Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jan 15, 2019; 10(1): 47-56
Published online Jan 15, 2019. doi: 10.4239/wjd.v10.i1.47
Relationship between sonographically measured median nerve cross-sectional area and presence of peripheral neuropathy in diabetic subjects
Fredrick Andrew Attah, Christianah Mopelola Asaleye, Adeleye Dorcas Omisore, Babatope Ayodeji Kolawole, Adeniyi Sunday Aderibigbe, Mathew Alo
Fredrick Andrew Attah, Adeniyi Sunday Aderibigbe, Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Osun 220222, Nigeria
Christianah Mopelola Asaleye, Adeleye Dorcas Omisore, Department of Radiology, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Osun 220222, Nigeria
Babatope Ayodeji Kolawole, Department of Internal Medicine, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Osun 220222, Nigeria
Mathew Alo, Department of Orthopedics, Obafemi Awolowo University Teaching Hospitals Complex, Osun 220222, Nigeria
Author contributions: Attah FA suggested the concept, did the data collection and initial write-up of the manuscript; Asaleye CM was involved in study design, literature search and editing of the manuscript; Omisore AD was involved in study design, data analysis, writing of the final version of the manuscript; Kolawole BA did literature search and editing of the manuscript; Aderibigbe AS did data collation and was involved with analysis; Alo M was part of patient recruitment and manuscript editing.
Institutional review board statement: The study was approved by the Ethical committee of the Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Osun State, Nigeria, and a copy is uploaded with the submission.
Informed consent statement: Written informed consent was obtained from all study participants before their inclusion into the study.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Adeleye Dorcas Omisore, MBBS, Attending Doctor, Lecturer, Department of Radiology, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Ilesa road, Osun 220222, Nigeria. omisoreadeleye@yahoo.com
Telephone: +234-803-1538004
Received: September 1, 2018
Peer-review started: September 3, 2018
First decision: November 8, 2018
Revised: December 29, 2018
Accepted: January 3, 2019
Article in press: January 3, 2019
Published online: January 15, 2019
Processing time: 138 Days and 19.2 Hours
Abstract
BACKGROUND

Neuropathy is a common complication of diabetes mellitus resulting from direct damage by hyperglycemia to the nerves and/or ischemia by microvascular injury to the endoneurial vessels which supply the nerves. Median nerve is one of the peripheral nerves commonly affected in diabetic neuropathy. The median nerve size has been studied in non-Nigerian diabetic populations. In attempt to contribute to existing literature, a study in a Nigerian population is needed.

AIM

To evaluate the cross-sectional area (CSA) of the median nerve using B-mode ultrasonography (USS) and the presence of peripheral neuropathy (PN) in a cohort of adult diabetic Nigerians.

METHODS

Demographic and anthropometric data of 85 adult diabetes mellitus (DM) and 85 age- and sex-matched apparently healthy control (HC) subjects were taken. A complete physical examination was performed on all study subjects to determine the presence of PN and modified Michigan Neuropathy Screening Instrument (MNSI) was used to grade its severity. Venous blood was taken from the study subjects for fasting lipid profile (FLP), fasting blood glucose (FBG) and glycated haemoglobin (HbA1c) while their MN CSA was evaluated at a point 5 cm proximal to (5cmCATL) and at the carpal tunnel (CATL) by high-resolution B-mode USS. Data was analysed using SPSS version 22.

RESULTS

The mean MN CSA was significantly thicker in DM subjects compared to the HC at 5cmCATL (P < 0.01) and at the CATL (P < 0.01) on both sides. The presence of diabetic peripheral neuropathy (DPN) further increased the MN CSA at the CATL (P < 0.05) but not at 5cmCATL (P > 0.05). However, the severity of DPN had no additional effect on MN CSA 5 cm proximal to and at the CATL. There was no significant association between MN CSA and duration of DM and glycemic control.

CONCLUSION

Thickening of the MN CSA at 5cmCATL and CATL is seen in DM. Presence of DPN is associated with worse thickening of the MN CSA at the CATL but not at 5cmCATL. Severity of DPN, duration of DM, and glycemic control had no additional effect on the MN CSA.

Keywords: Median nerve; Cross-sectional area; Sonography; Diabetics; Peripheral neuropathy

Core tip: We report median nerve cross-sectional area findings in diabetics of Nigerian origin. This study demonstrates that the median nerve is thicker at the carpal tunnel and 5 cm proximal to the carpal tunnel in diabetic subjects than age- and sex-matched healthy controls. Further thickening in the median nerve size is seen in the presence of diabetic peripheral neuropathy at the carpal tunnel but not at a point 5 cm proximal to it. Median nerve size has no significant relationship with age, gender, severity of diabetic peripheral neuropathy, duration of diabetes mellitus or glycemic control in diabetic subjects.