scholarly journals Challenges in Diabetic Micro-Complication Management: Focus on Diabetic Neuropathy

2021 ◽  
Vol 1 (3) ◽  
pp. 175-186
Author(s):  
Prawej Ansari ◽  
J.M.A. Hannan ◽  
Shofiul Azam ◽  
Md. Jakaria
Keyword(s):  
Diabetic Neuropathy ◽  
Current Knowledge ◽  
Microvascular Complications ◽  
Clinical Manifestations ◽  
Treatment Strategies ◽  
Underlying Mechanism ◽  
Sensory Function ◽  
Diabetic Patients ◽  
Type I ◽  
Substantial Morbidity

The progression of diabetes leads to macro and microvascular complications, including diabetic neuropathy, which is the most prevalent microvascular complication with diabetes. Clinical manifestations of diabetic neuropathy begin with the loss of distal sensory function, pain, and substantial morbidity. It has been evident that ~50% of diabetic patients develop neuropathy at a certain stage in their lifetime. Interestingly, two major subtypes (type I and II) of diabetes do not share the same epidemiology and pathophysiology of diabetic neuropathy; thus, their management or treatment strategies may vary from each other. The past few decades of research suggest that many etiological features, diagnosis, and management complexities depend on the type of diabetes. However, the underlying mechanism of neuropathy in type I and type II diabetes remains unclear. This review provides the current knowledge on successful assessment, management, and pharmacological biomarkers to explore the treatment and surpass current challenges in diabetic neuropathy.

Polymorphism in exon 7 of the endothelial nitric oxide synthase gene is associated with low incidence of microvascular damage in type 1 diabetic neuropathy

2009 ◽  
Vol 4 (4) ◽  
pp. 521-527 ◽  
Author(s):  
Constantina Heltianu ◽  
Simona-Adriana Manea ◽  
Cristian Guja ◽  
Alexandra Robciuc ◽  
Constantin Ionescu-Tirgoviste
Keyword(s):  
Nitric Oxide ◽  
Nitric Oxide Synthase ◽  
Diabetic Neuropathy ◽  
Endothelial Nitric Oxide Synthase ◽  
Microvascular Complications ◽  
Diabetic Patients ◽  
Enos Gene ◽  
Oxide Synthase ◽  
Endothelial Nitric Oxide

AbstractMicrovascular complications associated with type 1 diabetes mellitus (T1DM) are caused in part by endothelial dysfunction. We aimed to determine the association between polymorphisms in endothelial nitric oxide synthase (eNOS) gene (894G>T, 4ab) and T1DM-associated microvascular disorders, and the roles of nitrite/nitrate products (NOx) and low molecular weight-AGEs (LMW-AGEs) levels in this relationship. We carried out a case-control study (328 subjects) and determined genotypes by PCR. The rare-type TT of eNOS 894G>T was significantly overrepresented in patients without microvascular disorders as compared with control (OR=3.64; 95% C.I.=1.02–12.73; P=0.039). The prevalence of neuropathy was high among 894GG homozygotes (OR=0.5; 95% C.I.=0.29–0.86; P=0.012) who had high levels of triglycerides, elevated systolic BP, increased NOx, and LMW-AGEs. Decreased NOx levels were associated with 894TT genotype (beta=−0.65; P=0.043) in diabetic patients prone to microvascular complications. Multiple regression analysis indicated a negative correlation between eNOS 894G>T and diabetic neuropathy (P=0.025). The distribution of eNOS 4aa genotype was high (P=0.042) in patients with T1DM; however, it does not represent a risk factor for neuropathy. The overrepresentation of eNOS 894TT genotype in diabetic patients is associated with low risk for neuropathy. Decreased NOx and LMW-AGEs levels and lower lipid profile are the main features of patients carrying the eNOS 894T allele. These data suggest that the eNOS 894TT genotype may play a protective role by preventing microvascular disorders.

scholarly journals ASSOCIATION OF SERUM HOMOCYSTEINE IN DIABETIC NEUROPATHY

2018 ◽  
Vol 11 ◽  
Author(s):  
Rujaswini T ◽  
Ranadheer Chowdary P ◽  
Vijey Aanandhi M ◽  
Shanmugasundaram P
Keyword(s):  
Diabetic Neuropathy ◽  
Blood Sugar ◽  
Elevated Serum ◽  
Serum Levels ◽  
Blood Parameters ◽  
P Value ◽  
Diabetic Patients ◽  
Type I ◽  
Type Ii ◽  
Serum Homocysteine

Aims and Objectives: The main aim of the study was to find out the association of serum homocysteine (HCY) in diabetic neuropathy patients. Methods: All the patients who were diagnosed with Type II diabetes mellitus will be included. Their serum levels of fasting blood sugar, postprandial blood sugar, glycated hemoglobin, and associated blood parameters will be assessed. Diabetic neuropathy will be confirmed using nerve conduction testing, electromyography, and quantitative sensory testing with clinically correlated. The serum HCY levels will be measured and correlated with other blood parameters. Results: Of 1000 patients, 46 were Type I diabetic and 954 were Type II. The prevalence of neuropathy in diabetic patients was 156. Mean serum HCY without diabetic neuropathy was 6.8+2.9 and serum HCY with diabetic neuropathy was 21.6+0.29 and p value was found to be 0.0017. The correlation between serum HCY and diabetic neuropathy was found to be 14.5 with p=0.001. Conclusion: There has been a significant increase of HCY in diabetic patients. It can be clearly seen that elevated serum HCY level has led to some of the complications of diabetic neuropathy.

Skin Microcirculation in Patients with Type I Diabetes with and without Neuropathy after Neurovascular Stimulation

1998 ◽  
Vol 94 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Thomas Forst ◽  
Andreas Pfützner ◽  
Thomas Kunt ◽  
Thomas Pohlmann ◽  
Ulrike Schenk ◽  
...  
Keyword(s):  
Blood Flow ◽  
Diabetic Neuropathy ◽  
Type I Diabetes ◽  
Capillary Blood ◽  
Capillary Blood Flow ◽  
Diabetic Patients ◽  
Type I ◽  
Skin Microcirculation ◽  
Skin Perfusion ◽  
Diabetes Patients

1. Neurovascular inflammation is impaired in patients suffering from diabetic neuropathy. The aim of our study was to evaluate the distribution of nutritive and total skin blood flow in diabetic patients with and without neuropathy after neurovascular stimulation with acetylcholine. 2. Twenty patients with Type I diabetes, 10 with and 10 without neuropathy, and 10 age-matched non-diabetic control subjects, underwent microvascular investigations before and after neurovascular stimulation by intracutaneous application of acetylcholine. The capillary blood cell velocity in the nailfold of the hallux was measured by videophotometric capillaroscopy, and the total skin microcirculation in the same area by laser Doppler flowmetry. 3. The increase in total skin blood flow was significantly impaired in the group of neuropathic diabetic patients compared with the non-neuropathic diabetic patients (17.5 ± 83 versus 51.0 ± 16.2; P < 0.05) and the non-diabetic subjects (17.5 ± 8.3 versus 67.8 ± 19.7; P < 0.01). The increase in capillary blood flow was not significantly impaired in Type 1 diabetes patients with neuropathy. 4. The ratio between capillary blood flow and total skin perfusion decreased significantly in the control group (from 0.82 ± 0.15 to 0.47 ± 0.11; P < 0.005) and in the Type I diabetes patients without neuropathy (from 0.79 ± 0.12 to 0.43 ± 0.12; P < 0.05), whereas the decrease in the neuropathic group was statistically insignificant (from 1.05 ± 0.19 to 0.72 ±0.16). 5. Diminished total skin perfusion in the foot after intracutaneous stimulation with acetylcholine in Type I diabetes patients is associated with diabetic neuropathy, indicating a disturbance in the neurovascular reflex arc. This impaired neurovascular response is caused by a diminished total and sub-papillary blood flow and not by a diminished nutritive capillary flow. There is no evidence of a diminished nutritive capillary blood flow during neurogenic inflammation in Type I diabetes patients suffering from diabetic neuropathy.

scholarly journals Impaired sensory nerve function and axon morphology in mice with diabetic neuropathy

2011 ◽  
Vol 106 (2) ◽  
pp. 905-914 ◽  
Author(s):  
Richard C. Lennertz ◽  
Karen A. Medler ◽  
James L. Bain ◽  
Douglas E. Wright ◽  
Cheryl L. Stucky
Keyword(s):  
Diabetic Neuropathy ◽  
Nerve Fiber ◽  
Sensory Nerve ◽  
The United States ◽  
Sensory Nerves ◽  
Sensory Function ◽  
Diabetic Patients ◽  
Fiber Morphology ◽  
C Fibers ◽  
Aβ Fibers

Diabetes is the most prevalent metabolic disorder in the United States, and between 50% and 70% of diabetic patients suffer from diabetes-induced neuropathy. Yet our current knowledge of the functional changes in sensory nerves and their distal terminals caused by diabetes is limited. Here, we set out to investigate the functional and morphological consequences of diabetes on specific subtypes of cutaneous sensory nerves in mice. Diabetes was induced in C57Bl/6 mice by a single intraperitoneal injection of streptozotocin. After 6–8 wk, mice were characterized for behavioral sensitivity to mechanical and heat stimuli followed by analysis of sensory function using teased nerve fiber recordings and histological assessment of nerve fiber morphology. Diabetes produced severe functional impairment of C-fibers and rapidly adapting Aβ-fibers, leading to behavioral hyposensitivity to both mechanical and heat stimuli. Electron microscopy images showed that diabetic nerves have axoplasm with more concentrated organelles and frequent axon-myelin separations compared with control nerves. These changes were restricted to the distal nerve segments nearing their innervation territory. Furthermore, the relative proportion of Aβ-fibers was reduced in diabetic skin-nerve preparations compared with nondiabetic control mice. These data identify significant deficits in sensory nerve terminal function that are associated with distal fiber loss, morphological damage, and behavioral hyposensitivity in diabetic C57Bl/6 mice. These findings suggest that diabetes damages sensory nerves, leading to functional deficits in sensory signaling that underlie the loss of tactile acuity and pain sensation associated with insensate diabetic neuropathy.

scholarly journals An Overview of Current Knowledge of Deadly CoVs and Their Interface with Innate Immunity

Viruses ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 560
Author(s):  
Yamei Zhang ◽  
Siobhan Gargan ◽  
Yongxu Lu ◽  
Nigel J. Stevenson
Keyword(s):  
Distress Syndrome ◽  
Current Knowledge ◽  
Immunosuppressive Treatment ◽  
Treatment Strategies ◽  
Large Family ◽  
Type I ◽  
Respiratory Tract Disease ◽  
Vaccine Research ◽  
Tract Disease ◽  
Human Coronaviruses

Coronaviruses are a large family of zoonotic RNA viruses, whose infection can lead to mild or lethal respiratory tract disease. Severe Acute Respiratory Syndrome-Coronavirus-1 (SARS-CoV-1) first emerged in Guangdong, China in 2002 and spread to 29 countries, infecting 8089 individuals and causing 774 deaths. In 2012, Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) emerged in Saudi Arabia and has spread to 27 countries, with a mortality rate of ~34%. In 2019, SARS-CoV-2 emerged and has spread to 220 countries, infecting over 100,000,000 people and causing more than 2,000,000 deaths to date. These three human coronaviruses cause diseases of varying severity. Most people develop mild, common cold-like symptoms, while some develop acute respiratory distress syndrome (ARDS). The success of all viruses, including coronaviruses, relies on their evolved abilities to evade and modulate the host anti-viral and pro-inflammatory immune responses. However, we still do not fully understand the transmission, phylogeny, epidemiology, and pathogenesis of MERS-CoV and SARS-CoV-1 and -2. Despite the rapid application of a range of therapies for SARS-CoV-2, such as convalescent plasma, remdesivir, hydroxychloroquine and type I interferon, no fully effective treatment has been determined. Remarkably, COVID-19 vaccine research and development have produced several offerings that are now been administered worldwide. Here, we summarise an up-to-date understanding of epidemiology, immunomodulation and ongoing anti-viral and immunosuppressive treatment strategies. Indeed, understanding the interplay between coronaviruses and the anti-viral immune response is crucial to identifying novel targets for therapeutic intervention, which may even prove invaluable for the control of future emerging coronavirus.

A new classification and strategies for endovascular treatment of celiac artery aneurysms

Vascular ◽  
2021 ◽  
pp. 170853812110327
Author(s):  
Xu Li ◽  
Wan Zhang ◽  
Min Zhou ◽  
Yong Ding ◽  
Yonggang Wang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Manifestations ◽  
Treatment Strategies ◽  
Celiac Artery ◽  
Type I ◽  
Type Ii ◽  
Main Trunk ◽  
Single Center Experience ◽  
Type Ia

Background Endovascular treatment is being increasingly used for celiac artery aneurysms (CAAs), but systematic endovascular treatment strategies have not been defined yet. This study intended to investigate the strategies of endovascular management of CAAs according to a single-center experience. Methods Anatomically, CAAs were classified into two types: Type I CAAs located in the main trunk of celiac artery. Type II CAAs located on the branches of the celiac artery. Type I and Type II CAAs can be further divided into two different subtypes according to fusiform (a) or saccular or (b) morphology: type Ia, type Ib, type IIa, and type IIb. Patient demographics, clinical manifestations, aneurysm characteristics, endovascular intervention procedures, and perioperative and follow-up outcomes were reviewed and analyzed. Results Between August 2012 and August 2020, 18 consecutive patients (12 men; mean age, 56.8 ± 14.5 years) with CAAs were identified and treated with endovascular procedures. There were seven patients with type Ia, three patients with type Ib, four patients with type IIa, and four patients with type IIb CAAs. One patient died of hemorrhagic shock due to a ruptured aneurysm. Technical success was achieved in 16 patients (88.9%). The mean follow-up period was 51.7 ± 19.4 months. No hepatic or intestinal ischemia or death developed perioperatively or during the follow-up period. No aneurysmal expansion was detected on CTA surveillance, except for one patient who was diagnosed with an endoleak during the follow-up and received reintervention. Conclusions The endovascular strategy based on the novel classification of CAAs was safe and effective, with a favorable mid-term clinical outcome.

scholarly journals Alpha Lipoic Acid Influence in the Attenuation of Oxidative Stress and of Clinical Manifestations of Neuropathy in Diabetes Mellitus Patients

2018 ◽  
Vol 15 (4) ◽  
pp. 15-26
Author(s):  
Bondar Andrei Cristian ◽  
Popa Amorin Remus
Keyword(s):  
Oxidative Stress ◽  
Diabetes Mellitus ◽  
Diabetic Neuropathy ◽  
Lipoic Acid ◽  
Healthy Subjects ◽  
Microvascular Complications ◽  
Clinical Manifestations ◽  
Clinical Aspects ◽  
Alpha Lipoic Acid ◽  
Perception Threshold

AbstractAlpha lipoic acid is an antioxidant substance used for the pathogenic treatment of diabetic neuropathy, oxidative stress being a central mechanism in diabetic microvascular complications. Our study included 24 diabetes mellitus patients with diabetic neuropathy and 20 healthy subjects. Diabetes patients were given alpha lipoic acid 600 mg intravenously for 10 days and then per os for 30 days.Significant improvements were observed concerning oxidative stress evaluated by measuring serum malondyaldehide and ceruloplasmin. The clinical characteristic of neuropathy improved, both the level of pain decreased and the vibration perception threshold increased. Our study demonstrated a two times higher level of oxidative stress in patients with diabetes compared to healthy subjects, and that by influencing oxidative stress we could influence the clinical aspects of neuropathy. Further investigations need to be done to explore the pleiotropic effects of alpha lipoic acid on other mechanisms that are implicated in the pathogenies of diabetic neuropathy.

scholarly journals The epidemiology and importance of vitamin B12 screening in diabetic patients

2021 ◽  
Author(s):  
Abrar A. A. Yamani ◽  
Jameel A. Awadain ◽  
Yousif A. A. Saleh ◽  
Mohammad S. Baothman ◽  
Feras H. Alhussainy ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Clinical Manifestations ◽  
Vitamin B12 Deficiency ◽  
Diabetic Patients ◽  
Type I ◽  
Type Ii ◽  
Impaired Metabolism ◽  
B12 Deficiency ◽  
Vitamin B12 Screening

Peripheral neuropathy is a commonly reported chronic adverse event among diabetes mellitus (DM) patients secondary to poor glycemic control. It might also result secondary to deficiency of vitamin B12, reportedly common among diabetic patients. Deficiency of vitamin B12 might result from prolonged metformin administration in patients with type II DM (T2DM). It might also result from reduced absorption and impaired metabolism-related events in type I DM (T1DM) patients. This occurs secondary to the presence of associated autoimmune disorders. Vitamin B12 deficiency is a commonly encountered condition among diabetic patients, both T1DM and T2DM, with variable etiologies. Our current study discussed the epidemiology and importance of screening of vitamin B12 in these patients. However, our findings show that screening is not commonly practiced in different settings. Therefore, awareness is low about the benefits and complications of this practice. Therefore, further research is encouraged to alleviate the quality of care in diabetic patients. Screening for vitamin B12 deficiency might intervene against any potential complications, including irreversible, painful, and potentially disabling nerve injury. Accordingly, it is recommended that screening should be initiated since the start of metformin administration and every year or when relevant clinical manifestations were reported.

Circulating Platelet-Leukocyte Aggregates as a Marker of Microvascular Lesions in Diabetic Patients.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3965-3965
Author(s):  
Ismail Elalamy ◽  
Tahar Chakroun ◽  
Francoise Robert ◽  
Chantal Lecrubier ◽  
Fabienne Elgrably ◽  
...  
Keyword(s):  
Type Ii Diabetes ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Inflammatory Cells ◽  
Vascular Lesions ◽  
Diabetic Patients ◽  
Type I ◽  
Flow Cytometry Assay ◽  
Thrombotic Diseases ◽  
Circulating Levels

Abstract Introduction: Evolution of diabetes is associated with multiple disorders including metabolic, cellular and blood disturbances leading to various vascular complications (micro-and macro-angiopathies). Increased circulating levels of platelet-leukocyte aggregates (PLA) have been described in several thrombotic diseases. Material and Methods: In this study, we have evaluated the circulating PLA in diabetic patients and we have investigated whether they may be linked to the vascular complications currently occurring during diabetes evolution. Using flow cytometry assay, we have quantified PLA percentages in 65 diabetics (37 males/28 females, 57 ± 11 years old) including 20 patients with type I and 45 with type II diabetes, and 25 healthy subjects (15 males/10 females, 44 ± 9 years old). Labelling approach using specific monoclonal antibodies permitted us to identify platelet-polymorphonuclear aggregates (PPA) and platelet-monocyte aggregates (PMA). Results: We have observed a significant increase of PPA and PMA levels in diabetics (22 ± 12% and 45 ± 18%, respectively) compared to control subjects (7 ± 4% and 19 ± 10%, respectively). However, both PPA and PMA values were similar in the two types of diabetes and they were not correlated to the disease duration. Circulating PPA and PMA percentages were significantly enhanced in diabetics with vascular lesions (n=37; PPA: 24 ± 13%; PMA: 50 ± 18%) than in diabetics without vascular lesions (n=28; PPA: 18 ± 8%; PMA: 38 ± 15%). Patients with PPA > 18% and /or PMA > 38% had a more important vascular thrombotic damage (OR: 6; 95%; IC: 1.6; 23). The increased PMA circulating percentage seems to be more specific for micro-retinopathy occurrence (OR: 19, 95% IC: 2.3; 154). The rare patients with elevated PMA percentage and without vascular lesions have a shorter duration of diabetes (7 ± 5 years) than patients presenting retinopathy lesions (16 ± 11 years). Conclusion: Together our findings established a relationship between increased circulating PLA rate, particularly that of PMA, and the incidence of microvascular complications in diabetic patients. In addition, they reinforce the concept that pro-inflammatory cells are involved in diabetic retinopathy pathogenesis.

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