1
|
Zhang Y, Sun W, Zhang Q, Bai Y, Ji L, Zheng H, Zhu X, Liu X, Zhang S, Xiong Q, Li Y, Chen L, Lu B. Estimated glucose disposal rate predicts the risk of diabetic peripheral neuropathy in type 2 diabetes: A 5-year follow-up study. J Diabetes 2024; 16:e13482. [PMID: 38225901 PMCID: PMC11045912 DOI: 10.1111/1753-0407.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/01/2023] [Accepted: 09/16/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Insulin resistance is associated with chronic complications of diabetes, including diabetic peripheral neuropathy (DPN). Estimated glucose disposal rate (eGDR), calculated by the common available clinical factors, was proved to be an excellent tool to measure insulin resistance in large patient population. Few studies have explored the association between eGDR and DPN longitudinally. Therefore, we performed the current study to analyze whether eGDR could predict the risk of DPN. METHODS In this prospective study, 366 type 2 diabetes (T2DM) subjects without DPN were enrolled from six communities in Shanghai in 2011-2014 and followed up until 2019-2020. Neuropathy was assessed by Michigan Neuropathy Screening Instrument (MSNI) at baseline and at the end of follow-up. FINDINGS After 5.91 years, 198 of 366 participants progressed to DPN according to MNSI examination scores. The incidence of DPN in the low baseline eGDR (eGDR < 9.15) group was significantly higher than in the high baseline eGDR (eGDR ≥ 9.15) group (62.37% vs. 45.56%, p = .0013). The incidence of DPN was significantly higher in patients with sustained lower eGDR level (63.69%) compared with those with sustained higher eGDR level (35.80%). Subjects with low baseline eGDR (eGDR < 9.15) had significantly higher risk of DPN at the end of follow-up (odds ratio = 1.75), even after adjusting for other known DPN risk factors. CONCLUSIONS The 5-year follow-up study highlights the importance of insulin resistance represented by eGDR in the development of DPN in T2DM. Diabetic patients with low eGDR are more prone to DPN and, therefore, require more intensive screening and more attention.
Collapse
Affiliation(s)
- Yuanpin Zhang
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Wanwan Sun
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Qi Zhang
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Yuetian Bai
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Lijin Ji
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Hangping Zheng
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Xiaoming Zhu
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Xiaoxia Liu
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Shuo Zhang
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Qian Xiong
- Department of EndocrinologyShanghai Gonghui HospitalShanghaiChina
| | - Yiming Li
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Lili Chen
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| | - Bin Lu
- Department of Endocrinology and MetabolismHuashan Hospital Fudan UniversityShanghaiChina
| |
Collapse
|
2
|
Morita M, Sada K, Hidaka S, Ogawa M, Shibata H. Glycemic variability is associated with sural nerve conduction velocity in outpatients with type 2 diabetes: Usefulness of a new point-of-care device for nerve conduction studies. J Diabetes Investig 2024. [PMID: 38685597 DOI: 10.1111/jdi.14211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/28/2024] [Accepted: 03/24/2024] [Indexed: 05/02/2024] Open
Abstract
AIMS/INTRODUCTION Although several studies have shown the association between continuous glucose monitoring (CGM)-derived glycemic variability (GV) and diabetic peripheral neuropathy, no studies have focused on outpatients or used NC-stat®/DPNCheck™, a new point-of-care device for nerve conduction study (NCS). We investigated the association between CGM-derived GV and NCS using DPNCheck™ in outpatients with type 2 diabetes, and further analyzed the difference in results between patients with and without well-controlled HbA1c levels. MATERIALS AND METHODS All outpatients with type 2 diabetes using the CGM device (FreeStyle Libre Pro®) between 2017 and 2022 were investigated. Sural nerve conduction was evaluated by sensory nerve action potential (SNAP) amplitude and sensory conduction velocity (SCV) using DPNCheck™. Associations of CGM-derived GV metrics with SNAP amplitude and SCV were investigated. RESULTS In total, 304 outpatients with type 2 diabetes were included. In a linear regression model, most CGM-derived GV metrics except for the mean amplitude of glucose excursion and low blood glucose index were significantly associated with SCV, but not with SNAP amplitude. The significant associations of most CGM-derived GV metrics with SCV remained after adjustment for possible confounding factors, but not after adjustment for glycated hemoglobin (HbA1c). Most CGM-derived GV metrics were significantly associated with SCV after adjustment for HbA1c in patients with a HbA1c ≤ 6.9%, but not in those with a HbA1c ≥ 7.0%. CONCLUSIONS In outpatients with type 2 diabetes, multiple CGM-derived GV metrics were significantly associated with SCV obtained by DPNCheck™. GV may have independent impacts on peripheral nerve function, particularly in patients with well-controlled HbA1c levels.
Collapse
Affiliation(s)
- Machiko Morita
- Department of Diabetes and Metabolism, Koseiren Tsurumi Hospital, Oita, Japan
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan
| | - Kentaro Sada
- Department of Diabetes and Metabolism, Koseiren Tsurumi Hospital, Oita, Japan
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan
| | - Shuji Hidaka
- Department of Diabetes and Metabolism, Koseiren Tsurumi Hospital, Oita, Japan
| | - Miki Ogawa
- Department of Diabetes and Metabolism, Koseiren Tsurumi Hospital, Oita, Japan
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan
| |
Collapse
|
3
|
Horinouchi S, Deguchi T, Mukai M, Ijuin A, Kawamoto Y, Nishio Y. Assessment of the severity of diabetic polyneuropathy aids in predicting the risk of developing diabetic complications in patients with untreated diabetes. Front Endocrinol (Lausanne) 2024; 15:1380970. [PMID: 38559690 PMCID: PMC10978669 DOI: 10.3389/fendo.2024.1380970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
This study aimed to determine the efficacy of assessing the severity of diabetic polyneuropathy (DPN) in patients with untreated diabetes. Seventy-two patients with untreated type 2 diabetes who were hospitalized for glycemic control were enrolled and divided into the following two groups: patients who had no prior diagnosis and patients who were unattended or had discontinued treatment. Electrophysiological criteria consistent with Baba's classification were used to diagnose and assess the severity of DPN. The patients were divided into three subgroups: no DPN (stage 0), mild DPN (stage 1), and moderate or more-severe DPN (stages 2-4). Intergroup comparisons were performed for the clinical characteristics and the results of the nerve conduction studies. Twenty-two (30%), 25 (35%), and 25 (35%) patients were categorized into the no DPN, mild DPN, and moderate or more-severe DPN subgroups, respectively. The number of patients who were unattended or had discontinued treatment in the moderate or more-severe DPN subgroup was significantly higher than that in the no DPN subgroup. The patients in the moderate or more-severe DPN subgroup had an increased risk of developing diabetic retinopathy and nephropathy, with odds ratios of 19.5 and 11.0 for advanced stages of retinopathy and nephropathy, respectively. Thus, the assessment of the severity of DPN could aid in the prediction of the risk of developing diabetic complications in patients with untreated diabetes.
Collapse
Affiliation(s)
- Shuji Horinouchi
- Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Takahisa Deguchi
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Miki Mukai
- Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Ayako Ijuin
- Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Yudai Kawamoto
- Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| |
Collapse
|
4
|
Mahalingasivam AA, Jespersen AK, Ejskjaer N, Hougaard DD, Vestergaard P, Rasmussen NHH, Røikjer J. The co-existence of peripheral and vestibular neuropathy in diabetes: a cross-sectional study. Eur Arch Otorhinolaryngol 2024; 281:663-672. [PMID: 37515636 PMCID: PMC10796646 DOI: 10.1007/s00405-023-08130-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/12/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Diabetic neuropathy can lead to decreased peripheral sensation and motor neuron dysfunction associated with impaired postural control and risk of falling. However, the relationship between decreased peripheral sensation and impaired vestibular function in diabetes mellitus is poorly investigated. Therefore, the aim of this study was to investigate the relationship between peripheral and autonomic measurements of diabetic neuropathy and measurements of vestibular function. METHODS A total of 114 participants with type 1 diabetes (n = 52), type 2 diabetes (n = 51) and controls (n = 11) were included. Vestibular function was evaluated by video head impulse testing. Peripheral neuropathy was assessed by quantitative sensory testing and nerve conduction. Autonomic neuropathy using the COMPASS 31 questionnaire. Data were analyzed according to data type and distribution. RESULTS Measurements of vestibular function did not differ between participants with type 1 diabetes, type 2 diabetes or controls (all p-values above 0.05). Subgrouping of participants according to the involvement of large-, small- or autonomic nerves did not change this outcome. Correlation analyses showed a significant difference between COMPASS 31 and right lateral gain value (ρ = 0.23, p = 0.02,), while no other significant correlations were found. CONCLUSION Diabetic neuropathy does not appear to impair vestibular function in diabetes, by means of the VOR. CLINICAL TRIALS NCT05389566, May 25th, 2022.
Collapse
Affiliation(s)
| | | | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Dan Dupont Hougaard
- Balance & Dizziness Centre, Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Nicklas Højgaard-Hessellund Rasmussen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Johan Røikjer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.
- Integrative Neuroscience, Aalborg University, Søndre Skovvej 3E, 9000, Aalborg, Denmark.
| |
Collapse
|
5
|
Ogawa T, Matsuda A, Ogawa Y, Tanaka R. Risk factors for the development of tinea pedis and onychomycosis: Real-world evidence from a single-podiatry center, large-scale database in Japan. J Dermatol 2024; 51:30-39. [PMID: 37904622 DOI: 10.1111/1346-8138.16991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/12/2023] [Accepted: 09/23/2023] [Indexed: 11/01/2023]
Abstract
Dermatomycosis, including tinea pedis and onychomycosis, is frequently encountered in routine medical care in Japan. Identifying the risk factors for tinea pedis and onychomycosis development is important to encourage hospital visits by patients who may have these diseases but who are not undergoing any treatment. This approach may lead to the prevention of disease progression and the spread of infections to others. Risk factors for onychomycosis development have been reported both in and outside of Japan. However, most of the risk factors were identified based on a multicenter, questionnaire survey study and included evidence obtained from unclear or inconsistent diagnostic criteria for tinea pedis, onychomycosis, and identified risk factors. The current study analyzed the risk factors for developing tinea pedis and onychomycosis in real-world practice in Japan using a single-center, large-scale database that included the data of patients managed with consistent diagnostic criteria at the Podiatry Center of Juntendo University Hospital. A total of 2476 patients (1012 males, 1464 females) with a mean age of 63.4 years were included. Among these patients, 337 (13.6%) had tinea pedis and 346 (14.0%) had onychomycosis. A total of 259 patients (~ 75% of each patient population) had both diseases concomitantly. Multivariate logistic regression analysis adjusted for the possible risk factors of age (per 10 years), sex, diabetes, dialysis, visual impairment, ulcer history, lower-limb ischemia (LLI), and diabetic peripheral neuropathy (DPN) revealed that advanced age, male sex, diabetes, and LLI were independent risk factors for the development of tinea pedis. In addition, DPN was an independent risk factor for developing onychomycosis. We believe that these data are useful for identifying patients who are at high risk of developing tinea pedis and onychomycosis, which may result in disease prevention and suppression in real-world clinical practice in Japan.
Collapse
Affiliation(s)
- Takasuke Ogawa
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Podiatry Center, Juntendo University Hospital, Tokyo, Japan
| | - Akinori Matsuda
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yumi Ogawa
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Rica Tanaka
- Podiatry Center, Juntendo University Hospital, Tokyo, Japan
- Division of Regenerative Therapy, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
6
|
Jasmin M, Yusuf S, Syahrul S, Abrar EA. Validity and Reliability of a Vibration-Based Cell Phone in Detecting Peripheral Neuropathy among Patients with a Risk of Diabetic Foot Ulcer. INT J LOW EXTR WOUND 2023; 22:687-694. [PMID: 34382442 DOI: 10.1177/15347346211037411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to determine the validity and reliability of a vibration-based cell phone in detecting peripheral neuropathy among individuals with a risk of diabetic foot ulcer (DFU). The current study consisted of 3 phases: a pilot study, concurrent validity study, and interreliability study. A 128 Hz tuning fork and vibration-based cell phone using the Vibrations-Test app was compared in the primary care setting. The pilot study confirmed that the vibration-based cell phone has an adequate reliability (r > 0.70, P < .001). The concurrent validity test involved 96 participants (aged 55.78 ± 8.32 years). The Pearson correlation test found the highest correlation in the fifth metatarsal heads (r = 0.741, right feet; 0.772, left feet; P < .001). In the 4 primary care settings, the interrater reliability between nurses of the vibration-based cell phone were k = 1.000, 1.000, 1.000, and 0.720. The concurrent validity test found moderate to strong correlation results and that the interrater reliability had a strong agreement that was almost perfect. Thus, vibration-based cell phone applications can be used as screening tools for detecting neuropathy among individuals with a risk of DFU.
Collapse
Affiliation(s)
- Muh Jasmin
- Nursing Study Program, College of Health Science Karya Kesehatan, Kendari, Indonesia
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
| | - Saldy Yusuf
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
| | - Syahrul Syahrul
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
| | - Eva Arna Abrar
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
- Stikes Nani Hasanuddin, Makassar, Indonesia
| |
Collapse
|
7
|
Rasmussen VF, Thrysøe M, Nyengaard JR, Tankisi H, Karlsson P, Hansen J, Krogh K, Brock C, Kamperis K, Madsen M, Singer W, Vestergaard ET, Kristensen K, Terkelsen AJ. Neuropathy in adolescents with type 1 diabetes: Confirmatory diagnostic tests, bedside tests, and risk factors. Diabetes Res Clin Pract 2023; 201:110736. [PMID: 37276985 DOI: 10.1016/j.diabres.2023.110736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
AIMS To estimate the prevalence of large fiber (LFN), small fiber (SFN), and autonomic neuropathy in adolescents with type 1 diabetes using confirmatory tests known from adults and to identify risk factors and bedside methods for neuropathy. METHODS Sixty adolescents with type 1 diabetes (diabetes duration > five years) and 23 control subjects underwent neurological examination and confirmatory diagnostic tests for neuropathy, including nerve conduction studies, skin biopsies determining intraepidermal nerve fiber density, quantitative sudomotor axon reflex test (QSART), cardiovascular reflex tests (CARTs), and tilt table test. Possible risk factors were analyzed. Bedside tests (biothesiometry, DPNCheck®, Sudoscan, and Vagus®device) were compared with the confirmatory tests using ROC analysis. RESULTS The prevalence of neuropathies in the adolescents with diabetes (mean HbA1c 7.6% (60 mmol/mol)) was as follows: 14% confirmed/26% subclinical LFN, 2% confirmed/25% subclinical SFN, 20% abnormal QSART, 8% abnormal CARTs, and 14% orthostatic hypotension. Higher age, higher insulin dose, previous smoking, and higher triglycerides level were found to increase the relative risk for neuropathy. The bedside tests showed poor to acceptable concordance with the confirmatory tests (all, AUC ≤ 0.75). CONCLUSIONS The diagnostic tests confirmed the presence of neuropathy in adolescents with diabetes and underscore the importance of prevention and screening.
Collapse
Affiliation(s)
- Vinni Faber Rasmussen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark; Department of Pediatrics and Adolescent Medicine, Randers Regional Hospital, Randers, Denmark.
| | - Mathilde Thrysøe
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Randel Nyengaard
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark; Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hatice Tankisi
- Department of Neurophysiology, Department of Clinical Medicine, Aarhus University, Denmark
| | - Páll Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - John Hansen
- Institute of Health Science and Technology, Aalborg University, Denmark
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Christina Brock
- Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Konstantinos Kamperis
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Mette Madsen
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Denmark; Steno Diabetes Center North Denmark, Aalborg, Denmark
| | | | - Esben Thyssen Vestergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark; Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | - Astrid Juhl Terkelsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
8
|
Fukuda T, Fujii A, Akihisa T, Otsubo N, Murakami M, Yamada T, Maki C. Association between Diabetic Peripheral Neuropathy as Measured Using a Point-of-Care Sural Nerve Conduction Device and Urinary Albumin Excretion in Patients with Type 2 Diabetes. J Clin Med 2023; 12:4089. [PMID: 37373782 DOI: 10.3390/jcm12124089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND It is not well known whether diabetic peripheral neuropathy diagnosed using a non-invasive point-of-care nerve conduction device called DPN-Check® is associated with diabetic nephropathy. Thus, we aimed to evaluate the association of diabetic peripheral neuropathy with urinary albumin excretion in patients with type 2 diabetes using DPN-Check®. METHODS This retrospective observational study included 323 Japanese patients with type 2 diabetes. The urinary albumin-to-creatinine ratio in a spot urine sample was defined as urinary albumin excretion. Multiple linear regression analysis was used to determine the association of DPN-Check®-determined diabetic peripheral neuropathy with urinary albumin excretion. RESULTS Patients with DPN-Check®-determined diabetic peripheral neuropathy had significantly higher urinary albumin excretion than those without, while there was no difference in urinary albumin excretion between patients with and without diabetic peripheral neuropathy determined by simplified diagnostic criteria. In the multivariate model, the DPN-Check® determined that diabetic peripheral neuropathy was significantly associated with urinary albumin excretion even after adjustment for covariates (standardized β, 0.123; p = 0.012). CONCLUSIONS Our study found a significant association between diabetic peripheral neuropathy diagnosed using DPN-Check® and urinary albumin excretion in patients with type 2 diabetes.
Collapse
Affiliation(s)
- Tatsuya Fukuda
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Okubo Hospital, Tokyo 160-8488, Japan
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Akiko Fujii
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Okubo Hospital, Tokyo 160-8488, Japan
| | - Taro Akihisa
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Okubo Hospital, Tokyo 160-8488, Japan
| | - Naoya Otsubo
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Okubo Hospital, Tokyo 160-8488, Japan
| | - Masanori Murakami
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Tetsuya Yamada
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Chisato Maki
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Okubo Hospital, Tokyo 160-8488, Japan
| |
Collapse
|
9
|
Nattero‐Chávez L, Luque‐Ramírez M, Quiñones‐Silva J, Montánez L, Fernández‐Durán E, Dorado‐Avendaño B, Escobar‐Morreale HF. Point-of-care sural nerve conduction could predict the presence of cardiovascular autonomic neuropathy in type 1 diabetes mellitus. J Diabetes Investig 2022; 13:1347-1356. [PMID: 35389567 PMCID: PMC9340859 DOI: 10.1111/jdi.13803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/23/2022] [Accepted: 04/05/2022] [Indexed: 12/29/2022] Open
Abstract
AIMS Assessment for cardiovascular autonomic neuropathy (CAN) in patients with type 1 diabetes mellitus remains time-consuming in the clinical setting. We aimed to examine the diagnostic performance of a portable point-of-care diagnostic tool (POCD) for assessing sural nerve conduction during the screening of CAN. METHODS Nerve amplitude (AMPPOCD ) and conduction velocity (CVPOCD ) were measured in a cross-sectional study including 198 asymptomatic patients with type 1 diabetes. CAN was diagnosed by the Ewing score and power spectral heart rate [low-frequency (LF) and high-frequency (HF) activity]. Diagnostic accuracy was determined by ROC curves. RESULTS CVPOCD and AMPPOCD showed positive correlations with LF and HF, and a negative correlation with age. Overall, AMPPOCD had an 81.7% accuracy in identifying CAN [AUC = 0.817 (95% CI 0.692-0.942)] with an AMPPOCD ≤6 μV showing 90% sensitivity and 73% specificity. In a stepwise binary logistic regression analysis, the model (R2 : 0.297; P < 0.001) retained the duration of type 1 diabetes [β: 1.131 (95% CI: 1.051-1.216); P = 0.001) and A1c [β: 2.131 (95% CI: 1.060-4.283); P = 0.034) as significant predictors of CAN. The combination of AMPPOCD ≤6 μV + a type 1 diabetes duration of ≥8 years maximized the sensitivity, showing a diagnostic performance of 87% [AUC = 0.867 (95% CI 0.769-0.965)] with 90%, 76%, and 99%, sensitivity, specificity, and NPV, respectively. Adding A1c ≥ 7% to this model maintained accuracy [AUC = 0.867 (95% CI: 0.788-0.963) and NPV (99%), while increasing specificity to 84%. CONCLUSIONS The combination of AMPPOCD with A1c and the duration of type 1 diabetes mellitus showed a good performance for the detection of asymptomatic CAN, making POCD an easy and rapid test for its routine screening in the clinical setting.
Collapse
Affiliation(s)
- Lía Nattero‐Chávez
- Department of Endocrinology and NutritionHospital Universitario Ramón y CajalMadridSpain,University of AlcaláMadridSpain
| | - Manuel Luque‐Ramírez
- Department of Endocrinology and NutritionHospital Universitario Ramón y CajalMadridSpain,University of AlcaláMadridSpain,Diabetes, Obesity, and Human Reproduction Research GroupInstituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Universidad de Alcalá, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) del Instituto de Salud Carlos IIIMadridSpain
| | | | - Laura Montánez
- Department of Endocrinology and NutritionHospital Universitario Ramón y CajalMadridSpain
| | - Elena Fernández‐Durán
- Diabetes, Obesity, and Human Reproduction Research GroupInstituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Universidad de Alcalá, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) del Instituto de Salud Carlos IIIMadridSpain
| | | | - Héctor F. Escobar‐Morreale
- Department of Endocrinology and NutritionHospital Universitario Ramón y CajalMadridSpain,University of AlcaláMadridSpain,Diabetes, Obesity, and Human Reproduction Research GroupInstituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Universidad de Alcalá, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) del Instituto de Salud Carlos IIIMadridSpain
| |
Collapse
|
10
|
Newlin Lew K, Arnold T, Cantelmo C, Jacque F, Posada-Quintero H, Luthra P, Chon KH. Diabetes Distal Peripheral Neuropathy: Subtypes and Diagnostic and Screening Technologies. J Diabetes Sci Technol 2022; 16:295-320. [PMID: 34994241 PMCID: PMC8861801 DOI: 10.1177/19322968211035375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Diabetes distal symmetrical peripheral neuropathy (DSPN) is the most prevalent form of neuropathy in industrialized countries, substantially increasing risk for morbidity and pre-mature mortality. DSPN may manifest with small-fiber disease, large-fiber disease, or a combination of both. This review summarizes: (1) DSPN subtypes (small- and large-fiber disease) with attention to clinical signs and patient symptoms; and (2) technological diagnosis and screening for large- and small-fiber disease with inclusion of a comprehensive literature review of published studies from 2015-present (N = 66). Review findings, informed by the most up-to-date research, advance critical understanding of DSPN large- and small-fiber screening technologies, including those designed for point-of-care use in primary care and endocrinology practices.
Collapse
Affiliation(s)
- Kelley Newlin Lew
- School of Nursing, University of
Connecticut (UConn), Storrs, CT, USA
- Kelley Newlin Lew, School of Nursing,
University of Connecticut (UConn), 231 Glenbrook Road, Storrs, CT 06269, USA.
| | - Tracey Arnold
- School of Nursing, University of
Connecticut (UConn), Storrs, CT, USA
| | | | - Francky Jacque
- Hispanic Alliance of Southeastern
Connecticut, New London, CT, USA
| | - Hugo Posada-Quintero
- Biomedical Engineering Department,
University of Connecticut (UConn), Storrs, CT, USA
| | - Pooja Luthra
- Division of Endocrinology and
Metabolism, UConn Health, Farmington, CT, USA
| | - Ki H. Chon
- Biomedical Engineering Department,
University of Connecticut (UConn), Storrs, CT, USA
| |
Collapse
|
11
|
Abe K, Maeda Y, Matsuzaki C, Yokomizo H, Inoue T, Sonoda N, Ogawa Y, Inoguchi T. Bilirubin is inversely related to diabetic peripheral neuropathy assessed by sural nerve conduction study. J Diabetes Investig 2021; 12:2028-2035. [PMID: 33949141 PMCID: PMC8565409 DOI: 10.1111/jdi.13568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 12/27/2022] Open
Abstract
AIMS/INTRODUCTION Diagnosis of diabetic peripheral neuropathy (DPN) depends on subjective findings, certain investigations for DPN risks have not been performed enough. Bilirubin protects against vascular complications by reducing oxidative stress in diabetes, but is not fully tested for DPN. This study aimed to evaluate sural nerve conduction impairments (SNCI) as an objective DPN marker and the contribution of bilirubin to SNCI. MATERIALS AND METHODS Using DPN-Check® , SNCI was defined as a decline of amplitude potential or conduction velocity below the normal limit in 150 inpatients with diabetes. The correlations between SNCI and conventional DPN diagnosis criteria, the incidence of diabetic retinopathy/nephropathy, biomarkers for atherosclerosis, cardiac function by ultrasonic cardiogram, and bilirubin were statistically tested, followed by the comparison of logistic regression models for SNCI to find confounders with bilirubin. RESULTS The incidence of SNCI was 72.0%. The sensitivity and specificity of SNCI for DPN prediagnosis by simplified criteria were 54.6 and 90.5%, respectively, and similarly corresponded with diabetic retinopathy and nephropathy (sensitivity 57.4 and 50.0%, respectively). SNCI significantly related to diabetes duration, declined estimated glomerular filtration rate, albuminuria and total bilirubin. SNCI incidence was attenuated in the higher bilirubin tertiles (89.8/65.3/54.8%, P < 0.001). Bilirubin was an independent inverse risk factor for SNCI, even after adjustment by known risk factors for DPN and markers for microvascular complications. CONCLUSIONS SNCI is a comprehensive marker for diabetic complications. We first showed the independent inverse relationship between bilirubin and SNCI through the independent pathway with other complications, provably reducing oxidative stress, as previously reported.
Collapse
Affiliation(s)
- Kentaro Abe
- Department of Medicine and Bioregulatory ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Diabetes, Endocrinology and MetabolismNational Hospital Organization Kokura Medical CenterKitakyusyuJapan
| | | | - Chitose Matsuzaki
- Department of Endocrine, Metabolism and DiabetesKyushu University HospitalFukuokaJapan
| | - Hisashi Yokomizo
- Department of Endocrine, Metabolism and DiabetesKyushu University HospitalFukuokaJapan
| | - Tomoaki Inoue
- Department of Endocrine, Metabolism and DiabetesKyushu University HospitalFukuokaJapan
| | - Noriyuki Sonoda
- Department of Medicine and Bioregulatory ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Endocrine, Metabolism and DiabetesKyushu University HospitalFukuokaJapan
| | | |
Collapse
|
12
|
Burgess J, Frank B, Marshall A, Khalil RS, Ponirakis G, Petropoulos IN, Cuthbertson DJ, Malik RA, Alam U. Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres. Diagnostics (Basel) 2021; 11:165. [PMID: 33498918 DOI: 10.3390/diagnostics11020165] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the most common complication of both type 1 and 2 diabetes. As a result, neuropathic pain, diabetic foot ulcers and lower-limb amputations impact drastically on quality of life, contributing to the individual, societal, financial and healthcare burden of diabetes. DPN is diagnosed at a late, often pre-ulcerative stage due to a lack of early systematic screening and the endorsement of monofilament testing which identifies advanced neuropathy only. Compared to the success of the diabetic eye and kidney screening programmes there is clearly an unmet need for an objective reliable biomarker for the detection of early DPN. This article critically appraises research and clinical methods for the diagnosis or screening of early DPN. In brief, functional measures are subjective and are difficult to implement due to technical complexity. Moreover, skin biopsy is invasive, expensive and lacks diagnostic laboratory capacity. Indeed, point-of-care nerve conduction tests are convenient and easy to implement however questions are raised regarding their suitability for use in screening due to the lack of small nerve fibre evaluation. Corneal confocal microscopy (CCM) is a rapid, non-invasive, and reproducible technique to quantify small nerve fibre damage and repair which can be conducted alongside retinopathy screening. CCM identifies early sub-clinical DPN, predicts the development and allows staging of DPN severity. Automated quantification of CCM with AI has enabled enhanced unbiased quantification of small nerve fibres and potentially early diagnosis of DPN. Improved screening tools will prevent and reduce the burden of foot ulceration and amputations with the primary aim of reducing the prevalence of this common microvascular complication.
Collapse
|
13
|
Hashem MM, Esmael A, Nassar AK, El-Sherif M. The relationship between exacerbated diabetic peripheral neuropathy and metformin treatment in type 2 diabetes mellitus. Sci Rep. 2021;11:1940. [PMID: 33479439 PMCID: PMC7820469 DOI: 10.1038/s41598-021-81631-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023] Open
Abstract
Metformin-treated diabetics (MTD) showed a decrease in cobalamin, a rise in homocysteine, and methylmalonic acid, leading to accentuated diabetic peripheral neuropathy (DPN). This study aimed to determine whether or not metformin is a risk factor for DPN. We compared MTD to non-metformin-treated diabetics (NMTD) clinically using the Toronto Clinical Scoring System (TCSS), laboratory (methylmalonic acid, cobalamin, and homocysteine), and electrophysiological studies. Median homocysteine and methylmalonic acid levels in MTD vs. NMTD were 15.3 vs. 9.6 µmol/l; P < 0.001 and 0.25 vs. 0.13 µmol/l; P = 0.02, respectively with high statistical significance in MTD. There was a significantly lower plasma level of cobalamin in MTD than NMTD. Spearman’s correlation showed a significant negative correlation between cobalamin and increased dose of metformin and a significant positive correlation between TCSS and increased dose of metformin. Logistic regression analysis showed that MTD had significantly longer metformin use duration, higher metformin dose > 2 g, higher TCSS, lower plasma cobalamin, and significant higher homocysteine. Diabetics treated with metformin for prolonged duration and higher doses were associated with lower cobalamin and more severe DPN.
Collapse
|
14
|
Kamiya H, Shibata Y, Himeno T, Tani H, Nakayama T, Murotani K, Hirai N, Kawai M, Asada-Yamada Y, Asano-Hayami E, Nakai-Shimoda H, Yamada Y, Ishikawa T, Morishita Y, Kondo M, Tsunekawa S, Kato Y, Baba M, Nakamura J. Point-of-care nerve conduction device predicts the severity of diabetic polyneuropathy: A quantitative, but easy-to-use, prediction model. J Diabetes Investig 2020; 12:583-591. [PMID: 32799422 PMCID: PMC8015817 DOI: 10.1111/jdi.13386] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 01/18/2023] Open
Abstract
Aims/Introduction A gold standard in the diagnosis of diabetic polyneuropathy (DPN) is a nerve conduction study. However, as a nerve conduction study requires expensive equipment and well‐trained technicians, it is largely avoided when diagnosing DPN in clinical settings. Here, we validated a novel diagnostic method for DPN using a point‐of‐care nerve conduction device as an alternative way of diagnosis using a standard electromyography system. Materials and Methods We used a multiple regression analysis to examine associations of nerve conduction parameters obtained from the device, DPNCheck™, with the severity of DPN categorized by the Baba classification among 375 participants with type 2 diabetes. A nerve conduction study using a conventional electromyography system was implemented to differentiate the severity in the Baba classification. The diagnostic properties of the device were evaluated using a receiver operating characteristic curve. Results A multiple regression model to predict the severity of DPN was generated using sural nerve conduction data obtained from the device as follows: the severity of DPN = 2.046 + 0.509 × ln(age [years]) − 0.033 × (nerve conduction velocity [m/s]) − 0.622 × ln(amplitude of sensory nerve action potential [µV]), r = 0.649. Using a cut‐off value of 1.3065 in the model, moderate‐to‐severe DPN was effectively diagnosed (area under the receiver operating characteristic curve 0.871, sensitivity 70.1%, specificity 87.7%, positive predictive value 83.0%, negative predictive value 77.3%, positive likelihood ratio 5.67, negative likelihood ratio 0.34). Conclusions Nerve conduction parameters in the sural nerve acquired by the handheld device successfully predict the severity of DPN.
Collapse
Affiliation(s)
- Hideki Kamiya
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yuka Shibata
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.,Department of Laboratory, The Medical Clinic of Aichi Medical University, Nagoya, Japan
| | - Tatsuhito Himeno
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hiroya Tani
- Department of Clinical Laboratory, Aichi Medical University Hospital, Nagakute, Japan
| | - Takayuki Nakayama
- Department of Clinical Laboratory, Aichi Medical University Hospital, Nagakute, Japan
| | - Kenta Murotani
- Biostatistics Center, Kurume University Graduate School of Medicine, Kurume, Japan
| | - Nobuhiro Hirai
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Miyuka Kawai
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yuriko Asada-Yamada
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Emi Asano-Hayami
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hiromi Nakai-Shimoda
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yuichiro Yamada
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Takahiro Ishikawa
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yoshiaki Morishita
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masaki Kondo
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Shin Tsunekawa
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yoshiro Kato
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masayuki Baba
- Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Jiro Nakamura
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| |
Collapse
|
15
|
Fernández-Torres R, Ruiz-Muñoz M, Pérez-Panero AJ, García-Romero J, Gónzalez-Sánchez M. Instruments of Choice for Assessment and Monitoring Diabetic Foot: A Systematic Review. J Clin Med 2020; 9:E602. [PMID: 32102313 DOI: 10.3390/jcm9020602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023] Open
Abstract
Diabetic foot is the most frequent disorder among the chronic complications of diabetes, happening in 25% of patients. Objective clinical outcome measures are tests or clinical instruments that provide objective values for result measurement. The aim of this study was to carry out a systematic review of specific objective clinical outcome measures focused on the assessment and monitoring of diabetic foot disorders. The databases used were PubMed, CINAHL, Scopus, PEDro, Cochrane, SciELO and EMBASE. Search terms used were foot, ankle, diabet*, diabetic foot, assessment, tools, instruments, objective outcome measures, valid*, reliab*. Because of the current published evidence, diabetic neuropathy assessment via sudomotor analysis, cardiovascular autonomic neuropathy and peripheral vascular disease detection by non-invasive electronic devices, wound 3D dimensional measurement, hyperspectral imaging for ulcer prediction and the probe-to-bone test for osteomyelitis diagnosis were highlighted in this study.
Collapse
|
16
|
Himeno T, Kamiya H, Nakamura J. Lumos for the long trail: Strategies for clinical diagnosis and severity staging for diabetic polyneuropathy and future directions. J Diabetes Investig 2020; 11:5-16. [PMID: 31677343 PMCID: PMC6944828 DOI: 10.1111/jdi.13173] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023] Open
Abstract
Diabetic polyneuropathy, which is a chronic symmetrical length-dependent sensorimotor polyneuropathy, is the most common form of diabetic neuropathy. Although diabetic polyneuropathy is the most important risk factor in cases of diabetic foot, given its poor prognosis, the criteria for diagnosis and staging of diabetic polyneuropathy has not been established; consequently, no disease-modifying treatment is available. Most criteria and scoring systems that were previously proposed consist of clinical signs, symptoms and quantitative examinations, including sensory function tests and nerve conduction study. However, in diabetic polyneuropathy, clinical symptoms, including numbness, pain and allodynia, show no significant correlation with the development of pathophysiological changes in the peripheral nervous system. Therefore, these proposed criteria and scoring systems have failed to become a universal clinical end-point for large-scale clinical trials evaluating the prognosis in diabetes patients. We should use quantitative examinations of which validity has been proven. Nerve conduction study, for example, has been proven effective to evaluate dysfunctions of large nerve fibers. Baba's classification, which uses a nerve conduction study, is one of the most promising diagnostic methods. Loss of small nerve fibers can be determined using corneal confocal microscopy and intra-epidermal nerve fiber density. However, no staging criteria have been proposed using these quantitative evaluations for small fiber neuropathy. To establish a novel diagnostic and staging criteria of diabetic polyneuropathy, we propose three principles to be considered: (i) include only generalizable objective quantitative tests; (ii) exclude clinical symptoms and signs; and (iii) do not restrictively exclude other causes of polyneuropathy.
Collapse
Affiliation(s)
- Tatsuhito Himeno
- Division of DiabetesDepartment of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Hideki Kamiya
- Division of DiabetesDepartment of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| | - Jiro Nakamura
- Division of DiabetesDepartment of Internal MedicineAichi Medical University School of MedicineNagakuteJapan
| |
Collapse
|
17
|
Himeno T, Kamiya H, Nakamura J. Diabetic polyneuropathy: Progress in diagnostic strategy and novel target discovery, but stagnation in drug development. J Diabetes Investig 2019; 11:25-27. [PMID: 31755662 PMCID: PMC6944845 DOI: 10.1111/jdi.13188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Tatsuhito Himeno
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hideki Kamiya
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Jiro Nakamura
- Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| |
Collapse
|