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Azharuddin M, Parveen S, Noohu MM. Effects of Neural Mobilization in Diabetic Peripheral Neuropathy: A Scoping Review. J Chiropr Med 2023; 22:313-321. [PMID: 38205228 PMCID: PMC10774613 DOI: 10.1016/j.jcm.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 07/25/2023] [Accepted: 10/05/2023] [Indexed: 01/12/2024] Open
Abstract
Objective The purpose of this scoping review was to explore the effects of neural mobilization (NM) on outcomes in adults with diabetic peripheral neuropathy (DPN). Methods Five databases were searched-PubMed, Web of Science (Web of Science Core Collection), Physiotherapy Evidence Database (PEDro), and Scopus-from inception to January 2022. The studies included were randomized controlled trials, pre-post single group design, multiple case studies, controlled case studies, quasi-experimental studies, and single case studies, which are published in full text in English. Results Six studies were included in this review, and most were of low-level evidence. The sample size of the studies ranges from 20 to 43, except for 1 case study, with a total of 158 participants in all the studies combined. In 4 out of 6 studies, only NM was given, whereas in 2 studies, NM was used along with other treatment strategies. The tibial nerve was the most studied nerve, whereas 1 study administered NM to nerves of the upper limbs, and only 1 trial examined the sciatic nerve. The outcomes included the Michigan Neuropathy Screening Instrument questionnaire, nerve conduction velocity, vibration perception threshold, heat/cold perception threshold, weight-bearing asymmetry and range of motion of lower limb, quality of life, and magnetic imaging changes. Conclusion At present, only a few low-level studies exist on the use of NM for the treatment of adults with DPN. The evidence for use of NM on DPN is still limited and insufficient.
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Affiliation(s)
- Muhammad Azharuddin
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (central university), New Delhi, India
| | - Sarah Parveen
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (central university), New Delhi, India
| | - Majumi M. Noohu
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (central university), New Delhi, India
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Debele GR, Kuse SA, Kefeni BT, Geda A, Jifar WW, Kitila KM, Hajure M. Why too soon? Predictors of time to diabetic peripheral neuropathy among newly diagnosed diabetes mellitus patients: a multicenter follow-up study at health-care setting of Ethiopia. Arch Public Health 2023; 81:186. [PMID: 37865762 PMCID: PMC10589986 DOI: 10.1186/s13690-023-01202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 10/12/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Due to the rising number of diabetic patients, the burden of diabetic peripheral neuropathy (DPN) is clearly posing a major challenge to the long-term viability of the health-care system. Despite this, most DPN epidemiological research in eastern Africa, including Ethiopia, has so far been limited to survey studies. Thus, we determined the incidence of DPN and its predictors among diabetic patients in tertiary health-care setting of southwest Ethiopia. METHODS A multicenter retrospective follow-up study was carried out on 567 randomly selected diabetic patients. Data were entered using Epi-Data v4.6 and analyzed using R v4.0.4. The survival curves were estimated using the Kaplan-Meier, and compared using Log-rank test between groups of categorical variables. The PHA were evaluated using the Schoenfeld residuals test. Multivariable Gompertz proportional hazard model was used to examine the predictors of DPN at 5% level of significance. RESULTS Overall, of 567 DM patients 119 developed DPN with an incidence rate of 3.75, 95%CI [3.13, 4.49] per 100 PY. About 15.13% and 69% of DPN cases occurred within 2 and 5 years of DM diagnosis, respectively. In the multivariable Gompertz PH model, being female [AHR = 1.47; 95% CI (1.01, 2.15)], T2DM [AHR = 3.49 95% CI (1.82, 6.71)], having diabetic retinopathy [AHR = 1.9 95% CI (1.25, 2.91)], positive proteinuria [AHR = 2.22 95% CI (1.35, 3.65)], being obese [AHR = 3.94 95% CI (1.2, 12.89)] and overweight [AHR = 3.34 95% CI (1.09, 10.25)] significantly predicts the future risk of DPN. CONCLUSION Nearly, 7 in 10 of DPN cases occurred within short period of time (5 year) of DM diagnosis. Being female, T2DM, DR, positive proteinuria, obese and overweight significantly predicts the risk of DPN. Therefore, we recommend screening and early diagnosis of diabetes with its complication. While doing so, attention should be given for DM patients with DR and positive proteinuria at baseline.
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Affiliation(s)
- Gebiso Roba Debele
- Department of Public Health, College of Health Sciences, Mattu University, Mattu, Ethiopia.
| | - Samuel Abdisa Kuse
- Department of Midwifery, College of Health Sciences, Oda Bultum University, Chiro, Ethiopia
| | | | - Abdi Geda
- Department of Public Health, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Wakuma Wakene Jifar
- Department of Pharmacology, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Keno Melkamu Kitila
- Department of Public Health, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Mohammedamin Hajure
- Department of Psychiatry, College of Health Sciences, Mattu University, Mattu, Ethiopia
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Ban J, Pan X, Yang L, Jia Z, Zhen R, Zhang X, Chen S. Correlation Between Fibrinogen/Albumin and Diabetic Peripheral Neuropathy. Diabetes Metab Syndr Obes 2023; 16:2991-3005. [PMID: 37790261 PMCID: PMC10543934 DOI: 10.2147/dmso.s427510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/16/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose This study aimed to examine the correlation between fibrinogen/albumin (FAR) and diabetic peripheral neuropathy (DPN). Patients and Methods A total of 342 patients were included and categorized into either the DPN group or the Non-DPN (NDPN) group based on their DPN status. The FAR index was determined by calculating the ratio of fibrinogen (FIB) to serum albumin (ALB), multiplied by 100. The participants were then divided into a High-FAR group and a Low-FAR group using the median FAR value as the threshold. Neurophysiological data were collected from the participants, which included motor conduction velocity (MCV) and sensory conduction velocity (SCV). Results The DPN group displayed higher FAR levels [(DPN vs NDPN:6.72 (5.89,7.74) vs 5.94±1.14], in addition to slower SCV and MCV data compared to the NDPN group. The high FAR group had a higher prevalence of DPN (78.9% vs 55.6%) (P<0.05). There was a negative correlation between FAR and NCV, including bilateral median nerve SCV, left ulnar nerve SCV, bilateral median nerve MCV, bilateral common peroneal nerve MCV, bilateral tibial nerve MCV, and left ulnar nerve MCV. FAR was revealed to be an independent risk factor for the development of DPN in patients and demonstrated a greater predictive value for DPN development in Type 2 diabetes mellitus (T2DM) compared with FIB, HbA1c. Conclusion The results suggest that monitoring FAR levels in patients with T2DM could identify those at higher risk for developing DPN, making the FAR index a valuable predictor of DPN development. Furthermore, since FAR has an inverse relationship with NCV, it stands to reason that high FAR levels may indicate nerve damage and slower conduction velocities. Thus, managing FAR could prove beneficial in both preventing and delaying the onset of DPN in T2DM patients.
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Affiliation(s)
- Jiangli Ban
- Graduate School of Hebei North University, Zhangjiakou, People’s Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Xiaoyu Pan
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- Graduate School of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Liqun Yang
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Zhuoya Jia
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- Graduate School of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Ruoxi Zhen
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- Graduate School of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Xueqing Zhang
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- Graduate School of North China University of Science and Technology, Tangshan, People’s Republic of China
| | - Shuchun Chen
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- Graduate School of Hebei Medical University, Shijiazhuang, People’s Republic of China
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Nkonge KM, Nkonge DK, Nkonge TN. Screening for diabetic peripheral neuropathy in resource-limited settings. Diabetol Metab Syndr 2023; 15:55. [PMID: 36945043 PMCID: PMC10031885 DOI: 10.1186/s13098-023-01032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Diabetic neuropathy is the most common microvascular complication of diabetes mellitus and a major risk factor for diabetes-related lower-extremity complications. Diffuse neuropathy is the most frequently encountered pattern of neurological dysfunction and presents clinically as distal symmetrical sensorimotor polyneuropathy. Due to the increasing public health significance of diabetes mellitus and its complications, screening for diabetic peripheral neuropathy is essential. Consequently, a review of the principles that guide screening practices, especially in resource-limited clinical settings, is urgently needed. MAIN BODY Numerous evidence-based assessments are used to detect diabetic peripheral neuropathy. In accordance with current guideline recommendations from the American Diabetes Association, International Diabetes Federation, International Working Group on the Diabetic Foot, and National Institute for Health and Care Excellence, a screening algorithm for diabetic peripheral neuropathy based on multiphasic clinical assessment, stratification according to risk of developing diabetic foot syndrome, individualized treatment, and scheduled follow-up is suggested for use in resource-limited settings. CONCLUSIONS Screening for diabetic peripheral neuropathy in resource-limited settings requires a practical and comprehensive approach in order to promptly identify affected individuals. The principles of screening for diabetic peripheral neuropathy are: multiphasic approach, risk stratification, individualized treatment, and scheduled follow-up. Regular screening for diabetes-related foot disease using simple clinical assessments may improve patient outcomes.
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Heiran A, Azarchehry SP, Dehghankhalili S, Afarid M, Shaabani S, Mirahmadizadeh A. Prevalence of diabetic retinopathy in the Eastern Mediterranean Region: a systematic review and meta-analysis. J Int Med Res 2022; 50:3000605221117134. [PMID: 36314851 PMCID: PMC9629581 DOI: 10.1177/03000605221117134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives Individual studies in the Eastern Mediterranean Region (EMR) have shown the high prevalence of diabetic retinopathy. We conducted a meta-analysis to yield an estimate of the prevalence of diabetic (type 1 and 2) retinopathy in the EMR. Additionally, we explored its potential modulators. Methods Two-step screening of relevant articles published from 1 January 2000 to 13 December 2019 was carried out. An estimation of summary proportions, subgroup analysis, meta-regression, and publication bias assessment were performed. Results One hundred nine articles were included in the meta-analysis, involving 280,566 patients. The prevalence of diabetic retinopathy was 31% (95% confidence interval [CI] = 28, 33). The highest and lowest diabetic retinopathy prevalence rates were observed in low human development index (HDI) countries (63.6; 95% CI = 52.4, 74.0) and very high HDI countries 22.6 (95% CI = 20.5, 24.7), respectively. Conclusions The prevalence of diabetic retinopathy is high in the EMR. Our results provide important information for diverse healthcare surveillance systems in the EMR to implement the modifiable risk factors, diabetes screening to decrease undiagnosed diabetes, early detection of retinopathy, and proper diabetes care to decrease untreated diabetes.
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Affiliation(s)
- Alireza Heiran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Alireza Mirahmadizadeh, Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Zand Blvd, Shiraz, Iran. PO: 7193635899.
| | - Seyede Pegah Azarchehry
- Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Mehrdad Afarid
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sonia Shaabani
- Alzahra Cardiovascular Charitable Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Pi CX, Gui TJ, He QD, Yin F, Cai RJ, Wang Y, Xue QX, Tian XK, Wang T, Zhe XW. Glomerular filtration Rate, urine Albumin/ creatinine ratio and current perception threshold in patients with diabetic kidney disease. Diabetes Res Clin Pract 2022; 189:109934. [PMID: 35640744 DOI: 10.1016/j.diabres.2022.109934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/28/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diabetic microvascular complications, including diabetic kidney disease (DKD), retinopathy (DR), and neuropathy (DN), were major causes of morbidity and mortality in diabetic patients worldwide. It has been suggested that urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) were not the only indicators of renal function impairment in DKD and that they were also associated with diabetic peripheral neuropathy (DPN) which might affect nerve conduction velocity (NCV). As 30-40% of DPN patients had no subjective symptoms, while current perception threshold (CPT) could detect sensory nerve damage at an early stage. As a result, we aimed to investigate correlation between UACR, eGFR and CPT in DKD patients. METHODS A total of 273 DKD patients from the First Affiliated Hospital of Kunming Medical University from January 2018 to June 2020 were enrolled to complete the CPT test. CPT values of the bilateral median nerve and superficial and deep peroneal nerves at 2000 Hz, 250 Hz, and 5 Hz were collected. RESULTS In normoesthesia and hypaesthesia patients with DKD, MDRD-eGFR correlated negatively with TC (r = -0.135, P = 0.037), left superficial peroneal and deep peroneal nerve 2000 Hz CPT (r = -0.205, P = 0.001) and right superficial peroneal and deep peroneal nerve 2000 Hz CPT (r = -0.154, P = 0.017). Besides, left and right superficial peroneal and deep peroneal nerve 2000 Hz CPT correlated with CKD-EPI-eGFR and UACR. Multivariate logistic regression analysis found left superficial peroneal and deep peroneal nerve 2000 Hz CPT was independently associated with both MDRD-eGFR and CKD-EPI-eGFR. CONCLUSION Decreased MDRD-eGFR and CKD-EPI-eGFR were expected to be a predictor of peripheral nerve injury in normoesthesia and hypaesthesia patients with DKD.
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Affiliation(s)
- Cheng-Xian Pi
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China
| | - Teng-Juan Gui
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China
| | - Qi-Da He
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Fang Yin
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China
| | - Ren-Jiao Cai
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China
| | - Yue Wang
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China
| | - Qiu-Xia Xue
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China
| | - Xin-Kui Tian
- Division of Nephrology, Peking University Third Hospital, Beijing, PR China
| | - Tao Wang
- Division of Nephrology, Peking University Third Hospital, Beijing, PR China
| | - Xing-Wei Zhe
- Division of Nephrology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, PR China.
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Pan J, Yan X, Li F, Zhang Y, Jiang L, Wang C. Association of glycemic variability assessed by continuous glucose monitoring with subclinical diabetic polyneuropathy in type 2 diabetes patients. J Diabetes Investig 2022; 13:328-335. [PMID: 34455710 PMCID: PMC8847148 DOI: 10.1111/jdi.13652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
AIMS/INTRODUCTION Diabetic peripheral neuropathy is a common diabetes-related microvascular complication. The relationship between peripheral nerve function and glucose variability is unclear. We investigated the association of glucose variability with subclinical diabetic polyneuropathy in a large-scale sample of patients with type 2 diabetes. MATERIALS AND METHODS We enrolled 509 individuals with type 2 diabetes who were screened for diabetic peripheral neuropathy and monitored using a continuous glucose monitoring system. Multiple glycemic variability parameters, including the mean amplitude of glycemic excursions, glucose standard deviation (SDgluc ) and glucose coefficient of variation were calculated from 3-day glucose profiles obtained from continuous glucose monitoring. All participants underwent nerve conduction studies, and the composite Z-scores for nerve conduction parameters were calculated. RESULTS Multivariate logistic regression analyses showed that SDgluc and the conventional risk factor hemoglobin A1c (HbA1c) were independently associated with abnormal nerve function, and the corresponding odds ratios (95% confidence interval) were 1.198 (1.027-1.397, SDgluc ) and 1.182 (1.061-1.316, HbA1c), respectively. The composite Z-score of nerve conduction velocity and response amplitude obviously decreased with greater SDgluc , and the composite Z-score of distal latency significantly increased with increasing tertiles of SDgluc (all P trend <0.05). After adjusting for age, sex, body mass index, diabetes duration and HbA1c, SDgluc was independently associated with nerve conduction velocity (β = -0.124, P = 0.021). CONCLUSIONS The SDgluc is a significant independent contributor to subclinical diabetic polyneuropathy, in addition to conventional risk factors including diabetes duration and HbA1c.
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Affiliation(s)
- Jiemin Pan
- Department of Endocrinology and MetabolismShanghai Clinical Center for DiabetesShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina
- Shanghai Key Laboratory of Diabetes MellitusShanghaiChina
| | - Xinfeng Yan
- Department of EndocrinologyShanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Fengwen Li
- Department of Endocrinology and MetabolismShanghai Clinical Center for DiabetesShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina
- Shanghai Key Laboratory of Diabetes MellitusShanghaiChina
| | - Yinan Zhang
- Shanghai Key Laboratory of Diabetes MellitusShanghaiChina
- The Metabolic Diseases BiobankCenter for Translational MedicineShanghai JiaoTong University Affiliated Sixth People’s HospitalShanghaiChina
| | - Lan Jiang
- Department of ElectrophysiologyShanghai JiaoTong University Affiliated Sixth People’s HospitalShanghaiChina
| | - Congrong Wang
- Department of Endocrinology and MetabolismShanghai Fourth People's Hospital Affiliated to Tongji UniversityShanghaiChina
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Cheng Y, Cao W, Zhang J, Wang J, Liu X, Wu Q, Lin Q. Determinants of Diabetic Peripheral Neuropathy and Their Clinical Significance: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2022; 13:934020. [PMID: 35957831 PMCID: PMC9360478 DOI: 10.3389/fendo.2022.934020] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In this study, we investigated the epidemiological characteristics and predictors of diabetic peripheral neuropathy (DPN) in adult patients with type 2 diabetes mellitus (DM). METHODS The study was designed as a retrospective cohort trial at the First Affiliated Hospital of Wenzhou Medical University. From January 2017 to December 2020, a total of 1,262 patients with DM were enrolled to assess the risk factors for DPN. The patients were divided into two groups (DPN group and non-DPN group). The Mann-Whitney U test or t-test, receiver operating characteristic (ROC) analyses, univariate chi-square analyses, and multiple logistic regression analyses were used to analyze the adjusted predictors of DPN. RESULTS The overall prevalence of DPN in DM patients was 72.7% (n = 793/1,091). Multivariate analysis revealed that age > 66 years (odds ratio [OR], 2.647; 95% confidence interval [CI] 1.469-4.770; p = 0.002), history of hypertension (OR, 1.829; 95% CI 1.146-2.920; p = 0.011), neutrophil (NE) levels exceeding 4.0 × 109/L (OR 0.256; 95% CI 0.162-0.405; p = 0.001), lymphocyte (LY) levels over 3.0 × 109/L (OR 7.173; 95% CI 4.258-12.086; p = 0.000), HbA1c > 7.7% (OR 3.151; 95% CI 1.959-5.068; p = 0.000), and FT3 > 4.4 pmol/L (OR 0.417; 95% CI 0.263-0.662; p = 0.000) were six significant predictive factors for the prevalence of DPN. CONCLUSIONS High levels of LY, HbA1c, history of hypertension, and > 66 years of age increase the risk of DPN in adult patients with DM, while high levels of NE and FT3 were protective factors of DPN. Thus, the prediction of DPN can significantly be improved by identifying older patients over the age of 66 and history of hypertension, as well as establishing the biochemical cutoff values of NE, LY, HbA1c, and FT3.
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Affiliation(s)
- Yifan Cheng
- Department of Neurology, Center for Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Wen Cao
- Department of Neurology, The Third Hospital of Peking University, Beijing, China
| | - Junzhe Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiabin Wang
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
| | - Xiang Liu
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
| | - Qianqian Wu
- Department of Geriatrics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Qingxia Lin
- Department of Psychiatry, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Qingxia Lin,
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MÜHÜRDAROĞLU M, AĞADAYI E, KÖSEM A. Can Low Magnesium be A Rısk Factor for the Development of Polyneuropathy in Patıents With Diabetes? KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.874172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Simo N, Kuate-Tegueu C, Ngankou-Tchankeu S, Doumbe J, Maiga Y, Cesari M, Dartigues JF, Kengne AP, Tabue-Teguo M. Correlates of diabetic polyneuropathy of the elderly in Sub-Saharan Africa. PLoS One 2020; 15:e0240602. [PMID: 33119646 PMCID: PMC7595408 DOI: 10.1371/journal.pone.0240602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 09/29/2020] [Indexed: 02/02/2023] Open
Abstract
Background Diabetic polyneuropathy is associated with significant physical disability among older adults. However, their frequency and correlates are not well known in the older adults in Sub-Saharan-Africa. The objectives were to evaluate the hospital-based prevalence of diabetic polyneuropathy and identify its correlates in older adults. Methods Over a period of 5 months, a cross-sectional survey was carried out at Douala Laquintinie Hospital (DLH), a main reference hospital in Douala, the economic capital of Cameroon. Participants in our study group comprised all patients with type 2 diabetes, whatever the reason for their reporting to the hospital. Diabetic Polyneuropathy was defined according to a Diabetic Neuropathy Examination score > 3/16. Results A total of 159 older adults with diabetes were examined during this recruitment period, among whom 106 (66.7%) were women. The mean age was 68.3 ± 6.5 years. Diabetes median duration was 108 months. For all patients assessed using the Diabetic Neuropathy Examination score, polyneuropathy was reported in 31.4%; among them, polyneuropathy proved symptomatic in 78% of them. Correlates of polyneuropathy were glycated hemoglobin (p = 0.049), HIV infection (p = 0.031) and albuminuria (p< 0.001), even after adjustment for age, gender and duration of diabetes. Conclusion A third of older adults with diabetes who visited our hospital were diagnosed with prevalent diabetes-related polyneuropathy. It shows that early detection is required through routine screening and regular follow-up examinations in order to reduce the risk of disability and improve the quality of life in elderly diabetics.
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Affiliation(s)
- Nadine Simo
- CHU de Guadeloupe, Equipe LAMIA, Université des Antilles, Fouillole, Guadeloupe
| | - Callixte Kuate-Tegueu
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé 1, Yaounde, Cameroon
| | - Steve Ngankou-Tchankeu
- Institut Supérieur des Sciences de la Santé, Université des Montagnes, Bangangté, Cameroun
| | - Jacques Doumbe
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Youssoufa Maiga
- Service de Neurologie, Hôpital Gabriel Toure (CHU), Bamako, Mali
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Andre-Pascal Kengne
- South African Medical Research Council of South Africa, Cape Town, South Africa
| | - Maturin Tabue-Teguo
- CHU de Guadeloupe, Equipe LAMIA, Université des Antilles, Fouillole, Guadeloupe
- INSERM U 1219, Université de Bordeaux, Bordeaux, France
- * E-mail:
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Sun J, Wang Y, Zhang X, Zhu S, He H. Prevalence of peripheral neuropathy in patients with diabetes: A systematic review and meta-analysis. Prim Care Diabetes 2020; 14:435-444. [PMID: 31917119 DOI: 10.1016/j.pcd.2019.12.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/10/2019] [Accepted: 12/25/2019] [Indexed: 01/10/2023]
Abstract
AIMS We aimed to determine pooled prevalence of diabetic peripheral neuropathy (DPN) in patients with diabetes and to explore the impacts of research variables on prevalence estimates. METHODS A systematic search was performed in PubMed, EMBASE, The Cochrane Library and Scopus from onset up to July 2018 to identify articles investigating the prevalence of DPN. Random-effects models were used to calculate the pooled prevalence of DPN. The heterogeneity of the study was estimated with the I2 statistic. The publication bias was described by Egger's test and funnel plot. RESULTS A total of 29 studies with a total of 50,112 participants were included in this meta-analysis. The results showed that the pooled prevalence of DPN was 30% (95% confidence interval, CI 25-34%). The pooled prevalence of DPN among patients with type 2 diabetes mellitus was higher than patients with type 1 diabetes mellitus (31.5%, 95% CI 24.4-38.6% vs 17.5%, 95% CI 4.8-30.2%). The pooled prevalence of DPN of studies involving a mixed type of diabetes mellitus was 24.8% (95% CI 13.1-36.5%, I2=99.1%). CONCLUSIONS Medical staff should strengthen the evaluation and diagnosis of DPN. Moreover, they need to teach diabetic patients how to prevent this complication.
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Affiliation(s)
- Juan Sun
- School of Medicine, Nantong University, No.19 Qixiu Road, Chongchuan District, Nantong, Jiangsu Province, China
| | - Ya Wang
- Affiliated Hospital of Nantong University, No. 20, Xisi Road, Chongchuan District, Nantong, Jiangsu Province, China
| | - Xiaoyi Zhang
- Department of Endocrinology, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Chongchuan District, Nantong, Jiangsu Province, China
| | - Shengze Zhu
- School of Medicine, Nantong University, No.19 Qixiu Road, Chongchuan District, Nantong, Jiangsu Province, China
| | - Hong He
- Department of Nursing, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Chongchuan District, Nantong, Jiangsu Province, 226001, China.
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12
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Haji Naghi Tehrani K. A study of nerve conduction velocity in diabetic patients and its relationship with tendon reflexes (T-Reflex). ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020066. [PMID: 32921766 PMCID: PMC7716994 DOI: 10.23750/abm.v91i3.7288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 02/22/2020] [Indexed: 11/23/2022]
Abstract
Background and Objective: Neuropathy is one of the most common complications of diabetes mellitus. Neuropathy can cause sensory deficit, neurological disorder, organ ulcers, osteomyelitis, and amputation. Therefore, neurological examinations, determining the nerve conduction velocity and performing sensory and motor tests are important for timely diagnosis and treatment. The present study aimed to investigate the nerve conduction velocity in diabetic patients and its relationship with tendon reflexes. Materials and Methods: The present study was observational-cross sectional research carried out on 77 diabetic patients who admitted to the EMG / NCV Department of Shariati Hospital in the academic year 1996-1997. In all patients, the medical history of the patient (age, duration of diabetes, gender and age of onset of diabetes), neurological examination, nerve conduction velocity, heat test, vibration test, tendon reflexes, D.L and Amplitude were examined and recorded. Finally, the raw data obtained was entered into the IBM SPSS Statistics software and the important relationships between these variables were analyzed. Moreover, in present study, the statistical significance level (P-value) was considered less than 0.05. Results: The present study was conducted on a population consisting of 48 women and 29 men with diabetes. The age range of participants was 14-70 years old with an average age of 50.506 ± 7.50. The results of present study showed that the participants with clinical neuropathy (11.2 ± 7.2) had significantly longer duration of diabetes than the normal group and those participants with sub-clinical neuropathy (P-value = 0.12). Statistical analyses indicated that increase in age, increase in the duration of diabetes and the gender of male significantly made the nerve conduction velocity abnormal. The analysis of the response to neural reflexes indicated that the ratio of neurological disorders in the five nerves of the ankle and knee was generally higher in the abnormal group (the patients with nerve conduction disorder) compared to the normal (the patients with normal nerve conduction) and in some cases, such as the ulnar motor nerve of ankle (P-value = 0.010), and the ulnar motor nerve of knee motor (P-value = 0.002) and also in the peroneal motor nerve of knee (P-value = 0.003) and the sural sensory nerve of knee (P-value = 0.003), increase in neurological disorders was significant. Conclusion: Increase in age, increase in the duration of diabetes and the gender of male can significantly make the nerve conduction velocity abnormal. (www.actabiomedica.it)
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Joshi D, Khan MA, Singh A. A clinical study of the association and risk factors for lower limb neuropathy in patients with diabetic retinopathy. J Family Med Prim Care 2020; 9:1891-1895. [PMID: 32670936 PMCID: PMC7346899 DOI: 10.4103/jfmpc.jfmpc_231_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/13/2020] [Accepted: 03/30/2020] [Indexed: 11/05/2022] Open
Abstract
Purpose: Association of peripheral neuropathy with diabetic retinopathy is known but the relationship of preclinical neuropathy with various grades of retinopathy is not well documented. This study evaluated the association of preclinical peripheral neuropathy using nerve conduction studies with various grades of retinopathy. Methods: Cases of diabetic retinopathy of various grades but asymptomatic for peripheral neuropathy underwent nerve conduction studies of the lower limbs using Caldwell machine and Sierra wave software. The risk factors for retinopathy and association of neuropathy with various grades of retinopathy were analyzed by bivariate and multivariate regression analysis. Results: The overall prevalence of neuropathy was 75.6% (sensory 58.54% and combined motor and sensory 17.1%) with increase in prevalence with increase in severity of retinopathy. Duration was positively associated with neuropathy (OR = 1.13, 95% CI = 1.02–1.24; P = 0.012); moderate nonproliferative diabetic retinopathy (NPDR) (OR = 5.60, P = 0.002), severe and very severe NPDR (OR = 5.8, P = 0.041), and PDR (OR = 16.05, P = 0.000) were significantly at higher risk for having neuropathy as compared to mild NPDR. Conclusion: Duration and severity of retinopathy are important risk factors for peripheral neuropathy. There is a high prevalence of peripheral neuropathy among diabetics with retinopathy especially with severe grades, when neuropathy is diagnosed using nerve conduction studies.
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Affiliation(s)
- Devika Joshi
- Department of Ophthalmology, Panel Consultant at Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
| | - Mansur Ali Khan
- Professor and Head, Department of Ophthalmology, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Anirudh Singh
- Associate Professor and Senior Advisor, Department of Ophthalmology, Command Hospital Air Force, Bangalore, Karnataka, India
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14
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Pfannkuche A, Alhajjar A, Ming A, Walter I, Piehler C, Mertens PR. Prevalence and risk factors of diabetic peripheral neuropathy in a diabetics cohort: Register initiative “diabetes and nerves”. ENDOCRINE AND METABOLIC SCIENCE 2020. [DOI: 10.1016/j.endmts.2020.100053] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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15
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Abdissa D, Hamba N, Kene K, Bedane DA, Etana G, Muleta D, Gerbi A. Prevalence and Determinants of Peripheral Neuropathy among Type 2 Adult Diabetes Patients Attending Jimma University Medical Center, Southwest Ethiopia, 2019, an Institutional-Based Cross-Sectional Study. J Diabetes Res 2020; 2020:9562920. [PMID: 32685561 PMCID: PMC7341394 DOI: 10.1155/2020/9562920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/23/2020] [Accepted: 06/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diabetes chronic complications are major causes of morbidity and mortality, among which diabetic peripheral neuropathy (DPN) stands out. One of the tools to screen DPN is the Michigan neuropathy screening instrument. However, there is no data compiled using this tool to assess the prevalence and its determinants in Jimma. So, the aim of this study was to assess the prevalence of DPN and its determinants among patients with diabetes mellitus at Jimma University Medical Center. Methods. A hospital-based cross-sectional study was conducted at Jimma University Medical Center on 366 type 2diabetic patients. Data were collected using pretested structured questionnaire and entered into EpiData 3.1 and exported to SPSS version 20 for analysis. Both bivariate and multivariate binary logistic regressions were employed to identify factors associated with DPN. A variable having a p value of < 0.25 in the bivariate model was subjected to multivariate analysis to avoid confounding variable's effect. Adjusted odds ratios were calculated at 95% confidence interval and considered significant with a p value of ≤ 0.05. RESULTS The mean age of participants was 50.1 ± 14.28 years. The study finding showed that the prevalence of DPN was 53.6% among study participants. According to the multivariate logistic regression age above 40 years (AOR = 4.57; 95% CI: 1.50, 13.9), above 50 years (AOR = 6.5; 95% CI: 2.24, 18.79), duration of diabetes above 5 years (AOR = 3.06; 95% CI: 1.63, 5.77), duration above 10 years (AOR = 7.1; 95% CI: 2.99, 17.28), physical inactivity (AOR = 2.02; 95% CI: 1.14, 3.55), and smoking (current smoker AOR = 7.96, 95% CI: 3.22, 19.64; former smoker (AOR = 2.65; 95% CI: 1.22, 5.77) were independent predictors of DPN among study participants. CONCLUSION Almost half of the study participants had DPN. Age above 40 years, diabetes duration of above 5 years, physical inactivity, and smoking were significantly associated with DPN. Early detection and appropriate interventions are important among patients with age above 40 years, physically inactive, smokers, and diabetes duration of above 5 years.
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Affiliation(s)
- Daba Abdissa
- Department of Biomedical Sciences (Clinical Anatomy), College of Medical Sciences, Institute of Health Sciences, Jimma University, Ethiopia
| | - Nigusse Hamba
- Department of Biomedical Sciences (Clinical Anatomy), College of Medical Sciences, Institute of Health Sciences, Jimma University, Ethiopia
| | - Kumsa Kene
- Department of Biomedical Sciences (Medical Biochemistry), College of Medical Sciences, Institute of Health Sciences, Jimma University, Ethiopia
| | - Deriba Abera Bedane
- Department of Biomedical Sciences (Medical Physiology), College of Medical Sciences, Institute of Health Sciences, Jimma University, Ethiopia
| | - Guluma Etana
- Department of Biomedical Sciences (Clinical Anatomy), College of Medical Sciences, Wollega University, Ethiopia
| | - Dassalegn Muleta
- Department of Medical laboratory Sciences (Medical Microbiology), College of Health Sciences, Mizan-Tepi University, Ethiopia
| | - Asfaw Gerbi
- Department of Biomedical Sciences (Clinical Anatomy), College of Medical Sciences, Institute of Health Sciences, Jimma University, Ethiopia
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16
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Younesian H, Farahpour N, Mazde M, Simoneau M, Turcot K. Standing Balance Performance and Knee Extensors' Strength in Diabetic Patients with Neuropathy. J Appl Biomech 2020; 36:171-177. [PMID: 32335529 DOI: 10.1123/jab.2019-0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/11/2020] [Accepted: 02/27/2020] [Indexed: 11/18/2022]
Abstract
Diabetes peripheral neuropathy (DPN) leads to balance impairment among diabetes mellitus (DM). The aims of this study were to (1) distinguish between DM patients who have/do not have DPN and to (2) compare quadriceps' strength and balance performance of DM, DPN, and healthy groups. Fifteen healthy females and 33 females with type 2 diabetic patients participated. The electrodiagnostic method was used to classify diabetic patients into DM and DPN. A dynamometer was used to measure quadriceps' strength. Single-leg standing on a force plate was also used to quantify participants' balance. Smaller conduction velocity and amplitude and greater distal latency of all nerves were observed in the DPN compared with the DM in particular for sensory nerve. In DPN, conduction velocity was asymmetrical. The quadriceps' strength of both legs in DPN and the right leg in DM was smaller than in the control group. The root mean square of the center of pressure was similar between DM and DPN. But it was larger in DPN than in the control group. DPN is associated with asymmetrical conduction velocity, smaller quadriceps' strength, and weaker balance performance that is suggestive of higher risk of falling. Balance training is recommended for the DPN group during their rehabilitation to reduce their falling risk.
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Affiliation(s)
- Hananeh Younesian
- Laval University
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)
- Bu-Ali Sina University
| | | | | | - Martin Simoneau
- Laval University
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)
| | - Katia Turcot
- Laval University
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)
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17
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Naqvi SSZH, Imani S, Hosseinifard H, Wen QL, Shahzad MN, Ijaz I, Deng Y, Guo M, Xu Y. Associations of serum low-density lipoprotein and systolic blood pressure levels with type 2 diabetic patients with and without peripheral neuropathy: systemic review, meta-analysis and meta-regression analysis of observational studies. BMC Endocr Disord 2019; 19:125. [PMID: 31767009 PMCID: PMC6878654 DOI: 10.1186/s12902-019-0453-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/31/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Compositional abnormalities in lipoproteins and cardiovascular risk factors play an important role in the progression of diabetic peripheral neuropathy (DPN). This systematic review aimed to estimate the predicting value of low-density lipoprotein (LDL) and systolic blood pressure (SBP) level in type-2 diabetes mellitus (T2DM) patients with and without peripheral neuropathy. We also tried to determine whether LDL and SBP are associated with an increased collision risk of DPN. METHODS A systematic search was conducted for eligible publications which explored the LDL and SBP level in T2DM patients with and without peripheral neuropathy. The quality of the included studies was assessed by the QUADAS-2 tool. The standardized mean difference (SMD) with 95% CI of LDL and SBP level were pooled to assess the correlation between LDL and SBP level with DPN. We performed random effects meta-regression analyses to investigate factors associated with an increased collision risk of DPN. RESULTS There was a significant association between LDL and SBP with poor prognosis of DPN in those included studies (I2 = 88.1% and I2 = 84.9%, respectively, Both P < 0.001). European T2DM patients have higher serum level of LDL in compare with the European DPN patients (SMD = 0.16, 95% CI: - 0.06 - 0.38; P < 0.001). SBP level was associated with a 2.6-fold decrease in non-DPN patients of T2DM (SMD = - 2.63, 95% CI: - 4.00 - -1.27, P < 0.001). Old age European T2DM patients have significantly high risk for diabetes drivers. Furthermore, the results of the case-control study design model are more precise to show the accuracy of SBP in Asian T2DM patients. CONCLUSION Our finding supports the LDL and SBP status could be associated with increased risk of peripheral neuropathy in T2DM patients.
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Affiliation(s)
- Syed Shah Zaman Haider Naqvi
- Department of Diabetes and Endocrinology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province People’s Republic of China
| | - Saber Imani
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province People’s Republic of China
| | - Hossein Hosseinifard
- Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Qing-Lian Wen
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province People’s Republic of China
| | - M. Naveed Shahzad
- Stem Cell Laboratory, Department of Hematology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province People’s Republic of China
| | - Iqra Ijaz
- Sichuan Provincial Center for Gynecological and Breast Diseases, Southwest Medical University, Luzhou, Sichuan Province People’s Republic of China
| | - Youcai Deng
- Institute of Materia Medical, College of Pharmacy, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
| | - Man Guo
- Luzhou Key Laboratory of Cardiovascular and Metabolic Diseases, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province People’s Republic of China
| | - Yong Xu
- Department of Diabetes and Endocrinology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province People’s Republic of China
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18
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Tang HY, Jiang AJ, Ma JL, Wang FJ, Shen GM. Understanding the Signaling Pathways Related to the Mechanism and Treatment of Diabetic Peripheral Neuropathy. Endocrinology 2019; 160:2119-2127. [PMID: 31318414 DOI: 10.1210/en.2019-00311] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/11/2019] [Indexed: 12/13/2022]
Abstract
Worldwide, the most prevalent metabolic disorder is diabetes mellitus (DM), an important condition that has been widely studied. Diabetic peripheral neuropathy (DPN), a complication that can occur with DM, is associated with pain and can result in foot ulcers and even amputation. DPN treatments are limited and mainly focus on pain management. There is a clear need to develop treatments for DPN at all stages. To make this progress, it is necessary to understand the molecular signaling pathways related to DPN. For this review, we aimed to concentrate on the main signaling cascades that contribute to DPN. In addition, we provide information with regard to treatments that are being explored.
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Affiliation(s)
- He-Yong Tang
- Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Ai-Juan Jiang
- Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Jun-Long Ma
- Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Fan-Jing Wang
- Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Guo-Ming Shen
- Anhui University of Chinese Medicine, Hefei, Anhui, China
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19
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Moradi Y, Baradaran HR, Djalalinia S, Chinekesh A, Khamseh ME, Dastoorpoor M, Sioofy-Khojine AB, Saed L, Qorbani M. Complications of type 2 diabetes in Iranian population: An updated systematic review and meta-analysis. Diabetes Metab Syndr 2019; 13:2300-2312. [PMID: 31235172 DOI: 10.1016/j.dsx.2019.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 05/22/2019] [Indexed: 01/17/2023]
Abstract
Complications among patients with type 2 diabetes mellitus (T2DM) have increased dramatically through two past decades. Thus, the aim of this updated systematic review and meta-analysis was to estimate the pooled prevalence of T2DM complications in Iranian patients. Using Medical Subject Headings terms, Emtree, and related equal Persian key words, international databases including PubMed, ISI/WOS, Scopus, Iran Medex, SID, Magiran, Irandoc, Medlib, domestic databases were searched from January 1990 till January 2018 reporting prevalence of any complications of type 2 diabetes in Iran. All the keywords were searched electronically by two Boolean operators through the explained search strategy, separately. Relevant additional articles were identified from the lists of the retrieved articles. Random and fixed effect meta-analysis was used to estimate the pooled prevalence of complications in Iranian patients with T2DM. Through searching steps, among 1238 publications retrieved from literature search, finally 45 studies met the inclusion criteria for meta-analysis, with number of 30679 participants. According to random effect, the estimated pooled prevalence of diabetic foot ulcer, cardiovascular disease, retinopathy, neuropathy and nephropathy in Iranian patients with T2DM were 3%(95% CI: 1-5%), 33%(95% CI: 16-49%), 36%(95% CI: 27-45%), 38% (95% CI: 14-63%), and 43% (95% CI: 27-60%), respectively. This updated meta-analysis shows that prevalence of major microvascular complications of T2DM in Iran is high. Our findings provide practical evidence for better planning and clinical decision making.
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Affiliation(s)
- Yousef Moradi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Iran.
| | - Shirin Djalalinia
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahdieh Chinekesh
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Mohamad Ebrahim Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Dastoorpoor
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir-Babak Sioofy-Khojine
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, FI-33520, Tampere, Finland
| | - Lotfolah Saed
- Department of Endocrinology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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20
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Tehrani KHN. A Study of Nerve Conduction Velocity in Diabetic Patients and its Relationship with Tendon Reflexes (T-Reflex). Open Access Maced J Med Sci 2018; 6:1072-1076. [PMID: 29983804 PMCID: PMC6026439 DOI: 10.3889/oamjms.2018.262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/21/2018] [Accepted: 05/25/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Neuropathy is one of the most common complications of diabetes mellitus. Neuropathy can cause the sensory deficit, neurological disorder, limb ulcers, osteomyelitis, and amputation. Therefore, neurological examinations, determining the nerve conduction velocity and performing sensory and motor tests are important for timely diagnosis and treatment. AIM The present study aimed to investigate the nerve conduction velocity in diabetic patients and its relationship with tendon reflexes. MATERIAL AND METHODS The present study was observational-cross sectional research carried out on 77 diabetic patients who were admitted into the EMG/NCV Department of Shariati Hospital in the academic year 1996-1997. In all patients, the medical history of the patient (age, duration of diabetes, gender and age of onset of diabetes), neurological examination, nerve conduction velocity, heat test, vibration test, tendon reflexes, D.L and Amplitude were examined and recorded. Finally, the raw data obtained were entered into the IBM SPSS Statistics software, and the important relationships between these variables were analysed. Moreover, in the present study, the statistical significance level (P-value) was considered less than 0.05. RESULTS The present study was conducted on a population consisting of 48 women and 29 men with diabetes. The age range of participants was 14-70 years old with an average age of 50.506 ± 7.50. The results of present study showed that the participants with clinical neuropathy (11.2 ± 7.2) had a significantly longer duration of diabetes than the normal group and those participants with sub-clinical neuropathy (P-value = 0.12). Statistical analyses indicated that increase in age, increase in the duration of diabetes and the gender of male significantly made the nerve conduction velocity abnormal. The analysis of the response to neural reflexes indicated that the ratio of neurological disorders in the five nerves of the ankle and knee was generally higher in the abnormal group (the patients with nerve conduction disorder) compared to the normal (the patients with normal nerve conduction) and in some cases, such as the ulnar motor nerve of ankle (P-value = 0.010), and the ulnar motor nerve of knee motor (P-value = 0.002) and also in the peroneal motor nerve of knee (P-value = 0.003) and the sural sensory nerve of knee (P-value = 0.003), increase in neurological disorders was significant. CONCLUSION Increase in age, increase in the duration of diabetes, and the male gender can significantly increase the risk of abnormal nerve conduction velocity.
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Noshad S, Afarideh M, Heidari B, Mechanick JI, Esteghamati A. Diabetes Care in Iran: Where We Stand and Where We Are Headed. Ann Glob Health 2018; 81:839-50. [PMID: 27108151 DOI: 10.1016/j.aogh.2015.10.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The prevalence of diabetes has steadily increased in Iran from the time of the first published nationally representative survey in 1999 and despite efforts and strategies to reduce disease burden. OBJECTIVES The aim of the present review was to describe the current status of diabetes care in Iran. METHODS A selective review of the relevant literature, focusing on properly conducted studies, describing past and present diabetes care strategies, policies, and outcomes in Iran was performed. FINDINGS The quality of diabetes care has gradually improved as suggested by a reduction in the proportion of undiagnosed patients and an increase in affordability of diabetes medications. The National Program for Prevention and Control of Diabetes has proven successful at identifying high-risk individuals, particularly in rural and remote-access areas. Unfortunately, the rising tide of diabetes is outpacing these efforts by a considerable margin. CONCLUSIONS Substantial opportunities and challenges in the areas of prevention, diagnosis, and management of diabetes exist in Iran that need to be addressed to further improve the quality of care and clinical outcomes.
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Affiliation(s)
- Sina Noshad
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Afarideh
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Heidari
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Chaturvedi R, Desai C, Patel P, Shah A, Dikshit RK. An evaluation of the impact of antidiabetic medication on treatment satisfaction and quality of life in patients of diabetes mellitus. Perspect Clin Res 2018; 9:15-22. [PMID: 29430413 PMCID: PMC5799947 DOI: 10.4103/picr.picr_140_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aims: This study aims to measure the quality of life (QOL), treatment satisfaction, and tolerability of antidiabetic drugs in patients suffering from type 2 diabetes mellitus (DM). Methods: The prospective, observational study was conducted in consenting patients of type 2 DM attending the outpatient department of a tertiary care hospital in Western India. The QOL instrument for Indian diabetes (QOLID) patients questionnaire and the Diabetes Treatment Satisfaction Questionnaire were administered to all patients at baseline, 3 months, and 6 months of treatment. Tukey–Kramer comparison test was used to analyze the difference in QOLID scores in various domains at baseline, 3 months, and 6 months. WHO-UMC scale, Naranjo's probability scale, Hartwig and Siegel, and Schumock and Thornton modified criteria were used to analyze the adverse drug reactions. Results: A male preponderance was observed in 200 patients enrolled in the study. The mean duration of diabetes was 10.96 ± 5.99 years. The patients received metformin alone (40), metformin and glipizide (47), metformin, glipizide and other oral hypoglycemic agents (OHAs) (78), and OHAs and insulin (35). A significant improvement in fasting and postprandial blood sugar was observed at 6 months as compared to the baseline (P < 0.05). A total of 39 (19.5%) patients suffered from adverse effects to metformin and insulin. Physical health and physical endurance improved in patients receiving metformin alone or in combination with glipizide as compared to patients receiving other OHAs and/or insulin. Treatment satisfaction, highest in patients receiving metformin and least in those receiving insulin, was unaltered during the study period. Conclusions: While polypharmacy is evident, using lesser medicines offers better treatment satisfaction and QOL in DM. Periodic assessment of QOL and treatment satisfaction are recommended in DM.
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Affiliation(s)
- Richa Chaturvedi
- Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Chetna Desai
- Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Prakruti Patel
- Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Asha Shah
- Department of Medicine, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Ram K Dikshit
- Department of Pharmacology, GCS Medical College Hospital and Research Centre, Ahmedabad, Gujarat, India
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Abou Zeid OA, Elkhouly NY, Osman EN, Youssef MH. Metabolic parameters in diabetic neuropathic patients after treatment with pregabalin. Diabetes Metab Syndr 2017; 11 Suppl 1:S263-S272. [PMID: 28041922 DOI: 10.1016/j.dsx.2016.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 12/12/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess metabolic parameters in patients with diabetic peripheral neuropathy (DPN) before and after 3 months treatment with a flexible dose pregabalin. METHODS This is a prospective clinical trial. The metabolic parameters observed and recorded after 3 months treatment with a flexible dose pregabalin (n=331). RESULTS The lipid profile parameters were significantly improved after treatment, total cholesterol, TC (P<0.01, 95% CI, 25.91-41.98), low-density lipoprotein, LDL (P<0.01, 95% CI, 21.11-34.80), triglycerides, TG (P<0.001, 95% CI, 56.43-79.26), all the three parameters significantly decreased while high-density lipoprotein, HDL, significantly increased (P<0.05, 95% CI, -8.61 to -5.51). Microalbumin mean was 16±1.39 before treatment versus 6.5±0.59 after treatment. Glycolated hemoglobin, HbA1c mean was 9.6±0.099 before pregabalin therapy and 7.6 ±0.06 after. BMI mean was 33.5±0.45 before versus 31.1±0.33 after (P<0.001). HbA1C was positively correlated with DPN severity before treatment (r=0.18, P<0.01). Same results were observed with weight and waist circumference (r=0.17, P<0.01, r=0.14, P<0.05 respectively). Oral anti diabetic medications (OAD) were also positively correlated to DPN severity before treatment (r=0.115, P<0.05). CONCLUSIONS Prompt treatment of DPN has a significant effect on the metabolic parameters.
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Affiliation(s)
- O A Abou Zeid
- Department of Internal Medicine, Faculty of Medicine, Taibah University, Universities Road, Madinah, PO Box: 344, Saudi Arabia.
| | - N Y Elkhouly
- Department of Internal Medicine, Faculty of Medicine, Taibah University, Universities Road, Madinah, PO Box: 344, Saudi Arabia; Department of Internal Medicine, Faculty of Medicine, Alazhar University, Egypt
| | - E N Osman
- Department of Internal Medicine, Faculty of Medicine, Taibah University, Universities Road, Madinah, PO Box: 344, Saudi Arabia
| | - M H Youssef
- Department of Internal Medicine, Faculty of Medicine, Taibah University, Universities Road, Madinah, PO Box: 344, Saudi Arabia
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Kargarian-Marvasti S, Rimaz S, Abolghasemi J, Heydari I. Comparing of Cox model and parametric models in analysis of effective factors on event time of neuropathy in patients with type 2 diabetes. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:115. [PMID: 29184573 PMCID: PMC5680655 DOI: 10.4103/jrms.jrms_6_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/28/2017] [Accepted: 07/18/2017] [Indexed: 12/24/2022]
Abstract
Background: Cox proportional hazard model is the most common method for analyzing the effects of several variables on survival time. However, under certain circumstances, parametric models give more precise estimates to analyze survival data than Cox. The purpose of this study was to investigate the comparative performance of Cox and parametric models in a survival analysis of factors affecting the event time of neuropathy in patients with type 2 diabetes. Materials and Methods: This study included 371 patients with type 2 diabetes without neuropathy who were registered at Fereydunshahr diabetes clinic. Subjects were followed up for the development of neuropathy between 2006 to March 2016. To investigate the factors influencing the event time of neuropathy, significant variables in univariate model (P < 0.20) were entered into the multivariate Cox and parametric models (P < 0.05). In addition, Akaike information criterion (AIC) and area under ROC curves were used to evaluate the relative goodness of fitted model and the efficiency of each procedure, respectively. Statistical computing was performed using R software version 3.2.3 (UNIX platforms, Windows and MacOS). Results: Using Kaplan–Meier, survival time of neuropathy was computed 76.6 ± 5 months after initial diagnosis of diabetes. After multivariate analysis of Cox and parametric models, ethnicity, high-density lipoprotein and family history of diabetes were identified as predictors of event time of neuropathy (P < 0.05). Conclusion: According to AIC, “log-normal” model with the lowest Akaike's was the best-fitted model among Cox and parametric models. According to the results of comparison of survival receiver operating characteristics curves, log-normal model was considered as the most efficient and fitted model.
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Affiliation(s)
| | - Shahnaz Rimaz
- Radiation Biology Research Center, Department of Epidemiology, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Jamileh Abolghasemi
- Department of Biostatistics, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Iraj Heydari
- Endocrine Research Center, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran.,Department of Endocrinology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Esteghamati A, Larijani B, Aghajani MH, Ghaemi F, Kermanchi J, Shahrami A, Saadat M, Esfahani EN, Ganji M, Noshad S, Khajeh E, Ghajar A, Heidari B, Afarideh M, Mechanick JI, Ismail-Beigi F. Diabetes in Iran: Prospective Analysis from First Nationwide Diabetes Report of National Program for Prevention and Control of Diabetes (NPPCD-2016). Sci Rep 2017; 7:13461. [PMID: 29044139 PMCID: PMC5647418 DOI: 10.1038/s41598-017-13379-z] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 09/22/2017] [Indexed: 02/07/2023] Open
Abstract
We estimated proportions of different types of diabetes, comorbidities, treatment (the use of oral glucose-lowering agents and insulin), control (hyperglycemia, dyslipidemia and hypertension) and chronic microvascular and macrovascular complications among people with diabetes presenting to the tertiary-care academic diabetes outpatient clinics in Iran. This study is the prospective analysis of data (n = 30,202) from the registry of university-affiliated adult outpatient diabetes clinics in the country during 2015-2016. The proportions of type 1 diabetes, types 2 diabetes, and other types of diabetes were 11.4%, 85.5%, and 1.3%, respectively. The frequencies of drug-naivety, use of oral agents, insulin monotherapy and insulin combination therapy were 2.9%, 60.5%, 11.5%, and 25.1%, respectively. Around 13.2%, 11.9% and 43.3% of patients with diabetes had controlled hyperglycemia, hyperlipidemia and hypertension, respectively. The proportions of retinopathy, nephropathy, peripheral neuropathy, diabetic foot, and ischemic heart disease were 21.9%, 17.6%, 28.0%, 6.2%, and 23.9%, respectively. Despite the wide availability of medications and insulin coverage in Iran, the estimated national control of hyperglycemia, hyperlipidemia and hypertension (especially for young men and old women) remains subpar. The present study further suggests that the frequencies of chronic vascular complications among patients with diabetes are relatively high in Iran.
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Affiliation(s)
- Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bagher Larijani
- Diabetes Researcher Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Ghaemi
- Diabetes Program, Deputy of Health, Ministry of Health and Medical Education (MOHME), Tehran, Iran
| | - Jamshid Kermanchi
- Deputy of Curative Affairs, Ministry of Health and Medical Education (MOHME), Tehran, Iran
| | - Ali Shahrami
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Saadat
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Nasli Esfahani
- Diabetes Researcher Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Morsaleh Ganji
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Noshad
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khajeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ghajar
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Heidari
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Afarideh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Faramarz Ismail-Beigi
- Department of Medicine, Biochemistry, Physiology and Biophysics, Division of Clinical and Molecular Endocrinology, Case Western Reserve University, Cleveland, Ohio, United States
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26
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Yang CP, Li CI, Liu CS, Lin WY, Hwang KL, Yang SY, Li TC, Lin CC. Variability of fasting plasma glucose increased risks of diabetic polyneuropathy in T2DM. Neurology 2017; 88:944-951. [PMID: 28179465 DOI: 10.1212/wnl.0000000000003682] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/12/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine whether variations in fasting plasma glucose (FPG), as measured by the coefficient of variation (CV), is a predictor of diabetic polyneuropathy (DPN) risk, considering glycated hemoglobin (HbA1c) and other traditional risk factors. METHODS Type 2 diabetic patients enrolled in the National Diabetes Care Management Program were ≥30 years of age and free of DPN (n = 36,152). They were enrolled in 2002-2004 and were monitored until 2011. The related factors were analyzed using Cox proportional hazards regression models. RESULTS During an average 7.23 years of follow-up, a total of 7,219 incident cases of DPN were identified, with a crude incidence rate of 27.62/1,000 person-years (25.83 for men and 29.31 for women). After multivariate adjustment, both FPG-CV and HbA1c were significant predictors of DPN, with corresponding hazard ratios of 1.14 (95% confidence interval [CI] 1.05-1.23) and 1.15 (95% CI 1.06-1.24) for FPG-CV in the fourth to fifth quintiles and 1.13 (95% CI 1.07-1.20) for HbA1c ≥7%. This finding maintained consistency after excluding potential confounders in the sensitivity analysis, further validating the results. CONCLUSIONS FPG-CV and HbA1c ≥7% were potent predictors of DPN in type 2 diabetic patients. The associations among HbA1c, glycemic variability, and DPN suggest a linked pathophysiologic mechanism, which may play a crucial role in clinical risk assessments.
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Affiliation(s)
- Chun-Pai Yang
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chia-Ing Li
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chiu-Shong Liu
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Wen-Yuan Lin
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Kai-Lin Hwang
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Sing-Yu Yang
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Tsai-Chung Li
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - Cheng-Chieh Lin
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Wang F, Zhang J, Yu J, Liu S, Zhang R, Ma X, Yang Y, Wang P. Diagnostic Accuracy of Monofilament Tests for Detecting Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis. J Diabetes Res 2017; 2017:8787261. [PMID: 29119118 PMCID: PMC5651135 DOI: 10.1155/2017/8787261] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/06/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To systematically evaluate the diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy. METHODS We searched EMBASE (OvidSP), MEDLINE (OvidSP), the Cochrane Library, and Web of Science to identify diagnostic accuracy trials of monofilament tests for detecting diabetic peripheral neuropathy. We used a hierarchical summary receiver operating characteristics (HSROC) model to conduct the meta-analysis of diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy. RESULTS A total of 19 comparative trials met the inclusion criteria and were part of the qualitative synthesis. Eight trials using nerve conduction studies as the reference standard were selected for the meta-analysis. The pooled sensitivity and specificity of monofilament tests for detecting diabetic peripheral neuropathy were 0.53 (95% confidence interval (CI) 0.32 to 0.74) and 0.88 (95% CI 0.78 to 0.94), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 4.56 (95% CI 2.93 to 7.10) and 0.53 (95% CI 0.35 to 0.81), respectively. CONCLUSIONS Our review indicated that monofilament tests had limited sensitivity for screening diabetic peripheral neuropathy. The clinical use of the monofilament test in the evaluation of diabetic peripheral neuropathy cannot be encouraged based on currently available evidence.
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Affiliation(s)
- Fengyi Wang
- Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jiadan Yu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Shaxin Liu
- Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Rengang Zhang
- Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xichao Ma
- Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yonghong Yang
- Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Pu Wang
- Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kelle B, Evran M, Ballı T, Yavuz F. Diabetic peripheral neuropathy: Correlation between nerve cross-sectional area on ultrasound and clinical features. J Back Musculoskelet Rehabil 2016; 29:717-722. [PMID: 26966822 DOI: 10.3233/bmr-160676] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the correlations of the cross-sectional area (CSA) of peripheral nerves in diabetic peripheral neuropathy (DPN) patients based on ultrasound (US) with clinical and demographic characteristics. METHODS A DPN patient group (n= 53) and a matched healthy control group (n= 53) underwent US imaging of the sciatic, tibial and median nerves. The CSAs of these nerves were recorded, and their associations with pain intensity according to the visual analog scale (VAS) score and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale score, diabetes mellitus (DM) duration, body mass index (BMI), HbA1c level and blood glucose levels were evaluated. RESULTS The CSAs of the examined nerves in diabetic patients were larger than those in healthy individuals (p< 0.05). No correlations were detected between the CSAs of the examined nerves and the parameters of interest (p> 0.05), including the VAS and LANSS pain scale scores (p= 0.32 and p= 0.31, respectively). CONCLUSIONS US is a sensitive diagnostic technique for detecting DPN; however, it does not indicate disease severity.
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Affiliation(s)
- Bayram Kelle
- Department of Physical Medicine and Rehabilitation, Cukurova University, Faculty of Medicine, Balcalı Hospital, Adana, Turkey
| | - Mehtap Evran
- Department of Endocrinology, Cukurova University, Faculty of Medicine, Balcalı Hospital, Adana, Turkey
| | - Tugsan Ballı
- Department of Radiology, Cukurova University, Faculty of Medicine, Balcalı Hospital, Adana, Turkey
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Petropoulos IN, Javed S, Azmi S, Khan A, Ponirakis G, Malik RA. Diabetic neuropathy and painful diabetic neuropathy in the Middle East and North Africa (MENA) region: Much work needs to be done. J Taibah Univ Med Sci 2016. [DOI: 10.1016/j.jtumed.2016.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Inoue R, Sumitani M, Yasuda T, Tsuji M, Nakamura M, Shimomura I, Shibata M, Yamada Y. Independent Risk Factors for Positive and Negative Symptoms in Patients with Diabetic Polyneuropathy. J Pain Palliat Care Pharmacother 2016; 30:178-83. [PMID: 27337438 DOI: 10.1080/15360288.2016.1192081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Patients with diabetes occasionally develop diabetic polyneuropathy (DPN), which is characterized by both positive symptoms such as pain and negative symptoms such as numbness/dysesthesia. However, these symptoms have always been collectively analyzed to determine their risk factors. This study aimed to independently analyze the risk factors for neuropathic pain and numbness/dysesthesia in DPN patients. In total, 298 patients with diabetes (age: 61.1 ± 10.4 years; 176 male) were included. The relationships among the incidence of DPN and its clinical parameters were determined using logistic regression models. Then, the statistical model was applied in two groups of DPN patients: those with pain only or both pain and the negative symptoms (pain group; n = 25) and those with the negative symptoms only or both pain and the negative symptoms (numbness/dysesthesia group; n = 60). All logistic regression models were adjusted for the duration of diabetes, glycosylated hemoglobin levels, and age. The depression score was higher for patients with DPN than for those without, although it did not reach an abnormal level. An abnormal Achilles tendon reflex (ATR) and insulin treatment, but not smoking, hypertension, hyperlipidemia, and diabetic retinopathy, were associated with DPN. Furthermore, female sex and an abnormal ATR and insulin treatment were significant clinical features in the pain and numbness/numbness groups, respectively. Overweight and obesity were the common clinical features in both groups. We conclude that the positive and negative symptoms of DPN possibly have independent risk factors, suggesting different underlying mechanisms and the need for separate diagnosis and treatment.
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Yang CP, Lin CC, Li CI, Liu CS, Lin WY, Hwang KL, Yang SY, Chen HJ, Li TC. Cardiovascular Risk Factors Increase the Risks of Diabetic Peripheral Neuropathy in Patients With Type 2 Diabetes Mellitus: The Taiwan Diabetes Study. Medicine (Baltimore) 2015; 94:e1783. [PMID: 26496307 PMCID: PMC4620799 DOI: 10.1097/md.0000000000001783] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This study aimed to examine whether poor glycemic control, measured by glycated hemoglobin A1C (HbA1c) and other cardiovascular risk factors, can predict diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (DM).Patients aged ≥30 years with type 2 DM, enrolled in the National Diabetes Care Management Program, and free of DPN (n = 37,375) in the period 2002 to 2004 were included and followed up until 2011. The related factors were analyzed using Cox proportional hazards regression models.For an average follow-up of 7.00 years, 8379 cases of DPN were identified, with a crude incidence rate of 32.04/1000 person-years. After multivariate adjustment, patients with HbA1c levels 7 to 8%, 8 to 9%, 9 to 10%, and ≥10% exhibited higher risk of DPN (adjusted HR: 1.11 [1.04-1.20], 1.30 [1.21-1.40], 1.32 [1.22-1.43], and 1.62 [1.51-1.74], respectively) compared with patients with HbA1c level 6 to 7%. There was a significant linear trend in DPN incidence with increasing HbA1c (P < 0.001) and significant HRs of DPN for patients with HbA1c level ≥7%, blood pressure ≥130/85 mm Hg, triglycerides (TG) ≥150 mg/dL, high density of lipoprotein-cholesterol (HDL-C) <40 mg/dL in males and <50 mg/dL in females, low density of lipoprotein-cholesterol (LDL-C) ≥100 mg/dL, and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m.Patients with type 2 DM and HbA1c ≥7.0% exhibit increased risk of DPN, demonstrating a linear relationship. The incidence of DPN is also associated with poor glucose control and cardiovascular risk factors like hypertension, hyper-triglyceridemia, low HDL-C, high LDL-C, and decreased eGFR.
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Affiliation(s)
- Chun-Pai Yang
- From the Department of Neurology, Kuang Tien General Hospital (C-PY); Department of Nutrition, Huang-Kuang University (C-PY); School of Medicine, College of Medicine, China Medical University (C-CL, C-IL, C-SL, W-YL); Department of Medical Research (C-CL, C-IL, C-SL); Department of Family Medicine, China Medical University Hospital (C-CL, C-SL, W-YL); Department of Public Health, Chung Shan Medical University (K-LH); Graduate Institute of Biostatistics, College of Public Health, China Medical University (S-YY, T-CL); Management Office for Health Data, China Medical University Hospital (H-JC); and Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan (T-CL)
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D'Souza M, Kulkarni V, Bhaskaran U, Ahmed H, Naimish H, Prakash A, S T, Dahiya B, Thapar R, Mithra P, Kumar N, Holla R, Bb D, Kumar A. Diabetic Peripheral Neuropathy and its Determinants among Patients Attending a Tertiary Health Care Centre in Mangalore, India. J Public Health Res 2015; 4:450. [PMID: 26425491 PMCID: PMC4568420 DOI: 10.4081/jphr.2015.450] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 04/28/2015] [Accepted: 05/06/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The burden of diabetes mellitus (DM) is on the rise especially in developing countries like India. Due to its chronic nature DM tends to cause many debilitating complications and diabetic peripheral neuropathy (DPN) is one of them. The aim of this study is to determine the prevalence of DPN among patients attending a tertiary care hospital and to identify the determinants associated with it. DESIGN AND METHODS A cross sectional study was conducted in Government Wenlock Hospital, Mangalore (India), during January-February 2014. A total of 208 patients with >5 year duration of DM were asked to respond to the patient history version of Michigan Neuropathy Screening Instrument (MNSI) and examinations were conducted after obtaining consent from them. The statistical analysis was done in terms of descriptive statistics and association between variables was tested using logistic regression test. RESULTS The prevalence of DPN using the MNSI history version and MNSI examination were found to be 18.3% and 32.2% respectively. The major determinants associated with DPN were found to be male gender (OR: 2.7, CI: 1.4-5.1, P=0.001), smoking (OR: 5.8, CI: 1.9-17.3, P=0.001) and age >40 years (OR: 2.7, CI: 1.2-5.8, P=0.011). CONCLUSIONS The burden of undetected DPN was found to be higher among diabetics, with an especially higher prevalence among males, smokers and those with long standing diabetes mellitus. Interventions in the form of early detection through routine screening, smoking cessation and regular follow up examinations would go a long way in reducing the burden of disability among diabetics and improve their quality of life significantly. Significance for public healthThe findings of the current research hold importance since diabetes is one of the leading causes of morbidity and mortality across the world. Due to its chronic nature and effects of hyperglycaemia, diabetes tends to be associated with many comorbidities, like peripheral neuropathy, nephropathy, retinopathy etc. The presence of diabetic peripheral neuropathy leads to a reduced quality of life among diabetic patients due to the trauma and consequent gangrenes andamputation. The concept of secondary prevention can be applied to the prevention of diabetic peripheral neuropathy using easy to apply screening tools and thus help in early diagnosis and treatment to reduce the burden of this debilitating illness.
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Affiliation(s)
- Monisha D'Souza
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
| | - Vaman Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
| | - Unnikrishnan Bhaskaran
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
| | - Humam Ahmed
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
| | - Hegde Naimish
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
| | - Anjali Prakash
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
| | - Tabreez S
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
| | - Bhanu Dahiya
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
| | - Rekha Thapar
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
| | - Nithin Kumar
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
| | - Ramesh Holla
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
| | - Darshan Bb
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
| | - Avinash Kumar
- Department of Community Medicine, Kasturba Medical College, Manipal University , Mangalore, India
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Li L, Chen J, Wang J, Cai D. Prevalence and risk factors of diabetic peripheral neuropathy in Type 2 diabetes mellitus patients with overweight/obese in Guangdong province, China. Prim Care Diabetes 2015; 9:191-195. [PMID: 25163987 DOI: 10.1016/j.pcd.2014.07.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 01/19/2023]
Abstract
AIMS To investigate the prevalence and risk factors of diabetic peripheral neuropathy (DPN) in Type 2 diabetes mellitus (T2DM) patients with overweight or obese in Guangdong province in China. METHODS A cross-sectional study was carried out on T2DM patients with overweight/obese in 60 hospitals in Guangdong province. Methods of data collection included questionnaire, clinical examination, blood draw and clinical measurement. Demographic characteristics, diagnosis of diabetes and DPN, disease history, life styles and self-management, most recent laboratory test results and physical examination were collected. Binary logistic regression was used to assess risk factors of DPN. RESULTS A total of 3359 T2DM patients (age range 20-90 years) were recruited. The overall prevalence of DPN was 33.1%. Binary logistic regression identified age (odds ratio [OR]: 1.016, 95% confidence interval [CI]: 1.008, 1.024), duration of diabetes mellitus (OR: 1.072, 95% CI: 1.056, 1.087) and HbA1c (OR: 1.053, 95% CI: 1.013, 1.095) as risk factors for the presence of DPN. CONCLUSIONS DPN is prevalent in T2DM patients with overweight or obese in Guangdong province in China and is significantly associated with age, HbA1c and duration of diabetes.
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Affiliation(s)
- Li Li
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China; Department of Nursing, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China.
| | - Jiali Chen
- Department of Nursing, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China
| | - Jiao Wang
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China
| | - Dehong Cai
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China
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Sobhani S, Asayesh H, Sharifi F, Djalalinia S, Baradaran HR, Arzaghi SM, Mansourian M, Rezapoor A, Ansari H, Masoud MP, Qorbani M. Prevalence of diabetic peripheral neuropathy in Iran: a systematic review and meta-analysis. J Diabetes Metab Disord 2014; 13:97. [PMID: 25364702 PMCID: PMC4215018 DOI: 10.1186/s40200-014-0097-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 09/27/2014] [Indexed: 01/17/2023]
Abstract
Diabetic peripheral neuropathy (DPN) is an important microvascular complication of diabetes mellitus (DM). It is a major contributor to foot ulceration and lower limb amputation in persons with DM and have also a significant negative effect on patient's quality of life. This meta-analysis reviews prevalence of DPN among patients with type 1 and 2 DM in Iran. Using PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS as the main international electronic data sources, and Iranmedex, Irandoc, and Scientific Information Database (SID), as the main domestic databases with systematic search capability, we systematically searched surveys, papers, and reports on the prevalence of DPN (between January 1991 to February 2013). Heterogeneity of reported prevalence’s between studies was assessed by the Chi-square-based Q test and due to heterogeneity; overall prevalence of DPN was estimated using random-effect meta-analysis model. We found 304 records; from them a total of 21 studies comprising 5540 diabetic patients were included. The prevalence of diabetic neuropathy (reported) from 16% to 87%. In overall the prevalence of DPN estimated 53% (95% CI: 41-65) by using random-effect. This study show that the prevalence of DPN seems very high among the population with diabetes in Iran and more than half of the patients with DM has any type of diabetic neuropathy.
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Affiliation(s)
- Sahar Sobhani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Asayesh
- Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran ; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran ; Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Hamid Reza Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Masoud Arzaghi
- Elderly Health Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Mansourian
- Department of Public Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Aziz Rezapoor
- Hospital Management Research Center, Department of Health Economic, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ansari
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Lazo MDLA, Bernabé-Ortiz A, Pinto ME, Ticse R, Malaga G, Sacksteder K, Miranda JJ, Gilman RH. Diabetic peripheral neuropathy in ambulatory patients with type 2 diabetes in a general hospital in a middle income country: a cross-sectional study. PLoS One 2014; 9:e95403. [PMID: 24789071 PMCID: PMC4006783 DOI: 10.1371/journal.pone.0095403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/25/2014] [Indexed: 01/12/2023] Open
Abstract
Aim We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a low-middle income country setting. Methods Cross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (<10 vs. ≥10 years), glycaemic control (HbA1c <7% vs. ≥7%), microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios. Results DPN was observed in 73/129 (56.6%) patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07–1.88) in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02–1.93) in patients with ≥10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p<0.001), onychomycosis (p = 0.012), abnormal Achilles reflex (p<0.001), pain perception (p<0.001) and vibration perception (p<0.001). Conclusion DPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin
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Affiliation(s)
- María de los Angeles Lazo
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Miguel E. Pinto
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Servicio de Endocrinología, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Ray Ticse
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Servicio de Endocrinología, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - German Malaga
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Katherine Sacksteder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
| | - Robert H. Gilman
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Farshchi A, Esteghamati A, Sari AA, Kebriaeezadeh A, Abdollahi M, Dorkoosh FA, Khamseh ME, Aghili R, Keshtkar A, Ebadi M. The cost of diabetes chronic complications among Iranian people with type 2 diabetes mellitus. J Diabetes Metab Disord 2014; 13:42. [PMID: 24593991 PMCID: PMC3975900 DOI: 10.1186/2251-6581-13-42] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/22/2014] [Indexed: 12/02/2022]
Abstract
Background To evaluate the cost of diabetes related micro- and macrovascular complications in Iranian people with type 2 diabetes mellitus. Methods In routine clinical practice, people with type 2 diabetes mellitus were assessed for 10 years at a diabetes care center. The type of medications and clinical data were extracted from patients’ documents. Mortality rate and the incidence of micro- and macrovascular complications recorded in patients’ documents were analyzed. Cost analysis was comprised of 1) para clinic costs as well as laboratory, medications, clinical visits and nonmedical costs 2) inpatient costs as well as hospital admission costs, disability, and mortality costs. Results From 1562 people with type 2 diabetes mellitus, a total of 1000 patients with mean duration disease of 11.2 years, who had completed information in their documents, were studied. All people were free from complications at baseline. Mean cumulative incidence of diabetes-related complications over 10 years were 10.9 ± 3.5%, 8.0 ± 3.1%, 4.6 ± 1.7%, 9.1 ± 3.6% and 2.3 ± 0.9% for peripheral neuropathy and diabetic foot ulcer, nephropathy, ophthalmic complications, cardiovascular disease and death, respectively. People with better glycemic control had less complication and also related expenditures. Average para clinic cost per patient was 393.6 ± 47.8 and average inpatient cost per patient was 1520.7 ± 104.5 USD. Conclusions Our findings demonstrate considerable incidence of diabetes chronic complications and also high health care expenditure for related complications among our patients. As the number of people with diabetes continues to rise, early detection of the disease and implementation of timely and appropriate therapeutic strategies could decrease the burden of diabetes chronic complications and also huge related expenditures.
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Affiliation(s)
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Baraz S, Zarea K, Shahbazian HB, Latifi SM. Comparison of the accuracy of monofilament testing at various points of feet in peripheral diabetic neuropathy screening. J Diabetes Metab Disord 2014; 13:19. [PMID: 24472435 PMCID: PMC3922886 DOI: 10.1186/2251-6581-13-19] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 12/19/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Diabetic Peripheral Neuropathy is one of the most prevalent complications of diabetes mellitus. The development and progression of such complications are responsible for much of the morbidity and mortality. The purpose of this study was to evaluate the effectiveness of Semmes-Weinstein monofilament ten gram in 3, 4, eight and ten points in the screening of diabetic peripheral neuropathy in patients with diabetes mellitus. METHODS In a descriptive correlational design, 150 patients with diabetes mellitus were selected using convenience sampling. All patients were evaluated for sensory neuropathy using ten gram Semmes-Weinstein Monofilaments and questionnaire on neuropathy symptoms. In the next phase, nerve conduction velocity was examined. The most common subjective symptoms were paresthesia of both feet, pain in feet, burning sensation in the extremities and numbness in the extremities. RESULTS The results showed that the sensitivity of Monofilament in three and four points were 35.9 to 53.8 present and 38.5 to 51.3 percent respectively. Specificity of Monofilament the same points, were 73.9 to 84.7 and 73 to 87.4 percent respectively. Monofilament sensitivity at eight and ten points were 38.5 to 61.5 and 64.1 to 30.8 percent respectively. Also, specificity of the same points were 77.5 to 95.5 and 64 to 89.2 percent respectively. It was revealed that the difference sensitivity and specificity of Monofilament in three and four points with sensitivity and specificity in eight and ten point is not statistically significant. CONCLUSIONS This study showed that Semmes-Weinstein monofilament can easily use as a simple and inexpensive device for screening. Since increasing the number of points it was not significantly difference. Therefore, we suggest that screening for diabetic peripheral neuropathy, especially in large populations to avoid wasting time on Monofilament application, areas like three or four points eight and ten points could be used.
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Affiliation(s)
| | - Kourosh Zarea
- Chronic Diseases Care Research Center, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences (AJUMS), Golestan Street, Ahvaz, Iran.
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Ziegler D, Papanas N, Vinik AI, Shaw JE. Epidemiology of polyneuropathy in diabetes and prediabetes. ACTA ACUST UNITED AC 2014; 126:3-22. [DOI: 10.1016/b978-0-444-53480-4.00001-1] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Zabetian A, Kelli HM, Echouffo-Tcheugui JB, Narayan KMV, Ali MK. Diabetes in the Middle East and North Africa. Diabetes Res Clin Pract 2013; 101:106-22. [PMID: 23642969 DOI: 10.1016/j.diabres.2013.03.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/04/2013] [Indexed: 02/07/2023]
Abstract
AIMS Even though the Middle East and North Africa (MENA) region had the highest comparative prevalence of diabetes in 2012, little is known about the nuances of diabetes risk and capacity to address the burdens. To provide a comprehensive overview, we reviewed the literature on diabetes in the MENA region. METHODS We conducted a systematic search in PubMed between January 1990 and January 2012 for studies on diabetes in the MENA region without language restriction. RESULTS There was a paucity of country-specific epidemiology data in the region. Diabetes prevalence varied widely across studies, from 2.5% in 1982 to 31.6% in 2011. Older age and higher body mass index were the most strongly associated risk factors for diabetes. Among people with diabetes, over half did not meet recommended care targets. In addition, macrovascular and microvascular complications were observed in 9-12% and 15-54% of diabetes population, respectively. CONCLUSIONS This review suggests a need for more representative surveillance data in this noteworthy focal point of the global diabetes epidemic. Such actions will not only help to understand the actual burden of diabetes but also motivate actions on design and implementation of diabetes prevention and control programs.
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Affiliation(s)
- Azadeh Zabetian
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
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Mørkrid K, Ali L, Hussain A. Risk factors and prevalence of diabetic peripheral neuropathy: A study of type 2 diabetic outpatients in Bangladesh. Int J Diabetes Dev Ctries 2011; 30:11-7. [PMID: 20431800 PMCID: PMC2859278 DOI: 10.4103/0973-3930.60004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 12/23/2009] [Indexed: 12/30/2022] Open
Abstract
Aims/Hypothesis: The purpose of the study is to estimate the prevalence and risk factors for diabetic peripheral neuropathy (DPN) in type 2 diabetic outpatients at the BIRDEM hospital, Bangladesh. Materials and Methods: Type 2 diabetic outpatients, diagnosed 5-11 years prior to the investigation were randomly selected for the study. DPN was assessed using the Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS). Data about demographics, blood pressure, height, weight, waist and hip circumference, and random blood and urine samples were collected. Results: Two hundred and ninety four (139 men, 155 women) type 2 diabetic outpatients were studied. The overall DPN prevalence was 19.7 %; male (20.9%), female (18.7 %). The prevalence increased with age (from 11.1% in the 23-40 year-old group to 32.3% in the 60-80 year-old group) and duration of diabetes (from 14.1% in patients with five years to 29.2% in patients with 9-11 years duration). Age > 60 years (OR 4.2, 95% CI 1.4-12.3), low/normal WHR (OR 3.8, 95% CI 1.6-9.3), income < 800 TK (OR 3.1, 95% CI 1.1-9.3) and insulin treatment (OR 2.0, 95% CI 1.0-4.0) were independent, significant risk factors. Longer duration of diabetes (OR1.2 95% CI 1.0-1.4), and higher HbA1c (OR1.1, 95% CI 1.0-1.3) were marginally independent, significant risk factors for DPN. Conclusions/Interpretations: We observed a DPN prevalence of 19.7%. Higher age, low socioeconomic status, treatment with insulin, longer duration of diabetes and poor glycemic control were risk factors for DPN.
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Affiliation(s)
- Kjersti Mørkrid
- Institute of General Practice and Community Medicine, Department of International Health, University of Oslo. Postbox 1130 Blindern, 0318 Oslo, Norway
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Expression-based network biology identifies alteration in key regulatory pathways of type 2 diabetes and associated risk/complications. PLoS One 2009; 4:e8100. [PMID: 19997558 PMCID: PMC2785475 DOI: 10.1371/journal.pone.0008100] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 10/06/2009] [Indexed: 12/12/2022] Open
Abstract
Type 2 diabetes mellitus (T2D) is a multifactorial and genetically heterogeneous disease which leads to impaired glucose homeostasis and insulin resistance. The advanced form of disease causes acute cardiovascular, renal, neurological and microvascular complications. Thus there is a constant need to discover new and efficient treatment against the disease by seeking to uncover various novel alternate signalling mechanisms that can lead to diabetes and its associated complications. The present study allows detection of molecular targets by unravelling their role in altered biological pathways during diabetes and its associated risk factors and complications. We have used an integrated functional networks concept by merging co-expression network and interaction network to detect the transcriptionally altered pathways and regulations involved in the disease. Our analysis reports four novel significant networks which could lead to the development of diabetes and other associated dysfunctions. (a) The first network illustrates the up regulation of TGFBRII facilitating oxidative stress and causing the expression of early transcription genes via MAPK pathway leading to cardiovascular and kidney related complications. (b) The second network demonstrates novel interactions between GAPDH and inflammatory and proliferation candidate genes i.e., SUMO4 and EGFR indicating a new link between obesity and diabetes. (c) The third network portrays unique interactions PTPN1 with EGFR and CAV1 which could lead to an impaired vascular function in diabetic nephropathy condition. (d) Lastly, from our fourth network we have inferred that the interaction of β-catenin with CDH5 and TGFBR1 through Smad molecules could contribute to endothelial dysfunction. A probability of emergence of kidney complication might be suggested in T2D condition. An experimental investigation on this aspect may further provide more decisive observation in drug target identification and better understanding of the pathophysiology of T2D and its complications.
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Amini M, Parvaresh E. Prevalence of macro- and microvascular complications among patients with type 2 diabetes in Iran: a systematic review. Diabetes Res Clin Pract 2009; 83:18-25. [PMID: 19091437 DOI: 10.1016/j.diabres.2008.10.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 10/28/2008] [Accepted: 10/02/2008] [Indexed: 10/21/2022]
Abstract
Although diabetes mellitus is becoming prevalent in Iran, no comprehensive data on diabetes-related complications exist. A systematic search of English and Farsi databases identified 26 publications on the prevalence of macro- and microvascular complications in adult Iranians with type 2 diabetes. Micro- and macroalbuminuria, retinopathy and neuropathy were highly prevalent and cardiovascular complications were prevalent. Valid studies on diabetic foot ulcers and lower limb amputations were few. Insufficient evidence of late complications precluded data extrapolation to the whole Iranian diabetic population. However, considering diabetes's high prevalence and impact on healthcare systems, current diabetes management in Iran requires further study.
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Affiliation(s)
- Masoud Amini
- Endocrine and Metabolism Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
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Alwakeel JS, Sulimani R, Al-Asaad H, Al-Harbi A, Tarif N, Al-Suwaida A, Al-Mohaya S, Isnani AC, Alam A, Hammad D. Diabetes complications in 1952 type 2 diabetes mellitus patients managed in a single institution in Saudi Arabia. Ann Saudi Med 2008; 28:260-6. [PMID: 18596402 PMCID: PMC6074352 DOI: 10.5144/0256-4947.2008.260] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Because there is no recent update on the state of diabetes and its concomitant complications in Saudi Arabia, we undertook a study of the prevalence of health complications in patients with type 2 diabetes mellitus admitted to our institution. METHODS We conducted a retrospective review of medical records of adult Saudi patients with type 2 diabetes who were seen in clinics or admitted to the Security Forces Hospital, Riyadh, Saudi Arabia, between January 1989 and January 2004. RESULTS Of 1952 patients, 943 (48.3%) were males. For the whole study population the mean age at enrollment was 58.4+/-14.2 years, the mean age at onset of diabetes was 48.1+/-12.8 years, the mean duration of diabetes was 10.4+/-7.5 years, and the mean duration of follow-up was 7.9+/-4.6 years. Nephropathy was the most prevalent complication, occurring in 626 patients (32.1%). Acute coronary syndrome occurred in 451 (23.1%), cataracts in 447 (22.9%), retinopathy in 326 (16.7%), and myocardial infarction in 279 (14.3%), Doubling of serum creatinine was seen in 250 (12.8%) and 79 (4.0%) went into dialysis. Hypertension was present in 1524 (78.1%) and dyslipidemia in 764 (39.1%). Overall mortality was 8.2%. Multiple complications were frequent. Males had higher prevalence of complications than females (P<.05). Mortality was significantly higher in males 92 (9.8%) than females 69 (6.8%) (P=.024). The prevalence of complications significantly increased with duration of diabetes and age (P<.05). CONCLUSION Among Saudis, the prevalence of concomitant diabetic complications is high, with cardiovascular and renal complications the most frequent. Many patients had multiple complications. Early and frequent screenings in the patients with type 2 diabetes are desirable to identify patients at high risk for concomitant complications and to prevent disabilities.
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Affiliation(s)
- Jamal S Alwakeel
- Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.
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