scholarly journals Clinical study of diabetic peripheral neuropathy screening by retinal vascular geometric parameters

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Guotao Hu ◽  
Hongmei Wu ◽  
Lei Kuang ◽  
Benny Chung-Ying Zee ◽  
Ying Huang ◽  
...  
Keyword(s):  
Fractal Dimension ◽  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Geometric Parameters ◽  
Fundus Photography ◽  
Retinal Vessels ◽  
Perception Threshold ◽  
Combined Use ◽  
Vascular Geometry ◽  
Retinal Vascular Geometry

AbstractTo investigate the relationship between geometrical changes of retinal vessels and diabetic peripheral neuropathy (DPN), and to determine the effectiveness of retinal vascular geometry analysis and vibration perception threshold (VPT) for DPN assessment. Type 2 diabetes patients (n = 242) were categorized by stage of DPN. VPT and fundus photography was performed to obtain retinal vascular geometry parameters. The risk factors for DPN and the correlation between DPN stages were analyzed. The efficiency of the retinal vascular geometric parameters obtained with VPT as a diagnostic tool for DPN was examined. Stages of DPN showed a linear correlation with VPT (r = 0.818), central retinal vein equivalent (CRVE) (r = 0.716), and fractal dimension arterioles (DFa) (r = − 0.769). VPT, CRVE, DFa, and fractal dimension veins (DFv) showed high sensitivity (80%, 55%, 82%, and 67%, respectively) and specificity (92%, 93%, 82%, and 80%, respectively) for DPN diagnosis. Good agreement was observed between combined use of geometric parameters (CRVE, DFa and DFv) and VPT (Kappa value 0.430). The detection rate of DPN with combined use of geometric parameters of retinal vessels (64.88%) was significantly higher than that with use of VPT (47.52%). Retinal vascular geometry changes demonstrated significant correlation with DPN severity. VPT, CRVE, DFa, and DFv may provide insights for understanding DPN.

Oral Alpha Lipoic Acid Treatment for Symptomatic Diabetic Peripheral Neuropathy: A Randomized Double-Blinded Placebo-Controlled Study

2020 ◽  
Vol 20 (9) ◽  
pp. 1531-1534 ◽  
Author(s):  
Mamdouh R. El-Nahas ◽  
Ghada Elkannishy ◽  
Hala Abdelhafez ◽  
Enas T. Elkhamisy ◽  
Amr A. El-Sehrawy
Keyword(s):  
Peripheral Neuropathy ◽  
Lipoic Acid ◽  
Diabetic Peripheral Neuropathy ◽  
Study Groups ◽  
Controlled Study ◽  
Alpha Lipoic Acid ◽  
Disability Score ◽  
Perception Threshold ◽  
Outcome Parameters ◽  
Double Blinded

Background: Alpha-lipoic acid (ALA) was used in the treatment of diabetic peripheral neuropathy (DPN) using different routes, doses and treatment durations. The aim of this work is to assess the efficacy of oral 600mg ALA twice daily over 6 months in the treatment of patients with DPN. Methods: This is a prospective, single-center, double-blinded, placebo-controlled study conducted at the outpatient clinic of Mansoura Specialized Hospital, Mansoura University. A total of 200 patients with DPN were randomly assigned to add on treatment with either oral 600mg twice daily ALA (n=100) or placebo (n=100) for 6 months. Treatment outcome was assessed using vibration perception threshold (VPT), neurological symptom score (NSS), neurological disability score (NDS), and visual analog scale (VAS) for pain at baseline and at each visit (1, 3 and 6 months) after the start of treatment. Results: Comparison between the study groups regarding the baseline data revealed no statistically significant differences. with respect to the outcome parameters, no significant differences were found between the studied groups at baseline. However, in subsequent visits, ALA-treated patients had significantly better results regarding almost all the outcome parameters (NSS, NDS, VAS, VPT). Mild nausea was reported in 6 patients. None of the studied patients discontinued treatment. Conclusions: Oral 600mg ALA twice-daily treatment for DPN over 6 months is effective, safe and tolerable.

Diagnostic accuracy of monofilament test to detect diabetic neuropathy

2021 ◽  
Vol 10 (1) ◽  
pp. 20-25
Author(s):  
Sujan Shrestha ◽  
Mamen Prasad Gorhaly ◽  
Manil Ratna Bajracharya
Keyword(s):  
Peripheral Neuropathy ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diabetic Peripheral Neuropathy ◽  
Perception Threshold ◽  
Sensitivity Specificity ◽  
Vibration Perception ◽  
Monofilament Test

Background Diabetic peripheral neuropathy (DPN) is a significant independent risk factor for diabetic foot, and an effective screening instrument is required to diagnose DPN early to prevent future ulceration and amputation. This study aims to determine the diagnostic accuracy of monofilament test to detect diabetic peripheral neuropathy. Methods This cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital, Mahabouddha, Kathmandu from February 2016 to January 2017. A total of 96 diabetic patients attending inpatient and outpatient Department were selected. Diabetic peripheral neuropathy was assessed by measurement of loss of protective sensation (LOPS) by monofilament test and compared with vibration perception threshold by standard biothesiometer. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were calculated. Results The prevalence of diabetic peripheral neuropathy was 26%. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were found to be 92.0%, 95.8%, 88.5% and 97.1% respectively. There was strong association between LOPS by monofilament and vibration perception threshold by biothesiometer. Conclusion This study showed a strong diagnostic accuracy of monofilament test to detect DPN when compared with biothesiometer. As monofilament test is a cheap, easily available, and portable, it can be used in the periphery where biothesiometer is not available.  

scholarly journals Association between Circulating B-Type Natriuretic Peptide and Diabetic Peripheral Neuropathy: A Cross-Sectional Study of a Chinese Type 2 Diabetic Population

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Pijun Yan ◽  
Qin Wan ◽  
Zhihong Zhang ◽  
Yong Xu ◽  
Ying Miao ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Natriuretic Peptide ◽  
Diabetic Peripheral Neuropathy ◽  
Ankle Brachial Index ◽  
Perception Threshold ◽  
Cross Sectional ◽  
Potential Biomarker ◽  
Increased Risk ◽  
Circulating Levels

Cardiovascular disease which is associated with cardiac dysfunction, usually measured with circulating levels of B-type natriuretic peptide (BNP), has been associated with incidence and progression of diabetic peripheral neuropathy (DPN). The potential relationship of circulating physiological levels of BNP with DPN, however, has not been reported. Circulating levels of BNP were measured in 258 patients with type 2 diabetes mellitus (T2DM), and participants were divided into a DPN group ( n = 61 ) and no DPN group ( n = 197 ). The relationship between circulating physiological levels of BNP and DPN and other parameters was analyzed. Circulating levels of BNP were significantly elevated in T2DM patients with DPN compared to those without ( P = 0.001 ). Circulating levels of BNP were significantly and positively associated with systolic blood pressure ( P = 0.035 ), neutrophil-to-lymphocyte ratio ( P = 0.007 ), creatinine ( P = 0.030 ), vibration perception threshold values ( P = 0.021 ), and the prevalence of diabetic foot ulceration ( P = 0.039 ), peripheral arterial disease ( P = 0.013 ), DPN ( P = 0.032 ), and diabetic nephropathy ( P = 0.020 ) and negatively with lymphocyte count ( P = 0.003 ) and ankle-brachial index ( P = 0.038 ), irrespective of age, sex, and body mass index. Moreover, circulating levels of BNP was an independent decisive factor for the presence of DPN after multivariate adjustment (odds ratio, 1.044; 95% confidence interval, 1.006-1.084; P = 0.024 ). Additionally, the higher quartiles of circulating BNP were related significantly to an increased risk of DPN compared to the lowest quartile ( P = 0.003 ). Last but most importantly, the analysis of receiver operating characteristic curves revealed that the best cutoff value for circulating levels of BNP to predict DPN was 15.18 pg/mL (sensitivity 78.7% and specificity 48.2%). These findings suggest that high circulating physiological levels of BNP may be associated with the development of DPN and may be a potential biomarker for DPN in patients with T2DM.

Relationship Between Glycated Hemoglobin and Vibration Perception Threshold in Diabetic Peripheral Neuropathy

2019 ◽  
Vol 19 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Arun G. Maiya ◽  
Anche Parameshwar ◽  
Manjunath Hande ◽  
Vinayak Nandalike
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Glycated Hemoglobin ◽  
Pearson Correlation ◽  
Regression Result ◽  
Perception Threshold ◽  
Cross Sectional ◽  
Vibration Perception Threshold ◽  
The Relationship ◽  
Vibration Perception

Foot ulcers, infections, and deformity are some of the major sources of mortality and morbidity among the diabetic population. The relationship between glycated hemoglobin (HbA1c) and diabetic peripheral neuropathy (DPN) has been well established. There is a dearth of literature on the relationship between vibration perception threshold (VPT) and HbA1c values. So, the objective of the study was to determine the strength of linear relationship between HbA1c levels and vibration perception threshold in DPN. This cross-sectional study was conducted at Kasturba Hospital, Manipal, and diabetic foot screening camps held at various parts of Udupi district. Ethical approval was obtained from the Institutional Ethics Committee, Kasturba Hospital, Manipal (IEC:281/2017). A total of 534 participants ranging from 30 to 70 years of age and were diagnosed with type 2 diabetes mellitus on medications were included in the study. Neuropathy assessment consisting of monofilament and vibration perception threshold was done using Neurotouch beta version (Yostra Labs, Bengaluru, India). HbA1c measurement was done using turbidimetric inhibition immunoassay technique (Roche Diagnostics, Mannheim, Germany). Pearson correlation coefficient showed a moderate to good correlation between HbA1c and VPT ( r = .0.753, P < .001). Linear regression result has shown a significant relationship of VPT with HbA1c (4.033 [95% confidence interval = 3.67-4.39]). The present study has concluded that there is strong relationship between HbA1c values and VPT and could be a predictor for complications in the foot following DPN.

scholarly journals Association between Hemoglobin Levels and Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes: A Cross-Sectional Study Using Electronic Health Records

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Jun Yang ◽  
Pi-jun Yan ◽  
Qin Wan ◽  
Hua Li
Keyword(s):  
Type 2 Diabetes ◽  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Patient Characteristics ◽  
Continuous Variable ◽  
Perception Threshold ◽  
Cross Sectional ◽  
Increased Risk ◽  
The Impact

Objective. To investigate the relationship between hemoglobin levels and diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM). Methods. 1511 patients with T2DM were included in the study. DPN was diagnosed based on symptoms, signs, and laboratory tests. Hemoglobin was defined as both a continuous variable and a quartile category variable. We compared patient characteristics between the no diabetic peripheral neuropathy (NDPN) and DPN groups. Logistic regression was conducted to investigate the association of DPN with hemoglobin in all T2DM patients. Linear regression was also performed to investigate the impact of hemoglobin on the vibrating perception threshold (VPT). Results. Compared with the NDPN group, hemoglobin level in the DPN group was significantly lower (118.54 ± 16.91 versus 131.62 ± 18.32 g/L, P<0.01). The prevalence of DPN increased by 50.1% (95% CI: 42.2–57.0%; P<0.001) per standard deviation decrease in hemoglobin. Compared to the highest quartile of hemoglobin, the lower quartiles were associated with a significantly increased risk of DPN in the entire T2DM population (all P<0.01). A per unit decrease in hemoglobin leads to a 0.12 (95% CI: 0.07–0.168) unit increase in VPT after adjustment for possible confounders (P<0.001). Conclusions. Lower hemoglobin levels were associated with increased prevalence of DPN and higher VPT.

scholarly journals Corneal Confocal Microscopy – A Novel, Noninvasive Method to Assess Diabetic Peripheral Neuropathy

2014 ◽  
Vol 21 (4) ◽  
pp. 319-326 ◽  
Author(s):  
Georgeta Inceu ◽  
Horea Demea ◽  
Ioan Andrei Veresiu
Keyword(s):  
Peripheral Neuropathy ◽  
Confocal Microscopy ◽  
Diabetic Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Diabetic Patients ◽  
Noninvasive Method ◽  
Anthropometric Parameters ◽  
Perception Threshold ◽  
Peripheral Diabetic Neuropathy ◽  
Corneal Confocal Microscopy

AbstractBackground and aims. This article aims to compare corneal confocal microscopy (CCM) with acknowledged tests of diabetic peripheral neuropathy (DPN), to assess corneal nerve morphology using CCM in diabetic patients, and to underline possible correlations between clinical and biological parameters, diabetes duration and DPN severity. Material and methods. A total of 90 patients with type 2 diabetes were included in the study for whom we measured anthropometric parameters and we performed laboratory measurements (tests). The patients were assessed for diabetic peripheral neuropathy using Semmes-Weinstein Monofilament Testing (SWMT), Rapid-Current Perception Threshold (R-CPT) measurements using the Neurometer®, and CCM. We stratified the patients according to DPN severity, based on four parameters extracted after image analysis. Results. A higher percentage of patients were diagnosed with DPN using CCM (88.8%), compared with SWMT and R-CPT measurement (17.8% and 40% respectively). The incidence of DPN detected with CCM was considerable in patients with normal protective sensation and with normal R-CPT values. Conclusions. Our study showed that corneal confocal microscopy is a useful noninvasive method for diabetic neuropathy assessement in early stages. It was proven to directly quantify small fiber pathology, and to stratify neuropathic severity, and therefore can be used as a new, reliable tool in the diagnosis, clinical evaluation, and follow-up of peripheral diabetic neuropathy.

scholarly journals Prealbumin to fibrinogen ratio is closely associated with diabetic peripheral neuropathy

2020 ◽  
Vol 9 (8) ◽  
pp. 858-863
Author(s):  
Shufei Zang ◽  
Lei Shi ◽  
Jinying Zhao ◽  
Min Yang ◽  
Jun Liu ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Nerve Conduction Velocity ◽  
Roc Analysis ◽  
Diagnostic Value ◽  
Related Factors ◽  
Perception Threshold ◽  
Area Under Roc Curve ◽  
Vibration Perception

The aim of our study was to explore the diagnostic value of prealbumin to fibrinogen ratio (PFR) for predicting prognosis with the optimal cut-off value in diabetic peripheral neuropathy (DPN) patients. A total of 568 type 2 diabetes mellitus (T2DM) patients were enrolled in this study. The values including Toronto clinical neuropathy score (TCNS), nerve conduction velocity (NCV), vibration perception threshold (VPT), blood cells count, biochemical parameters, fibrinogen and PFR were recorded. The patients were divided into tertiles based on admission PFR value. First, clinical parameters were compared among the groups. Secondly, a logistic regression and ROC analysis were performed as the statistical model. The percentage of DPN, TCNS and VPT were significantly higher in the lowest PFR tertile than in the middle PFR tertile and the highest PFR tertile (P < 0.01–0.001). NCV was significantly lower in lowest PFR tertile than in the middle PFR tertile and the highest PFR tertile (P < 0.01–0.001). The Spearman correlation analysis showed that PFR was negatively correlated with TCNS and VPT (P < 0.001), while PFR was positively correlated with median motor NCV (P < 0.001), peroneal motor NCV (P < 0.001), median sensory NCV (P < 0.001), and peroneal sensory NCV (P < 0.001). After adjusting these potentially related factors, PFR was independently related to DPN (P = 0.007). The area under ROC curve was 0.627. This study finds the first evidence to suggest PFR may be the key component associated with DPN in T2DM, while PFR might underlie the pathophysiologic features of DPN.

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