Sensory Impairment is Associated With Recurrent Falls: Study of Women’s Health Across the Nation

This study evaluated the relationship between individual and combined sensory impairments (vision, hearing, peripheral nerve (PN)) with recurrent falls in the past year among 1951 women (mean age 65.6 years) from the Study of Women’s Health Across the Nation. Sensory impairments were defined as self-reported vision difficulty, hearing loss, or ≥4 on the Michigan Neuropathy Screening Instrument. Recurrent falls were defined as ≥2 self-reported falls. Hearing was the most commonly reported impairment (39.2%), followed by vision (22.1%) and PN (16.0%). Among those with any impairments, 7.0% of women reported impairments in all domains. Recurrent falls were more common among women with vision (19.4%), hearing (17.3%), or PN impairments (24.7%) as compared to women without sensory impairments (7.0%). The greatest burden of recurrent falls was among women with all three sensory impairments; one-third (34.6%) of women with vision, hearing and PN impairment were recurrent fallers. In an adjusted logistic regression model, vision, hearing, and PN impairments were associated with statistically significantly higher odds of recurrent falls in the past year (odds ratio (OR) = 1.58, 1.76, 2.11, respectively; all p<0.01), after adjustment for age, race/ethnicity, economic strain, and depressive symptoms. The presence of all three sensory impairments was associated with nearly 6-fold increased odds of recurrent falls (OR=5.65, 95% CI 3.25, 9.82) compared to women with no impairments. Sensory impairments often onset during mid-life and early late adulthood. This work demonstrates that these impairments are associated with falls and that women with impairments across multiple sensory domains are at greatest risk.

Efficacy and Safety of Gabapentine and Duloxetine in Diabetic Peripheral Neuropathic Pain

Introduction: Diabetic peripheral neuropathy (DPNP) is not uncommon now a days. As the pathophysiology is not completely understood, symptoms relief is still the main goal of treatment. Gabapentine and Duloxetine are being using around the world for this purpose. But clinical data regarding its efficacy and safety are not sufficiently available. Materials and Methods: This prospective comparative clinical study conducted in Sylhet MAG Osmani Medical College and Sylhet Diabetic Hospital, Bangladesh from January 2013 to December 2013. Diagnosis of DPNP confirmed by Michigan Neuropathy Screening Instrument (MNSI) and Douleur Neuropathic en-4 (DN4). Patients were treated by Gabapentine (Group-A) and Duloxetine (Group-B); and followed up at 4th, 8th and 12th week of treatment using 11-point numerical pain rating scale (NRS), clinical global impression of change (CGIC) score and patient’s global impression of change (PGIC) score. Results: A total of 72 patients with DPNP were recruited. Final comparison was done in 64 patients – 33 in Group-A and 31 in Group-B. Changes in NRS (p = <0.001), CGIC (p = <0.001) and PGIC (p = <0.001) were statistically significant during the course of treatment. However, inter-group variation of NRS, CGIC and PGIC were not statistically significant at the beginning and 4th, 8th and 12th week of treatment. Insignificant adverse effects were noted between the groups in this study except constipation (p = 0.022) and nausea-vomiting (p = 0.01) of Duloxetine taking group. Conclusion: Gabapentine and Duloxetine are equally effective in the treatment of DPNP with good safety profile. Medicine Today 2021 Vol.33(2): 108-113

Diabetic Peripheral Neuropathy and Urological Complications in Type 1 Diabetes: Findings From the Epidemiology of Diabetes Interventions and Complications Study

Objective: <br>To evaluate associations between diabetic peripheral neuropathy (DPN) and urological complications in men and women with type 1 diabetes. <br>ResearchDesignandMethods: <br>Measurements of DPN at EDIC years 1, 13/14 and 17 and urological complications at EDIC year 17 were examined in 635 men (mean age 51.6 yrs, diabetes duration 29.5 yrs) and 371 women (mean age 50.6 yrs and diabetes duration 29.8 yrs) enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. DPN was defined by symptoms, signs and abnormal electrophysiology, or by abnormal Michigan Neuropathy Screening Instrument (MNSI) examination or questionnaire scores. <br>Results: <br>Erectile dysfunction (ED) in combination with lower urinary tract symptoms (LUTS) was reported in 15% of men, and female sexual dysfunction (FSD), LUTS and urinary incontinence (UI) in 16% of women. When controlling for age, drinking status, BMI, depression, DCCT/EDIC time-weighted mean HbA1c, microalbuminuria, hypertension, triglycerides and statin medication use, men with confirmed DPN at EDIC year 13/14 had a higher odds of ED/LUTS at year 17 compared to men without DPN (OR=3.52 95% CI 1.69,7.31). Men with DPN based on abnormal MNSI examination or questionnaire scores had significantly higher odds of ED and LUTS at year 17 than men without DPN at all time points. There were no significant differences in DPN between women reporting both FSD and LUTS/UI compared to those without FSD or LUTS/UI at EDIC year 17. <br>Conclusions: <br>In long-standing T1D, DPN is associated with the later development of urological complications in men. <b></b>

Diabetic Peripheral Neuropathy and Urological Complications in Type 1 Diabetes: Findings From the Epidemiology of Diabetes Interventions and Complications Study

Objective: <br>To evaluate associations between diabetic peripheral neuropathy (DPN) and urological complications in men and women with type 1 diabetes. <br>ResearchDesignandMethods: <br>Measurements of DPN at EDIC years 1, 13/14 and 17 and urological complications at EDIC year 17 were examined in 635 men (mean age 51.6 yrs, diabetes duration 29.5 yrs) and 371 women (mean age 50.6 yrs and diabetes duration 29.8 yrs) enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. DPN was defined by symptoms, signs and abnormal electrophysiology, or by abnormal Michigan Neuropathy Screening Instrument (MNSI) examination or questionnaire scores. <br>Results: <br>Erectile dysfunction (ED) in combination with lower urinary tract symptoms (LUTS) was reported in 15% of men, and female sexual dysfunction (FSD), LUTS and urinary incontinence (UI) in 16% of women. When controlling for age, drinking status, BMI, depression, DCCT/EDIC time-weighted mean HbA1c, microalbuminuria, hypertension, triglycerides and statin medication use, men with confirmed DPN at EDIC year 13/14 had a higher odds of ED/LUTS at year 17 compared to men without DPN (OR=3.52 95% CI 1.69,7.31). Men with DPN based on abnormal MNSI examination or questionnaire scores had significantly higher odds of ED and LUTS at year 17 than men without DPN at all time points. There were no significant differences in DPN between women reporting both FSD and LUTS/UI compared to those without FSD or LUTS/UI at EDIC year 17. <br>Conclusions: <br>In long-standing T1D, DPN is associated with the later development of urological complications in men. <b></b>

Distal Symmetric Polyneuropathy Pain in Diabetes Mellitus

Objective: To evaluate neuropathic pain (NP), its intensity, and complications in people with type 2 diabetes mellitus (T2DM) in a city of eastern São Paulo. Method: Cross-sectional study conducted with 96 individuals with T2DM served by primary health units in São João da Boa Vista-SP. The following instruments were used to screen NP: Michigan Neuropathy Screening Instrument, Leeds Assessment of Neuropathic Symptoms and Signs, Douleur Neuropathique 4, and Brief Pain Inventory. The data were analyzed using descriptive and inferential statistics, with a 5 % significance level. Results: Of the 96 people with T2DM for longer than five years, 22.9 % had pain. NP was related to high levels of fasting blood glucose (mean = 214 ± 65.58 mg/dl; p = 0.0002), glycated hemoglobin (mean = 8.8 ± 0.11 %; p < 0.001), absence of a balanced diet (p = 0.0066), obesity (p = 0.023), and high blood pressure (p < 0.001). Conclusion: Higher values ​​of glycated hemoglobin rates increased three times the chance of NP. The screening and management of painful diabetic neuropathy is a challenge but adopting a screening protocol supports the secondary prevention of this manifestation.

Buerger Exercise Reduces the Risk of Neuropathy in People with Diabetes Mellitus

Introduction: Diabetes mellitus (DM) remains the major global health problem, predicted to exceed half a billion people in 2040. One of the major complications was lower extremity neuropathy leading to foot ulcer and amputation. This study aimed to investigate the effect of routine Buerger exercise on the neuropathy index of people with DM. Methods: A pre-and posttest quasi-experimental study between May and August 2018 involving DM patients in primary health centre was conducted. They were prospectively recruited and either be allocated into the intervention group where the monitored routine Buerger exercise was performed or control group with the standard education on DM. Michigan Neuropathy Screening Instrument (MNSI) with subjective and objective measurement was used to evaluate the neuropathy index. Results: Seventy-seven participants (63 females) with mean age of 58.2±7.2 years completed the study with similar characteristics. Mean pretest MNSI score for intervention and control group were 3.8±1.7 and 3.9±1.6 respectively, and were not different (P = 0.561). At the end of follow up, significant decrease was observed in the intervention group (2.8±2.2, P = 0.011) but not in control group (4.0±1.9, P=0.947). Physical examination according to MNSI guideline showed a significant reduction in the neuropathy score for the intervention group from 1.8±1.4 at the start to 1.3±1.1 at the end of the study (P< 0.001), but this was not seen in the control group. Conclusion: Buerger exercise had a beneficial effect on improving the neuropathy index and symptoms of DM patients with high risk of diabetic foot ulcer.

Reduced microvascular reactivity in patients with diabetic neuropathy

BACKGROUND: Neurogenic regulation is involved in the development of microcirculation response to local heating. We suggest that microvascular reactivity can be used to estimate the severity of diabetic polyneuropathy (DPN). OBJECTIVE: To evaluate the prospects for using the parameters of skin microvascular reactivity to determine the severity of DPN. METHODS: 26 patients with diabetes mellitus were included in the study (patients with retinopathy (n = 15), and without retinopathy (n = 11)). The severity of DPN was assessed using Michigan Neuropathy Screening Instrument (MNSI) and Norfolk QOL-DN (NQOLDN). Skin microcirculation was measured by laser Doppler flowmetry with local heating test. RESULTS: There were revealed moderate negative correlations between microvascular reactivity and the severity of DPN (for MNSI (Rs = –0.430), for NQOLDN (Rs = –0.396)). In patients with retinopathy, correlations were stronger than in the general group (for MNSI (Rs = –0.770) and NQOLDN (Rs = –0.636)). No such correlations were found in patients without retinopathy. CONCLUSION: Correlation of the microvascular reactivity and DPN was revealed in patients with registered structural disorders in microvessels (retinopathy). The lack of such correlation in patients without retinopathy may be explained by the intact compensatory mechanisms of microvessels without severe disorders.

RASTREAMENTO DE COMPLICAÇÕES CRÔNICAS EM PACIENTES DIABÉTICOS EM UMA FARMÁCIA BÁSICA DO MUNICÍPIO DE CASCAVEL-PR

Introdução: O diabetes mellitus (DM) não controlado pode provocar, a longo prazo, disfunção e falência de vários órgãos, estando associado ao aumento da mortalidade e ao alto risco de desenvolvimento de complicações micro e macrovasculares. Diante disso, o bom controle do DM na atenção primária evita hospitalizações e maiores complicações, por isso, a detecção de retinopatia, nefropatia, neuropatia e pé diabético deve ser realizada em tempo oportuno para acompanhamento e seguimento de cada paciente. Objetivo: O objetivo desse trabalho foi rastrear e identificar as complicações crônicas de Diabetes Mellitus em pacientes assistidos pela Farmácia Básica do município de Cascavel-PR. Métodos: Foram coletados os dados sociodemográficos dos pacientes e exame de microalbuminúria para rastreamento de nefropatia. Além disso, para o rastreamento de neuropatia diabética foi aplicado um questionário de Escore de Sintomas Neuropático (ESN) e, para o rastreamento de pé diabético foi aplicado o questionário Michigan Neuropathy Screening Instrument (MNSI). Esse projeto foi aprovado pelo Comitê de Ética, sob o Parecer Consubstanciado do CEP, nº 3.848.285. Resultados: Dos 62 pacientes incluídos no estudo, o gênero feminino foi mais prevalente (64,5%) e a maioria (71,0%) possuíam como comorbidade hipertensão arterial sistêmica (HAS). Em relação às características antropométricas a prevalência de obesidade grau I foi expressiva (24,2%). Em relação às complicações crônicas do DM, foi expressiva a identificação de neuropatia (33; 53,2%), além disso, nefropatia (12; 19,4%) também foi uma complicação crônica relevante identificada. Apenas 1 paciente apresentou histórico atual de pé diabético, com presença de ulceração e deformidade. A retinopatia diabética foi identificada em apenas 2 pacientes com histórico prévio da complicação. Conclusão: O presente trabalho evidencia a prevalência de complicações microvasculares e alerta para a necessidade de rastreamento destas ainda em tempo oportuno, a fim de realizar o manejo e tratamento adequado com o paciente.