Advances in Screening, Early Diagnosis and Accurate Staging of Diabetic Neuropathy

Peripheral Neuropathy Symptoms and Ocular Surface Lesions in Patients with Type 2 Diabetes Mellitus and Dry Eye: A Clinical Correlational Study

INTRODUCTION

Reduced corneal sensation in individuals with type 2 diabetes mellitus (T2DM) leads to a dissociation between dry eye disease (DED) signs and symptoms, thereby affecting diagnostic accuracy. This study aimed to investigate the correlation between ocular surface signs and diabetic peripheral neuropathy (DPN) symptoms in patients with T2DM-associated DED.

METHODS

The Michigan Neuropathy Screening Instrument Questionnaire (MNSIQ) was used to categorize patients with T2DM into MNSIQ-DPN and non-DPN groups. Ocular irritation symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Ocular surface lesions were assessed via Cochet-Bonnet esthesiometry, corneal fluorescein staining (CFS), the Schirmer I tear test (SIT), tear meniscus height (TMH), noninvasive keratography break-up time (NIKf-BUT), and the meibomian gland loss (MGL) grade detected by OCULUS. Corneal nerve fiber parameters were evaluated using in vivo confocal microscopy (IVCM).

RESULTS

A total of 116 patients with T2DM, comprising 76 non-DPN patients and 40 MNSIQ-DPN patients, along with 51 age-matched participants without diabetes, were enrolled. Although OSDI scores were equivalent between MNSIQ-DPN patients and non-DPN patients, MNSIQ-DPN patients presented significantly more severe CFS (p < 0.001), meibomian gland dysfunction (MGD) (p < 0.001), corneal nerve fiber loss (p < 0.001), sensory dysfunction (p = 0.02), and corneal microneuromas (p < 0.001). The MNSIQ score was significantly positively correlated with CFS (p < 0.001); MGD (p < 0.01); corneal nerve fiber loss, including corneal nerve fiber density and length and branch density, in the paracentral (all p < 0.001) and inferior-whorl areas (p < 0.01, p < 0.05 and p < 0.01, respectively); and corneal microneuromas, characterized by increased microneuroma numbers (p < 0.001) and areas (p < 0.001) in these regions.

CONCLUSION

MNSIQ scores were significantly and robustly correlated with the presence of corneal epithelial defects, MGD, and nerve fiber loss in patients with T2DM. These findings suggest that DPN is a critical factor in diabetic ocular surface complications, highlighting the importance of the MNSIQ for assessing these conditions.

Clinical and Electrophysiological Characterization of Diabetic Neuropathy in a Sub-Saharan African Cohort

BACKGROUND

Diabetic neuropathy (DN) is the most frequent complication of diabetes mellitus, contributing to increased morbidity and mortality. Previous clinical studies on DN in sub-Saharan Africa (sSA) have used purely clinical approaches, potentially underestimating the true magnitude of this disease. This study was designed to determine the prevalence of definite diabetic neuropathy and describe the different subtypes using objective small and large fiber function measures.

METHODS

This was a hospital-based cross-sectional study that included diabetes and prediabetes patients, followed up at Jordan Medical Services, Yaoundé, Cameroon, between March 2022 and February 2023. The "Toronto Clinical Neuropathy Score" and "Douleur Neuropathique en 4" questionnaires were used for clinical evaluation. Autonomic symptoms were equally recorded. Nerve conduction studies and Sudoscan were used for electrophysiological assessments of large and small fibre functions.

RESULTS

Eighty-four participants were included; 91.7% had type 2 DM, 2.4% had type 1 DM, and 6% had glucose intolerance. DN was found in 73/84 (86.9%). Diabetic sensorimotor polyneuropathy (DSP) was the most frequent subtype (63.8%), followed by diabetic autonomic neuropathy (40.5%), mononeuropathy (36.9%), asymmetric axonal sensory neuropathy (4.8%) and treatment-induced neuropathy of diabetes (TIND) in 1.2% of patients. The prevalence of large and small fibre neuropathies was 38.1% and 25.0%, respectively.

CONCLUSION

The prevalence of DN and specifically DSP in our study was higher than previously described in African literature. We identified subtypes never before reported in sSA, mainly small fibre neuropathy and TIND. This may have management and policy implications.

Phenotypic characteristics of diabetic neuropathic pain and factors associated in patients with Diabetes Mellitus-type 2

AIMS/INTRODUCTION

To identify subgroups of patients with diabetic neuropathic pain according to their phenotypic characteristics and factors associated with belonging to each of these groups.

MATERIALS AND METHODS

A multicenter cross-sectional study carried out in patients with DM-type2 and diabetic neuropathy. We recorded sociodemographic and clinical data, intensity of pain, pain phenotypes, mood disorders, sleep quality, social support, and health-related quality of life. A hierarchical cluster analysis was carried out to find groups according to their phenotype. The factors associated with belonging to these groups were assessed with a multinomial logistic regression model.

RESULTS

Four phenotypic groups were found: G1 with longer pain duration, predominance of pain provoked by brushing or pressure, and sensation of pins/needles and tingling; G2 characterized by stabbing, pins and needles, and electric shocks; G3 with lower scores in all the NPSI items; and G4 with low-moderate scores in almost all the items, but showing some level of pins and needles and tingling. Intensity and duration of pain, and level of anxiety were the factors associated with belonging to G1, G2, and G4 with respect to G3, although the magnitude of the risk was slightly different among them.

CONCLUSIONS

Specific treatment strategies should be developed for the different profiles found, with special attention to those with more pain and anxiety levels, including cognitive-behavioral therapies or mindfulness-based interventions.

The diabetic neuropathy and bone mineral density in type 2 diabetes mellitus: a cross-sectional and meta-analytic study

Diabetic neuropathy (DN) is a common complication of type 2 diabetes mellitus (T2DM), yet its impact on bone mineral density (BMD) remains unclear. This study combines cross-sectional and meta-analytic methods to comprehensively explore the relationship between DN and osteoporosis in T2DM patients. The cross-sectional study included 523 T2DM patients, classified into DN and non-DN groups. BMD was measured using dual-energy X-ray absorptiometry (DXA), and multivariate analysis identified osteoporosis-related factors. The meta-analysis included studies published from 1999 to 2021, comparing BMD between patients with and without DN. The results showed that while significant differences in clinical characteristics and biochemical indices (such as age, HbA1c, and 25(OH) vitamin D levels) were observed between the groups, no significant association between DN and osteoporosis was found after adjusting for covariates like body mass index and blood pressure. Additionally, the meta-analysis confirmed no significant impact of DN on BMD across skeletal sites, including the lumbar spine, hip, and femoral neck. These findings suggest that while DN may indirectly affect bone health through alterations in bone metabolism (such as bone formation markers), its direct impact on BMD is limited. The study's limitations include its cross-sectional design, which restricts causal inference, and retrospective data collection, underscoring the need for prospective studies to further elucidate the mechanisms behind DN's effects on bone health. These results highlight the complex interplay of factors influencing osteoporosis risk in T2DM and underscore the importance of a multifactorial approach to bone health management in this population.

The comparison of miRNA expression levels in Type 2 diabetes and diabetic peripheral neuropathy patients

OBJECTIVES

We aimed to investigate the correlation between miRNA expression levels in patients with type 2 diabetes mellitus (T2DM) and diabetic peripheral neuropathy (DPN) and determine their potential functions in DPN.

MATERIAL AND METHODS

The study participants were between 30 and 75 years old and divided into three groups: 30 patients with Type 2 T2DM without DPN (group 1), 30 patients with DPN (group 2), and 30 healthy controls (group 3). Whole blood samples were obtained from the individuals forming the groups, and the expression of the miR-128a, miR-146a, miR-155, and miR-375 genes in these samples was determined by real-time polymerase chain reaction (PCR). RNU6 was used as the housekeeping gene.

RESULTS

No significant differences were observed in the expression levels of miR-128a, miR-146a, and miR-155 among all groups (p > 0.05). However, miR-375 expression levels differed significantly between the group 2 and the group 3 (p < 0.05). No significant differences in miR-375 expression levels were found between the group 1 and the group 3, nor between the group 1 and the group 2 (p > 0.05).

CONCLUSIONS

miR-375 may be linked to the progression of diabetic peripheral neuropathy (DPN).

Computer-aided diagnostic screening of diabetic peripheral neuropathy using colorimetric membrane analysis

BACKGROUND

The aim of this study was to develop an objective computational solution, including a smartphone app, to evaluate colorimetric quantification of a membrane designed to diagnose small fiber peripheral neuropathies in individual with diabetes. This membrane, SudoPad, was developed to improve diagnostic speed and accuracy, while minimizing patient discomfort.

METHODS

SudoPad is polymeric adhesive membrane made from sodium alginate, glycerol, Alizarin Red S, and sodium carbonate. A pilot study for a clinical trial was conducted with three groups to evaluate the membrane's effectiveness. Statistical analysis focused on calculating positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, and accuracy.

RESULTS

The SudoPad app demonstrated an PPV of 88.46%, NPV of 85.90%, sensitivity of 67.65% (58,65% to 76,64% - CI 95%), specificity of 95.71% (91,81% to 99,60% - CI 95%) and accuracy of 86.54%. These metrics indicated the system's effectiveness in diagnosing peripheral neuropathies with a significant improvement in diagnostic accuracy.

CONCLUSIONS

The results suggest that SudoPad,a low-cost, biodegradable membrane, could enhance health technologies for diagnosing neuropathies. It offers a faster, accurate, and more comfortable alternative to current diagnostic methods.

Implications of the Glycemia Risk Index in Assessing Metabolic Control and its Correlation With Therapy-Related Quality of Life During-Ramadan Fasting in Adults With Type 2 Diabetes

BACKGROUND

Ramadan fasting presents unique challenges for individuals with type 2 diabetes (T2D) due to alterations in diet and medication regimens. This study evaluates the effects of Ramadan fasting on glycemia by utilizing the glycemia risk index (GRI), which integrates both hypoglycemic and hyperglycemic risks into a unified metric, alongside continuous glucose monitoring (CGM) data. In addition, the study examines the correlation between GRI and diabetes therapy-related quality of life (DTR-QOL) to understand the broader impact on patient outcomes.

METHODS

An ambispective, one-group pre-post design was employed at a tertiary diabetes treatment center, involving 111 adults with T2D. Data were collected across three periods: one month before Ramadan, during, and one month after. Clinical, metabolic, and glycemic parameters were recorded. The CGM-based calculations included GRI, with its hypoglycemia component (CHypo) and hyperglycemia component (CHyper). The DTR-QOL was measured to evaluate therapy-related quality of life (QoL).

RESULTS

During Ramadan, GRI significantly decreased (median = 30.5) compared to before (35.2) and after (37.4; P < .001), indicating improved glycemic stability. Both CHypo and CHyper were significantly reduced during fasting. The %TIR70-180 increased from 42% before to 66% during (P < .001), accompanied by a notable decrease in glycemic variability. The DTR-QOL scores were high across all domains, reflecting a positive therapy-related QoL (scale score: 78.3 [interquartile range = 75.4-81.3]). No significant differences were observed across GRI zones.

CONCLUSIONS

With tailored education and CGM-based monitoring, Ramadan fasting can improve glycemia in individuals with T2D, enhancing GRI and related glycometric parameters for safer, more stable glycemic patterns.

Association between adiponectin single nucleotide polymorphisms and the risk of diabetic polyneuropathy

Genetic factors play a significant role in the occurrence and clinical course of diabetic peripheral neuropathy (DPN). This research aimed to search the influence of adiponectin single nucleotide polymorphisms (SNPs) on the risk of developing and the severity of DPN in Egyptian patients. Adiponectin SNPs were genotype in 360 participants comprising diabetic sufferers with and without peripheral neuropathy and healthy volunteers via the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) approach. Regarding the + 45 T/G SNP, the TG/ and GG genotypes and the G allele were linked to an rised risk of DPN by comparing the DPN group with both the control and diabetic patients without peripheral neuropathy (DWPN) groups, and when comparing the DWPN group with the control group. Concerning + 276 G/T SNP, the GT genotype and T allele were linked to a declined risk of occuring DPN when comparing the DPN group with both other groups. Patients with DPN had greater frequencies of the GA genotype of the - 11,391 G/A SNP than individuals in the control group, while patients with DPN had greater frequencies of the AA genotype than patients in the DWPN group. Regarding clinic-pathological features, a meaningful rise in the mean values of fasting blood glucose (FBG), duration of the disease, and Toronto Clinical Neuropathy Severity Score (TCSS) were noted in the + 45 GG genotype and G allele carriers. Contrariwise, the + 276 TT genotype carriers had lower mean values for the same clinic-pathological features. For the T allele carriers, the same results were observed in case of duration of the disease and TCSS value. Our results concluded that adiponectin + 45 T/G SNP could be a risk factor considering DPN and the severity of the disease. The - 11391G/A SNP might be associated with DPN. In addition, + 276 G/T SNP could be a protective factor regarding DPN and the severity of the disease.

Tangzu granule alleviate neuroinflammation in diabetic peripheral neuropathy by suppressing pyroptosis through P2X7R /NLRP3 signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus, mainly manifested as paresthesia. Tangzu granule (TZG) is derived from famous traditional Chinese medicine decoctions and optimized by long-term temporary practice. TZG has good efficacy in improving numbness, pain and pruritus of the lower extremities of DPN patients. However, the overall regulatory mechanisms underlying its effects on DPN remain unclear.

AIM OF THE STUDY

This study aims to explore the potential mechanism of TZG for treating DPN.

MATERIALS AND METHODS

Sprague-Dawley (SD) rats were used to establish an in vivo model of DPN with streptozotocin (STZ) injection and high-fat diet (HFD) feeding. Additionally, sciatic glial RSC96 cells were induced with high glucose in vitro. SD rats in intervention group received TZG treatment for 12 weeks. After 12 weeks of treatment, sciatic nerve function was evaluated by intelligent hot plate meter and neuro electrophysiology detector. The morphological changes of sciatic nerve cells were observed by hematoxylin-eosin staining and transmission electron microscope. IL-1β, IL-18 inflammatory cytokines, pyroptosis and P2X7R/NLRP3 signaling pathway were observed by Western blotting, immunofluorescence staining and ELISA.

RESULTS

TZG improved nerve conduction velocity and sciatic neuropathy rational structural changes in DPN rats. It also inhibited RSC96 inflammatory response and cell death that induced by high glucose. This may be related to TZG inhibiting P2X7R, decreasing the activation of NLRP3 inflammasomes, down-regulating the levels of pyroptosis proteins such as caspase-1, cleaved caspase-1, gasdermin D (GSDMD), and GSDMD-N, and inhibiting the release of interleuki (IL)-18 and IL-1β inflammatory cytokines.

CONCLUSIONS

TZG inhibited pyroptosis through P2X7R/NLRP3 signaling pathway, alleviated neuroinflammation, and showed protective effect in the treatment of DPN.

Network Pharmacology Combined With Metabolomics Reveals the Mechanism of Yangxuerongjin Pill Against Type 2 Diabetic Peripheral Neuropathy in Rats

Purpose

This study aims to explore the mechanism of Yangxuerongjin pill (YXRJP) in the treatment of diabetic peripheral neuropathy (DPN) by network pharmacology and metabolomics technology combined with animal experiments, and to provide scientific basis for the treatment of DPN.

Methods

In this study, network pharmacology analysis was applied to identify the active compounds, core targets and signal pathways, which might be responsible for the effect of DPN. The DPN model was established by high-fat diet combined with streptozotocin (STZ) injection, and the rats were given administration for 12 weeks. The body weight, thermal withdrawal latency (TWL), sciatic motor nerve conduction velocity (MNCV), biochemical indexes, pathological sections of sciatic nerve, oxidative stress factors and the expression levels of neuroprotection-related proteins were detected. Metabolomics technology was used to analyze the potential biomarkers and potential metabolic pathways in DPN treated with YXRJP.

Results

The results of network pharmacology showed that YXRJP could treat DPN through baicalin, β-sitosterol, 7-methoxy-2-methylisoflavone, aloe-emodin and luteolin on insulin resistance, Toll-like receptor (TLR), tumor necrosis factor (TNF) and other signaling pathways. YXRJP can prolong the TWL, increase the MNCV of the sciatic nerve, alleviate the injury of the sciatic nerve, reduce the levels of triglyceride (TG), improve the expression of Insulin-like growth factor 1 (IGF-1) protein in the sciatic nerve, and reduce the expression of protein kinase B (AKT) protein. Metabolomics results showed that the potential metabolic pathways of YXRJP in the treatment of DPN mainly involved amino acid metabolism such as arginine, alanine, aspartic acid, lipid metabolism and nucleotide metabolism.

Conclusion

YXRJP can effectively improve the symptoms of DPN rats and reduce nerve damage. The effects are mainly related to reducing oxidative stress injury, promoting the expression of neuroprotection-related proteins, reducing the expression of inflammation-related proteins, and affecting amino acid metabolism, lipid metabolism, and nucleotide metabolism pathways. Our findings revealed that YXRJP has a good therapeutic potential for DPN, which provides a reference for further studies on YXRJP.

Transdermal electrophysiological recordings of diet-induced small fiber peripheral neuropathy using a needle electrode array in mice and man

Background

Diabetic peripheral neuropathy (DPN) is a common complication of diabetes. Proactive treatment options remain limited, which is exacerbated by a lack of sensitive and convenient diagnostics, especially early in disease progression or specifically to assess small fiber neuropathy (SFN), the loss of distal small diameter axons that innervate tissues and organs.

Methods

We designed, fabricated, tested, and validated a first-of-its-kind medical diagnostic device for the functional assessment of transdermal small fiber nerve activity. This device, the Detecting Early Neuropathy (DEN), is an electrically conductive needle array designed to record nerve electrical activity in the skin and subdermal tissues, as a feature of a broader theragnostic platform.

Results

DEN recordings were validated across a time course of diet-induced PN in mice, using statistical and computational analyses and compared to other SFN measures. Based on these preclinical mouse data, the device design was adapted to obtain recordings in human with a flexible printed circuit board to mold to the leg or other skin regions. The DEN successfully recorded various types of neural activity in mouse and human, with or without stimulation, including validated action potentials and electromyography signals.

Conclusion

New functional diagnostic tools like DEN offer a promising outlook for patients needing an earlier or more sensitive diagnosis of DPN/SFN, to allow for earlier and more effective treatment options, especially as more become available in the clinic in future years.

Prevalence and Predictors of Diabetic Peripheral Neuropathy in Newly Diagnosed Type 2 Diabetes Mellitus Patients

AIM

The present study aimed to determine the prevalence and predictors of DPN in newly diagnosed T2DM patients.

BACKGROUND

Diabetic Peripheral Neuropathy (DPN) is the most common and debilitating complication of Type 2 Diabetes Mellitus (T2DM).

METHODS

Newly diagnosed T2DM patients visiting the outpatient department were recruited. Detailed demographic parameters, histories, physical examinations, and biochemical investigations were carried out. Patients were screened for DPN using the Diabetic Neuropathy Symptom (DNS) score, the revised Disability Neuropathy Score (NDS), Vibration Perception Threshold (VPT) using a biosthesiometer, and the 10 g SW Monofilament Test (MFT).

RESULTS

A total of 350 newly diagnosed T2DM patients (mean age 46.4±13.6 years) were included. The prevalence of DPN was found to be 34% using the combined DNS and NDS scores. VPT was moderately impaired in 18.3% and severely impaired in 12% patients, while MFT revealed a loss of protective sensation in 35.4% patients. After logistic regression analysis, DPN was significantly associated with increasing age (OR 1.08, 95%CI 1.06-1.11), increasing HbA1C levels (OR 1.23, 95%CI 1.05-1.42), increasing TSH levels (OR 1.23, 95%CI 1.05-1.44), presence of hypertension (OR 2.78, 95%CI 1.51-5.11), and reduced BMI (OR 0.9, 95%CI 0.84- 0.99). The sensitivity and specificity of detecting DPN by combining VPT and MFT were 91.6% and 84.2%, respectively.

CONCLUSION

The prevalence of DPN was high even in newly diagnosed T2DM and associated significantly with increasing age, HbA1C levels, TSH levels, hypertension, and reduced BMI. Earlier screening for DPN, along with aggressive control of glycemia, blood pressure, and hypothyroidism, may be beneficial.

The Landscape of Products for Diabetic Peripheral Neuropathy: A Scientific and Patent Systematic Review

BACKGROUND

Diabetic peripheral neuropathy (DPN) is a complication of diabetes that occurs in 40 - 60 million individuals worldwide and is associated with other chronic diseases. However, there are no review studies that present the state-of- the- art and technologies developed to circumvent this important health problem.

MATERIALS AND METHODS

This review was conducted based on scientific papers and patents. The papers were retrieved from Lilacs, PubMed, and Web of Science databases, and the patents from INPI, ESPACENET, WIPO, and GOOGLE PATENTS. Thus, a sample consisting of 14 scientific articles and 667 patents was analyzed.

RESULTS

From the analysis of the data, we drew an overview of the development of biomedical technologies for DPN and detected the pioneering spirit of China, the USA, and Japan in the area, with a focus on the treatment of DPN. Based on this, we carried out a SWOT analysis to help direct future efforts in the area, which should focus primarily on developing technologies for prevention, early diagnosis, and, above all, cure of the disease to reduce the important impact of this disease in various sectors of society.

CONCLUSION

This study finds a concentration of diabetic peripheral neuropathy products, especially therapeutic drugs, in high-income countries. It highlights the need for global collaboration and strategic focus on therapeutic adherence and preventive strategies to effectively manage DPN.

Earlier diagnosis of peripheral neuropathy in primary care in Latin America using a simple screening tool (ACT)

Peripheral Neuropathy (PN) can significantly impair quality of life, but often remains undiagnosed due to limited clinic time, lack of specialist expertise and lack of patient awareness. There are several validated questionnaires for diagnosing PN, but the time taken to administer them in busy primary care clinics limits their utilization. A new, simpler questionnaire was developed following an advisory board meeting in Southeast Asia and was further refined and translated to Portuguese and Spanish following a second advisory board meeting in Latin America. We consider current hurdles and propose a quick and reliable questionnaire that can be widely adopted to enable earlier diagnosis and improved management of PN in resource-limited settings in Latin America.

Construction and validation of a nomogram model for predicting diabetic peripheral neuropathy

Objective

Diabetic peripheral neuropathy (DPN) is a chronic complication of diabetes that can potentially escalate into ulceration, amputation and other severe consequences. The aim of this study was to construct and validate a predictive nomogram model for assessing the risk of DPN development among diabetic patients, thereby facilitating the early identification of high-risk DPN individuals and mitigating the incidence of severe outcomes.

Methods

1185 patients were included in this study from June 2020 to June 2023. All patients underwent peripheral nerve function assessments, of which 801 were diagnosed with DPN. Patients were randomly divided into a training set (n =711) and a validation set (n = 474) with a ratio of 6:4. The least absolute shrinkage and selection operator (LASSO) logistic regression analysis was performed to identify independent risk factors and develop a simple nomogram. Subsequently, the discrimination and clinical value of the nomogram was extensively validated using receiver operating characteristic (ROC) curves, calibration curves and clinical decision curve analyses (DCA).

Results

Following LASSO regression analysis, a nomogram model for predicting the risk of DPN was eventually established based on 7 factors: age (OR = 1.02, 95%CI: 1.01 - 1.03), hip circumference (HC, OR = 0.94, 95%CI: 0.92 - 0.97), fasting plasma glucose (FPG, OR = 1.06, 95%CI: 1.01 - 1.11), fasting C-peptide (FCP, OR = 0.66, 95%CI: 0.56 - 0.77), 2 hour postprandial C-peptide (PCP, OR = 0.78, 95%CI: 0.72 - 0.84), albumin (ALB, OR = 0.90, 95%CI: 0.87 - 0.94) and blood urea nitrogen (BUN, OR = 1.08, 95%CI: 1.01 - 1.17). The areas under the curves (AUC) of the nomogram were 0.703 (95% CI 0.664-0.743) and 0.704 (95% CI 0.652-0.756) in the training and validation sets, respectively. The Hosmer-Lemeshow test and calibration curves revealed high consistency between the predicted and actual results of the nomogram. DCA demonstrated that the nomogram was valuable in clinical practice.

Conclusions

The DPN nomogram prediction model, containing 7 significant variables, has exhibited excellent performance. Its generalization to clinical practice could potentially help in the early detection and prompt intervention for high-risk DPN patients.

Promise of the gut microbiota in prevention and traditional Chinese medicine treatment of diabetic peripheral neuropathy

The pathogenesis of diabetic peripheral neuropathy (DPN) has not been fully elucidated, and treatment options are limited. Currently, the main strategies for treating DPN are strict glycemic control and symptomatic pain relief. In this editorial, we comment on an article by Li et al, which suggested that modulating the gut microbiota using traditional Chinese medicine (TCM) may be a promising strategy for alleviating DPN symptoms. The regulation of the gut microbiota has received widespread attention in the study of various diseases. TCM can participate in the regulation of gut microbiota through multiple mechanisms, and this regulatory effect can alleviate the clinical symptoms of DPN. We briefly analyzed the promise of the gut microbiota in the early diagnosis, treatment, and clinical efficacy of TCM for DPN. The gut microbiota has potential value at multiple nodes in the occurrence and progression of DPN.

Diagnostic Accuracy of Screening Tests for Diabetic Peripheral Neuropathy: An Umbrella Review

Peripheral neuropathy is a common cause of morbidity in diabetes. Despite recent advancements in early diagnosis methods, there is a need for practical, highly sensitive, and cost-effective screening methods in clinical practice. This study summarizes evidence from systematic reviews and meta-analyses on the diagnostic accuracy of validated screening methods for diabetic peripheral neuropathy. Two independent reviewers assessed methodological quality and bias using AMSTAR and ROBIS tools. Seven reviews with 19,531 participants were included. The monofilament test showed inconsistent sensitivity (S: 0.53-0.93) and specificity (Sp: 0.64-1.00), along with high variability in its application. Neuropad exhibited high S (86%, 95% CI 79-91). However, variations in the interpretation of results across the included studies may have impacted its Sp (65%, 95% CI 51-76). The Ipswich touch test exhibited adequate diagnostic accuracy (S: 0.77, Sp: 0.96, DOR: 75.24) but lacked comparison with gold standard tests. In vibration perception studies, the biothesiometer outperformed the tuning fork (S: 0.61-0.80 vs. 0.10-0.46). In general, heterogeneity was observed due to varied reference tests, thresholds, and patient differences. The development of automated analysis methods, as well as determination of predictive value of the combination of screening tools, is needed for further studies. Based on the study results, we suggest that clinicians should select screening tools tailored to their patient population, clinical setting, and available resources, as no single test can be universally recommended for all clinical scenarios.

Current Perspectives in Pre- and Diabetic Peripheral Neuropathy Diagnosis and Management: An Expert Statement for the Gulf Region

Peripheral neuropathy (PN) significantly impacts the quality of life, causing substantial morbidity and increased mortality, as well as escalating healthcare costs. While PN can have various causes, the most common form, diabetic peripheral neuropathy, poses considerable risks for potential complications. Diabetic peripheral neuropathy (DPN) affects over 50% of people with prediabetes and diabetes. Despite its prevalence, a global gap in diagnosis and management exists, exacerbated by the COVID-19 pandemic. This expert consensus was formulated through a comprehensive evaluation by a panel of experts, informed by a focused literature review, aiming to establish a clinically robust approach to diagnosing and managing pre- and diabetic PN with the early utilization of neurotropic B vitamins. This document offers a consensus perspective on the existing challenges in diagnosing and managing PN, focusing on DPN. The expert panel proposes measures to address this underdiagnosed burden, highlighting the importance of early intervention through innovative screening methods, integrated care approaches, and therapeutic strategies. The document advocates for increased awareness, targeted campaigns, and proactive care strategies to bridge gaps in the patient care of individuals with diabetes, emphasizing the importance of early detection and timely management to improve overall health outcomes. Specific recommendations include incorporating simplified questionnaires and innovative screening methods into routine care, prioritizing neurotropic B vitamin supplementation, optimizing glucagon-like peptide 1 (GLP-1) receptor agonist treatments, and adopting a holistic approach to neuropathy management. The consensus underscores the urgent need to address the underdiagnosis and undertreatment of PN, offering practical measures to enhance early detection and improve health outcomes for individuals with DPN.

Gene Expression Analysis in T2DM and Its Associated Microvascular Diabetic Complications: Focus on Risk Factor and RAAS Pathway

Prolonged hyperglycemic conditions in type 2 diabetes mellitus (T2DM) cause pathological and functional damage to many organs and tissues, including the kidneys, retina, skin, and neuronal tissues, resulting in the development of microvascular diabetic complications. The altered renin angiotensin aldosterone system (RAAS) pathway has been reported to play an important role in the development of insulin resistance in T2DM and associated complications. The current study was carried out to evaluate the association of risk factors and altered expression of RAAS genes in T2DM patients without complications and T2DM patients with complications (retinopathy, nephropathy, and neuropathy). Four hundred and twenty subjects including 140 healthy controls, 140 T2DM patients with diabetic complications, and 140 T2DM patients without diabetic complications were included in the study. Risk factors associated with the development of T2DM and diabetic complications were evaluated. Further, expression analysis of RAAS genes (AGT, ACE, ACE2, and AGT1R) was carried out using qRTPCR in healthy controls, T2DM patients with complications, and T2DM patients without complications. Various risk factors like urban background, higher BMI, alcoholism, smoking, and family history of diabetes among others were found to be associated with the development of T2DM as well as diabetic complications. The expression level of AGT, ACE, and AGT1R was found to be upregulated whereas ACE2 was found to be downregulated in T2DM patients with complications and T2DM patients without complications as compared to controls. Altered expression of the studied genes of RAAS pathway is associated with the development of microvascular diabetic complications.

A New Quantitative Neuropad for Early Diagnosis of Diabetic Peripheral Neuropathy

AIMS

Diabetic peripheral neuropathy (DPN) often coexists with sudomotor dysfunction, resulting in an increased risk of diabetic foot. This study aimed to explore an efficient method for early diagnosis of DPN by establishing a quantitative Neuropad.

METHODS

We recruited 518 patients with type 2 diabetes. Neuropathy Symptoms Score (NSS) combined with Neuropathy Disability Score (NDS) was used to assess distal symmetrical peripheral neuropathy (DSPN). The area under the ROC curve (AUROC), sensitivity, and specificity were used to compare the diagnostic efficacy of quantitative Neuropad (the change rate of the chromatic aberration value per minute) and two types of visual Neuropad (visual Neuropad A: whether the time to complete colour change within 10 min, visual Neuropad B: the time to complete colour change) for DPN.

RESULTS

We did not observe very good diagnostic efficacy of Neuropad (visual Neuropad A and B: 0.59 and 0.64, quantitative Neuropad AUROC: 0.62-0.64) when using standard DSPN diagnostic criteria (NDS 6-12 or NDS 3-5 combined with NSS 5-9). When DPN was assessed by NSS + NDS ≥ 4, visual Neuropad B improved the specificity (AUROC 0.72, 67.00%, specificity 71.70%) by extending the detection time compared with visual Neuropad A (AUROC 0.62, sensitivity 81.80%, specificity 41.70%). Quantitative Neuropad significantly improved the diagnostic effect (AUROC 0.81, sensitivity 80.0%, specificity 76.3%) and reduced the detection time (4 min).

CONCLUSIONS

This study provides a new quantitative Neuropad, which has great potential to be an extremely useful diagnostic tool for early screening of sudomotor dysfunction in the clinical practice.

Promising predictors of diabetic peripheral neuropathy in children and adolescents with type 1 diabetes mellitus

BACKGROUND

Diabetic peripheral neuropathy (DPN) in children and adolescents with type 1 diabetes mellitus (T1DM) is a growing issue, with controversial data in the terms of prevalence and evaluation timelines. Currently, there are no clear standards for its early detection. Therefore, our aim was to assess the contribution of the Michigan neuropathy screening instrument (MNSI), lipid profile, serum neuron specific enolase (NSE), and serum heat shock protein 27 (HSP 27) to the prediction of DPN in children and adolescents with T1DM.

METHODS

In this case-control study, fifty children diagnosed with T1DM for at least five years were enrolled and evaluated through complete neurological examination, MNSI, and nerve conduction study (NCS). Additionally, HbA1c, lipid profile, serum NSE, and serum HSP 27 levels were measured for patients and controls.

RESULTS

The prevalence of DPN in our study was 24% by NCS, and electrophysiological changes showed a statistically significant lower conduction velocity for the posterior tibial and sural nerves, as well as a prolonged latency period for the common peroneal and sural nerves in neuropathic patients. In these patients, older age, earlier age of diabetes onset, longer disease duration, higher total cholesterol, triglycerides, low density lipoprotein cholesterol, HbA1c, serum NSE, and HSP27 levels were observed. The MNSI examination score ≥ 1.5 cutoff point had an area under the curve (AUC) of 0.955, with 75% sensitivity and 94.74% specificity, according to receiver operating characteristic curve analysis. However, the questionnaire's cutoff point of ≥ 5 had an AUC of 0.720, 75% sensitivity, and 63% specificity, with improved overall instrument performance when combining both scores. Regarding blood biomarkers, serum NSE had greater sensitivity and specificity in discriminating neuropathic patients than HSP27 (92% and 74% versus 75% and 71%, respectively). Regression analysis revealed a substantial dependency for MNSI and serum NSE in predicting DPN in patients.

CONCLUSIONS

Despite limited research in pediatrics, MNSI and serum NSE are promising predictive tools for DPN in children and adolescents with T1DM, even when they are asymptomatic. Poor glycemic control and lipid profile changes may play a critical role in the development of DPN in these patients, despite conflicting results in various studies.

Causality between sarcopenia and diabetic neuropathy

Background

Past studies have demonstrated that diabetic neuropathy is related to sarcopenia, but the further causal relation is still unclear. We sought to investigate the causal relationship by combining data from cross-sectional and Mendelian randomization (MR) studies.

Methods

The genome-wide association studies data were collected from the UK Biobank and the European Working Group on Sarcopenia to conduct a bi-directional two-sample MR study to explore the causality between diabetic neuropathy and relevant clinical traits of sarcopenia, including appendicular lean mass (ALM), walking speed and low hand grip strength. The inverse-variance weighted and various sensitivity analyses were used to obtain MR estimates. We also enrolled a total of 196 Type 2 diabetes patients from April 2021 to April 2024 and divided them into the Distal peripheral neuropathy (DPN) group (n=51) and non-DPN group (n=145) via vibration perception threshold (VPT) and neuropathy deficit score. Logistic regression and ROC curve analysis were used to investigate the relationship between DPN and relevant sarcopenia clinical features.

Results

According to a forward MR analysis, decreased walking speed (OR: 0.04, 95% confidence interval (CI): 0.01-0.16; P<0.001) and increased ALM (1.25 [1.05-1.50], P=0.012) had a causal effect on developing diabetic neuropathy. According to reverse MR results, developing diabetic neuropathy had a causal effect on decreased walking speed (0.99 [0.99-1.00], P=0.007) and low grip strength (1.05 [1.02-1.08], P<0.001). The cross-sectional study showed that 5-time stand time (P=0.002) and 6-meter walking speed (P=0.009) had an inverse association with DPN. Additionally, we discovered that ASMI (P=0.030) and 5-time stand time (P=0.013) were separate risk factors for DPN.ConclusionThe MR study suggested that diabetic neuropathy may have a causality with relevant clinical traits of sarcopenia, and our cross-sectional study further proved that sarcopenia indexes are predictors of diabetic neuropathy.

Longitudinal evaluation of polyneuropathy in Parkinson's disease

BACKGROUND

Increasing evidence indicates a higher prevalence of polyneuropathy (PNP) in Parkinson's disease (PD). However, the involvement of large fiber neuropathy in PD still remains poorly understood. Given the lack of longitudinal data, we investigated the course of PNP associated with PD.

METHODS

In total, 41 PD patients underwent comprehensive clinical evaluation including motor and non-motor assessments as well as nerve conduction studies at baseline and at 2 years of follow-up. The definition of PNP was based on electrophysiological standard criteria. Common causes of PNP were excluded.

RESULTS

At baseline, PNP was diagnosed in 65.85% of PD patients via electroneurography. Patients with PNP presented with higher age (p = 0.019) and PD motor symptom severity (UPDRS III; p < 0.001). Over the course of 2 years, PNP deteriorated in 21.95% of cases, and 26.83% remained without PNP. Deterioration of nerve amplitude was most prevalent in the median sensory nerve affecting 57.58% of all PD cases with an overall reduction of median sensory nerve amplitude of 45.0%. With regard to PD phenotype, PNP progression was observed in 33.33% of the tremor dominant and 23.81% of the postural instability/gait difficulties subtype. Decrease of sural nerve amplitude correlated with lower quality of life (PDQ-39, p = 0.037) and worse cognitive status at baseline (MoCA, p = 0.042).

CONCLUSION

The study confirms the high PNP rate in PD, and demonstrates a significant electrophysiological progression also involving nerves of the upper extremities. Longitudinal studies with larger cohorts are urgently needed and should elucidate the link between PD and PNP with the underlying pathomechanisms.

Electrodiagnostic evaluation in diabetes mellitus: A study based on case series in 72 diabetic patients

Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes; so, a nerve conduction study (NCS) is conducted to detect the type of neuropathy that is present. To discuss the NCS findings in diabetic patients. An observational study was conducted in the Physiology Department of AIIMS, Bhopal, in collaboration with the Medicine Department of the Institute. Seventy-two diagnosed type 2 diabetes mellitus (T2DM) patients were examined using NCS (Nihon Kohden Neuropack XI Machine). Microsoft Excel was utilized for data compilation and result analysis. Based on NCS, 94% of patients were abnormal, and 6% were normal. Of abnormal patients, 89% had asymmetrical involvement, and 5% had symmetrical involvement. About 74% had mixed neuropathy, 11% had motor neuropathy, and 10% had sensory neuropathy. Mixed involvement was seen in 60% of patients and axonal involvement in 35% of patients, and 5% were normal. Lower limb involvement was seen predominately. The most common bilaterally involved motor nerve was the peroneal nerve, seen in 49% of cases, whereas the most common bilaterally involved sensory nerve was the sural nerve involved in 59% of cases. The left tibial nerve was the most common unilaterally involved motor nerve seen in 32% of cases, and the left sural nerve was the most common sensory nerve involved in 54% of cases. Asymmetric sensorimotor involvement with mixed involvement (axonal + demyelinating) was seen in diabetic patients. Peroneal and sural nerves were the most common bilaterally involved motor and sensory nerves, respectively. Similarly, the left tibial and left sural nerves were the most common unilaterally affected motor and sensory nerves, respectively.

Antioxidant Effect in Diabetic Peripheral Neuropathy in Rat Model: A Systematic Review

Oxidative stress is a contributing factor that leads to the vascular complications of diabetes mellitus. Diabetic peripheral neuropathy (DPN) is one of the microvascular complications with rising concern as the disease progresses despite strict glucose control and monitoring. Thus, there is an ongoing need for an early intervention that is effective in halting or slowing the progression of DPN where antioxidants have been proposed as potential therapeutic agents. This systematic review aims to evaluate the existing evidence on the antioxidant effect in DPN and provide insight on the role of antioxidants in the progression of DPN in a rat model. A comprehensive literature search was conducted on Web of Science, EBSCOhost, and Scopus to identify the effects and role of antioxidants in DPN. Data extraction was performed and SYRCLE's risk of bias (RoB) tool was used for risk assessment. This systematic review was written following the PRISMA 2020 statements. From the literature search, 1268 articles were screened, and a total of 101 full-text articles were further screened before 33 were analyzed. These findings collectively suggest that antioxidants can play a crucial role in managing and potentially reversing the effects of diabetic neuropathy by targeting oxidative stress and improving nerve function.

Advances in the treatment of diabetic peripheral neuropathy by modulating gut microbiota with traditional Chinese medicine

Diabetic peripheral neuropathy (DPN) is one of the strongest risk factors for diabetic foot ulcers (neuropathic ulcerations) and the existing ulcers may further deteriorate due to the damage to sensory neurons. Moreover, the resulting numbness in the limbs causes difficulty in discovering these ulcerations in a short time. DPN is associated with gut microbiota dysbiosis. Traditional Chinese medicine (TCM) compounds such as Shenqi Dihuang Decoction, Huangkui Capsules and Qidi Tangshen Granules can reduce the clinical symptoms of diabetic nephropathy by modulating gut microbiota. The current review discusses whether TCM compounds can reduce the risk of DPN by improving gut mic-robiota.

Association of Helicobacter pylori infection with complications of diabetes: a single-center retrospective study

BACKGROUND

Previous studies examined the association of Helicobacter pylori infection (H. pylori) with complications of diabetes, but the results have been inconsistent. The aim of this study of patients with type-2 diabetes (T2D) was to determine the association of H. pylori infection with the major complications of diabetes.

METHODS

This single-center retrospective study examined patients with T2D who received H. pylori testing between January 2016 and December 2021. Logistic regression analyses were used to evaluate the association of H. pylori infection with four major complications of diabetes.

RESULTS

We examined 960 patients with T2D, and 481 of them (50.1%) were positive for H. pylori. H. pylori infection was significantly associated with diabetic nephropathy (odds ratio [OR] = 1.462; 95% confidence interval [CI]: 1.006,2.126; P = 0.046). In addition, the co-occurrence of H. pylori positivity with hypertension (OR = 4.451; 95% CI: 2.351,8.427; P < 0.001), with glycated hemoglobin A1c (HbA1c) of at least 8% (OR = 2.925; 95% CI: 1.544,5.541; P = 0.001), and with diabetes duration of at least 9 years (OR = 3.305; 95% CI:1.823,5.993; P < 0.001) further increased the risk of diabetic nephropathy. There was no evidence of an association of H. pylori infection with retinopathy, neuropathy, or peripheral vascular disease.

CONCLUSIONS

Our study of T2D patients indicated that those with H. pylori infections had an increased risk of nephropathy, and this risk was greater in patients who also had hypertension, an HbA1c level of 8% or more, and diabetes duration of 9 years or more.

Lower Visceral Fat is Related to Diabetic Peripheral Neuropathy

Objective

Visceral fat area (VFA) levels have been found to exhibit a strong association with various conditions such as insulin resistance (IR), inflammation, oxidative stress, metabolic syndrome (MetS), hyperlipidemia, diabetes, and its vascular complications. These complications include hypertension, cardiovascular disease, diabetic retinopathy (DR), albuminuria, and cardiovascular autonomic dysfunction, which is considered one of the main types of diabetic neuropathy. This study aimed to investigate the correlation between visceral fat and peripheral neuropathy in patients with type 2 diabetes (T2DM).

Methods

A retrospective analysis of clinical data of patients diagnosed with type 2 diabetes admitted to our hospital was conducted. After excluding 28 cases, a total of 488 patients were included, divided into the group with peripheral neuropathy (207 cases) and the control group without peripheral neuropathy (281 cases). The correlation between VFA and the presence of DPN was assessed using correlation and multiple logistic regression analyses.

Results

In terms of general information, the group with peripheral neuropathy had lower BMI but longer duration of diabetes compared to the control group. Regarding biochemical indicators, VFA were lower in the group with peripheral neuropathy, while FPG and HbA1c levels were higher (all P<0.05). Spearman correlation analysis showed a negative correlation between VFA, and the presence of peripheral neuropathy in patients with type 2 diabetes (P<0.05). Logistic regression analysis indicated that VFA, duration of diabetes, and HbA1c level were influencing factors for the occurrence of peripheral neuropathy in patients with type 2 diabetes (P<0.05).

Conclusion

This study revealed a correlation between visceral fat and peripheral neuropathy in patients with type 2 diabetes, highlighting the importance of monitoring visceral fat in such patients. In addition to lower levels of VFA, factors such as duration of diabetes and glycated hemoglobin (HbA1c) level were also associated with peripheral neuropathy in patients with T2DM.

Correlation between Neutrophil-to-Lymphocyte Ratio and Diabetic Neuropathy in Chinese Adults with Type 2 Diabetes Mellitus Using Machine Learning Methods

Objective

One of the most frequent consequences of diabetes mellitus has been identified as diabetic peripheral neuropathy (DPN), and numerous inflammatory disorders, including diabetes, have been documented to be reflected by the neutrophil-to-lymphocyte ratio (NLR). This study aimed to explore the correlation between peripheral blood NLR and DPN, and to evaluate whether NLR could be utilized as a novel marker for early diagnosis of DPN among those with type 2 Diabetes Mellitus (T2DM).

Methods

We reviewed the medical records of 1154 diabetic patients treated at Tongji Hospital Affiliated to Tongji University from January 2022 to March 2023. These patients did not have evidence of acute infections, chronic inflammatory status within the past three months. The information included the clinical, laboratory, and demographic characteristics of the patient. Finally, a total of 442 T2DM individuals with reliable, complete, and accessible medical records were recruited, including 216 T2DM patients without complications (DM group) and 226 T2DM patients with complications of DPN (DPN group). One-way ANOVA and multivariate logistic regression were applied to analyze data from the two groups, including peripheral blood NLR values and other biomedical indices. The cohort was divided in a 7 : 3 ratio into training and internal validation datasets following feature selection and data balancing. Based on machine learning, training was conducted using extreme gradient boosting (XGBoost) and support vector machine (SVM) methods. K-fold cross-validation was applied for model assessment, and accuracy, precision, recall, F1-score, and the area under the receiver operating characteristic curve (AUC) were used to validate the models' discrimination and clinical applicability. Using Shapley Additive Explanations (SHAP), the top-performing model was interpreted.

Results

The values of 24-hour urine volume (24H UV), lower limb arterial plaque thickness (LLAB thickness), carotid plaque thickness (CP thickness), D-dimer and onset time were significantly higher in the DPN group compared to the DM group, whereas the values of urine creatinine (UCr), total cholesterol (TC), low-density lipoprotein (LDL), alpha-fetoprotein (AFP), fasting c-peptide (FCP), and nerve conduction velocity and wave magnitude of motor and sensory nerve shown in electromyogram (EMG) were considerably lower than those in the DM group (P < 0.05, respectively). NLR values were significantly higher in the DPN group compared to the DM group (2.60 ± 4.82 versus 1.85 ± 0.98, P < 0.05). Multivariate logistic regression analysis revealed that NLR (P = 0.008, C = 0.003) was a risk factor for DPN. The multivariate logistic regression model scores were 0.6241 for accuracy, 0.6111 for precision, 0.6667 for recall, 0.6377 for F1, and 0.6379 for AUC. Machine learning methods, XGBoost and SVM, built prediction models, showing that NLR can predict the onset of DPN. XGBoost achieved an accuracy of 0.6541, a precision of 0.6316, a recall of 0.7273, a F1 value of 0.6761, and an AUC value of 0.690. SVM scored an accuracy of 0.5789, a precision of 0.5610, a recall of 0.6970, an F1 value of 0.6216, and an AUC value of 0.6170.

Conclusions

Our findings demonstrated that NLR is highly correlated with DPN and is an independent risk factor for DPN. NLR might be a novel indicator for the early diagnosis of DPN. XGBoost and SVM models have great predictive performance and could be reliable tools for the early prediction of DPN in T2DM patients. This trial is registered with ChiCTR2400087019.

Using biothesiometer, Neuropathy Symptom Score, and Neuropathy Disability Score for the early detection of peripheral neuropathy: A cross-sectional study

Patients with peripheral neuropathy could have damaged peripheral nerves, which leads to sensory and motor dysfunction. Diabetes, infections, and trauma are the major causes of peripheral neuropathy. Vibratory perception threshold (VPT) tools are commonly used to detect peripheral neuropathy. This study aims to determine the assessment of peripheral neuropathy through the different diagnostic tools in the community in Malaysia. A total number of 1283 participants were recruited from the seven retail pharmacies located in Selangor, Malaysia. The peripheral neuropathy test was conducted based on VPT tools on both feet using the digital biothesiometer. Following that, Neurological Symptom Score (NSS) and Neurological Disability Score (NDS) were taken from the participants to assess the neurological symptoms. Participants had an average age of 40.6 ± 12.9 years and were mostly of Chinese ethnicity (54.1%). The findings show that increasing age was associated with more severe peripheral neuropathy across the various assessment tools, but gender differences were found with the biothesiometer test and ethnicity has severity in the biothesiometer and disability scores. The sensitivity and specificity of the biothesiometer test were 0.63 and 0.84, respectively. The combined tool NSS and NDS had high specificity and a high positive predictive value, suggesting that it could be a reliable indicator of peripheral neuropathy when both scores are elevated. The findings show that the biothesiometer test, NSS, and NDS are considered screening VPT tools for diagnosing peripheral neuropathy. However, further evaluation and diagnostic testing are necessary in cases of a positive test result.

Prevalencia de neuropatía periférica dolorosa y asintomática de un programa de tamizaje para riesgo de pie diabético en un hospital público peruano

Objetivo: determinar la prevalencia de la neuropatía periférica (NP) dolorosa y asintomática en personas con diabetes mellitus tipo 2 (DM2) y sus características asociadas. Materiales y métodos: estudio transversal-descriptivo de pacientes del programa de pie en riesgo del Servicio de Endocrinología del Hospital Nacional María Auxiliadora (HMA). Se incluye a pacientes con DM2 atendidos entre el 2015 y el 2020. La definición de NP fue según el Consenso de Toronto, que considera la evaluación de tres componentes: síntomas, signos y reflejo aquíleo, calificando la certeza como posible y probable, según su combinación. Para la evaluación de síntomas se aplicó el puntaje total de síntomas (TTS, del inglés Total Symptom Score); para los signos se usó la prueba de monofilamento y se evaluó la sensibilidad vibratoria con diapasón de 128 Hz. La prevalencia de NP se calculó según sintomatología y la certeza del diagnóstico. Además, se describieron las características clínicas entre los grupos. Resultados: se incluyó a 1006 personas con una edad media de 60,5 años, de las cuales el 69,3% correspondió a mujeres. En aquellos que tenían al menos un criterio de Toronto (neuropatía posible y probable), un 60,5% presentó NP dolorosa y un 21,8% NP asintomática. Utilizando una mayor certeza diagnóstica, es decir, dos de tres criterios positivos (solo neuropatía probable), la prevalencia de NP dolorosa fue del 42,2% y la NP asintomática, 6,5%. Se establecieron cuatro grupos que presentaron distribuciones diferentes respecto a sexo, tiempo de diabetes, antecedente de úlcera, enfermedad arterial periférica y control glicémico. Conclusión: en pacientes del Servicio de Endocrinología del HMA, el 42,2 y el 6,5% presentaron una mayor certeza de presentar NP probable dolorosa y asintomática respectivamente. Se requiere estudios que confirmen la utilidad de estos criterios para estimar correctamente la carga de enfermedad.

Prevalence of peripheral neuropathy, amputation, and quality of life in patients with diabetes mellitus

Peripheral neuropathy and amputation are common complications of diabetes mellitus (DM) that significantly impact the quality of life of the affected individuals. This study aims to investigate the prevalence of peripheral neuropathy, the level of amputation, and the quality of life in patients with DM. This cross-sectional study was conducted after approval of the synopsis involving 225 diagnosed patients with DM on pre-defined eligibility criteria, selected from public sector OPDs, specialized diabetes centres, and centres manufacturing orthotics and prosthetics. Data were collected through interviews, observations, and the administration of the Michigan Neuropathy Screening Instrument and the Asian Diabetes Quality of Life Questionnaire. The level of amputation was recorded for each participant. Data was entered into SPSS, and results were synthesized. Pearson correlation is applied to find an association between gender and the quality of life of the participants, while P ≤ 0.05 will be considered significant. The prevalence of peripheral neuropathy in a sample of 225, based on a self-administered questionnaire, was (44.4%), and in terms of foot examination was (51.1%). As people progressed in age, the prevalence increased to 20.0% in patients above 60 years and 8.9% in ≤ 35 years of age. The majority of participants (56.0%) have had DM for less than five years. Females were 57.8% of the study population, while 97.8% of participants had type II DM. Below-knee amputation of the right limb was observed in 22(9.8%) of the participants. The QoL was poor in the majority of the participants (96.9%) patients with DM (P = 0.638 and T = -0.471). This cross-sectional study highlights a high prevalence of peripheral neuropathy and amputation and poor QoL in patients with diabetic mellitus.

A Review of Fetal Development in Pregnancies with Maternal Type 2 Diabetes Mellitus (T2DM)-Associated Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation: Possible Links to Pregestational Prediabetes

Research has identified fetal risk factors for adult diseases, forming the basis for the Developmental Origins of Health and Disease (DOHaD) hypothesis. DOHaD suggests that maternal insults during pregnancy cause structural and functional changes in fetal organs, increasing the risk of chronic diseases like type 2 diabetes mellitus (T2DM) in adulthood. It is proposed that altered maternal physiology, such as increased glucocorticoid (GC) levels associated with a dysregulated hypothalamic-pituitary-adrenal (HPA) axis in maternal stress and T2DM during pregnancy, exposes the fetus to excess GC. Prenatal glucocorticoid exposure reduces fetal growth and programs the fetal HPA axis, permanently altering its activity into adulthood. This programmed HPA axis is linked to increased risks of hypertension, cardiovascular diseases, and mental disorders in adulthood. With the global rise in T2DM, particularly among young adults of reproductive age, it is crucial to prevent its onset. T2DM is often preceded by a prediabetic state, a condition that does not show any symptoms, causing many to unknowingly progress to T2DM. Studying prediabetes is essential, as it is a reversible stage that may help prevent T2DM-related pregnancy complications. The existing literature focuses on HPA axis dysregulation in T2DM pregnancies and its link to fetal programming. However, the effects of prediabetes on HPA axis function, specifically glucocorticoid in pregnancy and fetal outcomes, are not well understood. This review consolidates research on T2DM during pregnancy, its impact on fetal programming via the HPA axis, and possible links with pregestational prediabetes.

Prevalence and disease burden of peripheral neuropathy in the general population in Mexico city: a cross-sectional epidemiological study

OBJECTIVE

Peripheral neuropathy (PN) is one of the most common diseases of the peripheral nervous system. Symptoms range from mild sensory signs to severe neuropathic pain. Untreated PN is progressive and can lead to complications and impair quality of life (QoL). However, PN prevalence is underestimated in the general population and affected individuals often remain undiagnosed. This study aimed to contribute to the global generation of prevalence data and determine sociodemographic and disease-related characteristics of PN sufferers.

METHODS

This cross-sectional study collected information on PN prevalence and associated factors in the adult population (40-65 years) of the Mexico City area. Participants were recruited in public places and screened for PN using the Michigan Neuropathy Screening Instrument (MNSI). Subjects with PN answered the Neuropathy Total Symptom Score-6 (NTSS-6), the Short Form-36 Health Survey (SF-36), and the QoL Pharmacoeconomic Questionnaire. Statistical analysis included descriptive methods and calculation of PN prevalence with 95% confidence intervals.

RESULTS

Of 3066 participants, 448 had PN based on the MNSI physical examination. The overall PN prevalence was 14.6%, with the highest (18.9%) seen in subjects aged 61-65 years. PN was undiagnosed in 82.6%, and 62.9% had never heard of PN. Although half of all subjects had only mild PN symptoms, QoL was impacted in 91.8%.

CONCLUSIONS

The results confirm that PN prevalence in the general population is high. Despite the disease burden, most affected persons are undiagnosed and unaware of the disease. Almost all felt their QoL was impacted. The data highlight the need to raise awareness and identify undiagnosed individuals to prevent complications.

Predictive Value of Combined HbA1c and Neutrophil-to-Lymphocyte Ratio for Diabetic Peripheral Neuropathy in Type 2 Diabetes

BACKGROUND Diabetic peripheral neuropathy (DPN) is a prevalent complication affecting over 60% of type 2 diabetes patients. Early diagnosis is challenging, leading to irreversible impacts on quality of life. This study explores the predictive value of combining HbA1c and Neutrophil-to-Lymphocyte Ratio (NLR) for early DPN detection. MATERIAL AND METHODS An observational study was conducted at the First People's Hospital of Linping District, Hangzhou spanning from May 2019 to July 2020. Data on sex, age, biochemical measurements were collected from electronic medical records and analyzed. Employing multivariate logistic regression analysis, we sought to comprehend the factors influencing the development of DPN. To assess the predictive value of individual and combined testing for DPN, a receiver operating characteristic (ROC) curve was plotted. The data analysis was executed using R software (Version: 4.1.0). RESULTS The univariate and multivariate logistic regression analysis identified the level of glycated hemoglobin (HbA1C) (OR=1.94, 95% CI: 1.27-3.14) and neutrophil-to-lymphocyte ratio (NLR) (OR=4.60, 95% CI: 1.15-22.62, P=0.04) as significant risk factors for the development of DPN. Receiver operating characteristic (ROC) curve analysis demonstrated that HbA1c, NLR, and their combined detection exhibited high sensitivity in predicting the development of DPN (71.60%, 90.00%, and 97.2%, respectively), with moderate specificity (63.8%, 45.00%, and 50.00%, respectively). The area under the curve (AUC) for these predictors was 0.703, 0.661, and 0.733, respectively. CONCLUSIONS HbA1c and NLR emerge as noteworthy risk indicators associated with the manifestation of DPN in patients with type 2 diabetes. The combined detection of HbA1c and NLR exhibits a heightened predictive value for the development of DPN.

Biomarkers and signaling pathways of diabetic nephropathy and peripheral neuropathy: possible therapeutic intervention of rutin and quercetin

Diabetic nephropathy and peripheral neuropathy are the two main complications of chronic diabetes that contribute to high morbidity and mortality. These conditions are characterized by the dysregulation of multiple molecular signaling pathways and the presence of specific biomarkers such as inflammatory cytokines, indicators of oxidative stress, and components of the renin-angiotensin system. In this review, we systematically collected and collated the relevant information from MEDLINE, EMBASE, ELSEVIER, PUBMED, GOOGLE, WEB OF SCIENCE, and SCOPUS databases. This review was conceived with primary objective of revealing the functions of these biomarkers and signaling pathways in the initiation and progression of diabetic nephropathy and peripheral neuropathy. We also highlighted the potential therapeutic effectiveness of rutin and quercetin, two plant-derived flavonoids known for their antioxidant and anti-inflammatory properties. The findings of our study demonstrated that both flavonoids can regulate important disease-promoting systems, such as inflammation, oxidative stress, and dysregulation of the renin-angiotensin system. Importantly, rutin and quercetin have shown protective benefits against nephropathy and neuropathy in diabetic animal models, suggesting them as potential therapeutic agents. These findings provide a solid foundation for further comprehensive investigations and clinical trials to evaluate the potential of rutin and quercetin in the management of diabetic nephropathy and peripheral neuropathy. This may contribute to the development of more efficient and comprehensive treatment approaches for diabetes-associated complications.

Wearable Movement Exploration Device with Machine Learning Algorithm for Screening and Tracking Diabetic Neuropathy-A Cross-Sectional, Diagnostic, Comparative Study

BACKGROUND

Diabetic neuropathy is one of the most common complications of diabetes mellitus. The aim of this study is to evaluate the Moveo device, a novel device that uses a machine learning (ML) algorithm to detect and track diabetic neuropathy. The Moveo device comprises 4 sensors positioned on the back of the hands and feet accompanied by a mobile application that gathers data and ML algorithms that are hosted on a cloud platform. The sensors measure movement signals, which are then transferred to the cloud through the mobile application. The cloud triggers a pipeline for feature extraction and subsequently feeds the ML model with these extracted features.

METHODS

The pilot study included 23 participants. Eleven patients with diabetes and suspected diabetic neuropathy were included in the experimental group. In the control group, 8 patients had suspected radiculopathy, and 4 participants were healthy. All participants underwent an electrodiagnostic examination (EDx) and a Moveo examination, which consists of sensors placed on the feet and back of the participant's hands and use of the mobile application. The participant performs six tests that are part of a standard neurological examination, and a ML algorithm calculates the probability of diabetic neuropathy. A user experience questionnaire was used to compare participant experiences with regard to both methods.

RESULTS

The total accuracy of the algorithm is 82.1%, with 78% sensitivity and 87% specificity. A high linear correlation up to 0.722 was observed between Moveo and EDx features, which underpins the model's adequacy. The user experience questionnaire revealed that the majority of patients preferred the less painful method.

CONCLUSIONS

Moveo represents an accurate, easy-to-use device suitable for home environments, showing promising results and potential for future usage.

Cross-Sectional Study of the Relationship Between Medial Plantar Nerve Conduction Studies and Severity of Diabetic Neuropathy

Objective

Diabetic peripheral neuropathy (DPN), a complication of diabetes, is detected only in later stages. Medial plantar nerve (MPL) can identify earlier stages of neuropathy. We evaluated the correlation of MPL sensory nerve action potentials (SNAPs) and severity of DPN measured using the Toronto Clinical Neuropathy Score (TCNS).

Methods

In this hospital-based, cross-sectional study, we recruited diabetic subjects referred for suspected DPN. Neuropathy was graded with TCNS. Sural nerve conduction studies were performed using standard techniques. MPL studies were conducted using the modified Ponsford technique. All evaluations were performed on Nihon Kohden (model MEB 9200K). Averaged MPL SNAP was correlated with TCNS using Pearson's correlation coefficient. To estimate a correlation of 0.4 with 80% power (P = 0.05), we needed 46 subjects. Linear regression was conducted to adjust for age, duration, and diabetic control. Receiver operating characteristic (ROC) curve analysis was performed to obtain the cutoff for MPL SNAP values using the Youden index.

Results

Fifty-one subjects with a mean age of 53.5 years (8.7) and mean duration of diabetes of 10.2 years (7.2) were included. MPL SNAPs were recordable in 12 patients, and the mean amplitude was 5.15 (2.9) µV. There was correlation between MPL SNAP and TCNS (r = -0.43, P = 0.02). No confounding was seen. Use of MPL SNAP resulted in diagnosis of DPN in an additional six (11.8%) patients. The ROC curve suggested that MPL SNAP cutoff of 1.05 µV had an accuracy of 67% in identifying neuropathy as defined by TCNS.

Conclusions

MPL SNAP has a moderate correlation with clinical score and identifies more diabetic neuropathy than sural nerve.

Severity of Neuropathy-Related Disability and Associated Factors of Diabetic Peripheral Neuropathy in a Tertiary Healthcare Center: A Comparative Cross-Sectional Study

BACKGROUND AND OBJECTIVES

The widespread presence of diabetic peripheral neuropathy (DN) and its related variables among diagnosed diabetes mellitus (DM) patients in Kerala lacks sufficient evidence. The objective of this study was to evaluate the frequency of DN and its related risk variables among those with DM who were receiving care at a tertiary health institution in Kerala.

MATERIALS AND METHODS

This study was conducted in a tertiary health center in Kerala using a cross-sectional design. The diagnosis of diabetes was established by assessing the glycated hemoglobin A1c (HbA1c) level and the fasting blood glucose (FBG) level. A validated survey questionnaire was employed to gather demographic data as well as the medical history of DM and associated ailments. A thorough physical examination, BMI, and blood pressure were recorded. Dermatological, musculoskeletal, neurological, and vascular assessments were conducted. The subjects were assessed for neuropathy using a neuropathy disability score (NDS). Consequently, those who met the criteria for DM were classified into two groups: those with neuropathy and those without neuropathy. All research participants underwent laboratory examinations such as blood lipid profiles, HbA1c, and vitamin B12 complex concentrations.

RESULTS

The study included 200 DM patients; 120 men and 80 women. Study participants were 40-70 years old, with a median age of 53. The prevalence of DN significantly increased with age (p<0.001). The longer a patient had DM, the higher the prevalence of DN, and this variance in percentage was statistically significant (p<0.009) with an OR (odds ratio) of 9.246. A statistically significant 81 (40.5%) of participants graduated, compared to 119 (59.5%) with only higher secondary education or less (OR = 2.042; p = 0.014). Approximately 107 (53.5%) of individuals earned an income under two lakhs, and this disparity was deemed statistically significant (p = 0.003) with an OR of 2.357. In the group of individuals being studied, 53 (26.5%) of them experienced a decrease in pressure sensation, 47 (23.5%) had a decrease or absence of vibration perception, 48 (24%) had an absence or decreased pinprick response, and 46 (23%) had an absent ankle reflex. The study found that the most commonly reported symptoms were tingling (n = 44; 22%), numbness (n = 42; 21%), burning (n = 37; 18.5%), pricking (n = 29; 14.5%), and pain (n = 27; 13.5%). A strong association was found between DN and glycemic status, namely, FBG levels exceeding 140 mg/dL (OR = 4.511, p < 0.001) and HbA1c levels exceeding 6.5% (OR = 3.87, p < 0.001). The prevalence of abnormal vitamin B12 levels in individuals with DN was 63% (p = 0.19), indicating that the finding was not statistically significant. Within the group of individuals with DN being studied, 22% exhibited mild neuropathy, 34% displayed moderate neuropathy, and 44% had severe neuropathy. The DN individuals had significantly reduced ankle dorsiflexion in cases of severe NDS scores compared to those with mild to moderate NDS scores (p = 0.009). During the binary logistic regression analysis, it was shown that the duration of DM (OR = 1.73; p = 0.038) and FBG levels (OR = 2.87; p = 0.018) were determined as predictors for DN.

CONCLUSION

The findings of this study reveal that the duration of diabetes, age, literacy level, income, HbA1c, and FBG were substantially related to a higher likelihood of DN among diabetic patients.

4. Painful diabetic polyneuropathy

INTRODUCTION

Pain as a symptom of diabetic polyneuropathy (DPN) significantly lowers quality of life, increases mortality and is the main reason for patients with diabetes to seek medical attention. The number of people suffering from painful diabetic polyneuropathy (PDPN) has increased significantly over the past decades.

METHODS

The literature on the diagnosis and treatment of diabetic polyneuropathy was retrieved and summarized.

RESULTS

The etiology of PDPN is complex, with primary damage to peripheral nociceptors and altered spinal and supra-spinal modulation. To achieve better patient outcomes, the mode of diagnosis and treatment of PDPN evolves toward more precise pain-phenotyping and genotyping based on patient-specific characteristics, new diagnostic tools, and prior response to pharmacological treatments. According to the Toronto Diabetic Neuropathy Expert Group, a presumptive diagnosis of "probable PDPN" is sufficient to initiate treatment. Proper control of plasma glucose levels, and prevention of risk factors are essential in the treatment of PDPN. Mechanism-based pharmacological treatment should be initiated as early as possible. If symptomatic pharmacologic treatment fails, spinal cord stimulation (SCS) should be considered. In isolated cases, where symptomatic pharmacologic treatment and SCS are unsuccessful or cannot be used, sympathetic lumbar chain neurolysis and/or radiofrequency ablation (SLCN/SLCRF), dorsal root ganglion stimulation (DRGs) or posterior tibial nerve stimulation (PTNS) may be considered. However, it is recommended that these treatments be applied only in a study setting in a center of expertise.

CONCLUSIONS

The diagnosis of PDPN evolves toward pheno-and genotyping and treatment should be mechanism-based.

Diagnostic contribution of multi-frequency vibrometry to detection of peripheral neuropathy in type 1 diabetes mellitus compared with nerve conduction studies

AIM

The aim was to assess the use of multi-frequency vibrometry (MFV) in detecting diabetic peripheral neuropathy (DPN) in type 1 diabetes in comparison to nerve conduction studies (NCS) and neurothesiometer (NT). Our objectives were to examine how VPTs correlated with NCS parameters, evaluate the efficacy of MFV in distinguishing DPN as well as to investigate whether MFV procedure could be based on fewer frequencies.

METHODS

Adults with type 1 diabetes with previous MFV examinations were recruited at Skåne University Hospital in Malmö, Sweden, between 2018 and 2020. Participants were examined regarding nerve function in the lower limbs through MFV, NT and NCS.

RESULTS

A total of 66 participants (28 women and 38 men) with a median age of 50 (39 to 64) years were included in the study. Through NCS assessment, 33 participants (50%) were diagnosed with DPN. We found negative correlations between VPTs and all NCS parameters, where the strongest correlation was found between sural nerve amplitude and the 125 Hz frequency of MFV. A combination of four frequencies, two low (4 and 8 Hz) and two high (125 and 250 Hz), showed the highest classification efficacy (AUC 0.83, 95% CI 0.73-0.93).

CONCLUSION

We conclude that a strong correlation exists between the sural nerve amplitude and the VPTs at 125 Hz and that VPT testing with MFV can be focused on only four frequencies instead of seven, thus shortening test time, to distinguish DPN in the lower limb.

Preliminary study of finger temperature recovery in patients with diabetes mellitus following cold stimulation

OBJECTIVE

To explore the difference in temperature recovery following cold stimulation between participants with and without diabetes mellitus (DM).

MATERIALS AND METHODS

The participants without (control group; n = 25) and with (DM group; n = 26) DM were subjected to local cold stimulation (10º C for 90 s). The thermal images of their hands were continuously captured using a thermal camera within 7 min following cold stimulation, and the highest temperature of each fingertip was calculated. According to the temperature values at different timepoints, the temperature recovery curves were drawn, and the baseline temperature (T-base), initial temperature after cooling (T0), temperature decline amplitude (T-range), and area under the temperature recovery curve > T0 (S) were calculated. Finally, symmetry differences between the two groups were analysed.

RESULTS

No statistical differences in the T-base, T0, and T-range were observed between the DM and control groups. After drawing the rewarming curve according to the temperature of the fingertips of the patients following cold stimulation, the S in the DM group was significantly lower than that in the control group (p < 0.05). Furthermore, the asymmetry of the base temperature of the hand was observed in the DM group.

CONCLUSIONS

Following cold stimulation, the patients with DM exhibited a different rewarming pattern than those without DM. Thus, cold stimulation tests under infrared thermography may contribute to the early screening of diabetic peripheral neuropathy in future.

Early Detection of Diabetic Peripheral Neuropathy in Diabetic Patients: A Cross-Sectional Study

BACKGROUND

Diabetic Peripheral Neuropathy (DPN) is a chronic complication in Type 2 Diabetes Mellitus (T2DM) patients and is characterized by paresthesia, pain, and hypoesthesia of the extremities. The Diabetic Neuropathy Symptom-Score (DNS) is a quick, inexpensive, and easy-to-perform tool to detect DPN in clinical practice. Biochemical markers like Nitric Oxide (NO) and Vascular Endothelial Growth Factor (VEGF) play a role in the early detection of DPN. This study aims to investigate the relationship between risk factors and these biomarkers. So, it is expected to improve the prevention and treatment of diabetic neuropathy more effectively.

METHOD

A cross-sectional method was used for this study. The sample size was 85 patients with T2DM who visited several primary healthcare in Medan, selected by consecutive sampling method based on eligibility criteria. Data collected included DNS, assessment of NO, VEGF, Glycated Hemoglobin (HbA1c), plasma blood glucose (PBG), and lipid profile. The collected data were analyzed using an independent T-test.

RESULT

The results showed that most T2DM patients, namely 73 people (85.9%), experienced DPN. From the bivariate analysis results, the risk factors associated with the prevalence of DPN in T2DM patients were found to be increased levels of total cholesterol, HbA1c, NO, and VEGF (p < 0.05). Meanwhile, blood pressure, fasting BGL, HDL-C, LDL-C, and triglycerides were not related to the occurrence of DPN in this study (p> 0.05).

CONCLUSION

DNS can be used as a quick and easy initial screening tool implemented in clinical practice for screening DPN. Diabetic patients with DPN tend to have lower NO and increased VEGF; besides, NO levels are also associated with the progression of DPN. Furthermore, education, blood sugar control, and physical exercise, especially leg exercises, can prevent progressive DPN.

Unveiling Diabetes: Categories, Genetics, Diagnostics, Treatments, and Future Horizons

Diabetes mellitus is a global epidemic affecting millions of individuals worldwide. This comprehensive review aims to provide a thorough understanding of the categorization, disease identity, genetic architecture, diagnosis, and treatment of diabetes. The categorization of diabetes is discussed, with a focus on type 1 and type 2 diabetes, as well as the lesser-known types, type 3 and type 4 diabetes. The geographical variation, age, gender, and ethnic differences in the prevalence of type 1 and type 2 diabetes are explored. The impact of disease identity on disease management and the role of autoimmunity in diabetes are examined. The genetic architecture of diabetes, including the interplay between genotype and phenotype, is discussed to enhance our understanding of the underlying mechanisms. The importance of insulin injection sites and the insulin signalling pathway in diabetes management are highlighted. The diagnostic techniques for diabetes are reviewed, along with advancements for improved differentiation between types. Treatment and management approaches, including medications used in diabetes management are presented. Finally, future perspectives are discussed, emphasizing the need for further research and interventions to address the global burden of diabetes. This review serves as a valuable resource for healthcare professionals, researchers, and policymakers, providing insights to develop targeted strategies for the prevention, diagnosis, and management of this complex disease.

Research on the changes and predictions of the burden of type 2 diabetes mellitus in Pacific Island countries from 1990 to 2019

AIMS

To assess the burden of type 2 diabetes in Pacific Island countries and predict future trends.

METHODS

We analyzed and processed data using R and Excel software, performed Joinpoint 4.7.0 software analysis to investigate changing trends in disease burden, and used an autoregressive integrated moving average model to forecast future trends.

RESULTS

Our study showed that from 1990 to 2019, the burden of type 2 diabetes in Pacific Island countries continues to increase, with the standardized incidence rate showing the most significant growth. Moreover, there were significant differences in the burden of type 2 diabetes between regions. In 2019, American Samoa had the highest standardized incidence rate, while Fiji had the highest standardized death rate and disability-adjusted life year rate. The standardized incidence rate peaked at ages 65-69 years, while the standardized death rate and disability-adjusted life year rate peaked at ages 95 years and 70-74 years respectively. Type 2 diabetes burden was higher among males than females. Based on our forecasting, from 2020 to 2030, the standardized incidence rate is expected to continue to rise, while the standardized death rate and disability-adjusted life year rate will slowly decline.

CONCLUSIONS

Our study highlights that the burden of type 2 diabetes in Pacific Island countries has been increasing from 1990 to 2019. Therefore, it is imperative to strengthen disease prevention and control measures in the region.

The landscape of global research on diabetic neuropathy

Introduction

Diabetic neuropathy (DN) is a prevalent and debilitating complication of diabetes, imposing a significant burden on individuals and healthcare systems worldwide. This study presents a comprehensive analysis of the global research landscape in DN, aiming to provide scientists, funders, and decision-makers with valuable insights into the current state of research and future directions.

Methods

Through a systematic review of published articles, key trends in DN research, including epidemiology, diagnosis, treatment strategies, and gaps in knowledge, are identified and discussed.

Results

The analysis reveals an increasing prevalence of DN alongside the rising incidence of diabetes, emphasizing the urgent need for effective prevention and management strategies. Furthermore, the study highlights the geographical imbalance in research activity, with a majority of studies originating from high-income countries.

Discussion

This study underscores the importance of fostering international collaboration to address the global impact of DN. Key challenges and limitations in DN research are also discussed, including the need for standardized diagnostic criteria, reliable biomarkers, and innovative treatment approaches. By addressing these gaps, promoting collaboration, and increasing research funding, we can pave the way for advancements in DN research and ultimately improve the lives of individuals affected by this debilitating condition.

Diagnostic accuracy of the 5.07 monofilament test for diabetes polyneuropathy: influence of age, sex, neuropathic pain and neuropathy severity

INTRODUCTION

There is a need for simple and cheap diagnostic tools for diabetic polyneuropathy (DPN). We aimed to assess the diagnostic accuracy of the 5.07/10 g monofilament test in patients referred to polyneuropathy assessments, as well as to examine how disease severity, age, sex and neuropathic pain (NP) impact diagnostic accuracy.

RESEARCH DESIGN AND METHODS

Five Norwegian university hospitals recruited patients with diabetes aged 18-70 referred to neurological outpatient clinics for polyneuropathy assessments. The 5.07/10 g Semmes-Weinstein monofilament examination (SWME) was validated against the Toronto consensus for diagnosing diabetic neuropathies; the results were stratified by age, sex and NP. Disease severity was graded by a combined nerve conduction study (NCS) Z-score, and logistic regression was applied to assess whether disease severity was a predictor of diagnostic accuracy.

RESULTS

In total, 506 patients were included in the study. Global sensitivity was 0.60 (95% CI 0.55, 0.66), specificity 0.82 (95% CI 0.75, 0.87), positive and negative predictive values were 0.86 (95% CI 0.81, 0.90) and 0.52 (95% CI 0.46, 0.58), respectively, positive and negative likelihood ratios were 3.28 (95% CI 2.37, 4.53) and 0.49 (95% CI 0.42, 0.57), respectively. The SWME was less sensitive in females (0.43), had lower specificity in patients with NP (0.56), and performed worse in patients ≥50 years. NCS-based disease severity did not affect diagnostic accuracy (OR 1.15, 95% CI 0.95, 1.40).

CONCLUSIONS

This multicenter study demonstrates poor diagnostic performance for the 5.07/10 g SWME in patients with diabetes referred to polyneuropathy assessments; it is particularly unsuited for female patients and those with NP. The diagnostic accuracy of the SWME was not influenced by NCS-based disease severity, demonstrating that it does not perform better in patients with later stages of DPN. We do not recommend the use of the 5.07/10 g monofilament in the evaluation of patients with diabetes referred to polyneuropathy assessments.

The pharmacology and therapeutic role of cannabidiol in diabetes

In recent years, cannabidiol (CBD), a non-psychotropic cannabinoid, has garnered substantial interest in drug development due to its broad pharmacological activity and multi-target effects. Diabetes is a chronic metabolic disease that can damage multiple organs in the body, leading to the development of complications such as abnormal kidney function, vision loss, neuropathy, and cardiovascular disease. CBD has demonstrated significant therapeutic potential in treating diabetes mellitus and its complications owing to its various pharmacological effects. This work summarizes the role of CBD in diabetes and its impact on complications such as cardiovascular dysfunction, nephropathy, retinopathy, and neuropathy. Strategies for discovering molecular targets for CBD in the treatment of diabetes and its complications are also proposed. Moreover, ways to optimize the structure of CBD based on known targets to generate new CBD analogues are explored.

Sudomotor dysfunction in diabetic peripheral neuropathy (DPN) and its testing modalities: A literature review

Long term consequences of diabetes mellitus (DM) may include multi-organ complications such as retinopathy, cardiovascular disease, neuronal, and kidney damage. One of the most prevalent complication is diabetic peripheral neuropathy (DPN), occurring in half of all diabetics, and is the main cause of disability globally with profound impact on a patient's quality of life. Small fiber neuropathy (SFN) can develop in the pre-diabetes stage preceding large fiber damage in DPN. Asymptomatic SFN is difficult to diagnose in early stages, with sudomotor dysfunction considered one of the earliest manifestations of autonomic neuropathy. Early detection is crucial as it can prevent potential cardiovascular events. Although punch skin biopsy is the gold-standard method for SFN diagnosis, implementation as routine screening is hindered due to its invasive, impractical, and time-consuming nature. Other sudomotor testing modalities, most of which evaluate the postganglionic cholinergic sympathetic nervous system, have been developed with varying sensitivity and specificity for SFN diagnosis. Here, we provide an overview on the general mechanism of DPN, the importance of sudomotor assessment for early detection of autonomic dysfunction in DPN, the benefits and disadvantages of current testing modalities, factors that may affect testing, and the importance of future discoveries on sudomotor testing for successful DPN diagnosis.