scholarly journals USEFULNESS OF ADDING BIOTHESIOMETRY TO CLINICAL ASSESSMENT PROTOCOLS IN PATIENTS WITH DIABETIC PERIPHERAL NEUROPATHY AFFECTING LOWER LIMBS

2020 ◽  
pp. 49-52
Author(s):  
Padma Kumar G ◽  
Selvan P ◽  
George Zachariah ◽  
S Abdul Gafoor
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Neuropathy ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Diabetic Peripheral Neuropathy ◽  
Lower Limbs ◽  
Perception Threshold ◽  
Cross Sectional ◽  
Major Health Problem ◽  
Patients With Diabetes

BACKGROUND Diabetes Mellitus is a major health problem of which Diabetic Peripheral Neuropathy (DPN) is an important complication resulting in ulceration and amputation. There are a number of bedside tests and evaluation which has been suggested for early diagnosis of DPN. This study aims to evaluate the usefulness of Biothesiometry when combined along with Diabetic Neuropathy Symptom Score (DNS) and Diabetic Neuropathy Examination Score (DNE) as compared against Nerve Conduction Study (NCS). NCS is considered as the gold standard in diagnosis of DPN. METHODS This is a cross-sectional study which was done in the Department of Physical Medicine & Rehabilitation, Government Medical College, Thiruvananthapuram, Kerala which is a tertiary level referral center. The study was done in a one-year period between January 2018 and January 2019 in patients with diabetes who satisfied the inclusion criteria. Patients were first evaluated with a Performa which included DNS and DNE scoring and compared with NCS parameters. Vibration Perception Threshold (VPT) was assessed with a Biothesiometer and the combined results were compared with Nerve Conduction Study (NCS). The values obtained were entered in excel sheet and statistically evaluated. RESULTS 127 patients with Diabetes were recruited into the study out of which 49 were males and 78 were females with a mean age of 57.2 +/- 9.9 years. When patients who were clinically positive for DPN on evaluation with DNS and DNE were compared with NCS parameters, it was shown that there was a sensitivity of 96.2 % and specificity of 38.1% and when VPT measurement using Biothesiometer was added to the clinical evaluation the sensitivity was 100% with a negative predictive value of 100% and specificity of 23.8%. This study has shown that all of the patients who tested negative were true negatives. CONCLUSION This study concluded that addition of Biothesiometry to the combination of DNS, DNE for the evaluation of DPN is as good as NCS evaluation. Hence this combination will be useful in rural settings, where accessibility to expensive Electrodiagnostic machine is limited.

scholarly journals HUBUNGAN KADAR LIPID DARAH DENGAN DERAJAT KEPARAHAN NEUROPATI DIABETIK PERIFER DI RUMAH SAKIT WAHIDIN SUDIROHUSODO

2019 ◽  
Vol 37 (1) ◽  
Author(s):  
Devina Irawan ◽  
Audry Devisanty Wuysang ◽  
Yudy Goysal
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Neuropathy ◽  
Nerve Conduction Study ◽  
Significant Relationship ◽  
Nerve Conduction ◽  
Diabetic Peripheral Neuropathy ◽  
Lipid Level ◽  
Blood Lipid ◽  
Lipid Levels ◽  
Blood Lipid Levels

CORRELATION BETWEEN BLOOD LIPID LEVELS AND SEVERITY OF DIABETIC PERIPHERAL NEUROPATHY IN WAHIDIN SUDIROHUSODO HOSPITALABSTRACTIntroduction: Blood lipid levels play a role in the etiopathogenesis of diabetic neuropathy and have a significant relationship to the severity of diabetic neuropathy in patients with diabetes mellitus (DM).Aim: To assess the correlation between blood lipid levels and the severity of diabetic peripheral neuropathy (DPN) based on nerve conduction study (NCS).Methods: A cross-sectional study at Wahidin Sudirohusodo General Hospital, Makassar, consecutively from December 2018 to March 2019 on type 2 DM patients with DPN based on screening for diabetic neuropathy symptoms. HbA1C and blood lipid levels were examined, and DPN severity based on NCS was assessed using electromyoneurography (ENMG) with England criteria. One-way ANOVA was used for correlation analysis.Results: There were 56 subjects with an average age of 60.25 years old, the majority was women (51.8%) with DM duration ≥5 years (62.5%), HbA1C levels of patients ≥7% (55.4%), dyslipidemia (76.8%), and experienced severe DPN (55.4%). There was a significant relationship between blood lipid levels and the severity of DPN (p<0.05), especially in subjects with a patient’s HbA1C level <7%.Discussion: High lipid level plays a role in etiopathogenesis of diabetic neuropathy.Keywords: Blood lipid levels, diabetic peripheral neuropathy, HbA1CABSTRAKPendahuluan: Kadar lipid darah berperan dalam etiopatogenesis neuropati diabetik dan memiliki hubungan signifikan terhadap derajat keparahan neuropati diabetik pada pasien diabetes melitus (DM).Tujuan: Menilai hubungan kadar lipid darah dengan derajat keparahan neuropati diabetik perifer (NDP) berdasarkan Nerve Conduction Study (NCS).Metode:  Penelitian  potong  lintang  di  RSUP  Wahidin  Sudirohusodo,  Makassar,  secara  konsekutif  periode Desember 2018-Maret 2019 terhadap pasien DM tipe 2 yang mengalami NDP berdasarkan skrining diabetic neuropathy symptoms. Dilakukan pemeriksaan kadar HbA1C dan lipid darah, serta penilaian derajat keparahan NDP berdasarkan KHS menggunakan alat elektromioneurografi (ENMG) dengan kriteria England. Analisis hubungan menggunakan uji one-way ANOVA.Hasil: Didapatkan 56 subjek dengan rerata usia 60,25 tahun, mayoritas perempuan (51,8%) dengan durasi DM ≥5 tahun (62,5%), kadar HbA1C pasien ≥7% (55,4%), dalam keadaan dislipidemia (76,8%), dan mengalami NDP berat (55,4%). Terdapat hubungan bermakna antara kadar lipid darah dan derajat keparahan NDP (p<0,05), terutama pada subjek dengan kadar HbA1C pasien <7%.Diskusi: Tingginya kadar lipid darah akan memperberat derajat keparahan NDP.Kata kunci: HbA1C, kadar lipid darah, neuropati diabetik perifer

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 Comparing the Diagnostic Accuracy of Simple Tests to Screen for Diabetic Peripheral Neuropathy: Protocol for a Cross-Sectional Study (Preprint)

2017 ◽  
Author(s):  
Kate Goddard ◽  
Prashanth Vas ◽  
Alistair Purves ◽  
Viktoria McMillan ◽  
Thomas Langford ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Diagnostic Accuracy ◽  
Conduction Velocity ◽  
Nerve Conduction ◽  
Diabetic Peripheral Neuropathy ◽  
Velocity Measurement ◽  
Sural Nerve ◽  
Nerve Conduction Velocity ◽  
Cross Sectional Study ◽  
Cross Sectional

BACKGROUND Various tests are used to detect diabetic peripheral neuropathy by assessing sense perception in the feet. Tests vary in terms of time and resources required. Simple tests are those that can be conducted quickly and easily in primary care without laboratory equipment. There are some limitations to these simple tests, an example being the variable amplitude of the 128 Hz tuning fork. A new test, VibraTip (McCallan Medical, UK), might be a valuable alternative as it emits a consistent amplitude and may offer improved diagnostic accuracy. OBJECTIVE The aims of this study are to estimate the diagnostic accuracy of the VibraTip device for diabetic peripheral neuropathy against the reference standard of sural nerve conduction velocity measurement, and to assess whether the VibraTip offers superior diagnostic accuracy to other routine tests based on vibration or touch. METHODS The study will prospectively recruit adults with type 2 diabetes who are due to attend a routine follow-up clinic. A cross-sectional study design will be employed to assess the diagnostic accuracy of 5 standard index tests for peripheral neuropathy, including VibraTip. The reference test will be sural nerve conduction velocity measurement. RESULTS Funding is being sought to conduct this research. The outcomes assessed will be the diagnostic accuracy of the 5 index tests against sural nerve conduction velocity measurement, including sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio. Receiver operating characteristic curves will be constructed and compared for each test. CONCLUSIONS This study will be the first within-study comparison of 5 simple tests for screening diabetic peripheral neuropathy and will address uncertainties in the potential benefits of using VibraTip in comparison with the other tests.

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 MR Micro-Neurography and a Segmentation Protocol Applied to Diabetic Neuropathy

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
P. F. Felisaz ◽  
G. Maugeri ◽  
V. Busi ◽  
R. Vitale ◽  
F. Balducci ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Neuropathy ◽  
Healthy Volunteers ◽  
Diabetic Peripheral Neuropathy ◽  
Structural Changes ◽  
Ultrastructural Changes ◽  
Diabetic Patients ◽  
Tissue Segmentation ◽  
Cross Sectional ◽  
Imaging Protocol

The aim of this study was to assess with MRI morphometric ultrastructural changes in nerves affected by diabetic peripheral neuropathy (DPN). We used an MR micro-neurography imaging protocol and a semiautomated technique of tissue segmentation to visualize and measure the volume of internal nerve components, such as the epineurium and nerve fascicles. The tibial nerves of 16 patients affected by DPN and of 15 healthy volunteers were imaged. Nerves volume (NV), fascicles volume (FV), fascicles to nerve ratio (FNR), and nerves cross-sectional areas (CSA) were obtained. In patients with DPN the NV was increased and the FNR was decreased, as a result of an increase of the epineurium (FNR in diabetic neuropathy 0,665; in controls 0,699, p=0,040). CSA was increased in subjects with DPN (12,84 mm2 versus 10,22 mm2, p=0,003). The FV was increased in patients with moderate to severe DPN. We have demonstrated structural changes occurring in nerves affected by DPN, which otherwise are assessable only with an invasive biopsy. MR micro-neurography appears to be suitable for the study of microscopic changes in tibial nerves of diabetic patients.

scholarly journals Spexin is associated with Painful Diabetic Peripheral Neuropathy

2021 ◽  
Author(s):  
Lu Zhu ◽  
Ping hang Zheng ◽  
jing yao Jiang ◽  
Qi Zhang ◽  
Bin Lu ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Antinociceptive Effect ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Control Group ◽  
Binary Logistic Regression Analysis ◽  
Cross Sectional ◽  
Lower Serum Level ◽  
Patients With Diabetes

Abstract Background: Spexin exerts multiple functions in the regulation of energy metabolism and glucose homeostasis. Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes and almost one-third of patients with DPN suffer from neuropathic pain. Recent studies have shown that Spexin has antinociceptive effect. This study aims to evaluate the correlation between circulating Spexin level with the painful DPN. Methods: This is a cross-sectional study including 20 patients with diabetes but without DPN (non-DPN) as the control group, 24 patients with painless DPN and 16 patients with painful DPN. A questionnaire and laboratory investigation were carried out to obtain information on demographic and clinical data. The existence and severity of DPN was assessed by electromyography (EMG) examination. Serum Spexin level was measured by ELISA. Results: The serum Spexin level of patients with painful DPN was significantly lower than that of non-DPN patients (p<0.001) and painless DPN patients (p=0.035). The binary logistic regression analysis showed that lower serum level of Spexin was independently associated with the presence of painful DPN after adjusting for age, sex, BMI, duration of diabetes, HbA1c, 2hPBG, hypertension and status of smoking or drinking. Compared to individuals with higher level of Spexin, the prevalence rate of painful DPN in those with lower level of Spexin was significantly higher. Conclusion: Circulating Spexin level decreased in painful DPN, suggesting a possible role of this peptide in pain-related pathogenesis.

scholarly journals Comparative study of detection of diabetic neuropathy by clinical and nerve conduction study in type 2 diabetes mellitus patients

2018 ◽  
Vol 5 (2) ◽  
pp. 380 ◽  
Author(s):  
Gurinder Mohan ◽  
Manish Chandey ◽  
Anusha Monga ◽  
Parik Dev
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Peripheral Neuropathy ◽  
Diabetic Neuropathy ◽  
Clinical Features ◽  
Clinical Examination ◽  
Nerve Conduction Study ◽  
Nerve Conduction

Background: Diabetes mellitus is known for its complications such as retinopathy, neuropathy and nephropathy. Diabetic neuropathy is one of the devastating complication associated with diabetes mellitus. The objective of this study was to detect sensory motor neuropathy in type 2 Diabetes mellitus by clinical examination and nerve conduction study and to correlate clinical features of peripheral neuropathy with nerve conduction study in Type 2 Diabetes mellitus.Methods: This study was undertaken to study types of neuropathy in type 2 diabetes and to correlate clinical features of peripheral neuropathy with nerve conduction study in type 2 diabetes mellitus.100 patients with diabetes whose onset of diabetes mellitus after age of 30 years and duration of diabetes 5 years or more visiting SGRDIMSR, Vallah, Amritsar were subjected to nerve conduction study to find out peripheral neuropathy.Results: Eight four percentage patients were found to have neuropathy on NCS whereas only 61% of patients were found to have neuropathy on clinical examination and detection rate with NCS was statistically significant (p <0.001) as compared to clinical examination.Conclusions: NCS helps in early detection of neuropathy and most common form of diabetic neuropathy is distal symmetrical polyneuropathy.

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