Predictors of Barefoot Plantar Pressure during Walking in Patients with Diabetes, Peripheral Neuropathy and a History of Ulceration

Background: Patients with diabetes have been shown to suffer from increased fall risk. Research shows that this risk is higher on irregular surfaces. Existing studies evaluate gait on irregular surfaces, such as stairs, asphalt, grass and stones. This study evaluates gait parameters in individuals with diabetes mellitus type II (DMII) with no history of peripheral neuropathy, while ascending and descending a ramp at an imposed speed, and compares them with healthy controls. Methods: Fifteen healthy volunteer participants and fifteen participants with DMII and no peripheral neuropathy (females and males) between the ages of 40-65 were recruited for this study. Participants walked three times at 100 bpm while ascending and descending a wooden ramp. Temporospatial and kinematic parameters were analyzed. Results: We observed minimal changes in temporospatial and kinetic parameters in people with controlled DMII with no evidence of peripheral neuropathy. Conclusion: Focusing on individuals with controlled DMII allowed us to determine if only the diagnosis of diabetes without peripheral neuropathy influenced gait parameters. Clinicians and researchers should focus their assessments on neuromuscular activation during this stage of the condition, thus preventing complications, such as abnormal gait, that increases the risk for falls.

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Peripheral neuropathy among patients with NSCLC undergoing chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e20552 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e20552-e20552

Author(s):

Jerzy Edward Tyczynski ◽

Dongmu Zhang ◽

Bruce Allen Bach

Keyword(s):

Peripheral Neuropathy ◽

Cox Model ◽

Sensory Neuropathy ◽

Diabetic Polyneuropathy ◽

Chemotherapy Treatment ◽

Anti Cancer ◽

Patients With Diabetes ◽

History Of ◽

Major Factors ◽

Nsclc Patients

e20552 Background: Peripheral neuropathy (PN) occurs in NSCLC patients and may be due to various factors. One of the major factors is chemotherapy treatment. This study assessed the frequency and risk of PN among chemotherapy exposed NSCLC patients. Methods: This retrospective cohort study used the Optum claims in 2015-2017. The main inclusion criteria included: at least 2 diagnosis (Dx) claims for lung cancer; no other systemic cancer Dx within 6 months prior to the NSCLC Dx; at least one line of systemic anti-cancer treatment after the NSCLC Dx; presence of secondary metastatic disease. NSCLC was identified using a published algorithm. PN was identified by at least one claim with ICD-9/ICD-10 PN diagnosis code. Patients were followed from the earliest chemotherapy treatment date until a censoring event (PN Dx, end of enrollment, death, or end of study interval). Descriptive statistics were used to describe demographics; the Cox model and logistic regression were used to analyze risk associated with PN. Results: A total of 5082 patients were identified with an average age of 70.9 years (SD = 8.7) and 52% of male. Most common first line of treatment (LoT) was carboplatin + paclitaxel (31.9%); 32.7% of patients received a 2nd line, 7.6% received a 3rd line, and 1.7% received a 4th or higher line. 857 patients had PN during the follow-up period (16.9%). Median Charlson comorbidity index (CCI) was 1, and mean 1.7 (SD = 1.8). Patients with CCI of 4+ (716 patients) had nearly 60% elevated risk of PN as compared with CCI = 0. Patients with diabetes presented the OR (odds ratio) of 1.58; patients with a history of PN had a higher risk of PN after the initiation of chemotherapy (OR = 3.90). Compared with the PN risk during 1st LoT (reference), the OR of developing PN during 2nd and 3rd+ LoTs was elevated to 1.78 (95%CI 1.49-2.11; p < 0.0001) and 2.61 (95%CI 2.03-3.34; p < 0.0001), respectively. The most common type of PN was sensory neuropathy (33%), then polyneuritis (21%) and diabetic polyneuropathy (18%). Conclusions: PN is common in NSCLC patients. This analysis shows that the risk of PN in NSCLC patients increases significantly along increasing number of LoT. A history of PN and presence of diabetes play an important role as risk factors of PN during anti-cancer systemic treatment.

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Pedobarographic Statistical Parametric Mapping may identify specific plantar pressure patterns in patients with diabetes mellitus among different degrees of peripheral neuropathy: a pilot study

Diabetic Medicine ◽

10.1111/dme.14572 ◽

2021 ◽

Author(s):

Antoine Chatrenet ◽

Bruno Beaune ◽

Jean‐Michel Audebrand ◽

Massimo Torreggiani ◽

Giorgina Barbara Piccoli ◽

...

Keyword(s):

Diabetes Mellitus ◽

Peripheral Neuropathy ◽

Pilot Study ◽

Plantar Pressure ◽

Statistical Parametric Mapping ◽

Parametric Mapping ◽

Patients With Diabetes

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Plantar Pressure as a Risk Assessment Tool for Diabetic Foot Ulceration in Egyptian Patients with Diabetes

Clinical Medicine Insights Endocrinology and Diabetes ◽

10.4137/cmed.s17088 ◽

2014 ◽

Vol 7 ◽

pp. CMED.S17088 ◽

Cited By ~ 10

Author(s):

Olfat A. Fawzy ◽

Asmaa I. Arafa ◽

Mervat A. El Wakeel ◽

Shaimaa H. Abdul Kareem

Keyword(s):

Pressure Gradient ◽

Plantar Pressure ◽

Assessment Tool ◽

Peak Pressure ◽

Foot Deformity ◽

Duration Of Diabetes ◽

Significant Difference ◽

Patients With Diabetes ◽

Peak Plantar Pressure ◽

History Of

Background Diabetic foot ulceration is a preventable long-term complication of diabetes. In the present study, peak plantar pressures (PPP) and other characteristics were assessed in a group of 100 Egyptian patients with diabetes with or without neuropathy and foot ulcers. The aim was to study the relationship between plantar pressure (PP) and neuropathy with or without ulceration and trying to clarify the utility of pedobarography as an ulceration risk assessment tool in patients with diabetes. Subjects and Methods A total of 100 patients having diabetes were selected. All patients had a comprehensive foot evaluation, including assessment for neuropathy using modified neuropathy disability score (MNDS), for peripheral vascular disease using ankle brachial index, and for dynamic foot pressures using the MAT system (Tekscan). The studied patients were grouped into: (1) diabetic control group (DC), which included 37 patients who had diabetes without neuropathy or ulceration and MNDS ≤ 2; (2) diabetic neuropathy group (DN), which included 33 patients who had diabetes with neuropathy and MNDS >2, without current or a history of ulceration; and (3) diabetic ulcer group (DU), which included 30 patients who had diabetes and current ulceration, seven of those patients also gave a history of ulceration. Results PP parameters were significantly different between the studied groups, namely, forefoot peak plantar pressure (FFPPP), rearfoot peak plantar pressure (RFPPP), forefoot/rearfoot ratio (F/R), forefoot peak pressure gradient (FFPPG) rearfoot peak pressure gradient (RFPPG), and forefoot peak pressure gradient/rearfoot peak pressure gradient (FFPPG/RFPPG) ( P < 0.05). FFPPP and F/R were significantly higher in the DU group compared to the DN and DC groups ( P < 0.05), with no significant difference between DN and DC. FFPPG was significantly higher in the DU and DN groups compared to the DC group ( P < 0.05). RFPPP and FFPPG/RFPPG were significantly higher in the DU and DN groups compared to the DC group ( P < 0.05) with no significant difference between the DN and DU groups ( P > 0.05). FFPPP, F/R ratio, FFPPG, and FFPPG/RFPPG correlated significantly with the severity of neuropathy according to MNDS ( P < 0.05). These same variables as well as MNDS were also significantly higher in patients with foot deformity compared to those without deformity ( P < 0.05). Using the receiver operating characteristic analysis, the optimal cut-point of PPP for ulceration risk, as determined by a balance of sensitivity, specificity, and accuracy was 335 kPa and was found at the forefoot. Multivariate logistical regression analysis for ulceration risk was statistically significant for duration of diabetes (odds ratio [OR] = 0.8), smoking (OR = 9.7), foot deformity (OR = 8.7), MNDS (OR = 1.5), 2-h postprandial plasma glucose (2 h-PPG) (OR = 0.9), glycated hemoglobin (HbAz1c) (OR = 2.1), FFPPP (OR = 1.0), and FFPPG (OR = 1.0). Conclusion In conclusion, persons with diabetes having neuropathy and/or ulcers have elevated PPP. Risk of ulceration was highly associated with duration of diabetes, smoking, severity of neuropathy, glcemic control, and high PP variables especially the FFPPP, F/R, and FFPPG. We suggest a cut-point of 355 kPa for FFPPP to denote high risk for ulceration that would be more valid when used in conjunction with other contributory risk factors, namely, duration of diabetes, smoking, glycemic load, foot deformity, and severity of neuropathy.

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Plantar Pressure in Diabetic Peripheral Neuropathy Patients with Active Foot Ulceration, Previous Ulceration and No History of Ulceration: A Meta-Analysis of Observational Studies

PLoS ONE ◽

10.1371/journal.pone.0099050 ◽

2014 ◽

Vol 9 (6) ◽

pp. e99050 ◽

Cited By ~ 40

Author(s):

Malindu Eranga Fernando ◽

Robert George Crowther ◽

Elise Pappas ◽

Peter Anthony Lazzarini ◽

Margaret Cunningham ◽

...

Keyword(s):

Peripheral Neuropathy ◽

Plantar Pressure ◽

Diabetic Peripheral Neuropathy ◽

Observational Studies ◽

Meta Analysis ◽

Foot Ulceration ◽

History Of

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Ankle and Hindfoot Fusions: Comparison of Outcomes in Patients with and without Diabetes

Foot & Ankle International ◽

10.3113/fai.2012.0020 ◽

2012 ◽

Vol 33 (1) ◽

pp. 20-28 ◽

Cited By ~ 63

Author(s):

Thomas G. Myers ◽

Nicholas J. Lowery ◽

Robert G. Frykberg ◽

Dane K. Wukich

Keyword(s):

Peripheral Neuropathy ◽

Tobacco Use ◽

Glucose Control ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Complication Rates ◽

Increased Risk ◽

Patients With Diabetes ◽

History Of

Background: Patients with diabetes mellitus (DM) are believed to have higher complication rates when undergoing ankle and hindfoot fusions, but data is lacking. The purpose of this study was to compare the postoperative outcomes of major foot and ankle arthrodeses in patients with and without DM. Another goal was to evaluate what effect glycemic control had on the outcomes of patients with diabetes. Methods: A retrospective review of charts from operative years 2005 to 2010 was performed. Inclusion criteria encompassed patients requiring major hindfoot and/or ankle fusion. Exclusion criteria included any patient who did not have at least 6-month followup. Seventy four patients with DM were matched with 74 non-DM patients based on age, gender, and length of surgery. Significance was set at p < 0.05 with associated 95% confidence intervals. Results: The overall complication rate was found to be significantly higher in patients with DM, a history of tobacco use, and peripheral neuropathy. The postoperative infection rate was found to be significantly higher in patients with DM, poor long-term glucose control (Hgb A1c levels greater than or equal to 7%), a history of tobacco use, peripheral artery disease, and peripheral neuropathy. Our rate of noninfectious complications was found to be significantly higher in patients with DM, poor short-term glucose control (a preoperative glucose greater than 200 mg/dL), a history of tobacco use, and previous solid organ transplantation. Patients greater than or equal to 65 years of age were significantly associated with fewer overall complications and postoperative infections. Conclusion: This study confirmed our hypothesis that patients with DM were at increased risk for postoperative complications after foot and/or ankle arthrodesis when compared to patients without DM. A secondary finding of this study demonstrated patients with poor short- and long-term glucose control experienced more complications. Level of Evidence: III, Retrospective Comparative Study

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Glycated Hemoglobin (HbA1c) as a Biomarker for Diabetic Foot Peripheral Neuropathy

Diseases ◽

10.3390/diseases9010016 ◽

2021 ◽

Vol 9 (1) ◽

pp. 16

Author(s):

Giulia Casadei ◽

Marta Filippini ◽

Lorenzo Brognara

Keyword(s):

Diabetes Mellitus ◽

Peripheral Neuropathy ◽

Diabetic Foot ◽

Glycated Hemoglobin ◽

Chronic Inflammatory Demyelinating Polyneuropathy ◽

Glycemic Variability ◽

Future Research ◽

Patients With Diabetes ◽

Axonal Dysfunction ◽

Biomarker Research

Background: Diabetic peripheral neuropathy (DPN) is known to predict foot ulceration, lower-extremity amputation and mortality. Patients with diabetes mellitus have a predisposition toward developing chronic inflammatory demyelinating polyneuropathy, and this may also facilitate the formation of diabetic foot and cutaneous impairment, which are considered one of the most serious impairments of diabetes mellitus, with a prevalence of 4–10% in this population. Biomarkers research provides opportunities for the early diagnosis of these complications for specific treatments useful to prevent amputation and, therefore, physical inability and mental disturbance. The recent literature has suggested that glycemic levels may be a novel factor in the pathogenesis of diabetic foot complications and is an important mediator of axonal dysfunction. The aim of this systematic literary review is to determine whether hemoglobin A1c (HbA1c) is a positive predictor for diabetic foot peripheral neuropathy and its complications, such as foot cutaneous impairments. There is a lack of consensus regarding the effect of glycemic variability on diabetic foot peripheral neuropathy, unlike other complications such as retinopathy, nephropathy or micro/macrovascular pathology. Methods: Relevant articles were searched in the Medline database using PubMed and Scopus and relevant keywords. The primary search terms used were “glycated hemoglobin” OR “HbA1c” AND “diabetic neuropathies” AND “Foot”. Results: A number of articles (336) were initially identified while searching the scientific literature regarding this topic, and 32 articles were selected and included in this review. Conclusions: This review highlights the role of HbA1c in diabetic foot peripheral neuropathy. Biomarkers play an important role in the decision-making process, and HbA1c levels are extensively used for diabetic foot clinical outcomes and settings, but biomarker research in diabetic foot peripheral neuropathy is in its infancy and will require careful attention to a number of factors and associations, since the consequences of DPN also include neurological alterations. HbA1c is an accurate and easy-to-administer test and can be an effective biomarker in establishing the diagnosis of diabetes, but future research should focus on standardizing the HbA1c level and selecting which DPN value and its correlated complications, such as foot cutaneous impairments, are the most informative.

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Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

Diabetologia ◽

10.1007/s00125-020-05351-w ◽

2021 ◽

Vol 64 (4) ◽

pp. 778-794 ◽

Cited By ~ 2

Author(s):

Matthieu Wargny ◽

◽

Louis Potier ◽

Pierre Gourdy ◽

Matthieu Pichelin ◽

...

Keyword(s):

Prognostic Factors ◽

Hospital Discharge ◽

Microvascular Complications ◽

White Cell Count ◽

Symptom Duration ◽

Protein Levels ◽

Reactive Protein ◽

Patients With Diabetes ◽

History Of ◽

Routine Therapy

Abstract Aims/hypothesis This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). Methods The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. Results We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th–75th percentile) 28.4 (25.0–32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5–14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. Conclusions/interpretation In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. Trial registration Clinicaltrials.gov identifier: NCT04324736 Graphical abstract

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Effects of offloading devices on static and dynamic balance in patients with diabetic peripheral neuropathy: A systematic review

Reviews in Endocrine and Metabolic Disorders ◽

10.1007/s11154-020-09619-9 ◽

2021 ◽

Author(s):

Koen Andre Horstink ◽

Lucas Henricus Vincentius van der Woude ◽

Juha Markus Hijmans

Keyword(s):

Systematic Review ◽

Peripheral Neuropathy ◽

Plantar Pressure ◽

Diabetic Peripheral Neuropathy ◽

Balance Control ◽

Dynamic Balance ◽

Movement Control ◽

Future Research ◽

Static Balance ◽

Somatosensory Information

AbstractPatients with diabetic peripheral neuropathy (DPN) usually have reduced somatosensory information and altered perception in feet and ankles. Somatosensory information acts as feedback for movement control and loss of somatosensation leads to altered plantar pressure patterns during gait and stance. Offloading devices are used to reduce peak plantar pressure and prevent diabetic foot ulcers. However, offloading devices can unfortunately have negative effects on static and dynamic balance. It is important to investigate these unwanted effects, since patient with DPN already are at high risk of falling and offloading devices could potentially increase this risk. The aim of this systematic review is to investigate the effects of plantar offloading devices used for ulcer prevention on their role in static and dynamic balance control in patients with DPN. PubMed and Embase were systematically searched using relevant search terms. After title selection, abstract selection, and full-text selection only five articles could be included for further analysis. Two articles included static balance measurements, two articles included dynamic balance measurements, and one article included both. Results suggested that static balance control is reduced when rocker bottom shoes and different insole configurations are used, however, toe-only rockers showed less evidence for reduced static balance control. There was no evidence for reduced dynamic balance control in combination with offloading devices. However, these results should be interpreted with care, since the number of studies was very small and the quality of the studies was moderate. Future research should evaluate balance in combination with different offloading devices, so that clinicians subscribing them are more aware of their potential unwanted consequences.

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