Comparison of Cross Sectional Area of Posterior Tibial Nerve in Diabetic Peripheral Neuropathy Patients with That of Healthy Controls Using High Resolution Ultrasonography - A Cross Sectional Comparative Descriptive Study from Bangalore

BACKGROUND Patients with diabetic peripheral neuropathy (DPN) suffer from numbness, burning feet, lightning pain, and pins-and-needles sensations. Recently, High resolution ultrasonography is commonly used for evaluation of peripheral nerve diseases because of its easy availability, time saving and non-invasiveness of the procedure. This study intended to compare the cross sectional area (CSA) of posterior tibial nerve (PTN) in type 2 diabetic patients with peripheral neuropathy with that of non-diabetic healthy adults using high resolution ultrasonography (HRU) and study the role of increase in HbA1c level and severity of DPN comparing with CSA of PTN. METHODS A cross sectional comparative descriptive study was conducted from November 2018 to May 2020 with 50 type 2 diabetic patients and 50 healthy adults. 50 type 2 diabetic patients, clinically diagnosed with DPN were analysed and using the Toronto Clinical Neuropathy Score (TCNS) System, the severity of neuropathy was determined. HbA1c level and other demographic data were collected. 50 healthy adults were taken as controls. The CSA of posterior tibial nerve was measured 3 cm proximal to the medial malleolus in both lower limbs using HRU. RESULTS The mean CSA of posterior tibial nerve in healthy subjects was 6.0 + / - 0.142 mm2 , and in diabetic patients with peripheral neuropathy was 11.77 + / - 0.291 mm2 . Upon comparing the mean CSA of posterior tibial nerve of diabetic subjects with peripheral neuropathy and control subjects were statistically significant (P < 0.001) in unpaired ‘t’ test. In our study, CSA of the posterior tibial nerve correlated significantly with TCNS and HbA1c levels, at P < 0.001. CONCLUSIONS This study showed that there is a significant difference between the cross sectional areas of posterior tibial nerve in diabetic subjects with peripheral neuropathy and healthy adult subjects. HRU can detect cross sectional area changes in the posterior tibial nerve early. Thus, ultrasonography can be used as a good screening tool in these patients. KEYWORDS Diabetic Peripheral Neuropathy, Posterior Tibial Nerve, High Resolution Ultrasonography

Download Full-text

Comparison of Cross Sectional Areas of Median Nerve in Type 2 Diabetic Patients with Peripheral Neuropathy with Healthy Adult Subjects Measured by 2 D-B Mode High Resolution Ultrasonography

BIRDEM Medical Journal ◽

10.3329/birdem.v8i1.35039 ◽

2017 ◽

Vol 8 (1) ◽

pp. 47-51

Author(s):

Md Towhidur Rahman ◽

AS Mohiuddin ◽

Md Mofazzal Sharif ◽

Jafreen Sultana ◽

Fahmida Yeshmine ◽

...

Keyword(s):

Peripheral Neuropathy ◽

Median Nerve ◽

Healthy Adult ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Cross Sectional ◽

The Mean ◽

The Difference ◽

Type 2 Diabetic

Background: Patients with diabetic peripheral neuropathy (DPN) have distal, symmetrical form of the disorder characterized by numbness, burning feet, pins-and-needles sensations and lightning pain. This study was designed to find out the difference between 2 Dimentional (D)-Brightness (B) mode high resolution ultrasonographically measured cross sectional areas of median nerve in type 2 diabetic patients with peripheral neuropathy and those of non-diabetic healthy adult subjects.Methods: This case-control study was done on 180 subjects aged 27-67 years in the department of Radiology and Imaging, BIRDEM from January 2012 to December 2013. Out of them 90 diabetic patients with peripheral neuropathy diagnosed electrophysiologically by nerve conduction study (NCS) were considered study group and age, sex and weight compatible 90 healthy subjects were considered as control group. Measurement of cross sectional areas of median nerve was performed first by the investigator himself purposefully, consecutively and subsequently confirmed by a radiologist in the department of Radiology and Imaging, BIRDEM, who did not know the subjects’ condition to eliminate bias. The major axis, minor axis and the cross sectional areas (CSA) of the median nerve were measured at the carpal tunnel.Results: In this study, the mean cross sectional areas (mm2) of median nerve healthy subjects was 7.78±1.00 mm2 and in diabetic patients with peripheral neuropathy was 13.67±2.97 mm2. The difference mean CSA of median nerve of diabetic subjects with peripheral neuropathy and control subjects were statistically significant (p<0.05) in unpaired ‘t’ test.Conclusion: This study showed that there is a significant difference between the cross sectional areas of median nerve in diabetic subjects with peripheral neuropathy and healthy adult subjects. The mean cross sectional areas of median nerve were increased in diabetic patients with peripheral neuropathy compared to control group.Birdem Med J 2018; 8(1): 47-51

Download Full-text

Serum free triiodothyronine is inversely associated with diabetic peripheral neuropathy but not with carotid atherosclerotic lesions in euthyroid patients with type 2 diabetes

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00760-2 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Mei-Fang Li ◽

Jiang-Feng Ke ◽

Shuai Li ◽

Jun-Wei Wang ◽

Zhi-Hui Zhu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Peripheral Neuropathy ◽

Intima Media Thickness ◽

Diabetic Patients ◽

Free Triiodothyronine ◽

Type 2 Diabetic Patients ◽

Cross Sectional ◽

Serum Free ◽

Atherosclerotic Lesions

Abstract Background The associations between serum free triiodothyronine (FT3) and diabetic peripheral neuropatprohy (DPN)/carotid atherosclerotic lesions in euthyroid patients with type 2 diabetes are still unclear. The purpose of our study was to explore the relations of FT3 to DPN and carotid atherosclerotic lesions in Chinese type 2 diabetes inpatients with euthyroid function. Methods 2477 euthyroid inpatients with type 2 diabetes were recruited and they were stratified into quartiles by FT3 levels in this cross-sectional study. Peripheral neuropathy was assessed by neurological symptoms and signs as well as nerve conduction velocity tests. Carotid atherosclerotic lesions, including carotid intima-media thickness, plaque and stenosis, were evaluated by Doppler ultrasound. Results The prevalence of DPN in type 2 diabetic patients exhibited the significant decrease across the FT3 quartiles (23.5%, 20.9%, 18.8%, and 11.2%, respectively, p < 0.001). Multiple logistical regression analysis also revealed that FT3 quartiles were significantly and inversely associated with DPN. Compared with the subjects in the highest FT3 quartile, the adjusted odds ratios (95% confidence interval) of DPN from the first to third FT3 quartile were successively 2.338 (1.407–3.884), 1.903 (1.134–3.194) and 1.598 (0.960–1.125). The patients with DPN had significantly higher prevalence of carotid atherosclerotic lesions compared with non-DPN patients. However, no statistical association was observed between FT3 quartiles and carotid atherosclerotic lesions after adjusting for confounder factors. Conclusions Lower FT3 within the normal range was independently associated with DPN, but not with carotid atherosclerotic lesions in Chinese euthyroid inpatients with type 2 diabetes.

Download Full-text

Prevalence and Determinants of Diabetic Peripheral Neuropathy/Foot Syndrome in a rural population of North India

10.21203/rs.3.rs-59734/v1 ◽

2020 ◽

Author(s):

MD Abu Bashar

Keyword(s):

Peripheral Neuropathy ◽

Diabetic Peripheral Neuropathy ◽

North India ◽

Limb Amputation ◽

Bivariate Analysis ◽

Diabetic Patients ◽

Care Hospital ◽

Type 2 Diabetic Patients ◽

Cross Sectional

Abstract Background Diabetic peripheral neuropathy (DPN), a common and troublesome complication in patients with type 2 diabetes mellitus (T2DM), contributes to a higher risk of diabetic foot ulcer and lower limb amputation. These situations can negatively impact the quality of life of affected individuals.Objectives The study aimed to assess prevalence of DPN in patients of type 2 DM from rural North India and associated risk factors. Methods A facility based cross sectional study was carried out among type 2 diabetic patients attending NCD clinic of a secondary care hospital in rural North India. A questionnaire which included socio-demographic details, clinical and laboratory parameters, and the Michigan Neuropathy Screening Instrument (MNSI) for detecting peripheral neuropathy, was administered to 100 consecutive patients. Statistical Package for Social Sciences (SPSS) version 25.0 was used for entering and analyzing data. Bivariate analysis was performed for determining the factors significantly associated with presence of DPN. Results The prevalence of DPN was 42.0%. Male gender, advancing age(≥60 years), longer duration of diabetes (>10 years ), smoking, physical inactivity, obesity, uncontrolled blood pressure, poor A glycaemic control and altered lipid profile were found to be significantly associated with the presence of DPN. Conclusion Prevalence of DPN among type 2 diabetics from rural north India is alarmingly high. There is need of essential screening of all diabetic patients by their primary care provider for early detection of DPN particularly in rural India.

Download Full-text

Prevalence of neuropathy in type 2 diabetic patients at sub-district hospital Akhnoor

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20211445 ◽

2021 ◽

Author(s):

Chandan Sharma ◽

Ashima Badyal

Keyword(s):

Peripheral Neuropathy ◽

District Hospital ◽

Vascular Complications ◽

Cross Sectional Study ◽

Effective Control ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Cross Sectional ◽

Study Participants

Background: Type 2 diabetes mellitus (T2DM) is a progressive disease and hampers the quality of life of the patients due to micro and macro-vascular complications associated with it, like: neuropathy. Peripheral neuropathy leads to numbness, loss of sensation, and sometimes pain in the feet, legs, or hands.Methods: A cross sectional study was conducted among 200 randomly selected T2DM patients of either gender presenting to the medicine outpatient department (OPD) of sub district hospital Akhnoor from August 2020 to February 2021.Results: Almost half of the participants having duration of DM for more than 10 years and a mean age of 56.8±12.2 years. Based on the Michigan neuropathy screening instrument (MNSI) assessment, 41% of study participants had a score of ≥6 in the history questionnaire. The most frequently reported symptoms among patients were numbness and pain while walking, which was present in 80.5% and 70.5% of study participants, respectively. Around 32-40.5% of T2DM patients were found to suffer from peripheral neuropathy in our study. A significantly higher prevalence of diabetic peripheral neuropathy (DPN) was found among males (43.7%) than females (37.1%).Conclusions: Early detection of DM and appropriate intervention and effective control is important for effective management among patients, especially with higher body mass index (BMI), obesity or with advancing age.

Download Full-text

Serum Free Triiodothyronine Is Inversely Associated With Diabetic Peripheral Neuropathy but Not With Carotid Atherosclerotic Lesions in Type 2 Diabetic Patients With Euthyroid Function

10.21203/rs.3.rs-773386/v1 ◽

2021 ◽

Author(s):

Mei-Fang Li ◽

Jiang-Feng Ke ◽

Shuai Li ◽

Jun-Wei Wang ◽

Zhi-Hui Zhu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Peripheral Neuropathy ◽

Diabetic Patients ◽

Free Triiodothyronine ◽

Type 2 Diabetic Patients ◽

Cross Sectional ◽

Serum Free ◽

Atherosclerotic Lesions ◽

Type 2 Diabetic

Abstract Background: The associations between serum free triiodothyronine (FT3) and diabetic peripheral neuropatprohy (DPN) / carotid atherosclerotic lesions in type 2 diabetic patients with normal thyroid function is still unclear. The purpose of our study was to explore the relationships of FT3 with DPN and carotid atherosclerotic lesions in Chinese type 2 diabetes inpatients with euthyroid function.Methods: A total of 2477 type 2 diabetes inpatients with euthyroid function were recruited in this cross-sectional study, and they were stratified into quartiles by FT3 levels. Peripheral neuropathy was assessed by neurological symptoms and signs as well as nerve conduction velocity tests. Carotid atherosclerotic lesions, including carotid intima-media thickness, plaque and stenosis, were evaluated by Doppler ultrasound. Results: After adjusting for potential confounders, there was a significant decrease in the prevalence of DPN in the patients with type 2 diabetes across the FT3 quartiles (23.5%, 20.9%, 18.9%, and 11.2%, respectively, p < 0.001). Logistical regression analysis further revealed that FT3 quartiles were significantly and inversely associated with DPN. Compared with the subjects in the highest FT3 quartile, the adjusted odds ratios (95% confidence interval) of DPN in the first to third FT3 quartile were successively 2.338 (1.407-3.884), 1.903 (1.134-3.194) and 1.598 (0.960-1.125). The patients with DPN had significantly higher prevalence of carotid plaques (55.8%) and carotid stenosis (1.3%) than non-DPN patients (44.8%; 0.5%). However, no statistical association was observed between FT3 quartiles and carotid atherosclerotic lesions.Conclusions: Lower FT3 within the normal range was independently associated with DPN, but not with carotid atherosclerotic lesions in Chinese type 2 diabetes inpatients with euthyroid function.

Download Full-text

Prevalence and Determinants of Diabetic Peripheral Neuropathy/Foot Syndrome in the Rural Population of North India

Iberoamerican Journal of Medicine ◽

10.53986/ibjm.2021.0005 ◽

2020 ◽

Vol 3 (1) ◽

pp. 18-25

Author(s):

MD Abu Bashar ◽

◽

Madhur Verma ◽

Keyword(s):

Peripheral Neuropathy ◽

Diabetic Peripheral Neuropathy ◽

North India ◽

Limb Amputation ◽

Bivariate Analysis ◽

Diabetic Patients ◽

Care Hospital ◽

Type 2 Diabetic Patients ◽

Cross Sectional

Introduction: Diabetic peripheral neuropathy (DPN), a common and troublesome complication of diabetes mellitus (DM), leads to a higher risk of diabetic foot ulcers and lower limb amputation. This study aimed to assess the prevalence of DPN among patients of type 2 DM from rural North India and associated risk factors for the condition. Materials and Methods: A facility-based cross-sectional study was carried out among type 2 diabetic patients attending the Non-Communicable Diseases (NCD) clinic of a secondary care hospital in rural North India. A questionnaire that included sociodemographic details, clinical and laboratory parameters, and the Michigan Neuropathy Screening Instrument (MNSI) for detecting peripheral neuropathy was administered to 100 consecutive eligible patients. Statistical Package for Social Sciences (SPSS) version 25.0 was used for entering and analyzing data. Bivariate analysis was performed to determine the factors significantly associated with the presence of DPN. Results: The prevalence of DPN was found to be 42.0%. Male gender, advancing age (≥60 years), longer duration of diabetes (>10 years), smoking, physical inactivity, obesity, uncontrolled blood pressure, poor glycemic control and altered lipid profile were found to be significantly associated with the presence of DPN. Conclusions: The prevalence of DPN among type 2 diabetes patients from rural northern India is alarmingly high. There is a need for essential screening of all diabetic patients by their primary care provider for early detection of DPN, particularly in rural India.

Download Full-text

Association Of Vitamin D Deficiency With Type 2 Diabetes

Journal of Bahria University Medical and Dental College ◽

10.51985/jbumdc2019080 ◽

2019 ◽

Vol 09 (04) ◽

pp. 286-289

Author(s):

Sehrish Shafique ◽

Rana Ansari ◽

Hamidullah Arif ◽

Sajid Abbas Jafri ◽

Naveed Faraz

Keyword(s):

Type 2 Diabetes ◽

Vitamin D ◽

Peripheral Neuropathy ◽

Vitamin D Deficiency ◽

Ethical Review ◽

Diabetic Patients ◽

Age Group ◽

Type 2 Diabetic Patients ◽

Cross Sectional

Objective: To determine the association of Vitamin D deficiency with peripheral neuropathy in patients of type-2 Diabetes mellitus. Study Design and Setting: It was a cross sectional study conducted in a private clinic in Karachi, during a period of three months. Methodology: Total of 70 cases were included according to inclusion and exclusion criteria. Approval was sought from Ethical review committee. Consent was signed from the patients before the data collection. All the patients who were coming to the clinic, 30-75years of age, had history of type 2 diabetes for more than 5 year with HbA1c of 7% or above and had peripheral neuropathy were included. Data was collected in a pre-designed proforma. For entry of data and its statistical analysis SPSS version 20 was used. Results: From the total 70 cases n=41(58.5%) were vit D deficient. Most of the patients with type 2 diabetes with neuropathy were in the age group of 61-75yrs (57%) followed by 46- 60yrs age group (30 %). This study also showed that 30 females (73%) and 11 males (26.8 %) were deficient in vitamin D. Conclusion: Type 2 diabetic patients with vitamin D deficiency were more at risk of developing diabetic peripheral neuropathy (DPN) earlier. It is required to supply vitamin D appropriately for preventing DPN in type 2 diabetes

Download Full-text

Electrophysiological evaluation of peripheral neuropathy in chronic kidney disease patients: A study from tertiary care centre, Maharashtra

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0802.09 ◽

2020 ◽

Vol 8 (2) ◽

pp. 29-37

Author(s):

Gajanan Gondhali ◽

J K Deshmukh ◽

Ashish Kundalwal ◽

ANANT TAKALKAR

Keyword(s):

Peripheral Neuropathy ◽

Tibial Nerve ◽

Motor Pattern ◽

Tertiary Care ◽

Motor Neuropathy ◽

Posterior Tibial Nerve ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Posterior Tibial ◽

Sensory Motor

ntroduction: CKD has turned a major cause of morbidity and mortality. The prevalence of peripheral neuropathy is directly proportional to duration and severity of CKD. Peripheral neuropathy becomes evident after the patient reaches stage 4 CKD, but electrophysiological evidences occurs earlier. NCS is an important means of evaluating the functional integrity of peripheral nerves and has implications regarding clinical course and prognosis. Objectives: To study electrophysiological findings of peripheral neuropathy in CKD patients Methodology: The present study was a cross sectional; descriptive study was conducted in October 2016 to October 2018. Data analysed by using SPSS 23.0 version. Clinical and neurological examinations were done and blood investigations were performed following which NCS was done. Results: Out of 90 subjects, majority were from 45-54 years age group (26). 70% were male and 30% were females. Total 10 (11.11%) patients showed pure sensory type of PN. Total 47 (52.22%) patients showed sensory-motor type of PN. sensory-motor type of PN was the predominant type (52.22%) found in study followed by pure sensory type of PN (11.11%). Pure axonal sensory motor pattern of PN found in 15 (25%) patients in preHD group, 11 (36.66%) patients in HD group. The difference between the pre-HD and HD groups were statistically significant for the median nerve amplitude, common peroneal nerve CV, posterior tibial nerve CV, posterior tibial nerve distal latency and sural nerve distal latency (p < 0.05). Conclusion:Peripheral neuropathy is very common in CKD, more common in dialysis patients as compared to predialysis patients. It’s frequency and severity increase as the duration of disease and stage of CKD increases. Sensory motor type of neuropathy is more common than pure sensory type of neuropathy.Pure axonal sensory motor and mixed (axonal + demyelinating) sensory motor neuropathy are common patterns of PN in CKD.

Download Full-text