, AKT3 upregulation could block the suppressive effects of SP1 depletion on cell proliferation, fibrosis, inflammation and oxidative stress in HG-induced mesangial cells. SP1 depletion reduced AKT3 expression to inactivate the AKT/mTOR pathway in HG-induced mesangial cells. Besides, AKT3 knockdown inhibited the activation of the AKT/mTOR pathway to hamper the development of DN in mice through alleviating fibrosis and inflammation in vivo.

CONCLUSION

Our results indicated that SP1 activated AKT3 and AKT/mTOR pathway to promote mesangial cell proliferation, fibrosis, inflammation and oxidative stress, thereby facilitating DN development.

Panic attack symptoms in patients with diabetic peripheral neuropathy

Assessment of diabetic peripheral neuropathy (DPN) usually focuses on nerve damage resulting from hyperglycaemia. However, screening for common psychiatric disorders may improve the recognition of psychopathology in patients with DPN. This epidemiological cohort study aimed to evaluate the prevalence of panic attack symptoms in patients with DPN compared toa control group of healthy individuals without type 2 diabetes mellitusorDPN.Additionally, this study sought to compare the severity of these symptoms between the two groups.The study was conducted via a survey over three years in an accredited practice of physicians at the Medical University-Sofia. A total of267 participants were included, comprising 83 patients with DPN and 184healthy controls. Both groups completed the Prime-MD Patient Health Questionnaire. The results indicated significant differences between the two study groups(t[127.513] = 3.293; p < 0.01), and patients with DPN had a higher prevalence of panic attack symptoms than those in the control group.Furthermore, significant differences were observed in the severity of panic attack symptoms within the DPN group (t[(81] = 2.017, p < 0.05).Patients who had experienced DPN for more than one year reported more severe symptoms than those who had experienced it for less than oneyear. Our results indicate that the high prevalence of panic attack symptoms inpatients with DPN highlights the need for integrated screening for psychiatric disorders within the overall management plan for diabetes mellitus.

Flavonoids regulating NLRP3 inflammasome: a promising approach in alleviating diabetic peripheral neuropathy

A common and serious side effect of diabetes is diabetic peripheral neuropathy (DPN), which is characterised by gradual nerve damage brought on by oxidative stress, chronic inflammation, and prolonged hyperglycemia. Studies identify NLRP3 inflammasome as a key mediator in the pathogenesis of DPN, connecting neuroinflammation and neuronal damage to metabolic failure. Because of their strong anti-inflammatory and antioxidant qualities, flavonoids, a broad class of naturally occurring polyphenols, have drawn interest as potential treatments for DPN. The various ways that flavonoids affect the NLRP3 inflammasome and their potential as a treatment for DPN are examined in this review. It has been demonstrated that flavonoids prevent NLRP3 activation, which lowers the release of pro-inflammatory cytokines including IL-1β and IL-18 and causes neuroinflammation. Flavonoids work mechanistically by reducing oxidative stress, altering important signalling pathways, and blocking the activities of NF-κB and caspase-1, which are both essential for the activation of the NLRP3 inflammasome. Preclinical research has shown that flavonoids have strong neuroprotective benefits, and few clinical evidence also points to the potential of flavonoids to improve nerve function and lessen neuropathic pain in diabetic patients. The current review emphasises how flavonoids may be used as a treatment strategy to target inflammation in DPN caused by the NLRP3 inflammasome. By targeting important inflammatory pathways, flavonoids provide a new way to slow the progression of this debilitating illness. Further investigation into the mechanisms, clinical translation, and novel drug delivery techniques could enhance the therapeutic efficacy of diabetic peripheral neuropathy.

Alpha-Tocopherol-Loaded Liposomes Reduce High Glucose Induced Oxidative Stress in Schwann Cells: A Proof of Concept Study

Although oxidative stress is the main pathophysiology of the development of diabetic neuropathy, oral administration of antioxidants has given disappointing results. Here, we hypothesized that local delivery of antioxidants would provide protective effects on Schwann cells due to the high concentration of local lesions. We prepared alpha-tocopherol (ATF)-loaded liposomes and tested their skin penetration after sonication. An in vitro study using IMS-32 cells was conducted to determine the level of reactive oxygen species (ROS) scavenging effects of ATF-liposomes. ATF reduced ROS in high-glucose-exposed IMS-32 cells in a dosedependent manner. ATF-liposomes also reduced the ROS level in vitro and ultrasound irradiation enhanced delivery to the dermis in porcine ear skin. This study showed that it is feasible to deliver ATF through the skin and can effectively reduce ROS. This model is worthy of development for clinical use.

From receptor to response: dissecting the TLR4 pathway in diabetic neuropathy

Diabetic neuropathy (DNP) is a common complication of diabetes that has a significant impact on the patient's quality of life. The primary objectives of clinical treatment for DNP these days are symptomatic pain management and glycemic control. Since there is currently no cure for nerve damage, the only objective is to alleviate discomfort and slow its progression. Pre-clinical research over the last decade has increasingly linked toll-like receptor 4 (TLR4)-mediated neuroinflammation as a major contributor to DNP development. The role of TLR4-mediated neuroinflammation in the pathophysiology of DNP is covered in this review, along with different therapeutic approaches that target TLR4-mediated neuroinflammation in DNP in pre-clinical research. Despite promising pre-clinical results, translating these findings into clinical practice remains a challenge, which we also discuss how to address and overcome in this review.

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.

Artificial Intelligence Algorithm to Screen for Diabetic Neuropathy: A Pilot Study

Background/Objectives: Patients with type 2 diabetes (T2D) are at risk of developing multiple complications, and diabetic polyneuropathy (DPN) is by far the most common. The purpose of the present study was to assess the ability of a new algorithm based on artificial intelligence (AI) to identify patients with T2D who are at risk of DPN in order to move on to further instrumental evaluation with the biothesiometer method. Methods: This is a single-centre, cross-sectional study with 201 consecutive T2D patients recruited at the Diabetes Operating Unit of the ULSS 6 of Padua (Northeast Italy). The individual risk of developing DPN was calculated using the AI-based MetaClinic Prediction Algorithm and compared with the DPN diagnosis provided by the digital biothesiometer method, which measures the vibratory perception threshold (VPT) on both feet. Results: Of the enrolled patients, 107 (53.23%) were classified by AI software as having a low probability of developing DPN, 39 (19.40%) as having a moderate probability, 29 (14.43%) as having a high probability, and 26 (12.94%) as having a very high probability. In 63 of the total patients, biothesiometer measurement showed a VPT ≥ 25 V, indicative of DPN, while 138 patients had a non-pathological VPT value (< 25 V) (prevalence of abnormal VPT 31.34%; prevalence of normal VPT 68.66%). The overall agreement between biothesiometer results and AI risk attribution was 65%. Cohen's κ was 0.162, and Gwet's AC1 coefficient 0.405. Conclusions: The use of an optimized AI algorithm can help estimate the risk of developing DPN, thereby guiding more targeted and in-depth screening, including instrumental assessment using the biothesiometer method.

The Trigeminal Nerve in Diabetes Mellitus: A Brief Narrative Review

This brief narrative review discusses the clinical manifestations, diagnosis, and management of trigeminal nerve-related conditions, such as neuropathy and neuralgia, in patients with diabetes mellitus. Although these conditions are not very common, there is a solid connection between them in diabetes patients. Symptoms typically include facial pain, sensory disturbances, and muscle weakness for neuropathy and severe, stabbing pain for neuralgia. Diagnosis is based on characteristic clinical manifestations, along with laboratory investigation and magnetic resonance imaging to exclude other potential causes, such as tumours, multiple sclerosis, or vascular compression. Treatment focuses on strict glycaemic control, modification of vascular risk factors, pharmacological agents (carbamazepine and oxcarbazepine), and neurostimulation to improve symptoms and quality of life.

A low-power approach to optical glucose sensing via polarisation switching

High-precision polarimetry is crucial for sensing and imaging applications, particularly for glucose monitoring within the physiological range of 50 to 400 mg/dl. Traditional approaches often rely on polarisation modulation using magneto-optic or liquid crystal modulators, which require high voltages or currents, limiting their practicality for wearable or implantable devices. In this work, we propose a polarisation-switching technique that alternates between two discrete polarisation states, offering a low-power alternative with miniaturisation potential. Using this method, we achieved a Mean Absolute Relative Difference of 7.7% and a Standard Error of Prediction of 9.6 mg/dl across the physiological glucose range, comparable to commercial continuous glucose monitors. Our approach demonstrates a limit of detection of approximately 40 mg/dl, with measurements performed in phosphate-buffered saline spiked with glucose. This work establishes polarisation switching as a viable alternative for glucose sensing, providing a foundation for future development of wearable and implantable glucose monitoring systems. By eliminating power-intensive components, our approach addresses key limitations of traditional polarimetric methods, paving the way for more accessible and energy-efficient diabetes management technologies.

Determinants of life satisfaction in older adults with diabetes in China: a national cross-sectional study

Background

The life satisfaction (LS) of individuals among older adults with diabetes should not be neglected. However, current research provides limited insight into the LS of older adults with diabetes in China. Therefore, the primary objective of this study is to assess the current life satisfaction status of older adults with diabetes in China, to delve into the factors influencing it, and to identify the key factors.

Methods

This study selected 1,304 patients with diabetes from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database for analysis. A multivariate logistic regression model was used to analyze the factors influencing life satisfaction among diabetic patients, and a random forest model was further utilized to rank the importance of significant influencing factors.

Results

30.14% of older adults with diabetes were dissatisfied with their lives. Multivariate Logistic regression analysis shows that self-assessed health status, self-assessed economic status, depressive symptoms, exercise, living arrangements, hearing impairment, and cognitive impairment all significantly affect the life satisfaction of older adults with diabetics. The OR values for self-assessed health and self-assessed economic status are relatively high, patients with fair and poor self-assessed health was 5.03 times and 9.72 times higher risk of life dissatisfaction compared to those with good self-assessed health (fair: OR = 5.03, 95% CI: 3.46-7.31; poor: OR = 9.72, 95% CI: 6.20-15.26). The risk of feeling dissatisfied with life was 7.69 times higher in patients with poor self-assessed economic status than in those with good self-assessed economic status (OR = 7.69, 95%CI: 4.25-13.89). The random forest results showed that the order of importance from highest to lowest was self-assessed health status, self-assessed economic status, depressive symptoms, exercise, living arrangements, hearing impairment, and cognitive impairment.

Conclusion

Our study reveals that the current rate of life satisfaction among older adults with diabetes is significantly high. Therefore, it is essential to implement measures from multiple perspectives for effective prevention and intervention. Among these factors, priority should be given to interventions focusing on economic support and health management, as these measures may serve as crucial protective factors in enhancing the well-being of older adults with diabetes.

Significant Impacts of the Body-Mass Index, Blood Pressure, Blood Glucose, and Ankle-Brachial Index on Peripheral Neuropathy Risk in Indonesian With Type 2 Diabetes: A Cross-Sectional Study

Background: Diabetic peripheral neuropathy is associated with morbidity and mortality in people with diabetes mellitus. Aims: In this study, we determined relationships of the body-mass index (BMI), systolic blood pressure, diastolic blood pressure, fasting blood glucose, HbA1c, and ankle-brachial index (ABI) with diabetic peripheral neuropathy risk. Methods: A cross-sectional study was conducted with 1088 Indonesians and data collected using self-reported questionnaires, laboratory examinations, and physical examinations. Instruments included a digital scale, height measurement device, digital sphygmomanometer, Doppler ultrasound, 10-g monofilament, and a 128-Hz tuning fork. Data analysis used the Chi-square test, Fisher Exact, and multiple logistic regression test with significance p < .05. Results: The BMI (p < .001), blood pressure (p < .001), ABI (p < .001), fasting blood glucose (p = .016), and HbA1c (p < .001) were significantly related to peripheral neuropathy risk. The conditions of obesity, hypertension, high ABI, high fasting blood glucose, and high HbA1c significantly increased the risk of peripheral neuropathy. Moreover, participants with ≥4 co-occurring abnormal levels of the BMI, systolic blood pressure, diastolic blood pressure, fasting blood glucose, HbA1c, and ABI had significantly synergistically increased risks of peripheral neuropathy, and the more abnormal conditions there were, the higher the risk of peripheral neuropathy. Conclusions: Abnormalities of the BMI, blood pressure, fasting blood glucose, HbA1c, and ABI significantly and synergistically increased the risk of peripheral neuropathy and can be considered predictors of peripheral neuropathy. Nurses are expected to be aware of these predictors so that they can immediately take appropriate steps if they encounter abnormal conditions by optimizing their role as educators.

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.

A real-world multicenter cross-sectional observational study to assess the clinical profile of peripheral neuropathy in patients with diabetes

BACKGROUND

There are limited studies on the prevalence of diabetic peripheral neuropathy (DPN) and related foot deformities in patients with T2DM from India.

AIM

To investigate the prevalence, characteristics, and risk factors for foot deformities in Asian-Indian individuals with T2DM and DPN.

METHODS

We analyzed 4290 patients (32.3% female, 67.7% male, mean age 51.1 ± 9.3 years) using a cross-sectional, retrospective observational method, focusing on signs and symptoms of foot complications and neuropathy.

RESULTS

Dry Skin (44%), infection (19.7%), and ingrown toenails (16.6%) were the foremost prevalent foot health conditions. The most common neuropathic symptoms were burning (35.4%), muscle cramps (31.5%), and loss of sensation (26.6%). Multivariable logistic regression analysis identified nephropathy (OR 3.96 [95% CI: 3.02-5.20]), retinopathy (OR 3.85 [95% CI: 2.72-5.48]), coronary disease (OR 3.48 [95% CI: 2.42-5.04]), COVID-19 history (OR 2.37 [95% CI: 1.73-3.26]), smoking (OR 2.13 [95% CI: 1.56-2.91]), hypertension (OR 2.10 [95% CI: 1.63-2.73]), dyslipidemia (OR 2.09 [95% CI: 1.62-2.69]), alcohol use (OR 1.57 [95% CI: 1.14-2.15]), and high HbA1c (OR 1.29 [95% CI: 1.16-1.42]) as significant predictors (p < 0.001) of increased risk for multiple foot health complications. Diabetes duration showed no significant correlation with increased risk for multiple foot complications.

CONCLUSION

This study revealed a significant incidence of foot deformities and neuropathic symptoms in Indian T2DM patients, influenced by various lifestyle and medical factors. The lack of correlation between diabetes duration and foot complications in the present study highlights the need for enhanced diabetes management and early detection strategies in India.

Exploring causal correlations between immune cells and diabetic neuropathy: a Mendelian randomization

BACKGROUND

Circulating immune cells reportedly affect diabetic neuropathy (DN). Although associations have been previously established between numerous biomarkers and diseases, elucidating their causal relationships remains challenging. Mendelian Randomization (MR) could overcome this difficulty by applying genetic instruments to discern causal links. In this study, we conducted bidirectional two-sample MR to address this problem.

METHODS

We used freely available genome-wide association study summary statistics. We obtained immune cell phenotype-related summary data from a study cohort comprising 3,757 Sardinian individuals that reported data concerning 731 immune cell phenotypes. We obtained DN-related summary data from the FinnGen database and conducted sensitivity analyses. Furthermore, we assessed horizontal pleiotropy using combined MR-Egger and MR-Presso methods. We evaluated heterogeneity using Cochran's Q test and applied False Discovery Rate correction to the findings.

RESULTS

Our MR analysis significantly associated 24 immune cell phenotypes with DN. Specifically, the presence of CD45 on CD66b + + myeloid cells, HLA DR on CD14 + CD16- monocytes, IgD- CD24- %B cells, and CD27 on IgD- CD38br lymphocytes significantly positively correlated with the risk of DN. In contrast, the presence of CD28- DN (CD4-CD8-) %T cells, FSC-A on HLA DR + T cells, and other four T cell types negatively correlated with DN. Finally, we further confirmed the relationship between different immune cell types and DN.

CONCLUSIONS

We demonstrated the immunological susceptibility of DN and clarified how immune responses influence the course of DN. These findings might help inform immunological therapy techniques as well as novel targets for DN diagnosis and treatment.

Interventional effects of exercise on neuropathy in patients with diabetes: a systematic review with meta-analysis

OBJECTIVE

This study aims to systematically evaluate the effects of exercise interventions on neurological dysfunction in diabetic patients, addressing inconsistencies in existing research. It seeks to clarify the impact of different exercise parameters and patient characteristics on nerve function improvements, providing evidence for optimized intervention strategies.

METHODS

A search was conducted using PubMed, Web of Science, The Cochrane Library, and Embase databases for randomized controlled trials related to exercise interventions for neurological dysfunction in diabetic patients. The quality of the included studies was assessed according to the Cochrane Handbook for Systematic Reviews. The study utilized RevMan 5.3 to determine effect sizes and assess heterogeneity. Stata 17.0 was employed to evaluate publication bias in the included studies.

RESULTS

The analysis incorporated 9 randomized controlled trials. The meta-analysis demonstrated that exercise leads to improvements in neurological dysfunction among diabetes patients (SMD = 0.61). Subgroup analysis revealed that an 8-week exercise regimen with moderate intensity was particularly effective in enhancing neurological function (SMD = 1.82, 1.58). Improvements were more pronounced in lower limb nerve conduction velocity (SMD = 0.60), peroneal nerve conduction velocity (SMD = 0.86), and sensory nerve conduction velocity (SMD = 0.59). Patients with a disease duration of 5 years or less showed significant improvement (SMD = 0.62).

CONCLUSION

Exercise effectively improves neurological dysfunction in diabetic patients, with an 8-week, moderate-intensity program showing the greatest benefits, particularly in lower limb and sensory nerve conduction velocity. These findings offer evidence-based guidance for clinical intervention and future research.

REGISTRATION AND PROPOSAL

This study was registered with PROSPEO under No. CRD42024586981; the proposal is available at www.crd.york.ac.uk .

Green Tea Intake Reduces High-Fat Diet-Induced Sensory Neuropathy in Mice by Upregulating the Antioxidant Defense System in the Spinal Cord

One of the most common complications of obesity is peripheral nerve damage, which progresses to sensory neuropathy. Green tea (GT) intake has been associated with weight loss and metabolic biomarkers modulation due to its antioxidant properties. The present work characterized the effects of GT in high-fat diet (HFD)-induced neuropathy and investigated the mechanisms involved. C57BL/6J male mice were fed an HFD or control diet, associated with GT or vehicle intake for 16 weeks. Weight, blood glucose, and nociceptive thresholds were assessed. Morphological and morphometric analyses of the sciatic nerves were performed. Activation of the cellular antioxidant system in the spinal cord was assessed by real-time PCR. GT intake reduced weight gain, hyperglycemia, and the development of sensory neuropathy. Furthermore, in HFD-fed mice that consumed GT, the morphology of the sciatic nerve was preserved. RT-qPCR analysis showed that HFD-fed mice ingesting GT had higher spinal levels of superoxide dismutase, catalase, glutathione peroxidase, and nuclear factor erythroid 2-related factor 2 (NRF2) mRNA compared to the HFD-fed mice ingesting vehicle, suggesting that the endogenous antioxidant system was more activated in response to GT consumption. In conclusion, the data suggest that GT intake reduces HFD-induced neuropathy, probably by upregulating antioxidant gene expression.

Dose dependent relationship of metformin use and diabetic peripheral neuropathy risk in patients with type 2 diabetes mellitus

This study investigated the correlation between metformin use and diabetic peripheral neuropathy (DPN) risk in patients with type 2 diabetes mellitus (T2DM) and its dose-dependent relationship. The study included new-onset T2DM patients from 2002 to 2013. Patients were divided into two groups based on metformin treatment, and DPN risk was assessed at 2- and 5-year follow-ups. After adjusting for various factors, two logistic models, metformin cumulative defined daily dose (cDDD) and metformin treatment intensity (defined daily dose [DDD]/month), evaluated the metformin-DPN risk association. Results showed that patients with metformin cDDD < 300, 300-500, and > 500 had higher DPN risk at both follow-ups. Odds ratios (ORs) and confidence intervals (CIs) for DPN were 1.74 (1.69-1.79), 2.05 (1.81-2.32), and 2.36 (1.34-4.16) at 2 years and 1.63 (1.60-1.65), 1.82 (1.69-1.96), and 2.17 (1.56-3.03) at 5 years. Similarly, patients with < 10, 10-25, and > 25 DDD/month had higher DPN risk at both follow-ups. Metformin use correlated with DPN risk in T2DM patients, with a dose-dependent relationship. Higher metformin cDDD or treatment intensity increased DPN risk. However, the absence of vitamin B12 data limits the understanding of the underlying mechanisms. Well-designed, large-scale studies are required to evaluate the potential risks of metformin therapy for DPN in patients with T2DM.

Selection of DNA Aptamers That Promote Neurite Outgrowth in Human iPSC-Derived Sensory Neuron Organoid Cultures

Sensory neurons in the dorsal root ganglia transmit sensory signals from the periphery to the central nervous system. Induced pluripotent stem cell derived models of sensory neurons and dorsal root ganglia are among the most advanced available tools for the study of sensory neuron activity and development in human genetic backgrounds. However, few available reagents modify sensory neuron growth with disease or other model-relevant outcomes. Small molecules, peptides, or oligonucleotides that predictably alter sensory neuron behavior in these contexts would be valuable tools with potentially wide-ranging application. Here we describe the selection and characterization of DNA aptamers that specifically interact with human sensory neurons. Several selected aptamers increase neurite outgrowth from sensory neuron organoid cultures after single-dose treatments.

Maladaptive Peripheral Ketogenesis in Schwann Cells Mediated by CB1R Contributes to Diabetic Neuropathy

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes. Although studies have previously investigated metabolic disruptions in the peripheral nervous system (PNS), the exact metabolic mechanisms underlying DPN remain largely unknown. Herein, a specific form of metabolic remodeling involving aberrant ketogenesis within Schwann cells (SCs) in streptozotocin (STZ)-induced type I diabetes mellitus is identified. The PNS adapts poorly to such aberrant ketogenesis, resulting in disrupted energy metabolism, mitochondrial damage, and homeostatic decompensation, ultimately contributing to DPN. Additionally, the maladaptive peripheral ketogenesis is highly dependent on the cannabinoid type-1 receptor (CB1R)-Hmgcs2 axis. Silencing CB1R reprogrammed the metabolism of SCs by blocking maladaptive ketogenesis, resulting in rebalanced energy metabolism, reduced histopathological changes, and improved neuropathic symptoms. Moreover, this metabolic reprogramming can be induced pharmacologically using JD5037, a peripheral CB1R blocker. These findings revealed a new metabolic mechanism underlying DPN, and promoted CB1R as a promising therapeutic target for DPN.

Trends and determinants of falls: A generalized estimating equations modelling approach using serial data from the Geelong Osteoporosis Study

BACKGROUND

With Australia's aging population, the incidence of falls is expected to rise. The proportion of adults aged ≥65 years is projected to increase from 15 % in 2017 to 22 % by 2057, highlighting the growing need for effective fall prevention measures. Therefore, this study aimed to assess fall trends and determinants using repeated follow-up data from a population-based study.

METHODS

This study utilized data from the Geelong Osteoporosis Study (GOS) to analyse fall trends in men and women. Men's data were collected at baseline (2001-2006; n = 1533), 5 years (2006-2011; n = 968), and 15 years (2016-2021; n = 627), while women's data were from 6 years (2001-2003; n = 1014), 10 years (2004-2008; n = 1098), and 15 years (2011-2014; n = 844). Falls data, self-reported for the past 12 months, were age-standardised to the Australian population. Data included self-reported prior fractures, medications, comorbidities, alcohol use, and smoking, along with measured anthropometrics, muscle strength, biochemical tests, and imaging. A multivariable Generalised Estimating Equation model identified fall determinants, reporting adjusted odds ratios (AORs) and 95 % confidence intervals.

RESULTS

In men, the age-adjusted prevalence of falls declined over time, while in women, it initially dropped by 4.2 % before a slight 0.6 % increase. After adjusting for confounders, each additional year of age raised the fall risk by 1 % (AOR = 1.01, 95 % CI: 1.00-1.02). Women had a 52 % higher likelihood of falling than men (AOR = 1.52, 95 % CI: 1.22-1.88). Diabetes increased the risk by 69 % (AOR = 1.69, 95 % CI: 1.23-2.31), while a 1 N/kg increase in hip flexion strength lowered the risk by 3 % (AOR = 0.97, 95 % CI: 0.95-0.99).

CONCLUSION

Men experienced a steady decrease in fall prevalence over time, whereas women displayed a more intricate trend, with falls initially declining before subsequently rising, following a polynomial pattern. The key predictors of falls included age, sex, diabetes and hip flexion strength. Policies should prioritize tailored fall prevention, strength training, and diabetes care integration.

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.

Novel three-dimensional analysis method for accurate evaluation of cutaneous small sensory nerve fibers in mice

Intraepidermal nerve fiber (IENF) density is commonly evaluated to diagnose peripheral neuropathy. However, conventional two-dimensional (2D) analysis using rodent models shows high interstudy variability. Three-dimensional (3D) IENF analysis has been proposed for human skin biopsies because the spatial location of each nerve can be easily determined. However, no studies have compared 2D and 3D analyses of mouse cutaneous nerve fibers under the same conditions. We aimed to establish a more accurate analysis method for mouse cutaneous nerve fibers. We used the glabrous plantar metatarsal skin of male C57BL/6J mice. The middle area of the plantar skin was used for 2D and 3D analyses, and the marginal area was also investigated in the 3D analysis. Tissue transparency, nerve fiber-specific antibodies, confocal microscopy, and IMARIS software were used for the 3D analysis. The 3D analysis clearly defined branching points and continuity, allowing accurate IENF density measurement. Conversely, the 2D analysis could not accurately determine IENF density because it could not detect the continuity of the nerve from the dermis to epidermis. Thus, the actual IENF density from the 3D analysis was significantly less than that from the 2D analysis. In addition, the density and length of IENFs in the middle area were significantly higher than those in the marginal area. This 3D approach enables the precise capture of IENF trajectories with various parameters, establishing a standard method for evaluating peripheral neuropathy models. Furthermore, our findings indicate that comparative studies aiming to analyze mouse IENF need to consider the site of skin sampling.

Dual-layer microneedles with NO/O2 releasing for diabetic wound healing via neurogenesis, angiogenesis, and immune modulation

Diabetic wounds present multiple functional impairments, including neurovascular dysregulation, oxidative imbalance, and immune dysfunction, making wound healing particularly challenging, while traditional therapeutical strategies fail to address these complex issues effectively. Herein, we propose a strategy utilizing dual-layer microneedles to deliver therapeutic gases by modulating neurovascular coupling and immune functions for diabetic wound treatment. The microneedle can respond to reactive oxygen species (ROS) in the diabetic microenvironment and subsequently generate oxygen (O2) and nitric oxide (NO). These gases comprehensively promote neuro-vascular regeneration, reduce oxidative stress levels, and attenuate inflammation. In vivo studies demonstrate that the microneedle can accelerate diabetic wound healing by modulating neurovascular regeneration and inflammatory processes. Transcriptomic analyses further validate the involvement of related advantageous signaling pathways. The potential mechanism involves the activation of the PI3K-AKT-mTOR pathway to facilitate autophagy, ultimately accelerating the healing process. Thus, our multifunctional dual-layer microneedles provide an effective strategy for treating diabetic wounds.