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Galiero R, Caturano A, Vetrano E, Beccia D, Brin C, Alfano M, Di Salvo J, Epifani R, Piacevole A, Tagliaferri G, Rocco M, Iadicicco I, Docimo G, Rinaldi L, Sardu C, Salvatore T, Marfella R, Sasso FC. Peripheral Neuropathy in Diabetes Mellitus: Pathogenetic Mechanisms and Diagnostic Options. Int J Mol Sci 2023; 24:ijms24043554. [PMID: 36834971 PMCID: PMC9967934 DOI: 10.3390/ijms24043554] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Diabetic neuropathy (DN) is one of the main microvascular complications of both type 1 and type 2 diabetes mellitus. Sometimes, this could already be present at the time of diagnosis for type 2 diabetes mellitus (T2DM), while it appears in subjects with type 1 diabetes mellitus (T1DM) almost 10 years after the onset of the disease. The impairment can involve both somatic fibers of the peripheral nervous system, with sensory-motor manifestations, as well as the autonomic system, with neurovegetative multiorgan manifestations through an impairment of sympathetic/parasympathetic conduction. It seems that, both indirectly and directly, the hyperglycemic state and oxygen delivery reduction through the vasa nervorum can determine inflammatory damage, which in turn is responsible for the alteration of the activity of the nerves. The symptoms and signs are therefore various, although symmetrical painful somatic neuropathy at the level of the lower limbs seems the most frequent manifestation. The pathophysiological aspects underlying the onset and progression of DN are not entirely clear. The purpose of this review is to shed light on the most recent discoveries in the pathophysiological and diagnostic fields concerning this complex and frequent complication of diabetes mellitus.
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Affiliation(s)
- Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Domenico Beccia
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Chiara Brin
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Maria Alfano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Jessica Di Salvo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Raffaella Epifani
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Alessia Piacevole
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Giuseppina Tagliaferri
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Maria Rocco
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Ilaria Iadicicco
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Giovanni Docimo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Teresa Salvatore
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
- Correspondence: ; Tel.: +39-08-1566-5010
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Li X, Wang H, Zhou X, Ma D, Chai J, Liu J, Qian X, Chen C, Chen X. Acupuncture combine with Tuina for diabetic peripheral neuropathy: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e28042. [PMID: 35049219 PMCID: PMC9191565 DOI: 10.1097/md.0000000000028042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of diabetes mellitus, with an incidence ranging from 60% to 90%. With the change in modern dietary structure, the incidence of diabetes is increasing year by year, and DPN is also on the rise. Acupuncture and Tuina treatments are often combined to treat DPN; however, there has been no meta-analysis on their synergistic effect; therefore, we aimed to perform a systematic review and meta-analysis to estimate the effectiveness of acupuncture combined with Tuina in DPN treatment. METHODS Nine electronic databases were retrieved for this study. The English databases mainly retrieved PubMed, Web of Science, Embase, AMED, and the Cochrane Library, while the CNKI, VIP, CBM, and Wanfang databases were used to retrieve the Chinese literature; there was no definite time limit for the retrieval literature, and the languages were limited to Chinese and English. We will consider articles published between database initiation and November 2021. We used Review Manager 5.4 software provided by the Cochrane Collaborative Network for statistical analysis. We then assessed the quality and risk of the included studies and observed the outcome measures. RESULTS This study provides a high-quality synthesis to assess the effectiveness and safety of acupuncture combined with Tuina for treating DPN. CONCLUSION This systematic review provided evidence to determine whether acupuncture combined with Tuina is an effective and safe intervention for patients with DPN. ETHICS AND DISSEMINATION The protocol for this systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences. SYSTEMATIC REVIEW REGISTRATION INPLASY2021110017.
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Affiliation(s)
- Xuefeng Li
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Heran Wang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Xue Zhou
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Dongyang Ma
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Jiapeng Chai
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Jiayi Liu
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Xin Qian
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Chunhai Chen
- Department of Acupuncture and Tuina, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Xinhua Chen
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
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Wang F, Wang F, Pan T, Wu Z, Wang Y, Liu P, Yu Z, Shang R, Song B. Tuina for diabetic peripheral neuropathy: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26222. [PMID: 34115007 PMCID: PMC8202603 DOI: 10.1097/md.0000000000026222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of diabetes mellitus, with an incidence ranging from 60% to 90%. With the change in modern dietary structure, the incidence of diabetes is increasing year by year, and DPN is also on the rise. Tuina therapy has been widely used in the treatment of DPN, but there is no systematic review on the treatment of DPN. Therefore, this study aimed to conduct a meta-analysis of Tuina in the treatment of DPN to clarify its efficacy. METHODS The following electronic databases will be searched: PubMed, the Cochrane Library, Embase, Web of Science, Medline, CNKI, Chinese Biomedical Literature Database, VIP, and Wan Fang databases. We will consider articles published between database initiation and May 2021. We will use Review Manager 5.4, provided by the Cochrane Collaborative Network for statistical analysis. Clinical randomized controlled trials related to Tuina for diabetic peripheral neuropathy were included in this study. Language is limited to both Chinese and English. Research selection, data extraction, and research quality assessments were independently completed by two researchers. We then assessed the quality and risk of the included studies and observed the outcome measures. RESULTS This study provides a high-quality synthesis to assess the effectiveness and safety of Tuina for treating diabetic peripheral neuropathy. CONCLUSION This systematic review will provide evidence to determine whether Tuina is an effective and safe intervention for patients with diabetic peripheral neuropathy. ETHICS AND DISSEMINATION The protocol of the systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences. REGISTRATION NUMBER INPLASY202150027.
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Affiliation(s)
- Fengyang Wang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine
| | - Fengjuan Wang
- Anesthesia professional, Traditional Chinese Medicine Hospital of Jilin Province
| | - Ting Pan
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine
| | | | - Yufeng Wang
- Department of Tuina, Traditional Chinese Medicine Hospital of Jilin Province
| | - Peng Liu
- Department of Tuina, Traditional Chinese Medicine Hospital of Jilin Province
| | - Ziyang Yu
- Endocrinology of Traditional Chinese Medicine, Changchun University of Chinese Medicine
| | - Rui Shang
- Department of Acupuncture and Tuina, Jilin Provincial Cancer Hospital
| | - Bailin Song
- Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
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Chawla S, Trehan S, Chawla A, Jaggi S, Chawla R, Kumar V, Singh D. Relationship between diabetic retinopathy microalbuminuria and other modifiable risk factors. Prim Care Diabetes 2021; 15:567-570. [PMID: 33551334 DOI: 10.1016/j.pcd.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diabetic Retinopathy (DR) is an important microvascular complication of diabetes that can lead to irreversible blindness. Microalbuminuria is strongly associated with diabetic retinopathy and can be used as a reliable marker of diabetic retinopathy. AIM To assess the association between DR, microalbuminuria, and other modifiable risk factors in patients with type 2 diabetes. METHODOLOGY 3090 patients with T2DM visiting North Delhi Diabetes Centre, New Delhi between July 2016 to October 2019 were evaluated for the clinical and biochemical parameters that included urinary albumin, HbA1C, lipid profiles, serum creatinine estimation and underwent biothesiometry. RESULTS 3090 patients (1350 females and 1740 males), with mean age of 52.7 ± 9.2 years and diabetes duration ranging from 1 to 19 years (mean 9.4 ± 6), duration of less than 5 years, 6-10 years and more than 10 years in 52%, 26% and in 22%, respectively. Duration of diabetes was strong predictor of retinopathy (p = 0.001). The HbA1c and BMI in patients with DR was significantly higher than in those without DR. 18.2% patients were diagnosed to have retinopathy. Peripheral neuropathy was observed in 24.2% and was positively associated with DR (p = 0.002). 33.9% and 4.5% patients had microalbuminuria macroalbuminuria, respectively and 9.7% patients had creatinine >1.3 mg/dL. There was significant positive relationship between different grades of retinopathy and albuminuria. CONCLUSIONS Our study is a large real-world study that demonstrates that HbA1c, BMI, duration of diabetes, microalbuminuria and peripheral neuropathy are relatively, yet cohesively contributing factors towards varying grade of retinopathy.
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Affiliation(s)
- Shubhaa Chawla
- Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Siddhant Trehan
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India
| | | | | | | | - Vinay Kumar
- North Delhi Diabetes Centre, New Delhi, India
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