1
|
Kristensen FPB, Christensen DH, Callaghan BC, Nielsen JS, Højlund K, Andersen H, Dekkers OM, Groenwold RHH, Sørensen HT, Thomsen RW. Lipid Levels and Risk of Diabetic Polyneuropathy in 2 Danish Type 2 Diabetes Cohorts. Neurology 2024; 103:e209538. [PMID: 38833657 DOI: 10.1212/wnl.0000000000209538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Reduction of blood lipids may aid in preventing diabetic polyneuropathy (DPN), but evidence remains conflicting. We investigated the association between lipid parameters and DPN risk in individuals with type 2 diabetes mellitus (T2DM). METHODS We conducted a population-based cohort study of individuals with newly diagnosed T2DM and a cross-sectional study using a clinically recruited T2DM cohort. Triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and non-HDL cholesterol were measured in routine diabetes care. Each lipid parameter was categorized according to the latest cutoffs in clinical guidelines on dyslipidemia. DPN was assessed with validated hospital diagnosis codes in the population-based cohort and with the Michigan Neuropathy Screening Instrument questionnaire in the clinical cohort. We calculated hazard ratios (HRs) using Cox regression and prevalence ratios (PRs) using Poisson regression. RESULTS We included 61,853 individuals in the population-based cohort (median age 63 [quartiles 54-72] years) and 4,823 in the clinical cohort (median age 65 [quartiles 57-72] years). The incidence rate of hospital-diagnosed DPN in the population-based cohort was 3.6 per 1000 person-years during a median follow-up of 7.3 years. Achieving guideline targets for HDL, LDL, and non-HDL cholesterol showed no association with DPN risk. By contrast, adjusted HRs (95% CI) for DPN were 1.02 (0.89-1.18) for triglyceride levels between 150 and 204 mg/dL (1.7-2.3 mmol/L) and 1.28 (1.13-1.45) for levels >204 mg/dL (2.3 mmol/L). In the clinical cohort with a DPN prevalence of 18%, DPN associated strongly with triglycerides >204 mg/dL (2.3 mmol/L) with an adjusted PR (95% CI) of 1.40 (1.21-1.62). The prevalence of DPN was modestly elevated for individuals with HDL cholesterol <39 mg/dL (1.0/1.3 mmol/L) in men and <50 mg/dL (1.3 mmol/L) in women (PR 1.13 [0.99-1.28]) and for individuals with non-HDL cholesterol >131 mg/dL (3.4 mmol/L) (PR 1.27 [1.05-1.52]). In both cohorts, spline models showed an increasing risk of DPN starting from triglyceride levels >124 mg/dL (1.4 mmol/L). All results were similar among statin users. DISCUSSION High triglyceride levels are a strong DPN risk factor. Future intervention studies shall determine whether triglyceride reduction is more important for DPN prevention than reduction of other lipids.
Collapse
Affiliation(s)
- Frederik P B Kristensen
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Diana H Christensen
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Brian C Callaghan
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Jens S Nielsen
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Kurt Højlund
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Henning Andersen
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Olaf M Dekkers
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Rolf H H Groenwold
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Henrik T Sørensen
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| | - Reimar W Thomsen
- From the Department of Clinical Epidemiology (F.P.B.K., D.H.C., H.T.S., R.W.T.), Aarhus University Hospital and Aarhus University; Department of Endocrinology and Internal Medicine (D.H.C.), Aarhus University Hospital, Denmark; Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Steno Diabetes Center Odense (J.S.N., K.H.), Odense University Hospital; Department of Clinical Research (J.S.N., K.H.), University of Southern Denmark, Odense; Department of Neurology (H.A.), Aarhus University Hospital, Denmark; Department of Clinical Epidemiology (O.M.D., R.H.H.G.), Department of Endocrinology (O.M.D.), and Department of Biomedical Data Sciences (R.H.H.G.), Leiden University Medical Center, the Netherlands
| |
Collapse
|
2
|
Elafros MA, Reynolds EL, Callaghan BC. Obesity-related neuropathy: the new epidemic. Curr Opin Neurol 2024:00019052-990000000-00172. [PMID: 38864534 DOI: 10.1097/wco.0000000000001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
PURPOSE OF REVIEW To examine the evidence evaluating the association between obesity and neuropathy as well as potential interventions. RECENT FINDINGS Although diabetes has long been associated with neuropathy, additional metabolic syndrome components, including obesity, are increasingly linked to neuropathy development, regardless of glycemic status. Preclinical rodent models as well as clinical studies are shedding light on the mechanisms of obesity-related neuropathy as well as challenges associated with slowing progression. Dietary and surgical weight loss and exercise interventions are promising, but more data is needed. SUMMARY High-fat-diet rodent models have shown that obesity-related neuropathy is a product of excess glucose and lipid accumulation leading to inflammation and cell death. Clinical studies consistently demonstrate obesity is independently associated with neuropathy; therefore, likely a causal risk factor. Dietary weight loss improves neuropathy symptoms but not examination scores. Bariatric surgery and exercise are promising interventions, but larger, more rigorous studies are needed. Further research is also needed to determine the utility of weight loss medications and ideal timing for obesity interventions to prevent neuropathy.
Collapse
Affiliation(s)
| | - Evan Lee Reynolds
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | | |
Collapse
|
3
|
Khan R, Laumet G, Leinninger GM. Hungry for Relief: Potential for Neurotensin to Address Comorbid Obesity and Pain. Appetite 2024:107540. [PMID: 38852785 DOI: 10.1016/j.appet.2024.107540] [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: 02/01/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
Chronic pain and obesity frequently occur together. An ideal therapy would alleviate pain without weight gain, and most optimally, could promote weight loss. The neuropeptide neurotensin (Nts) has been separately implicated in reducing weight and pain but could it be a common actionable target for both pain and obesity? Here we review the current knowledge of Nts signaling via its receptors in modulating body weight and pain processing. Evaluating the mechanism by which Nts impacts ingestive behavior, body weight, and analgesia has potential to identify common physiologic mechanisms underlying weight and pain comorbidities, and whether Nts may be common actionable targets for both.
Collapse
Affiliation(s)
- Rabail Khan
- Neuroscience Program, Michigan State University, East Lansing, MI 48824
| | - Geoffroy Laumet
- Neuroscience Program, Michigan State University, East Lansing, MI 48824; Department of Physiology, Michigan State University, East Lansing, MI 48824
| | - Gina M Leinninger
- Neuroscience Program, Michigan State University, East Lansing, MI 48824; Department of Physiology, Michigan State University, East Lansing, MI 48824.
| |
Collapse
|
4
|
Strand N, Anderson MA, Attanti S, Gill B, Wie C, Dawodu A, Pagan-Rosado R, Harbell MW, Maloney JA. Diabetic Neuropathy: Pathophysiology Review. Curr Pain Headache Rep 2024; 28:481-487. [PMID: 38558164 DOI: 10.1007/s11916-024-01243-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW Diabetic neuropathy is a debilitating complication of diabetes mellitus that affects millions of individuals worldwide. It is characterized by nerve damage resulting from prolonged exposure to high blood glucose levels. Diabetic neuropathy may cause a range of symptoms, including pain, numbness, muscle weakness, autonomic dysfunction, and foot ulcers, potentially causing significant impairment to the quality of life for those affected. This review article aims to provide a comprehensive overview of the pathophysiology of diabetic neuropathy. The etiology of diabetic neuropathy will be discussed, including risk factors, predisposing conditions, and an overview of the complex interplay between hyperglycemia, metabolic dysregulation, and nerve damage. Additionally, we will explore the molecular mechanisms and pathways of diabetic neuropathy, including the impact of hyperglycemia on nerve function, abnormalities in glucose metabolism, the role of advanced glycation end products (AGEs), and inflammatory and immune-mediated processes. We will provide an overview of the various nerve fibers affected by diabetic neuropathy and explore the common symptoms and complications associated with diabetic neuropathy in the pain medicine field. RECENT FINDINGS This review highlights advances in understanding the pathophysiology of diabetic neuropathy as well as reviews potential novel therapeutic strategies and promising areas for future research. In conclusion, this review article aims to shed light on the pathophysiology of diabetic neuropathy, its far-reaching consequences, and the evolving strategies for prevention and management. In understanding the mechanisms of diabetic neuropathy and the ongoing research in this area, healthcare professionals can better serve patients with diabetes, ultimately improving well-being and reducing complications.
Collapse
Affiliation(s)
- Natalie Strand
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA.
| | | | | | - Benjamin Gill
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Christopher Wie
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Azizat Dawodu
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Monica W Harbell
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Jillian A Maloney
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| |
Collapse
|
5
|
Yeung N, Li T, Lin HM, Timmins HC, Goldstein D, Harrison M, Friedlander M, Mahon KL, Giles C, Meikle PJ, Park SB, Horvath LG. Plasma Lipidomic Profiling Identifies Elevated Triglycerides as Potential Risk Factor in Chemotherapy-Induced Peripheral Neuropathy. JCO Precis Oncol 2024; 8:e2300690. [PMID: 38691814 DOI: 10.1200/po.23.00690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/11/2024] [Accepted: 03/07/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting side effect of cytotoxic cancer treatment, often necessitating dose reduction (DR) or chemotherapy discontinuation (CD). Studies on peripheral neuropathy related to chemotherapy, obesity, and diabetes have implicated lipid metabolism. This study examined the association between circulating lipids and CIPN. METHODS Lipidomic analysis was performed on plasma samples from 137 patients receiving taxane-based treatment. CIPN was graded using Total Neuropathy Score-clinical version (TNSc) and patient-reported outcome measure European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-CIPN (EORTC-QLQ-CIPN20). RESULTS A significant proportion of elevated baseline lipids were associated with high-grade CIPN defined by TNSc and EORTC-QLQ-CIPN20 including triacylglycerols (TGs). Multivariable Cox regression on lipid species, adjusting for BMI, age, and diabetes, showed several elevated baseline TG associated with shorter time to DR/CD. Latent class analysis identified two baseline lipid profiles with differences in risk of CIPN (hazard ratio, 2.80 [95% CI, 1.50 to 5.23]; P = .0013). The higher risk lipid profile had several elevated TG species and was independently associated with DR/CD when modeled with other clinical factors (diabetes, age, BMI, or prior numbness/tingling). CONCLUSION Elevated baseline plasma TG is associated with an increased risk of CIPN development and warrants further validation in other cohorts. Ultimately, this may enable therapeutic intervention.
Collapse
Affiliation(s)
- Nicole Yeung
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Tiffany Li
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- The University of Sydney, Camperdown, NSW, Australia
| | - Hui-Ming Lin
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia
| | - Hannah C Timmins
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- The University of Sydney, Camperdown, NSW, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | | | - Michael Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Kate L Mahon
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- The University of Sydney, Camperdown, NSW, Australia
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Corey Giles
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Bundoora, VIC, Australia
| | - Peter J Meikle
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Bundoora, VIC, Australia
| | - Susanna B Park
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Lisa G Horvath
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- The University of Sydney, Camperdown, NSW, Australia
- St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| |
Collapse
|
6
|
Dillon BR, Ang L, Pop-Busui R. Spectrum of Diabetic Neuropathy: New Insights in Diagnosis and Treatment. Annu Rev Med 2024; 75:293-306. [PMID: 38285516 DOI: 10.1146/annurev-med-043021-033114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Diabetic neuropathy is a highly prevalent complication of diabetes. It consists of a broad range of neuropathic conditions, such as distal symmetric polyneuropathy and various forms of autonomic neuropathies involving the cardiovascular, gastrointestinal, and urogenital systems. Prevention or diagnosis in early stages of disease is crucial to prevent symptomatic onset and progression, particularly in the absence of current disease-modifying therapies. In this review, we describe the four main types of diabetic neuropathy. We review current understanding with respect to diagnosis and treatment while highlighting knowledge gaps and future directions.
Collapse
Affiliation(s)
- Brendan R Dillon
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA;
| | - Lynn Ang
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, Ann Arbor, Michigan, USA; ,
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, Ann Arbor, Michigan, USA; ,
| |
Collapse
|
7
|
Heo S, Kang J, Barbé T, Kim J, Bertulfo TF, Troyan P, Stewart D, Umeakunne E. Relationships of multidimensional factors to self-management in patients with diabetes: A Cross-sectional, correlational study. Geriatr Nurs 2024; 55:270-276. [PMID: 38096658 DOI: 10.1016/j.gerinurse.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 02/06/2024]
Abstract
Poor self-management in patients with diabetes is a consistent issue, leading to diabetes complications. The purpose of this study was to examine the relationships of demographic, cognitive, psychological, social, and physiological factors to self-management in patients with diabetes. In this cross-sectional, correlational study, data were collected from 98 patients through REDCap in 2023. Multiple regression analysis was used to address the study purpose. In the sample, adherence to adequate self-management was poor. Knowledge, self-efficacy, and body mass index (BMI) were associated with overall diabetes self-management. Self-efficacy and BMI were associated with diet and exercise. Knowledge and self-efficacy were associated with blood glucose testing. No factors were associated with smoking and foot care. In conclusion, different factors were associated with different types of self-management, but BMI and self-efficacy were associated with most types of self-management. Clinicians and researchers can target BMI, self-efficacy, and knowledge to improve self-management in patients with diabetes.
Collapse
Affiliation(s)
- Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, Georgia 30341, USA.
| | - JungHee Kang
- College of Nursing, University of Kentucky, 2201 Regency Rd, Suite 403, Lexington, KY, 40503, USA
| | - Tammy Barbé
- Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, Georgia 30341, USA
| | - JinShil Kim
- College of Nursing, Gachon University, 191 Hambakmeoro, Yeonsu-gu, Incheon, 21936, South Korea
| | - Tara F Bertulfo
- Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, Georgia 30341, USA
| | - Pattie Troyan
- Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, Georgia 30341, USA
| | - Daphnee Stewart
- Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, Georgia 30341, USA
| | - Erica Umeakunne
- Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, Georgia 30341, USA
| |
Collapse
|
8
|
Heo S, Kang J, Umeakunne E, Lee S, Bertulfo TF, Barbé T, Kim J, Black V, An M, Randolph J. Effects of Meditation Intervention on Self-management in Adult Patients With Type 2 Diabetes: A Systematic Literature Review and Meta-analysis. J Cardiovasc Nurs 2023; 38:581-592. [PMID: 37816085 DOI: 10.1097/jcn.0000000000000973] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diabetes complications are prevalent and cause adverse effects on the physical, psychological, and economic status of adult patients with type 2 diabetes. Meditation may positively affect self-management and, in turn, reduce diabetes complications. However, the systematic examination of the effects of meditation without additional components on self-management in this population have been rarely examined. PURPOSE The aim of this study was to examine the effects of meditation interventions on self-management (ie, control of glucose, blood pressure, cholesterol, and obesity and self-management) among adult patients with type 2 diabetes in randomized controlled trials. METHODS In this systematic review and meta-analysis, 6 electronic databases were searched using major keywords of meditation , diabetes , and self-management during March 2022. RESULTS Eight studies (9 articles) using mindfulness-based meditation were included. The meta-analysis showed that meditation improved hemoglobin A 1c (effect size = -0.75; 95% confidence interval, -1.30 to -0.21; P = .007) but not fasting blood glucose. Only a few studies examined meditation effects on other types of self-management (eg, blood pressure, body mass index, cholesterol, diet, exercise, foot care, and monitoring of blood glucose), and the effects were inconsistent. In 1 study, meditation improved diabetes self-management. CONCLUSIONS Mindfulness-based meditation reduced hemoglobin A 1c levels in adult patients with type 2 diabetes but did not consistently improve other types of self-management in a few studies examined. This may imply the need for additional intervention components to improve different types of self-management. Further studies are needed to examine the effects of different types of meditations with additional components on different types of self-management.
Collapse
|
9
|
Kristensen FPB, Sanchez-Lastra MA, Dalene KE, Del Pozo Cruz B, Ried-Larsen M, Thomsen RW, Ding D, Ekelund U, Tarp J. Leisure-Time Physical Activity and Risk of Microvascular Complications in Individuals With Type 2 Diabetes: A UK Biobank Study. Diabetes Care 2023; 46:1816-1824. [PMID: 37549380 DOI: 10.2337/dc23-0937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE The aim of this study was to determine dose-response associations, including the minimal effective level, between leisure-time physical activity and risk of incident neuropathy, nephropathy, and retinopathy. RESEARCH DESIGN AND METHODS This cohort study included 18,092 individuals with type 2 diabetes from the UK Biobank. Self-reported leisure-time physical activity was converted into MET-hours per week. Participants were categorized into no physical activity (0 MET-h/week), below recommendations (0-7.49 MET-h/week), at recommendations (7.5-14.9 MET-h/week), and above recommendations (≥15 MET-h/week). Microvascular complications were identified from hospital inpatient records using diagnosis codes. We used Cox proportional hazards regression analysis to calculate adjusted hazard ratios (aHRs) and restricted cubic splines to identify the minimal effective level of physical activity. RESULTS During a median follow-up of 12.1 years, 672 individuals (3.7%) were diagnosed with neuropathy, 1,839 (10.2%) with nephropathy, and 2,099 (11.7%) with retinopathy. Any level of physical activity was associated with a lower risk of neuropathy and nephropathy but not retinopathy. Compared with those reporting no physical activity, the aHR of neuropathy was 0.71 (95% CI 0.53, 0.90) below recommendations, 0.73 (0.56, 0.96) at recommendations, and 0.67 (0.52, 0.87) above recommendations. Corresponding aHRs for nephropathy were 0.79 (0.68, 0.92), 0.80 (0.67, 0.95), and 0.80 (0.68, 0.95). The association with retinopathy was weaker, with aHRs of 0.91 (0.78, 1.06), 0.91 (0.77, 1.08), and 0.98 (0.84, 1.15), respectively. CONCLUSIONS Any level of leisure-time physical activity was associated with a lower risk of neuropathy and nephropathy but not retinopathy in individuals with type 2 diabetes. For both neuropathy and nephropathy, the minimal effective physical activity level may correspond to <1.5 h of walking per week.
Collapse
Affiliation(s)
| | - Miguel Adriano Sanchez-Lastra
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Special Didactics, Faculty of Education and Sports Sciences, University of Vigo, Pontevedra, Spain
- Well-Move Research Group, Galicia Sur Health Research Institute, University of Vigo, Vigo, Spain
| | - Knut Eirik Dalene
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Borja Del Pozo Cruz
- Centre for Active and Healthy Ageing, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Faculty of Education, University of Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mathias Ried-Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ding Ding
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Jakob Tarp
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
10
|
Elafros MA, Callaghan BC. Diabetic Neuropathies. Continuum (Minneap Minn) 2023; 29:1401-1417. [PMID: 37851036 PMCID: PMC11088946 DOI: 10.1212/con.0000000000001291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This article provides an up-to-date review of the diagnosis and management of the most common neuropathies that occur in patients with diabetes. LATEST DEVELOPMENTS The prevalence of diabetes continues to grow worldwide and, as a result, the burden of diabetic neuropathies is also increasing. Most diabetic neuropathies are caused by hyperglycemic effects on small and large fiber nerves, and glycemic control in individuals with type 1 diabetes reduces neuropathy prevalence. However, among people with type 2 diabetes, additional factors, particularly metabolic syndrome components, play a role and should be addressed. Although length-dependent distal symmetric polyneuropathy is the most common form of neuropathy, autonomic syndromes, particularly cardiovascular autonomic neuropathy, are associated with increased mortality, whereas lumbosacral radiculoplexus neuropathy and treatment-induced neuropathy cause substantial morbidity. Recent evidence-based guidelines have updated the recommended treatment options to manage pain associated with distal symmetric polyneuropathy of diabetes. ESSENTIAL POINTS Identifying and appropriately diagnosing the neuropathies of diabetes is key to preventing progression. Until better disease-modifying therapies are identified, management remains focused on diabetes and metabolic risk factor control and pain management.
Collapse
|
11
|
Eid SA, Rumora AE, Beirowski B, Bennett DL, Hur J, Savelieff MG, Feldman EL. New perspectives in diabetic neuropathy. Neuron 2023; 111:2623-2641. [PMID: 37263266 PMCID: PMC10525009 DOI: 10.1016/j.neuron.2023.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/20/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Abstract
Diabetes prevalence continues to climb with the aging population. Type 2 diabetes (T2D), which constitutes most cases, is metabolically acquired. Diabetic peripheral neuropathy (DPN), the most common microvascular complication, is length-dependent damage to peripheral nerves. DPN pathogenesis is complex, but, at its core, it can be viewed as a state of impaired metabolism and bioenergetics failure operating against the backdrop of long peripheral nerve axons supported by glia. This unique peripheral nerve anatomy and the injury consequent to T2D underpins the distal-to-proximal symptomatology of DPN. Earlier work focused on the impact of hyperglycemia on nerve damage and bioenergetics failure, but recent evidence additionally implicates contributions from obesity and dyslipidemia. This review will cover peripheral nerve anatomy, bioenergetics, and glia-axon interactions, building the framework for understanding how hyperglycemia and dyslipidemia induce bioenergetics failure in DPN. DPN and painful DPN still lack disease-modifying therapies, and research on novel mechanism-based approaches is also covered.
Collapse
Affiliation(s)
- Stephanie A Eid
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA; NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI 48109, USA
| | - Amy E Rumora
- Department of Neurology, Columbia University, New York, NY 10032, USA
| | - Bogdan Beirowski
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford OX3 9DU, UK
| | - Junguk Hur
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, ND 58202, USA
| | - Masha G Savelieff
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, ND 58202, USA
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA; NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI 48109, USA.
| |
Collapse
|
12
|
Lian X, Qi J, Yuan M, Li X, Wang M, Li G, Yang T, Zhong J. Study on risk factors of diabetic peripheral neuropathy and establishment of a prediction model by machine learning. BMC Med Inform Decis Mak 2023; 23:146. [PMID: 37533059 PMCID: PMC10394817 DOI: 10.1186/s12911-023-02232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is a common complication of diabetes. Predicting the risk of developing DPN is important for clinical decision-making and designing clinical trials. METHODS We retrospectively reviewed the data of 1278 patients with diabetes treated in two central hospitals from 2020 to 2022. The data included medical history, physical examination, and biochemical index test results. After feature selection and data balancing, the cohort was divided into training and internal validation datasets at a 7:3 ratio. Training was made in logistic regression, k-nearest neighbor, decision tree, naive bayes, random forest, and extreme gradient boosting (XGBoost) based on machine learning. The k-fold cross-validation was used for model assessment, and the accuracy, precision, recall, F1-score, and the area under the receiver operating characteristic curve (AUC) were adopted to validate the models' discrimination and clinical practicality. The SHapley Additive exPlanation (SHAP) was used to interpret the best-performing model. RESULTS The XGBoost model outperformed other models, which had an accuracy of 0·746, precision of 0·765, recall of 0·711, F1-score of 0·736, and AUC of 0·813. The SHAP results indicated that age, disease duration, glycated hemoglobin, insulin resistance index, 24-h urine protein quantification, and urine protein concentration were risk factors for DPN, while the ratio between 2-h postprandial C-peptide and fasting C-peptide(C2/C0), total cholesterol, activated partial thromboplastin time, and creatinine were protective factors. CONCLUSIONS The machine learning approach helped established a DPN risk prediction model with good performance. The model identified the factors most closely related to DPN.
Collapse
Affiliation(s)
- Xiaoyang Lian
- Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Juanzhi Qi
- School of Artificial Intelligence and Information Technology, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - Mengqian Yuan
- Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Xiaojie Li
- Jiangsu Health Vocational College, Nanjing, 210036, Jiangsu, China
| | - Ming Wang
- Geriatric Hospital of Nanjing Medical University, Jiangsu Province Official Hospital, Nanjing, Jiangsu, 210036, China
| | - Gang Li
- School of Artificial Intelligence and Information Technology, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - Tao Yang
- School of Artificial Intelligence and Information Technology, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China.
| | - Jingchen Zhong
- Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, 210029, China.
| |
Collapse
|
13
|
Zhang H, Chen Y, Zhu W, Niu T, Song B, Wang H, Wang W, Zhang H. The mediating role of HbA1c in the association between elevated low-density lipoprotein cholesterol levels and diabetic peripheral neuropathy in patients with type 2 diabetes mellitus. Lipids Health Dis 2023; 22:102. [PMID: 37443036 DOI: 10.1186/s12944-023-01865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Increased levels of low-density lipoprotein cholesterol (LDL-C) have been identified as one potential risk factor for diabetic peripheral neuropathy (DPN) in patients. The current study seeks to clarify the link between LDL-C, hyperglycemia, and DPN in patients with type 2 diabetes mellitus (T2DM). METHODS Here, a total of 120 T2DM individuals were recruited. These volunteers with T2DM were divided into 2 groups, based on the presence or absence of peripheral neuropathy. Additionally, their baseline characteristics were compared. Association among LDL-C and glycosylated hemoglobin (HbA1c) levels and DPN, particularly with respect to specific nerve conduction velocity were analyzed. To identify factors influencing DPN, regression was performed. Furthermore, mediation analysis was employed to evaluate the indirect, direct and total effects of LDL-C on specific nerve conduction velocity, with HbA1c serving as a mediator. RESULTS Compared to 55 patients without DPN, 65 patients with DPN demonstrated elevated levels of LDL-C and HbA1c. Both LDL-C and HbA1c have been found to be associated with reduced the motor fiber conduction velocities of Ulnar (or the Common peroneal) nerve in diabetic patients. HbA1c is one of the known risk factors for DPN in individuals with T2DM. Further mediation analysis revealed that the effect of LDL-C on the Ulnar (or the Common peroneal) nerve motor fiber conduction velocities are fully mediated by HbA1c in patients with T2DM. CONCLUSIONS The impact of elevated LDL-C levels upon the Ulnar (or the Common peroneal) nerve motor fiber conduction velocities in patients with T2DM was found to be entirely mediated by increased HbA1c levels.
Collapse
Affiliation(s)
- Hui Zhang
- Henan Key Laboratory of Rare Diseases, Endocrinology and Metabolism Center, The First Affiliated Hospital and College of Clinical Medicine of Henan of Science and Technology, Luoyang, China
| | - Yang Chen
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wenwen Zhu
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Tong Niu
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Bing Song
- Department of Endocrinology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Hongxiao Wang
- Department of Endocrinology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Wei Wang
- Department of Endocrinology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China.
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
| | - Haoqiang Zhang
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
| |
Collapse
|
14
|
Li C, Wang W, Ji Q, Ran X, Kuang H, Yu X, Fang H, Yang J, Liu J, Xue Y, Feng B, Lei M, Zhu D. Prevalence of painful diabetic peripheral neuropathy in type 2 diabetes mellitus and diabetic peripheral neuropathy: A nationwide cross-sectional study in mainland China. Diabetes Res Clin Pract 2023; 198:110602. [PMID: 36871876 DOI: 10.1016/j.diabres.2023.110602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/31/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
AIM The study aimed to assess the prevalence and risk factors of painful diabetic peripheral neuropathy (PDPN) in patients with type 2 diabetes mellitus (T2DM) and diabetic peripheral neuropathy (DPN) in mainland China. METHODS This nationwide cross-sectional study enrolled T2DM patients with DPN from 25 provinces in China between July 2017 and December 2017. The prevalence, characteristics, and risk factors of PDPN were analyzed. RESULTS Among 25,710 patients with T2DM and DPN, 14,699 (57.2%) had PDPN. The median age was 63 years old. Age over 40 years old, education level, hypertension, myocardial infarction, duration of diabetes of over five years, diabetic retinopathy and nephropathy, moderate total cholesterol, moderate and higher low-density lipoprotein (LDL) increased uric acid (UA) and decreased estimated glomerular filtration rate (eGFR) were independently associated with PDPN (all P < 0.05). Compared with low levels of C-peptide, moderate levels were independently associated with a higher risk of PDPN, while high levels were associated with a lower risk (all P < 0.001). CONCLUSIONS In mainland China, more than half of the patients with DPN have neuropathic pain. Patients with older age, lower education level, longer duration of diabetes, lower LDL, increased UA, decreased eGFR, and comorbidities had an increased risk of PDPN.
Collapse
Affiliation(s)
- Chenxi Li
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Weimin Wang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Qiuhe Ji
- Xijing Hospital of PLA Air Force Medical University, Xi'an, Shanxi Province, China
| | - Xingwu Ran
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Hongyu Kuang
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xuefeng Yu
- Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Hui Fang
- Tangshan Gongren Hospital, TangShan, Hebei Province, China
| | - Jing Yang
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Jing Liu
- Gansu Provincial Hospital, Lanzhou, Gansu Province, China
| | - Yaoming Xue
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Bo Feng
- Department of Endocrinology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Minxiang Lei
- Department of Endocrinology, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Dalong Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.
| |
Collapse
|
15
|
Haque F, Reaz MBI, Chowdhury MEH, Shapiai MIB, Malik RA, Alhatou M, Kobashi S, Ara I, Ali SHM, Bakar AAA, Bhuiyan MAS. A Machine Learning-Based Severity Prediction Tool for the Michigan Neuropathy Screening Instrument. Diagnostics (Basel) 2023; 13:diagnostics13020264. [PMID: 36673074 PMCID: PMC9857736 DOI: 10.3390/diagnostics13020264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/21/2022] [Accepted: 12/31/2022] [Indexed: 01/12/2023] Open
Abstract
Diabetic sensorimotor polyneuropathy (DSPN) is a serious long-term complication of diabetes, which may lead to foot ulceration and amputation. Among the screening tools for DSPN, the Michigan neuropathy screening instrument (MNSI) is frequently deployed, but it lacks a straightforward rating of severity. A DSPN severity grading system has been built and simulated for the MNSI, utilizing longitudinal data captured over 19 years from the Epidemiology of Diabetes Interventions and Complications (EDIC) trial. Machine learning algorithms were used to establish the MNSI factors and patient outcomes to characterise the features with the best ability to detect DSPN severity. A nomogram based on multivariable logistic regression was designed, developed and validated. The extra tree model was applied to identify the top seven ranked MNSI features that identified DSPN, namely vibration perception (R), 10-gm filament, previous diabetic neuropathy, vibration perception (L), presence of callus, deformities and fissure. The nomogram's area under the curve (AUC) was 0.9421 and 0.946 for the internal and external datasets, respectively. The probability of DSPN was predicted from the nomogram and a DSPN severity grading system for MNSI was created using the probability score. An independent dataset was used to validate the model's performance. The patients were divided into four different severity levels, i.e., absent, mild, moderate, and severe, with cut-off values of 10.50, 12.70 and 15.00 for a DSPN probability of less than 50, 75 and 100%, respectively. We provide an easy-to-use, straightforward and reproducible approach to determine prognosis in patients with DSPN.
Collapse
Affiliation(s)
- Fahmida Haque
- Centre of Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia
- Laboratory of Emotions Neurobiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Ludwika Pasteura 3, 02-093 Warszawa, Poland
| | - Mamun B. I. Reaz
- Centre of Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia
- Malaysia-Japan International Institute of Technology, Universiti Teknologi Malaysia, Jalan Sultan Yahya Petra, Kuala Lumpur 54100, Malaysia
- Correspondence: (M.B.I.R.); (M.E.H.C.); (M.A.S.B.)
| | - Muhammad E. H. Chowdhury
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
- Correspondence: (M.B.I.R.); (M.E.H.C.); (M.A.S.B.)
| | - Mohd Ibrahim bin Shapiai
- Malaysia-Japan International Institute of Technology, Universiti Teknologi Malaysia, Jalan Sultan Yahya Petra, Kuala Lumpur 54100, Malaysia
| | - Rayaz A. Malik
- Department of Medicine, Weill Cornell Medicine—Qatar, Doha 24144, Qatar
| | - Mohammed Alhatou
- Neuromuscular Division, Hamad General Hospital, Doha 3050, Qatar
- Department of Neurology, Al khor Hospital, Doha 3050, Qatar
| | - Syoji Kobashi
- Graduate School of Engineering, University of Hyogo, Himeji 678-1297, Hyogo, Japan
| | - Iffat Ara
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | - Sawal H. M. Ali
- Centre of Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia
| | - Ahmad A. A. Bakar
- Centre of Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia
| | - Mohammad Arif Sobhan Bhuiyan
- Electrical and Electronics Engineering, Xiamen University Malaysia, Sepang 43900, Malaysia
- Correspondence: (M.B.I.R.); (M.E.H.C.); (M.A.S.B.)
| |
Collapse
|
16
|
Ang L, Mizokami-Stout K, Eid SA, Elafros M, Callaghan B, Feldman EL, Pop-Busui R. The conundrum of diabetic neuropathies-Past, present, and future. J Diabetes Complications 2022; 36:108334. [PMID: 36306721 PMCID: PMC10202025 DOI: 10.1016/j.jdiacomp.2022.108334] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/01/2022] [Accepted: 10/01/2022] [Indexed: 10/31/2022]
Abstract
Diabetic neuropathy (DN) remains arguably the most prevalent chronic complication in people with both type 1 and type 2 diabetes, including in youth, despite changes in the current standards of clinical care. Additionally, emerging evidence demonstrates that neuropathy affects a large proportion of people with undiagnosed diabetes and/or prediabetes, as well as those with obesity. Here we summarize the latest epidemiology of DN, recent findings regarding the pathophysiology of the disease, as well as current outcome measures for screening and diagnosis, in research and clinical settings. The authors discuss novel perspectives on the impact of social determinants of health in DN development and management, and the latest evidence on effective therapies, including pharmacological and nonpharmacological therapies for neuropathic pain. Throughout the publication, we identify knowledge gaps and the need for future funding to address these gaps, as well as needs to advocate for a personalized care approach to reduce the burden of DN and optimize quality of life for all affected individuals.
Collapse
Affiliation(s)
- Lynn Ang
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States of America
| | - Kara Mizokami-Stout
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States of America; Ann Arbor Veteran Affairs Hospital, Ann Arbor, MI, United States of America
| | - Stephanie A Eid
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States of America
| | - Melissa Elafros
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States of America
| | - Brian Callaghan
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States of America
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States of America
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States of America.
| |
Collapse
|
17
|
Lawal Y, Mshelia-Reng R, Omonua SO, Odumodu K, Shuaibu R, Itanyi UD, Abubakar AI, Kolade-Yunusa HO, Songden ZD, Ehusani CO, Adediran O, Anumah FE. Comparison of waist-height ratio and other obesity indices in the prediction of diabetic peripheral neuropathy. Front Nutr 2022; 9:949315. [PMID: 36276814 PMCID: PMC9582519 DOI: 10.3389/fnut.2022.949315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Waist-height ratio (WHtR) is increasingly being studied as a simple and effective measure of central obesity. Reports have shown that WHtR is a better predictor of hypertension, diabetes, and cardiovascular diseases when compared to traditional obesity indices like body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR). This study is therefore aimed at comparing WHtR with other obesity indices in the prediction of peripheral neuropathy in persons with diabetes mellitus (DM). Methodology One thousand and forty persons with DM were enrolled following consent. Relevant details of history were obtained, followed by physical examinations. Data were analyzed using IBM-SPSS version 23. Logistic regression was used to compare the odds ratio of obesity indices in the prediction of peripheral neuropathy. The level of significance used was p = 0.05. Results Logistic regression showed that WHtR had the highest odds ratio (OR) for the prediction of "probable" diabetic peripheral neuropathy (OR 9.11, 95% CI 3.07-47.97, p = 0.002), followed by WC (OR 2.01, 95% CI 1.09-4.05, p = 0.004), and BMI (OR 1.26, 95% CI 1.00-3.99, p = 0.019) after correction for age; systemic hypertension; duration of DM; control of SBP, DBP, HbA1c, FPG, and 2HrPP. Conclusion WHtR has the highest odds ratio in the prediction of "probable" diabetic peripheral neuropathy in both genders, followed by WC in the males and BMI in the females.
Collapse
|
18
|
Elafros MA, Andersen H, Bennett DL, Savelieff MG, Viswanathan V, Callaghan BC, Feldman EL. Towards prevention of diabetic peripheral neuropathy: clinical presentation, pathogenesis, and new treatments. Lancet Neurol 2022; 21:922-936. [PMID: 36115364 PMCID: PMC10112836 DOI: 10.1016/s1474-4422(22)00188-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 12/24/2022]
Abstract
Diabetic peripheral neuropathy (DPN) occurs in up to half of individuals with type 1 or type 2 diabetes. DPN results from the distal-to-proximal loss of peripheral nerve function, leading to physical disability and sometimes pain, with the consequent lowering of quality of life. Early diagnosis improves clinical outcomes, but many patients still develop neuropathy. Hyperglycaemia is a risk factor and glycaemic control prevents DPN development in type 1 diabetes. However, glycaemic control has modest or no benefit in individuals with type 2 diabetes, probably because they usually have comorbidities. Among them, the metabolic syndrome is a major risk factor for DPN. The pathophysiology of DPN is complex, but mechanisms converge on a unifying theme of bioenergetic failure in the peripheral nerves due to their unique anatomy. Current clinical management focuses on controlling diabetes, the metabolic syndrome, and pain, but remains suboptimal for most patients. Thus, research is ongoing to improve early diagnosis and prognosis, to identify molecular mechanisms that could lead to therapeutic targets, and to investigate lifestyle interventions to improve clinical outcomes.
Collapse
Affiliation(s)
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | | | - Vijay Viswanathan
- MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Royapuram, Chennai, India
| | | | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
19
|
Rumora AE, Kim B, Feldman EL. A Role for Fatty Acids in Peripheral Neuropathy Associated with Type 2 Diabetes and Prediabetes. Antioxid Redox Signal 2022; 37:560-577. [PMID: 35152728 PMCID: PMC9499450 DOI: 10.1089/ars.2021.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 11/12/2022]
Abstract
Significance: As the global prevalence of diabetes rises, diabetic complications are also increasing at an alarming rate. Peripheral neuropathy (PN) is the most prevalent complication of diabetes and prediabetes, and is characterized by progressive sensory loss resulting from nerve damage. While hyperglycemia is the major risk factor for PN in type 1 diabetes (T1D), the metabolic syndrome (MetS) underlies the onset and progression of PN in type 2 diabetes (T2D) and prediabetes. Recent Advances: Recent reports show that dyslipidemia, a MetS component, is strongly associated with PN in T2D and prediabetes. Dyslipidemia is characterized by an abnormal plasma lipid profile with uncontrolled lipid levels, and both clinical and preclinical studies implicate a role for dietary fatty acids (FAs) in PN pathogenesis. Molecular studies further show that saturated and unsaturated FAs differentially regulate the nerve lipid profile and nerve function. Critical Issues: We first review the properties of FAs and the neuroanatomy of the peripheral nervous system (PNS). Second, we discuss clinical and preclinical studies that implicate the involvement of FAs in PN. Third, we summarize the potential effects of FAs on nerve function and lipid metabolism within the peripheral nerves, sensory neurons, and Schwann cells. Future Directions: Future directions will focus on identifying molecular pathways in T2D and prediabetes that are modulated by FAs in PN. Determining pathophysiological mechanisms that underlie the injurious effects of saturated FAs and beneficial properties of unsaturated FAs will provide mechanistic targets for developing new targeted therapies to treat PN associated with T2D and prediabetes. Antioxid. Redox Signal. 37, 560-577.
Collapse
Affiliation(s)
- Amy E. Rumora
- Department of Neurology, Columbia University, New York, New York, USA
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Bhumsoo Kim
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Eva L. Feldman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
20
|
Afshinnia F, Reynolds EL, Rajendiran TM, Soni T, Byun J, Savelieff MG, Looker HC, Nelson RG, Michailidis G, Callaghan BC, Pennathur S, Feldman EL. Serum lipidomic determinants of human diabetic neuropathy in type 2 diabetes. Ann Clin Transl Neurol 2022; 9:1392-1404. [PMID: 35923113 PMCID: PMC9463947 DOI: 10.1002/acn3.51639] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The serum lipidomic profile associated with neuropathy in type 2 diabetes is not well understood. Obesity and dyslipidemia are known neuropathy risk factors, suggesting lipid profiles early during type 2 diabetes may identify individuals who develop neuropathy later in the disease course. This retrospective cohort study examined lipidomic profiles 10 years prior to type 2 diabetic neuropathy assessment. METHODS Participants comprised members of the Gila River Indian community with type 2 diabetes (n = 69) with available stored serum samples and neuropathy assessment 10 years later using the combined Michigan Neuropathy Screening Instrument (MNSI) examination and questionnaire scores. A combined MNSI index was calculated from examination and questionnaire scores. Serum lipids (435 species from 18 classes) were quantified by mass spectrometry. RESULTS The cohort included 17 males and 52 females with a mean age of 45 years (SD = 9 years). Participants were stratified as with (high MNSI index score > 2.5407) versus without neuropathy (low MNSI index score ≤ 2.5407). Significantly decreased medium-chain acylcarnitines and increased total free fatty acids, independent of chain length and saturation, in serum at baseline associated with incident peripheral neuropathy at follow-up, that is, participants had high MNSI index scores, independent of covariates. Participants with neuropathy also had decreased phosphatidylcholines and increased lysophosphatidylcholines at baseline, independent of chain length and saturation. The abundance of other lipid classes did not differ significantly by neuropathy status. INTERPRETATION Abundance differences in circulating acylcarnitines, free fatty acids, phosphatidylcholines, and lysophosphatidylcholines 10 years prior to neuropathy assessment are associated with neuropathy status in type 2 diabetes.
Collapse
Affiliation(s)
- Farsad Afshinnia
- Department of Internal Medicine‐NephrologyUniversity of MichiganAnn ArborMichiganUSA
| | - Evan L. Reynolds
- NeuroNetwork for Emerging TherapiesUniversity of MichiganAnn ArborMichiganUSA,Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
| | - Thekkelnaycke M. Rajendiran
- University of Michigan, Michigan Regional Comprehensive Metabolomics Resource CoreAnn ArborMichiganUSA,Department of PathologyUniversity of MichiganAnn ArborMichiganUSA
| | - Tanu Soni
- University of Michigan, Michigan Regional Comprehensive Metabolomics Resource CoreAnn ArborMichiganUSA
| | - Jaeman Byun
- Department of Internal Medicine‐NephrologyUniversity of MichiganAnn ArborMichiganUSA
| | - Masha G. Savelieff
- NeuroNetwork for Emerging TherapiesUniversity of MichiganAnn ArborMichiganUSA
| | - Helen C. Looker
- Chronic Kidney Disease SectionNational Institute of Diabetes and Digestive and Kidney DiseasesPhoenixArizonaUSA
| | - Robert G. Nelson
- Chronic Kidney Disease SectionNational Institute of Diabetes and Digestive and Kidney DiseasesPhoenixArizonaUSA
| | - George Michailidis
- Department of Statistics and the Informatics InstituteUniversity of FloridaGainesvilleFloridaUSA
| | - Brian C. Callaghan
- NeuroNetwork for Emerging TherapiesUniversity of MichiganAnn ArborMichiganUSA,Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
| | - Subramaniam Pennathur
- Department of Internal Medicine‐NephrologyUniversity of MichiganAnn ArborMichiganUSA,University of Michigan, Michigan Regional Comprehensive Metabolomics Resource CoreAnn ArborMichiganUSA,Department of Molecular and Integrative PhysiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Eva L. Feldman
- NeuroNetwork for Emerging TherapiesUniversity of MichiganAnn ArborMichiganUSA,Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
| |
Collapse
|
21
|
Pasha R, Azmi S, Ferdousi M, Kalteniece A, Bashir B, Gouni-Berthold I, Malik RA, Soran H. Lipids, Lipid-Lowering Therapy, and Neuropathy: A Narrative Review. Clin Ther 2022; 44:1012-1025. [PMID: 35810030 DOI: 10.1016/j.clinthera.2022.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022]
Abstract
Statins, or 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, are the mainstay of treatment for hypercholesterolemia as they effectively reduce LDL-C levels and risk of atherosclerotic cardiovascular disease. Apart from hyperglycemia, dyslipidemia and HDL dysfunction are known risk factors for neuropathy in people with obesity and diabetes. Although there are case reports of statin-induced neuropathy, ad hoc analyses of clinical trials and observational studies have shown that statins may improve peripheral neuropathy. However, large randomized controlled trials and meta-analyses of cardiovascular outcome trials with statins and other lipid-lowering drugs have not reported on neuropathy outcomes. Because neuropathy was not a prespecified outcome in major cardiovascular trials, one cannot conclude whether statins or other lipid-lowering therapies increase or decrease the risk of neuropathy. The aim of this review was to assess if statins have beneficial or detrimental effects on neuropathy and whether there is a need for large well-powered interventional studies using objective neuropathy end points.
Collapse
Affiliation(s)
- Raabya Pasha
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Shazli Azmi
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Trust, Manchester, United Kingdom
| | - Maryam Ferdousi
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Trust, Manchester, United Kingdom
| | - Alise Kalteniece
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Trust, Manchester, United Kingdom
| | - Bilal Bashir
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Ioanna Gouni-Berthold
- Polyclinic for Endocrinology, Diabetes, and Preventive Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Rayaz A Malik
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Handrean Soran
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Trust, Manchester, United Kingdom.
| |
Collapse
|
22
|
Trouvin AP, Attal N, Perrot S. Lifestyle and chronic pain: double jeopardy? Br J Anaesth 2022; 129:278-281. [PMID: 35803752 DOI: 10.1016/j.bja.2022.06.006] [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: 05/24/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022] Open
Abstract
Given the often disappointing results of pharmacotherapy, many patients with chronic pain seek to modify their lifestyle. Some lifestyle factors, such as the consumption of alcohol, tobacco, cannabis, or psychostimulants, are deleterious in this context, whereas others, such as physical activity and a balanced diet, are considered beneficial, but these require substantial effort on the part of patients. In all cases, it is important to analyse lifestyle factors in patients with chronic pain, without stigmatisation, as the co-existence of pain and inappropriate behaviour can be seen as double jeopardy in patients with pain.
Collapse
Affiliation(s)
- Anne-Priscille Trouvin
- Centre d'Evaluation et de Traitement de la Douleur, Hôpital Cochin, Université Paris Cité, INSERM U987, Paris, France; CETD and INSERM U987, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Paris Saclay University, Versailles, France
| | - Nadine Attal
- CETD and INSERM U987, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Paris Saclay University, Versailles, France
| | - Serge Perrot
- Centre d'Evaluation et de Traitement de la Douleur, Hôpital Cochin, Université Paris Cité, INSERM U987, Paris, France; CETD and INSERM U987, Hôpital Ambroise Paré, Boulogne-Billancourt, France.
| |
Collapse
|
23
|
Corneal Confocal Microscopy Identifies Small Nerve Fibre Damage in Patients with Hypertriglyceridemia. J Clin Lipidol 2022; 16:463-471. [DOI: 10.1016/j.jacl.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/01/2022] [Accepted: 04/24/2022] [Indexed: 11/20/2022]
|
24
|
Guo K, Savelieff MG, Rumora AE, Alakwaa FM, Callaghan BC, Hur J, Feldman EL. Plasma Metabolomics and Lipidomics Differentiate Obese Individuals by Peripheral Neuropathy Status. J Clin Endocrinol Metab 2022; 107:1091-1109. [PMID: 34878536 PMCID: PMC8947234 DOI: 10.1210/clinem/dgab844] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Indexed: 12/19/2022]
Abstract
CONTEXT Peripheral neuropathy (PN) is a frequent prediabetes and type 2 diabetes (T2D) complication. Multiple clinical studies reveal that obesity and dyslipidemia can also drive PN progression, independent of glycemia, suggesting a complex interplay of specific metabolite and/or lipid species may underlie PN. OBJECTIVE This work aimed to identify the plasma metabolomics and lipidomics signature that underlies PN in an observational study of a sample of individuals with average class 3 obesity. METHODS We performed plasma global metabolomics and targeted lipidomics on obese participants with (n = 44) and without PN (n = 44), matched for glycemic status, vs lean nonneuropathic controls (n = 43). We analyzed data by Wilcoxon, logistic regression, partial least squares-discriminant analysis, and group-lasso to identify differential metabolites and lipids by obesity and PN status. We also conducted subanalysis by prediabetes and T2D status. RESULTS Lean vs obese comparisons, regardless of PN status, identified the most significant differences in gamma-glutamyl and branched-chain amino acid metabolism from metabolomics analysis and triacylglycerols from lipidomics. Stratification by PN status within obese individuals identified differences in polyamine, purine biosynthesis, and benzoate metabolism. Lipidomics found diacylglycerols as the most significant subpathway distinguishing obese individuals by PN status, with additional contributions from phosphatidylcholines, sphingomyelins, ceramides, and dihydroceramides. Stratifying the obese group by glycemic status did not affect discrimination by PN status. CONCLUSION Obesity may be as strong a PN driver as prediabetes or T2D in a sample of individuals with average class 3 obesity, at least by plasma metabolomics and lipidomics profile. Metabolic and complex lipid pathways can differentiate obese individuals with and without PN, independent of glycemic status.
Collapse
Affiliation(s)
- Kai Guo
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, Michigan, USA
| | - Masha G Savelieff
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, Michigan, USA
| | - Amy E Rumora
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, Michigan, USA
| | - Fadhl M Alakwaa
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian C Callaghan
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, Michigan, USA
| | - Junguk Hur
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, Michigan, USA
- Correspondence: Eva L. Feldman, MD, PhD, Department of Neurology, University of Michigan 5017 AAT-BSRB, 109 Zina Pitcher Pl, Ann Arbor, MI 48109-0588, USA.
| |
Collapse
|
25
|
Jende JME, Mooshage C, Kender Z, Kopf S, Groener JB, Heiland S, Juerchott A, Nawroth P, Bendszus M, Kurz FT. Magnetic Resonance Neurography Reveals Smoking-Associated Decrease in Sciatic Nerve Structural Integrity in Type 2 Diabetes. Front Neurosci 2022; 15:811085. [PMID: 35242003 PMCID: PMC8886720 DOI: 10.3389/fnins.2021.811085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
Objective It is controversially discussed in how far smoking contributes to diabetic polyneuropathy (DPN) in type 2 diabetes (T2D). Diffusion-weighted magnetic resonance neurography (MRN) at 3 Tesla has been shown to provide objective values for structural nerve integrity in patients with T2D. The aim of this study was to investigate the contribution of cigarette smoking on structural nerve integrity in T2D. Methods This cross-sectional prospective cohort study investigated the structural integrity of the sciatic nerve in 10 smokers, 40 never-smokers, and 20 ex-smokers with T2D and 10 healthy control subjects, using diffusion tensor imaging MRN at 3 Tesla and semi-automated nerve fiber tracking. Results were correlated with clinical, electrophysiological, and serological data. Results The sciatic nerve’s fractional anisotropy (FA), a parameter for structural nerve integrity, was significantly lower in smokers with T2D when compared to controls (p = 0.002) and never-smokers (p = 0.015), and lower in ex-smokers when compared to controls (p = 0.015). In addition, sciatic nerve radial diffusivity, a marker of myelin damage, was increased in smokers versus controls and never-smokers (p = 0.048, p = 0.049, respectively). Furthermore, FA in T2D patients was negatively correlated with clinical and electrophysiological markers of DPN. FA also showed negative correlations with the pulse wave velocity, a marker of arterial stiffness and associated microangiopathy, in controls (r = −0.70; p = 0.037), never-smokers (r = −0.45; p = 0.004), ex-smokers (r = −0.55; p = 0.009), and a similar trend in smokers (r = −0.63; p = 0.076). Negative correlations were found between FA and skin auto-fluorescence, a marker of tissue advanced glycation end product accumulation and therefore long-term glycemic stress in T2D, in never-smokers (r = −0.39; p = 0.020) and smokers (r = −0.84; p = 0.004), but not in ex-smokers (r = −0.07; p = 0.765). Conclusion The findings indicate that smoking contributes to sciatic nerve damage in T2D, potentially worsening DPN due to glycemic stress and less microangiopathy-associated myelin damage in active smokers, while angiopathic effects predominate in ex-smokers. To stop smoking may therefore pose a promising preventive measure to slow the progression of DPN in T2D.
Collapse
Affiliation(s)
- Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Mooshage
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany
| | - Jan B Groener
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Experimental Radiology, Department of Neuroradiology, Heidelberg, Germany
| | - Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany.,Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Radiology (E010), German Cancer Research Center, Heidelberg, Germany
| |
Collapse
|
26
|
Hossain MJ, Kendig MD, Letton ME, Morris MJ, Arnold R. Peripheral Neuropathy Phenotyping in Rat Models of Type 2 Diabetes Mellitus: Evaluating Uptake of the Neurodiab Guidelines and Identifying Future Directions. Diabetes Metab J 2022; 46:198-221. [PMID: 35385634 PMCID: PMC8987683 DOI: 10.4093/dmj.2021.0347] [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: 12/08/2021] [Accepted: 02/25/2022] [Indexed: 11/08/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) affects over half of type 2 diabetes mellitus (T2DM) patients, with an urgent need for effective pharmacotherapies. While many rat and mouse models of T2DM exist, the phenotyping of DPN has been challenging with inconsistencies across laboratories. To better characterize DPN in rodents, a consensus guideline was published in 2014 to accelerate the translation of preclinical findings. Here we review DPN phenotyping in rat models of T2DM against the 'Neurodiab' criteria to identify uptake of the guidelines and discuss how DPN phenotypes differ between models and according to diabetes duration and sex. A search of PubMed, Scopus and Web of Science databases identified 125 studies, categorised as either diet and/or chemically induced models or transgenic/spontaneous models of T2DM. The use of diet and chemically induced T2DM models has exceeded that of transgenic models in recent years, and the introduction of the Neurodiab guidelines has not appreciably increased the number of studies assessing all key DPN endpoints. Combined high-fat diet and low dose streptozotocin rat models are the most frequently used and well characterised. Overall, we recommend adherence to Neurodiab guidelines for creating better animal models of DPN to accelerate translation and drug development.
Collapse
Affiliation(s)
- Md Jakir Hossain
- Department of Pharmacology, School of Medical Sciences, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Michael D. Kendig
- Department of Pharmacology, School of Medical Sciences, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Meg E. Letton
- Department of Exercise Physiology, School of Medical Sciences, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Margaret J. Morris
- Department of Pharmacology, School of Medical Sciences, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Ria Arnold
- Department of Pharmacology, School of Medical Sciences, University of New South Wales (UNSW) Sydney, Sydney, Australia
- Department of Exercise Physiology, School of Medical Sciences, University of New South Wales (UNSW) Sydney, Sydney, Australia
- Department of Exercise and Rehabilitation, School of Medical, Indigenous and Health Science, University of Wollongong, Wollongong, Australia
- Corresponding author: Ria Arnold https://orcid.org/0000-0002-7469-6587 Department of Exercise Physiology, School of Health Sciences, UNSW Sydney, Sydney, NSW 2052, Australia E-mail:
| |
Collapse
|
27
|
Bönhof GJ, Herder C, Ziegler D. Diagnostic Tools, Biomarkers, and Treatments in Diabetic polyneuropathy and Cardiovascular Autonomic Neuropathy. Curr Diabetes Rev 2022; 18:e120421192781. [PMID: 33845748 DOI: 10.2174/1573399817666210412123740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022]
Abstract
The various manifestations of diabetic neuropathy, including distal symmetric sensorimotor polyneuropathy (DSPN) and cardiovascular autonomic neuropathy (CAN), are among the most prevalent chronic complications of diabetes. Major clinical complications of diabetic neuropathies, such as neuropathic pain, chronic foot ulcers, and orthostatic hypotension, are associated with considerable morbidity, increased mortality, and diminished quality of life. Despite the substantial individual and socioeconomic burden, the strategies to diagnose and treat diabetic neuropathies remain insufficient. This review provides an overview of the current clinical aspects and recent advances in exploring local and systemic biomarkers of both DSPN and CAN assessed in human studies (such as biomarkers of inflammation and oxidative stress) for better understanding of the underlying pathophysiology and for improving early detection. Current therapeutic options for DSPN are (I) causal treatment, including lifestyle modification, optimal glycemic control, and multifactorial risk intervention, (II) pharmacotherapy derived from pathogenetic concepts, and (III) analgesic treatment against neuropathic pain. Recent advances in each category are discussed, including non-pharmacological approaches, such as electrical stimulation. Finally, the current therapeutic options for cardiovascular autonomic complications are provided. These insights should contribute to a broader understanding of the various manifestations of diabetic neuropathies from both the research and clinical perspectives.
Collapse
Affiliation(s)
- Gidon J Bönhof
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
| |
Collapse
|
28
|
Savelieff MG, Noureldein MH, Feldman EL. Systems Biology to Address Unmet Medical Needs in Neurological Disorders. Methods Mol Biol 2022; 2486:247-276. [PMID: 35437727 PMCID: PMC9446424 DOI: 10.1007/978-1-0716-2265-0_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Neurological diseases are highly prevalent and constitute a significant cause of mortality and disability. Neurological disorders encompass a heterogeneous group of neurodegenerative conditions, broadly characterized by injury to the peripheral and/or central nervous system. Although the etiology of neurological diseases varies greatly, they share several characteristics, such as heterogeneity of clinical presentation, non-cell autonomous nature, and diversity of cellular, subcellular, and molecular pathways. Systems biology has emerged as a valuable platform for addressing the challenges of studying heterogeneous neurological diseases. Systems biology has manifold applications to address unmet medical needs for neurological illness, including integrating and correlating different large datasets covering the transcriptome, epigenome, proteome, and metabolome associated with a specific condition. This is particularly useful for disentangling the heterogeneity and complexity of neurological conditions. Hence, systems biology can help in uncovering pathophysiology to develop novel therapeutic targets and assessing the impact of known treatments on disease progression. Additionally, systems biology can identify early diagnostic biomarkers, to help diagnose neurological disease preceded by a long subclinical phase, as well as define the exposome, the collection of environmental toxicants that increase risk of certain neurological diseases. In addition to these current applications, there are numerous potential emergent uses, such as precision medicine.
Collapse
Affiliation(s)
- Masha G Savelieff
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
| | - Mohamed H Noureldein
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Eva L Feldman
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA.
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA.
| |
Collapse
|
29
|
Eid SA, Feldman EL. Advances in diet-induced rodent models of metabolically acquired peripheral neuropathy. Dis Model Mech 2021; 14:273425. [PMID: 34762126 PMCID: PMC8592018 DOI: 10.1242/dmm.049337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Peripheral neuropathy (PN) is a severe complication that affects over 30% of prediabetic and 60% of type 2 diabetic (T2D) patients. The metabolic syndrome is increasingly recognized as a major driver of PN. However, basic and translational research is needed to understand the mechanisms that contribute to nerve damage. Rodent models of diet-induced obesity, prediabetes, T2D and PN closely resemble the human disease and have proven to be instrumental for the study of PN mechanisms. In this Perspective article, we focus on the development, neurological characterization and dietary fat considerations of diet-induced rodent models of PN. We highlight the importance of investigating sex differences and discuss some of the challenges in translation from bench to bedside, including recapitulating the progressive nature of human PN and modeling neuropathic pain. We emphasize that future research should overcome these challenges in the quest to better mimic human PN in animal models.
Collapse
Affiliation(s)
- Stéphanie A Eid
- Department of Neurology, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Eva L Feldman
- Department of Neurology, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| |
Collapse
|
30
|
Haque F, Ibne Reaz MB, Chowdhury MEH, Md Ali SH, Ashrif A Bakar A, Rahman T, Kobashi S, Dhawale CA, Sobhan Bhuiyan MA. A nomogram-based diabetic sensorimotor polyneuropathy severity prediction using Michigan neuropathy screening instrumentations. Comput Biol Med 2021; 139:104954. [PMID: 34715551 DOI: 10.1016/j.compbiomed.2021.104954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diabetic Sensorimotor polyneuropathy (DSPN) is one of the major indelible complications in diabetic patients. Michigan neuropathy screening instrumentation (MNSI) is one of the most common screening techniques used for DSPN, however, it does not provide any direct severity grading system. METHOD For designing and modeling the DSPN severity grading systems for MNSI, 19 years of data from Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials were used. Different Machine learning-based feature ranking techniques were investigated to identify the important MNSI features associated with DSPN diagnosis. A multivariable logistic regression-based nomogram was generated and validated for DSPN severity grading using the best performing top-ranked MNSI features. RESULTS Top-10 ranked features from MNSI features: Appearance of Feet (R), Ankle Reflexes (R), Vibration perception (L), Vibration perception (R), Appearance of Feet (L), 10-gm filament (L), Ankle Reflexes (L), 10-gm filament (R), Bed Cover Touch, and Ulceration (R) were identified as important features for identifying DSPN by Multi-Tree Extreme Gradient Boost model. The nomogram-based prediction model exhibited an accuracy of 97.95% and 98.84% for the EDIC test set and an independent test set, respectively. A DSPN severity score technique was generated for MNSI from the DSPN severity prediction model. DSPN patients were stratified into four severity levels: absent, mild, moderate, and severe using the cut-off values of 17.6, 19.1, 20.5 for the DSPN probability less than 50%, 75%-90%, and above 90%, respectively. CONCLUSIONS The findings of this work provide a machine learning-based MNSI severity grading system which has the potential to be used as a secondary decision support system by health professionals in clinical applications and large clinical trials to identify high-risk DSPN patients.
Collapse
Affiliation(s)
- Fahmida Haque
- Department of Electrical, Electronic and System Engineering, Universiti Kebangsaan Malaysia, Bangi, 43600, Selangor, Malaysia
| | - Mamun Bin Ibne Reaz
- Department of Electrical, Electronic and System Engineering, Universiti Kebangsaan Malaysia, Bangi, 43600, Selangor, Malaysia.
| | | | - Sawal Hamid Md Ali
- Department of Electrical, Electronic and System Engineering, Universiti Kebangsaan Malaysia, Bangi, 43600, Selangor, Malaysia
| | - Ahmad Ashrif A Bakar
- Department of Electrical, Electronic and System Engineering, Universiti Kebangsaan Malaysia, Bangi, 43600, Selangor, Malaysia
| | - Tawsifur Rahman
- Department of Electrical Engineering, Qatar University, Doha, 2713, Qatar
| | - Syoji Kobashi
- Graduate School of Engineering, University of Hyogo, Hyogo, Japan
| | - Chitra A Dhawale
- P. R. Pote College of Engineering and Management, Kathora Road, Amravati, 444602, India
| | - Mohammad Arif Sobhan Bhuiyan
- Department Electrical and Electronic Engineering, Xiamen University Malaysia, Bandar Sunsuria, Sepang, 43900, Selangor, Malaysia.
| |
Collapse
|
31
|
Khan KS, Christensen DH, Nicolaisen SK, Gylfadottir SS, Jensen TS, Nielsen JS, Thomsen RW, Andersen H. Falls and fractures associated with type 2 diabetic polyneuropathy: A cross-sectional nationwide questionnaire study. J Diabetes Investig 2021; 12:1827-1834. [PMID: 33686761 PMCID: PMC8504903 DOI: 10.1111/jdi.13542] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION To examine the prevalence of falls and fractures, and the association with symptoms of diabetic polyneuropathy (DPN) in patients with recently diagnosed type 2 diabetes. MATERIALS AND METHODS A detailed questionnaire on neuropathy symptoms and falls was sent to 6,726 patients enrolled in the Danish Center for Strategic Research in Type 2 Diabetes cohort (median age 65 years, diabetes duration 4.6 years). Complete data on fractures and patient characteristics were ascertained from population-based health registries. We defined possible DPN as a score ≥4 on the Michigan Neuropathy Screening Instruments questionnaire. Using Poisson regression analyses, we estimated the adjusted prevalence ratio (aPR) of falls and fractures, comparing patients with and without DPN. RESULTS In total, 5,359 patients (80%) answered the questions on the Michigan Neuropathy Screening Instruments questionnaire and falls. Within the year preceding the questionnaire response, 17% (n = 933) reported at least one fall and 1.4% (n = 76) suffered from a fracture. The prevalence ratio of falls was substantially increased in patients with possible DPN compared with those without (aPR 2.33, 95% confidence interval [CI] 2.06-2.63). The prevalence ratio increased with the number of falls from aPR 1.51 (95% CI 1.22-1.89) for one fall to aPR 5.89 (95% CI 3.84-9.05) for four or more falls within the preceding year. Possible DPN was associated with a slightly although non-significantly increased risk of fractures (aPR 1.32, 95% CI 0.75-2.33). CONCLUSIONS Patients with recently diagnosed type 2 diabetes and symptoms of DPN had a highly increased risk of falling. These results emphasize the need for preventive interventions to reduce fall risk among patients with type 2 diabetes and possible DPN.
Collapse
Affiliation(s)
- Karolina Snopek Khan
- Department of Clinical MedicineInternational Diabetic Neuropathy ConsortiumAarhus UniversityAarhusDenmark
- Department of NeurologyAarhus University HospitalAarhusDenmark
| | - Diana Hedevang Christensen
- Department of Clinical MedicineInternational Diabetic Neuropathy ConsortiumAarhus UniversityAarhusDenmark
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | | | - Sandra Sif Gylfadottir
- Department of Clinical MedicineInternational Diabetic Neuropathy ConsortiumAarhus UniversityAarhusDenmark
- Department of Clinical MedicineDanish Pain Research CenterAarhus UniversityAarhusDenmark
| | - Troels Staehelin Jensen
- Department of Clinical MedicineInternational Diabetic Neuropathy ConsortiumAarhus UniversityAarhusDenmark
- Department of Clinical MedicineDanish Pain Research CenterAarhus UniversityAarhusDenmark
| | - Jens Steen Nielsen
- Department of Clinical MedicineInternational Diabetic Neuropathy ConsortiumAarhus UniversityAarhusDenmark
- The Danish Center for Strategic Research in Type 2 DiabetesSteno Diabetes Center OdenseOdense University HospitalOdenseDenmark
- Research Unit of SDCODepartment of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | | | - Henning Andersen
- Department of Clinical MedicineInternational Diabetic Neuropathy ConsortiumAarhus UniversityAarhusDenmark
- Department of NeurologyAarhus University HospitalAarhusDenmark
| |
Collapse
|
32
|
Ziegler D, Bönhof GJ, Strom A, Straßburger K, Karusheva Y, Szendroedi J, Roden M. Progression and regression of nerve fibre pathology and dysfunction early in diabetes over 5 years. Brain 2021; 144:3251-3263. [PMID: 34499110 DOI: 10.1093/brain/awab330] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/24/2021] [Accepted: 08/08/2021] [Indexed: 12/17/2022] Open
Abstract
It has been traditionally suggested that the early development of diabetic sensorimotor polyneuropathy (DSPN) is characterized by a predominant and progressive injury to small nerve fibres followed by large fibre impairment. We alternatively hypothesized that small and large fibre damage due to DSPN in type 1 and type 2 diabetes could develop in parallel and may not only be progressive but also reversible. Participants from the German Diabetes Study baseline cohort with recent-onset type 1/type 2 diabetes (n = 350/570) and age-matched glucose-tolerant control individuals (Control 1/Control 2: n = 114/190) were assessed by nerve conduction studies (NCS), thermal detection thresholds (TDT), vibration perception threshold (VPT), Neuropathy Symptom Score (NSS), Neuropathy Disability Score (NDS), and intraepidermal nerve fibre density (IENFD) in skin biopsies (type 1/type 2 diabetes: n = 102/226; Control 1/Control 2: n = 109/208). Subsets of participants with type 1/type 2 diabetes were followed for 5 years (n = 184/307; IENFD subset: n = 18/69). DSPN was defined by the Toronto Consensus criteria. At baseline, DSPN was present in 8.1 and 13.3% of the type 1 and type 2 diabetes groups, respectively. The most frequently abnormal tests in the lower limbs below or above the 2.5th and 97.5th centile of the controls were IENFD (13.7%) and individual NCS (up to 9.4%) in type 1 diabetes participants and IENFD (21.8%), malleolar VPT (17.5%), and individual NCS (up to 11.8%) in those with type 2 diabetes, whereas TDT abnormalities did not differ between the control and diabetes groups. After 5 years in type 2 diabetes participants, the highest progression rates from the normal to the abnormal range were found for IENFD (18.8%) by -4.1 ± 2.8 fibres/mm, malleolar VPT (18.6%) by 9.1 ± 20.2 µm, and NDS (15.0%) by 3.7 ± 1.5 points, while vice versa the highest regression rates were observed for NDS (11.2%) by -3.1 ± 1.3 points, sural nerve amplitude (9.1%) by 4.7 ± 3.0 µV, IENFD (8.7%) by 1.4 ± 1.3 fibres/mm, and NSS (8.2%) by -5.8 ± 1.6 points. In type 1 diabetes participants, no major progression was seen after 5 years, but subclinical DSPN regressed in 10.3%. These findings point to an early parallel damage to both small and large nerve fibres in well-controlled recent-onset type 2 and, to a lesser extent, type 1 diabetes. After 5 years peripheral nerve morphology and function and clinical measures progress to the abnormal range in type 2 diabetes, but initial nerve alterations are also reversible to a meaningful degree.
Collapse
Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany.,Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany.,German Center for Diabetes Research, Partner Düsseldorf, 85764 München-Neuherberg, Germany
| | - Gidon J Bönhof
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany.,Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany.,German Center for Diabetes Research, Partner Düsseldorf, 85764 München-Neuherberg, Germany
| | - Klaus Straßburger
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Yanislava Karusheva
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany.,Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany.,German Center for Diabetes Research, Partner Düsseldorf, 85764 München-Neuherberg, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany.,Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany.,German Center for Diabetes Research, Partner Düsseldorf, 85764 München-Neuherberg, Germany
| | | |
Collapse
|
33
|
Sloan G, Selvarajah D, Tesfaye S. Pathogenesis, diagnosis and clinical management of diabetic sensorimotor peripheral neuropathy. Nat Rev Endocrinol 2021; 17:400-420. [PMID: 34050323 DOI: 10.1038/s41574-021-00496-z] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 02/08/2023]
Abstract
Diabetic sensorimotor peripheral neuropathy (DSPN) is a serious complication of diabetes mellitus and is associated with increased mortality, lower-limb amputations and distressing painful neuropathic symptoms (painful DSPN). Our understanding of the pathophysiology of the disease has largely been derived from animal models, which have identified key potential mechanisms. However, effective therapies in preclinical models have not translated into clinical trials and we have no universally accepted disease-modifying treatments. Moreover, the condition is generally diagnosed late when irreversible nerve damage has already taken place. Innovative point-of-care devices have great potential to enable the early diagnosis of DSPN when the condition might be more amenable to treatment. The management of painful DSPN remains less than optimal; however, studies suggest that a mechanism-based approach might offer an enhanced benefit in certain pain phenotypes. The management of patients with DSPN involves the control of individualized cardiometabolic targets, a multidisciplinary approach aimed at the prevention and management of foot complications, and the timely diagnosis and management of neuropathic pain. Here, we discuss the latest advances in the mechanisms of DSPN and painful DSPN, originating both from the periphery and the central nervous system, as well as the emerging diagnostics and treatments.
Collapse
Affiliation(s)
- Gordon Sloan
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dinesh Selvarajah
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK
| | - Solomon Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| |
Collapse
|
34
|
Kristensen AG, Gylfadottir S, Itani M, Kuwabara S, Krøigård T, Khan KS, Finnerup NB, Andersen H, Jensen TS, Sindrup S, Tankisi H. Sensory and motor axonal excitability testing in early diabetic neuropathy. Clin Neurophysiol 2021; 132:1407-1415. [PMID: 34030050 DOI: 10.1016/j.clinph.2021.02.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of the present study was to gain insight into the pathophysiology of diabetic polyneuropathy (DPN) and examine the diagnostic value of sensory and motor axonal excitability testing. METHODS One hundred and eleven type 2 diabetics with and without DPN (disease duration: 6.36 ± 0.25 years) and 60 controls were included. All participants received a thorough clinical examination including Michigan Neuropathy Screening Instrument (MNSI) score, nerve conduction studies (NCS), and sensory and motor excitability tests. Patients were compared by the likelihood of neuropathy presence, ranging from no DPN (17), possible/probable DPN (46) to NCS-confirmed DPN (48). RESULTS Motor excitability tests showed differences in rheobase and depolarizing threshold electrotonus measures between NCS-confirmed DPN group and controls but no changes in hyperpolarising threshold electrotonus or recovery cycle parameters. Sensory excitability showed even less changes despite pronounced sensory NCS abnormalities. There were only weak correlations between the above motor excitability parameters and clinical scores. CONCLUSIONS Changes in excitability in the examined patient group were subtle, perhaps because of the relatively short disease duration. SIGNIFICANCE Less pronounced excitability changes than NCS suggest that axonal excitability testing is not of diagnostic value for early DPN and does not provide information on the mechanisms.
Collapse
Affiliation(s)
- A G Kristensen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark; Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark
| | - S Gylfadottir
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - M Itani
- Department of Neurology, Odense University Hospital, Denmark
| | - S Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - T Krøigård
- Department of Neurology, Odense University Hospital, Denmark
| | - K S Khan
- Department of Neurology, Aarhus University Hospital, Denmark
| | - N B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Denmark
| | - T S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - S Sindrup
- Department of Neurology, Odense University Hospital, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark.
| |
Collapse
|
35
|
Taams NE, Ahmadizar F, Hanewinckel R, Drenthen J, Voortman T, Ikram MA, Kavousi M, van Doorn PA. Cardiovascular health and chronic axonal polyneuropathy: A population-based study. Eur J Neurol 2021; 28:2046-2053. [PMID: 33590563 PMCID: PMC8251905 DOI: 10.1111/ene.14777] [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: 12/07/2020] [Revised: 01/20/2021] [Accepted: 02/04/2021] [Indexed: 12/02/2022]
Abstract
Background and purpose Chronic axonal polyneuropathy is a common, usually multifactorial, disease for which there is no treatment yet available. We investigated the association between cardiovascular health, defined by the health score of the American Heart Association, and chronic axonal polyneuropathy. Methods Between June 2013 and January 2017, we investigated participants of the Rotterdam Study, a population‐based cohort study. Participants were screened for polyneuropathy and categorized as having no, possible, probable or definite polyneuropathy. The cardiovascular health score (range 0–14; higher score reflecting better health) consisted of four health behaviours (diet, physical activity, smoking and body mass index) and three health factors (blood pressure, serum cholesterol and fasting glucose level). Results We included 1919 participants, of whom 120 (6.3%) had definite polyneuropathy. The median (interquartile range [IQR]) age was 69.0 (58.6–73.7) years and 53.4% were women. A higher cardiovascular health score was associated with a lower prevalence of definite polyneuropathy (per point increase: odds ratio [OR] 0.90, 95% confidence interval [CI] 0.84–0.96). Optimal cardiovascular health (score≥10) was strongly associated with a lower prevalence of definite polyneuropathy (OR 0.55, 95% CI 0.32–0.90). An increase in health factors and health behaviour scores separately was associated with a lower prevalence of polyneuropathy (per point increase: OR 0.82, 95% CI 0.71–0.95 and OR 0.86, 95% CI 0.78–0.96, respectively). The association between a lower cardiovascular health score and lower sural nerve amplitude was not significant after correction for covariates (difference 0.07µV, 95% CI −0.02–0.17). Conclusions Better cardiovascular health, consisting of both modifiable health behaviours and health factors, is associated with a lower prevalence of chronic axonal polyneuropathy.
Collapse
Affiliation(s)
- Noor E Taams
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Fariba Ahmadizar
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rens Hanewinckel
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Judith Drenthen
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Clinical Neurophysiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
36
|
Abraham A, Lovblom LE, Bril V. The complex association between pain and neuropathy. Muscle Nerve 2021; 63:538-545. [PMID: 33433915 DOI: 10.1002/mus.27171] [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: 06/23/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Several studies of patients with polyneuropathy failed to show differences between patients with and without pain. In the current study, we aimed to explore the association between neuropathic symptoms, mainly pain, and polyneuropathy characteristics. METHODS A prospective cross-sectional study recruiting 151 patients with non-diabetic polyneuropathy was performed between November 2016 and May 2017. A total of 38 patients with chronic inflammatory demyelinating neuropathy were excluded. Patients underwent clinical, electrophysiological and functional assessments of their polyneuropathy. Polyneuropathy characteristics were compared depending on the presence and severity of neuropathic symptoms. RESULTS The presence and the severity of weakness were associated with a more severe neuropathy as measured by clinical, electrophysiological and functional assessments, while the presence of pain was associated with higher sural amplitudes, and the severity of pain showed a curvilinear association with neuropathy severity. CONCLUSIONS Our study shows a novel finding of a curvilinear association between pain and polyneuropathy severity.
Collapse
Affiliation(s)
- Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Leif E Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
37
|
Kristensen FP, Christensen DH, Callaghan BC, Kahlert J, Knudsen ST, Sindrup SH, Feldman EL, Østergaard L, Andersen H, Jensen TS, Sørensen HT, Thomsen RW. Statin Therapy and Risk of Polyneuropathy in Type 2 Diabetes: A Danish Cohort Study. Diabetes Care 2020; 43:2945-2952. [PMID: 32998990 DOI: 10.2337/dc20-1004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/02/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Statins may reduce the risk of diabetic polyneuropathy (DPN) as a result of lipid-lowering and anti-inflammatory effects, but statins have also been associated with neurotoxicity. We examined whether statin therapy affects the risk of DPN. RESEARCH DESIGN AND METHODS We identified all Danish patients with incident type 2 diabetes during 2002-2016. New users initiated statins between 180 days before and 180 days after their first diabetes record, while prevalent users had initiated statins before that period. Patients were followed for incident DPN using validated hospital diagnosis codes, starting 180 days after their first diabetes record. Cox proportional hazard analysis was used to compute adjusted hazard ratios (aHRs) for DPN. RESULTS The study cohort comprised 59,255 (23%) new users, 75,528 (29%) prevalent users, and 124,842 (48%) nonusers; median follow-up time was 6.2 years (interquartile range 3.4-9.6). The incidence rate of DPN events per 1,000 person-years was similar in new users (4.0 [95% CI 3.8-4.2]), prevalent users (3.8 [3.6-3.9]), and nonusers (3.8 [3.7-4.0]). The aHR for DPN was 1.05 (0.98-1.11) in new users and 0.97 (0.91-1.04) in prevalent users compared with statin nonusers. New users had a slightly increased DPN risk during the first year (1.31 [1.12-1.53]), which vanished after >2 years of follow-up. Findings were similar in on-treatment and propensity score-matched analyses and with additional adjustment for pretreatment blood lipid levels. CONCLUSIONS Statin therapy is unlikely to increase or mitigate DPN risk in patients with type 2 diabetes, although a small acute risk of harm cannot be excluded.
Collapse
Affiliation(s)
- Frederik P Kristensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark .,The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Diana H Christensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Brian C Callaghan
- The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren T Knudsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Søren H Sindrup
- The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Eva L Feldman
- The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Leif Østergaard
- The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Andersen
- The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neurology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Troels S Jensen
- The International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Neurology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
38
|
Typ-2-Diabetes: Metabolische Risikofaktoren einer Polyneuropathie. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1213-3856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
39
|
Hossain MJ, Kendig MD, Wild BM, Issar T, Krishnan AV, Morris MJ, Arnold R. Evidence of Altered Peripheral Nerve Function in a Rodent Model of Diet-Induced Prediabetes. Biomedicines 2020; 8:biomedicines8090313. [PMID: 32872256 PMCID: PMC7555926 DOI: 10.3390/biomedicines8090313] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022] Open
Abstract
Peripheral neuropathy (PN) is a debilitating complication of diabetes that affects >50% of patients. Recent evidence suggests that obesity and metabolic disease, which often precede diabetes diagnosis, may influence PN onset and severity. We examined this in a translationally relevant model of prediabetes induced by a cafeteria (CAF) diet in Sprague–Dawley rats (n = 15 CAF versus n = 15 control). Neuropathy phenotyping included nerve conduction, tactile sensitivity, intraepidermal nerve fiber density (IENFD) and nerve excitability testing, an in vivo measure of ion channel function and membrane potential. Metabolic phenotyping included body composition, blood glucose and lipids, plasma hormones and inflammatory cytokines. After 13 weeks diet, CAF-fed rats demonstrated prediabetes with significantly elevated fasting blood glucose, insulin and impaired glucose tolerance as well as obesity and dyslipidemia. Nerve conduction, tactile sensitivity and IENFD did not differ; however, superexcitability was significantly increased in CAF-fed rats. Mathematical modeling demonstrated this was consistent with a reduction in sodium–potassium pump current. Moreover, superexcitability correlated positively with insulin resistance and adiposity, and negatively with fasting high-density lipoprotein cholesterol. In conclusion, prediabetic rats over-consuming processed, palatable foods demonstrated altered nerve function that preceded overt PN. This work provides a relevant model for pathophysiological investigation of diabetic complications.
Collapse
Affiliation(s)
- Md Jakir Hossain
- School of Medical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.H.); (M.D.K.); (B.M.W.); (M.J.M.)
| | - Michael D. Kendig
- School of Medical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.H.); (M.D.K.); (B.M.W.); (M.J.M.)
| | - Brandon M. Wild
- School of Medical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.H.); (M.D.K.); (B.M.W.); (M.J.M.)
| | - Tushar Issar
- Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW 2052, Australia; (T.I.); (A.V.K.)
| | - Arun V. Krishnan
- Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW 2052, Australia; (T.I.); (A.V.K.)
| | - Margaret J. Morris
- School of Medical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.H.); (M.D.K.); (B.M.W.); (M.J.M.)
| | - Ria Arnold
- School of Medical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia; (M.J.H.); (M.D.K.); (B.M.W.); (M.J.M.)
- Correspondence: ; Tel.: +61-293858709
| |
Collapse
|
40
|
Bonora E, Trombetta M, Dauriz M, Travia D, Cacciatori V, Brangani C, Negri C, Perrone F, Pichiri I, Stoico V, Zoppini G, Rinaldi E, Da Prato G, Boselli ML, Santi L, Moschetta F, Zardini M, Bonadonna RC. Chronic complications in patients with newly diagnosed type 2 diabetes: prevalence and related metabolic and clinical features: the Verona Newly Diagnosed Type 2 Diabetes Study (VNDS) 9. BMJ Open Diabetes Res Care 2020; 8:8/1/e001549. [PMID: 32819978 PMCID: PMC7443259 DOI: 10.1136/bmjdrc-2020-001549] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION We explored the presence of chronic complications in subjects with newly diagnosed type 2 diabetes referred to the Verona Diabetes Clinic. Metabolic (insulin secretion and sensitivity) and clinical features associated with complications were also investigated. RESEARCH DESIGN AND METHODS The comprehensive assessment of microvascular and macrovascular complications included detailed medical history, resting ECG, ultrasonography of carotid and lower limb arteries, quantitative neurological evaluation, cardiovascular autonomic tests, ophthalmoscopy, kidney function tests. Insulin sensitivity and beta-cell function were assessed by state-of-the-art techniques (insulin clamp and mathematical modeling of glucose/C-peptide curves during oral glucose tolerance test). RESULTS We examined 806 patients (median age years, two-thirds males), of whom prior clinical cardiovascular disease (CVD) was revealed in 11.2% and preclinical CVD in 7.7%. Somatic neuropathy was found in 21.2% and cardiovascular autonomic neuropathy in 18.6%. Retinopathy was observed in 4.9% (background 4.2%, proliferative 0.7%). Chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2) was found in 8.8% and excessive albuminuria in 13.2% (microalbuminuria 11.9%, macroalbuminuria 1.3%).Isolated microvascular disease occurred in 30.8%, isolated macrovascular disease in 9.3%, a combination of both in 9.1%, any complication in 49.2% and no complications in 50.8%.Gender, age, body mass index, smoking, hemoglobin A1c and/or hypertension were independently associated with one or more complications. Insulin resistance and beta-cell dysfunction were associated with macrovascular but not microvascular disease. CONCLUSIONS Despite a generally earlier diagnosis for an increased awareness of the disease, as many as ~50% of patients with newly diagnosed type 2 diabetes had clinical or preclinical manifestations of microvascular and/or macrovascular disease. Insulin resistance might play an independent role in macrovascular disease. TRIAL REGISTRATION NUMBER NCT01526720.
Collapse
Affiliation(s)
- Enzo Bonora
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Maddalena Trombetta
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Marco Dauriz
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Daniela Travia
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Vittorio Cacciatori
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Corinna Brangani
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Carlo Negri
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Fabrizia Perrone
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Isabella Pichiri
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Vincenzo Stoico
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giacomo Zoppini
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Elisabetta Rinaldi
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Giuliana Da Prato
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Maria Linda Boselli
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Lorenza Santi
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Federica Moschetta
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Monica Zardini
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | | |
Collapse
|