The relationship between exacerbated diabetic peripheral neuropathy and metformin treatment in type 2 diabetes mellitus

AbstractMetformin-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.

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The Changes of Nerve Growth Factor Serum Levels After External Muscle Stimulation and The Correlation with Diabetic Neuropathy Symptom in Diabetic Peripheral Neuropathy

Indonesian Journal of Physical Medicine & Rehabilitation ◽

10.36803/ijpmr.v6i01.146 ◽

2017 ◽

Vol 6 (01) ◽

pp. 7

Author(s):

Dian Herdiansyah ◽

Marina Annete Moeliono ◽

Tertianto Prabowo

Keyword(s):

Nerve Growth Factor ◽

Peripheral Neuropathy ◽

Growth Factor ◽

Diabetic Neuropathy ◽

Diabetic Peripheral Neuropathy ◽

Significant Negative Correlation ◽

Muscle Stimulation ◽

Study Objective ◽

Nerve Growth ◽

Before And After

Background: Diabetic Peripheral neuropathy (DPN) is a common complication of diabetes mellitus. Recentstudies have demonstrated the involvement of Nerve growth factor (NGF) in the occurrence of DPN. TheDiabetes Mellitus was caused reduced the number and disruption of the function of the NGF. External MuscleStimulation (EMS) might be induced the NGF synthesis. The study objective has to found the effect of EMSon the NGF.Methods: Study design was before and after treatment without control on subjects with DPN. The bloodsample was taken before and after an intervention, as well as the Diabetic Neuropathy symptom (DNSym) andscore (DNSc). The EMS treated all of the participants within three times a week for four weeks.Results: There were 35 subjects were participated. Paired t-test showed a significant increase in NGF serumlevels and decrease both DNSym and DNSc with the difference value 12.64 ± 16.09 (p=0.000), 1.23 ± 0.82(p=0.000), 1.20 ± 0.85 (p=0.000). There was a significant negative correlation between NGF serum level withthe DNS- INA (r= -0.56; p=0.001) and the DNE-INA (r= -0.48; p=0.007).Conclusion: EMS treatment can increase serum NGF level. EMS has a strong correlation with a decrease inthe value of the DNS-INA and DNE-INA.Keywords: Diabetic Peripheral neuropathy, External Muscle Stimulation, Nerve Growth Factor.

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Case Report: Successful Outcome for Refractory Diabetic Peripheral Neuropathy in Patients With Ultrasound-Guided Injection Treatment

Frontiers in Endocrinology ◽

10.3389/fendo.2021.735132 ◽

2021 ◽

Vol 12 ◽

Author(s):

Hua Qiong Hu ◽

Hailun Huang ◽

Jing Huang ◽

Ji Cui Leng ◽

Mi Li ◽

...

Keyword(s):

Peripheral Neuropathy ◽

Diabetic Peripheral Neuropathy ◽

Scoring System ◽

Autonomic Nerve ◽

Successful Outcome ◽

Ultrasound Guided ◽

Intensive Glucose Control ◽

Chronic Complication ◽

Clinical Scoring ◽

Electrophysiological Examination

Diabetic peripheral neuropathy is the most prevalent chronic complication of diabetes and is based on sensory and autonomic nerve symptoms. Generally, intensive glucose control and nerve nourishment are the main treatments. However, it is difficult to improve the symptoms for some patients; such cases are defined as refractory diabetic peripheral neuropathy (RDPN). In this paper, we present five patients treated with saline and mecobalamin by ultrasound-guided injection. The Visual Analog Scale and Toronto Clinical Scoring System were used to evaluate the symptoms, and the neuro-ultrasound scoring system and electrophysiological severity scale were evaluated by ultrasound and electrophysiological examination. In brief, ultrasound-guided hydrodissection may be a safe way to treat RDPN.

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