|
1
|
Borrelli EP. Estimating the annual cost burden of diabetic peripheral neuropathy in the United States. Endocrine 2025:10.1007/s12020-025-04318-4. [PMID: 40517209 DOI: 10.1007/s12020-025-04318-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 06/04/2025] [Indexed: 06/16/2025]
Abstract
PURPOSE Diabetic peripheral neuropathy (DPN) is one of the leading complications of diabetes. Given the significant growth in prevalence of diabetes and therefore DPN in the United States in recent years, a quantitative analysis is needed to estimate the annual cost burden of DPN. METHODS A cost-of-illness burden model was created to estimate the cost burden on DPN in the United States. A review of the literature was undertaken to identify the most appropriate epidemiologic and economic inputs. One-way sensitivity analyses were conducted for every model input parameter to show the potential variability in the estimated cost-burden. RESULTS There is an estimated prevalence of approximately 13,209,600 patients with DPN in the U.S., with an estimated annual cost burden from DPN of $45,930,580,972. Of the estimated cost burden, $30,859,424,749 was from DPN specific care ($2,389,038,060 for outpatient office visits, $26,830,282,752 for inpatient hospitalizations, and $1,640,103,936 from prescription medications) and $15,071,156,223 from treating incident DPN complications ($12,875,200,000 for diabetic foot ulcers and $2,195,956,223 for diabetic lower limb amputations). CONCLUSIONS DPN is a very costly condition, and the burden is expected to continue to grow in the coming years.
Collapse
Affiliation(s)
- Eric P Borrelli
- University of California San Diego, Skaggs School of Pharmacy & Pharmaceutical Sciences, La Jolla, CA, USA.
| |
Collapse
|
|
2
|
Chokote SE, Lemdjo G, Idiaquez Rios JF, Anakeu AT, Ngarka L, Nfor LN, Mengnjo MK, Njamnshi WY, Kengni HNT, Ngongang RJ, Simeni G, Piameu L, Nkonda AB, Yepnjio F, Tatah GY, Thirugnanam UN, Njamnshi AK. Clinical and Electrophysiological Characterization of Diabetic Neuropathy in a Sub-Saharan African Cohort. J Peripher Nerv Syst 2025; 30:e70021. [PMID: 40348590 PMCID: PMC12063200 DOI: 10.1111/jns.70021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Revised: 04/16/2025] [Accepted: 04/18/2025] [Indexed: 05/14/2025]
Abstract
BACKGROUND Diabetic neuropathy (DN) is the most frequent complication of diabetes mellitus, contributing to increased morbidity and mortality. Previous clinical studies on DN in sub-Saharan Africa (sSA) have used purely clinical approaches, potentially underestimating the true magnitude of this disease. This study was designed to determine the prevalence of definite diabetic neuropathy and describe the different subtypes using objective small and large fiber function measures. METHODS This was a hospital-based cross-sectional study that included diabetes and prediabetes patients, followed up at Jordan Medical Services, Yaoundé, Cameroon, between March 2022 and February 2023. The "Toronto Clinical Neuropathy Score" and "Douleur Neuropathique en 4" questionnaires were used for clinical evaluation. Autonomic symptoms were equally recorded. Nerve conduction studies and Sudoscan were used for electrophysiological assessments of large and small fibre functions. RESULTS Eighty-four participants were included; 91.7% had type 2 DM, 2.4% had type 1 DM, and 6% had glucose intolerance. DN was found in 73/84 (86.9%). Diabetic sensorimotor polyneuropathy (DSP) was the most frequent subtype (63.8%), followed by diabetic autonomic neuropathy (40.5%), mononeuropathy (36.9%), asymmetric axonal sensory neuropathy (4.8%) and treatment-induced neuropathy of diabetes (TIND) in 1.2% of patients. The prevalence of large and small fibre neuropathies was 38.1% and 25.0%, respectively. CONCLUSION The prevalence of DN and specifically DSP in our study was higher than previously described in African literature. We identified subtypes never before reported in sSA, mainly small fibre neuropathy and TIND. This may have management and policy implications.
Collapse
Affiliation(s)
- Samuel Eric Chokote
- Neurology DepartmentJamot HospitalYaoundéCameroon
- Brain Research Africa InitiativeYaoundéCameroon
- Brain Research Africa InitiativeGenevaSwitzerland
| | - Gaelle Lemdjo
- Endocrinology DepartmentJordan Hospital YaoundéYaoundéCameroon
| | - Juan Francisco Idiaquez Rios
- Division of Neurology TorontoEllen and Martin Prosserman Centre for Neuromuscular DiseasesTorontoCanada
- Department of MedicineUniversity Health Network, Toronto General HospitalTorontoCanada
| | | | - Leonard Ngarka
- Brain Research Africa InitiativeYaoundéCameroon
- Brain Research Africa InitiativeGenevaSwitzerland
- Neurology DepartmentYaoundé Central HospitalYaoundéCameroon
- Neuroscience Lab, Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
| | - Leonard N. Nfor
- Brain Research Africa InitiativeYaoundéCameroon
- Brain Research Africa InitiativeGenevaSwitzerland
- Neurology DepartmentYaoundé Central HospitalYaoundéCameroon
- Neuroscience Lab, Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
| | - Michel K. Mengnjo
- Brain Research Africa InitiativeYaoundéCameroon
- Brain Research Africa InitiativeGenevaSwitzerland
- Neurology DepartmentYaoundé Central HospitalYaoundéCameroon
- Neuroscience Lab, Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
| | - Wepnyu Y. Njamnshi
- Brain Research Africa InitiativeYaoundéCameroon
- Brain Research Africa InitiativeGenevaSwitzerland
- Neuroscience Lab, Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
- Global Brain Health Institute, Neuroscience Center, University of CaliforniaSan FransiscoCaliforniaUSA
| | | | | | - Gilles Simeni
- Endocrinology DepartmentJordan Hospital YaoundéYaoundéCameroon
| | - Lylian Piameu
- Endocrinology DepartmentJordan Hospital YaoundéYaoundéCameroon
| | | | | | - Godwin Y. Tatah
- Brain Research Africa InitiativeYaoundéCameroon
- Brain Research Africa InitiativeGenevaSwitzerland
- Neurology Department Saint Nazaire Hospital CanterSaint NazaireFrance
| | - Umapathi N. Thirugnanam
- National Neuroscience InstituteSingaporeSingapore
- Singapore National Eye CentreSingaporeSingapore
| | - Alfred Kongnyu Njamnshi
- Brain Research Africa InitiativeYaoundéCameroon
- Brain Research Africa InitiativeGenevaSwitzerland
- Neurology DepartmentYaoundé Central HospitalYaoundéCameroon
- Neuroscience Lab, Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
| |
Collapse
|
|
3
|
Fadlilah S, Amelia VL, Tuppal CP, Chang HCR, Chang CW, Lin CL, Tsai HT. Significant Impacts of the Body-Mass Index, Blood Pressure, Blood Glucose, and Ankle-Brachial Index on Peripheral Neuropathy Risk in Indonesian With Type 2 Diabetes: A Cross-Sectional Study. Biol Res Nurs 2025:10998004251336795. [PMID: 40261070 DOI: 10.1177/10998004251336795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2025]
Abstract
Background: Diabetic peripheral neuropathy is associated with morbidity and mortality in people with diabetes mellitus. Aims: In this study, we determined relationships of the body-mass index (BMI), systolic blood pressure, diastolic blood pressure, fasting blood glucose, HbA1c, and ankle-brachial index (ABI) with diabetic peripheral neuropathy risk. Methods: A cross-sectional study was conducted with 1088 Indonesians and data collected using self-reported questionnaires, laboratory examinations, and physical examinations. Instruments included a digital scale, height measurement device, digital sphygmomanometer, Doppler ultrasound, 10-g monofilament, and a 128-Hz tuning fork. Data analysis used the Chi-square test, Fisher Exact, and multiple logistic regression test with significance p < .05. Results: The BMI (p < .001), blood pressure (p < .001), ABI (p < .001), fasting blood glucose (p = .016), and HbA1c (p < .001) were significantly related to peripheral neuropathy risk. The conditions of obesity, hypertension, high ABI, high fasting blood glucose, and high HbA1c significantly increased the risk of peripheral neuropathy. Moreover, participants with ≥4 co-occurring abnormal levels of the BMI, systolic blood pressure, diastolic blood pressure, fasting blood glucose, HbA1c, and ABI had significantly synergistically increased risks of peripheral neuropathy, and the more abnormal conditions there were, the higher the risk of peripheral neuropathy. Conclusions: Abnormalities of the BMI, blood pressure, fasting blood glucose, HbA1c, and ABI significantly and synergistically increased the risk of peripheral neuropathy and can be considered predictors of peripheral neuropathy. Nurses are expected to be aware of these predictors so that they can immediately take appropriate steps if they encounter abnormal conditions by optimizing their role as educators.
Collapse
Affiliation(s)
- Siti Fadlilah
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Program Study of Nursing, Universitas Respati Yogyakarta, Yogyakarta, Indonesia
| | - Vivi Leona Amelia
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Program Study of Nursing, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Cyruz P Tuppal
- College of Health Allied, National University, Manila, Philippines
| | | | - Ching Wen Chang
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chia Ling Lin
- Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hsiu Ting Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
- Research Unit for Enhancing Well-being in Vulnerable and Chronic Illness Populations, Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
|
4
|
Lazar S, Reurean-Pintilei DV, Ionita I, Avram VF, Herascu A, Timar B. Glycemic Variability and Its Association with Traditional Glycemic Control Biomarkers in Patients with Type 1 Diabetes: A Cross-Sectional, Multicenter Study. J Clin Med 2025; 14:2434. [PMID: 40217883 PMCID: PMC11989622 DOI: 10.3390/jcm14072434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2025] [Revised: 03/27/2025] [Accepted: 04/01/2025] [Indexed: 04/14/2025] Open
Abstract
Background/Objectives: Glycemic variability (GV) is a novel concept in the assessment of the quality of glycemic control in patients with diabetes, with its importance emphasized in patients with type 1 diabetes. Its adoption in clinical practice emerged with the increased availability of continuous glycemic monitoring systems. The aim of this study is to evaluate the GV in patients with type 1 diabetes mellitus (T1DM) and to assess its associations with other parameters used to evaluate the glycemic control. Methods: GV indexes and classical glycemic control markers were analyzed for 147 adult patients with T1DM in a multicentric cross-sectional study. Results: Stable glycemia was associated with a higher time in range (TIR) (78% vs. 63%; p < 0.001) and a lower HbA1c (6.8% vs. 7.1%; p = 0.006). The coefficient of variation (CV) was reversely correlated with TIR (Spearman's r = -0.513; p < 0.001) and positively correlated with hemoglobin A1c (HbA1c) (Spearman's r = 0.349; p < 0.001), while TIR was reversely correlated with HbA1c (Spearman's r = -0.637; p < 0.001). The composite GV and metabolic outcome was achieved by 28.6% of the patients. Conclusions: Stable glycemia was associated with a lower HbA1c, average and SD of blood glucose, and a higher TIR. A TIR higher than 70% was associated with a lower HbA1c, and SD and average blood glucose. Only 28.6% of the patients with T1DM achieved the composite GV and metabolic outcome, despite 53.7% of them achieving the HbA1c target, emphasizing thus the role of GV in the assessment of the glycemic control.
Collapse
Affiliation(s)
- Sandra Lazar
- Doctoral School of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.L.); (A.H.)
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Hematology, Emergency Municipal Hospital, 300254 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (V.-F.A.); (B.T.)
| | - Delia-Viola Reurean-Pintilei
- Department of Medical-Surgical and Complementary Sciences, Faculty of Medicine and Biological Sciences, “Stefan cel Mare” University, 720229 Suceava, Romania
- Consultmed Medical Centre, Department of Diabetes, Nutrition and Metabolic Diseases, 700544 Iasi, Romania
| | - Ioana Ionita
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Hematology, Emergency Municipal Hospital, 300254 Timisoara, Romania
- Multidisciplinary Research Center for Malignant Hematological Diseases (CCMHM), Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Vlad-Florian Avram
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (V.-F.A.); (B.T.)
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Diabetes, “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania
| | - Andreea Herascu
- Doctoral School of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.L.); (A.H.)
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (V.-F.A.); (B.T.)
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Diabetes, “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania
| | - Bogdan Timar
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (V.-F.A.); (B.T.)
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Diabetes, “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania
| |
Collapse
|
|
5
|
Andrejic N, Božovic I, Moradi H, Tataei R, Knezevic NN. Neuropathic pain management: a focused review of current treatments and novel data from main ongoing clinical trials. Expert Opin Investig Drugs 2025; 34:287-299. [PMID: 40016085 DOI: 10.1080/13543784.2025.2473692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 02/20/2025] [Accepted: 02/25/2025] [Indexed: 03/01/2025]
Abstract
INTRODUCTION Neuropathic pain (NP) remains a significant challenge in clinical practice, requiring a sophisticated pharmacotherapeutic strategy for effective symptom management. This review provides a comprehensive analysis of the current pharmacological treatments for NP, focusing on their efficacy, mechanism of action, and therapeutic potential. Additionally, it evaluates ongoing clinical trials investigating novel drugs and therapeutic approaches, highlighting emerging trends and future directions in NP management. AREAS COVERED This review examines first- to third-line therapeutic modalities for NP, critically analyzing their efficacy, safety profiles, and clinical applications. It also includes an overview of ongoing clinical trials exploring innovative pharmacological therapies. A thorough literature review was conducted using the MEDLINE database without temporal limitations, offering a detailed assessment of established and emerging treatments. EXPERT OPINION While current pharmacological options offer significant symptom relief, their overall effectiveness in managing NP remains limited, highlighting the need for further therapeutic advancements. Staying informed about emerging therapies and clinical trials is vital to enhancing patient care and quality of life. The future of NP management lies in optimizing individualized treatment strategies, refining therapeutic approaches, and fostering interdisciplinary collaboration. Close monitoring of outcomes and continued research are essential for advancing understanding and improving the precision of NP therapies.
Collapse
Affiliation(s)
- Nikola Andrejic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL, USA
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivo Božovic
- Neurology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Hadi Moradi
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL, USA
- Faculty of Medicine, University of Hamedan, Hamedan, Iran
- Faculty of Medicine, Belarusian State Medical University, Minsk, Belarus
| | - Rojin Tataei
- Faculty of Medicine, University of Hamedan, Hamedan, Iran
| | - Nebojsa Nick Knezevic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL, USA
- Department of Anesthesiology, University of Illinois, Chicago, IL, USA
- Department of Surgery, University of Illinois, Chicago, IL, USA
| |
Collapse
|
|
6
|
Burande AR, Burande MA, Powar SN, Vora TU. Descriptive Analysis of Anatomical Location and Metabolic and Microbiological Factors in Diabetic Foot (DF) Treated at a DF Specialty Tertiary Care Hospital With a Multidisciplinary Approach. Cureus 2025; 17:e80690. [PMID: 40242699 PMCID: PMC12000793 DOI: 10.7759/cureus.80690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2025] [Indexed: 04/18/2025] Open
Abstract
Background and aims The outcome of a diabetic foot ulcer (DFU) may be affected by many factors, including the clinical anatomy of the ulcer, metabolic control, the presence of complications, and infections. This study evaluates the effect of metabolic factors, the clinical anatomy of the ulcer at presentation, and antibiotic appropriateness on treatment outcomes in terms of amputation in patients with diabetic foot (DF). Materials and methods This is a cross-sectional observational study involving data collected from patients with IPD diagnosed with type 2 diabetes mellitus and DFU at a tertiary care DF specialty hospital in Maharashtra, India. Results Data from a total of 106 patients were included for analysis. Fifty-two patients healed without amputation while 54 underwent either minor or major amputation. Patients who did not require amputation had a statistically significant higher incidence of cellulitis, ulcers at the heel and lateral malleolus, and ulcers classified as Wagner grade 1 or 2. In contrast, factors significantly associated with amputation included lower weight and BMI, multiple ulcers at presentation, ulcers involving the second, third, fourth, or fifth toe, midfoot, or medial malleolus, ulcers graded 3, 4, or 5, and additional surgery performed during the same hospital admission. The most commonly collected specimen was pus, followed by tissue and bone. The most frequently isolated microorganisms were Escherichia (E.) coli and Klebsiella. All microorganisms were sensitive to Piperacillin-Tazobactam and matched the initially prescribed antibiotic, which was chosen as per the hospital antibiogram. Angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin receptor blockers (ARBs) were prescribed more frequently in the non-amputation group while insulin use was higher in the amputation group, although there was no significant difference in the use of metabolic drugs between the two groups. Conclusion The anatomical location of the wound, advanced grade, number of ulcers, additional procedures, nutritional status, and the presence of Coagulase-negative Staphylococcus aureus in tissue are significant predictors of amputation.
Collapse
Affiliation(s)
- Amit R Burande
- Anatomy, D. Y. Patil Medical College, Kolhapur, IND
- Orthopaedics and Diabetic Foot Surgery, Surya Hospital, Kolhapur, IND
| | - Meeta A Burande
- Pharmacology, D. Y. Patil Medical College, Kolhapur, IND
- Diabetology, Surya Hospital, Kolhapur, IND
| | | | | |
Collapse
|
|
7
|
Kostopoulos D, Rizopoulos K, McGilvrey J, Hauskey J, Courcier J, Connor-Israel K, Koster H, von Leden R. An Open-Label Comparative Study of the Impact of Two Types of Electrical Stimulation (Direct Current Neuromuscular Electrical Stimulation and Transcutaneous Electrical Stimulation) on Physical Therapy Treatment of Diabetic Peripheral Neuropathy. J Diabetes Res 2025; 2025:9970124. [PMID: 39949402 PMCID: PMC11824710 DOI: 10.1155/jdr/9970124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 01/07/2025] [Indexed: 02/16/2025] Open
Abstract
Objective:The objective of this study is to evaluate and compare the effectiveness of treatments with two different electrical stimulation (e-stim) devices-pulsed direct current (DC) (Neubie) and alternating current (AC) (transcutaneous electrical stimulation (TENS))-in the treatment of symptoms for patients with diabetic peripheral neuropathy (DPN). Design:Randomized controlled trial (RCT) with parallel groups. Methods: One hundred fifty participants were recruited from 13 Hands-On Diagnostics-affiliated sites across several US locations. Participants were randomly divided into two groups for comparison-Neubie and TENS. Participants received a 30-min foot stimulation protocol with either TENS unit electrodes or Neubie electrodes. Outcome measures included the Toronto Clinical Neuropathy Score (TCNS), two-point discrimination, visual analogue scale (VAS), vibration sense (VBS), nerve conduction velocity (NCV), and nerve amplitude. The effect of the two variables on all outcome measures was determined using an analysis of covariance (ANCOVA). Results: The Neubie group demonstrated statistically significant improvements in TCNS for both right and left sides (p < 0.001), two-point discrimination of the dominant foot (p = 0.001), VBS (p = 0.022) and VAS scores (p = 0.009), and some but not all nerves tested by NCV (p < 0.05). Conclusion: Overall, DPN treatment with the Neubie resulted in significant improvements in several major outcome measures, whereas TENS showed no significant difference in any outcome measure. These findings support the use of DC devices as a potentially superior therapeutic treatment for neuropathy over AC devices like the TENS unit. Trial Registration: ClinicalTrials.gov identifier: NCT05442021.
Collapse
Affiliation(s)
| | | | - Joe McGilvrey
- Department of Physical Therapy, Hands-On Diagnostics, New York, New York, USA
| | - Jennifer Hauskey
- Department of Physical Therapy, Hands-On Diagnostics, New York, New York, USA
| | - Jeff Courcier
- Department of Physical Therapy, Hands-On Diagnostics, New York, New York, USA
| | - Kay Connor-Israel
- Department of Physical Therapy, Hands-On Diagnostics, New York, New York, USA
| | - Harry Koster
- Department of Physical Therapy, Hands-On Diagnostics, New York, New York, USA
| | - Ramona von Leden
- Department of Psychology, The University of Texas at Austin, Austin, Texas, USA
- Department of Research, NeuFit, Austin, Texas, USA
| |
Collapse
|
|
8
|
Pal B, Ghosh R, Sarkar RD, Roy GS. The irreversible, towards fatalic neuropathy: from the genesis of diabetes. Acta Diabetol 2025; 62:139-156. [PMID: 39636401 DOI: 10.1007/s00592-024-02429-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Accepted: 11/25/2024] [Indexed: 12/07/2024]
Abstract
Diabetic neuropathy is the most prevalent diabetes-associated complication that negatively impacts the quality of life of the patients. The extensive complications of diabetic peoples in the world are the leading cause of neuropathic pain, and over-activation of different biochemical signalling process induces the pathogenic progression and are also corresponding the epidemic painful symptom of diabetic neuropathy. The main prevalent abnormality is neuropathy, which further causing distal symmetric polyneuropathy and focal neuropathy. The exact pathological complication of diabetes associated neuropathic algesia is still unclear, but the alteration in micro-angiopathy associated nerve fibre loss, hyper polyol formation, MAPK signalling, WNT signalling, tau-derived insulin signalling processes are well known. Furthermore, the post-translational modification of different ion channels, oxidative and nitrosative stress, brain plasticity and microvascular changes can contributes the development of neuropathic pain. However, in the current review we discussed about these pathogenic development of neuropathic pain from the genesis of diabetes, and how diabetes affects the physiological and psychological health, and quality of life of the patients. Furthermore, the treatment of diabetic neuropathy with conventional monotherapy and emerging therapy are discussed. In addition, the treatment with phytochemical constituents their mechanisms and clinical evidences are also reported. The future investigation is required on pathological alteration occurs in neuropathic individuals, and on molecular mechanisms as well as the adverse effect of phytochemicals to determine all aspects of neuropathic algesia including effective treatments, which will prevents the sympathetic pain in patients.
Collapse
Affiliation(s)
- Bhaskar Pal
- Department of Pharmacology, Charaktala College of Pharmacy, Charaktala, Mothabari, Malda, West Bengal, India.
| | - Rashmi Ghosh
- Bengal College of Pharmaceutical Science & Research, Durgapur, West Bengal, India
| | - Raktimava Das Sarkar
- Department of Pharmaceutical Technology, Bengal School of Technology, Sugandha, Delhi Road, Chinsurah, Hooghly, West Bengal, India
| | - Gouranga Sundar Roy
- Department of Pharmaceutical Technology, Bengal School of Technology, Sugandha, Delhi Road, Chinsurah, Hooghly, West Bengal, India
| |
Collapse
|
|
9
|
Arı M, Erdogan MA, Erbaş O. Investigation of the protective effects of dichloroacetic acid in a rat model of diabetic neuropathy. BMC Pharmacol Toxicol 2025; 26:15. [PMID: 39844306 PMCID: PMC11756200 DOI: 10.1186/s40360-025-00849-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Accepted: 01/20/2025] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Diabetic neuropathy (DN) is a heterogeneous condition characterized by complex pathophysiological changes affecting both autonomic and somatic components of the nervous system. Inflammation and oxidative stress are recognized contributors to the pathogenesis of DN. This study aims to evaluate the therapeutic potential of dichloroacetic acid (DCA) in alleviating DN symptoms, focusing on its anti-inflammatory and antioxidant properties. METHODS Thirty-two adult male Sprague Dawley rats were divided into four groups: Control, Diabetic, and two DCA-treated groups receiving 5 mg/kg and 10 mg/kg of DCA, respectively. Diabetes was induced with streptozotocin (STZ) injections. Assessments included lipid peroxidation levels, plasma fibroblast growth factor-21 (FGF-21) and transforming growth factor-beta (TGF-β) levels, electrophysiological measurements, histological examination of the sciatic nerve, and motor function tests. RESULTS Treatment with DCA significantly reduced malondialdehyde (MDA) levels, indicating decreased lipid peroxidation. Plasma TGF-β levels were also lower in the DCA-treated groups, suggesting diminished inflammation. Conversely, plasma FGF-21 levels were elevated. Electrophysiological assessments revealed enhanced compound muscle action potential (CMAP) amplitudes and reduced distal latencies in DCA-treated rats, indicative of improved nerve conduction. Histopathological examinations showed reduced perineural thickness in the sciatic nerves of DCA-treated rats, pointing to decreased fibrosis. Enhanced performance in motor function tests was observed in these rats, implying improved muscle strength and motor capacity. CONCLUSIONS The study demonstrates that DCA therapy significantly reduces oxidative stress and inflammation in a rat model of DN, thereby ameliorating neuropathic symptoms. These results support the potential of DCA as a promising therapeutic agent for DN treatment. Further research is warranted to explore its clinical applications and to provide more detailed insights.
Collapse
Affiliation(s)
- Murat Arı
- Söke Health Services Vocational School, Aydin Adnan Menderes University, Aydin, Turkey.
| | - Mumin Alper Erdogan
- Faculty of Medicine, Department of Physiology, Izmir Katip Celebi University, Izmir, Turkey
| | - Oytun Erbaş
- Faculty of Medicine, Department of Physiology, Istanbul Demiroglu Bilim University, Istanbul, Turkey
| |
Collapse
|
|
10
|
Prem R, Vignaraja V, Lewis T, Budair B. Weight bearing versus non-weight bearing total contact cast in the management of active Charcot foot: A systematic review. SAGE Open Med 2024; 12:20503121241306957. [PMID: 39691864 PMCID: PMC11650502 DOI: 10.1177/20503121241306957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 11/25/2024] [Indexed: 12/19/2024] Open
Abstract
Aim Diabetic Charcot neuro-osteoarthropathy carries a significant worldwide disease burden including diabetic foot infection, ulceration and amputation. The current accepted standard of treatment during the active phase of Charcot neuro-osteoarthropathy is offloading with total contact casting; however, controversy remains regarding weight-bearing status during this period. Methods A systematic review was performed following PRISMA guidelines of Pubmed, EMBASE, MEDLINE and the Cochrane central register of controlled trials for clinical studies from inception until June 2024 investigating weight-bearing and non-weight-bearing total contact casting for active Charcot neuro-osteoarthropathy. Results Four hundred ninety-three studies were identified in the search strategy of which 5 studies met the inclusion criteria comprising 158 patients. These studies found that allowing patients to weight-bear during total contact casting does not have a negative impact on the healing process. There were no comparative studies between weight-bearing and non-weight-bearing total contact casting. Conclusions There is limited evidence to support current practice of non-weight bearing in a total contact casting for active Charcot neuro-osteoarthropathy. Allowing patients to weight bear carries advantages to patient independence and quality of life. Further investigation with randomised control trial should be considered to investigate if weight bearing is associated with negative outcomes.
Collapse
Affiliation(s)
- Rachna Prem
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Vikramman Vignaraja
- King’s Foot and Ankle Unit, King’s College Hospital NHS Foundation Trust, London, UK
| | - Thomas Lewis
- King’s Foot and Ankle Unit, King’s College Hospital NHS Foundation Trust, London, UK
| | | |
Collapse
|
|
11
|
Fuss FK, Tan AM, Weizman Y. Advanced Dynamic Centre of Pressure Diagnostics with Smart Insoles: Comparison of Diabetic and Healthy Persons for Diagnosing Diabetic Peripheral Neuropathy. Bioengineering (Basel) 2024; 11:1241. [PMID: 39768059 PMCID: PMC11673908 DOI: 10.3390/bioengineering11121241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 11/26/2024] [Accepted: 12/04/2024] [Indexed: 01/11/2025] Open
Abstract
Although diabetic polyneuropathy (DPN) has a very high prevalence among people with diabetes, gait analysis using cyclograms is very limited, and cyclogram research, in general, is limited to standard measures available in software packages. In this study, cyclograms (movements of the centre of pressure, COP, on and between the plantar surfaces) of diabetics and healthy individuals recorded with a smart insole were compared in terms of geometry and balance index, BI. The latter was calculated as the summed product of standard deviations of cyclogram markers, i.e., start/end points, turning points, and intersection points of the COP. The geometry was assessed by the positions of, and distances between, these points, and the distance ratios (14 parameters in total). The BI of healthy and diabetic individuals differed significantly. Of the fifteen parameters (including the BI), three were suitable as classifiers to predict DPN, namely two distances and their ratio, with false negatives ranging from 1.8 to 12.5%, and false positives ranging from 2.9 to 7.1%. The standard metric of the cyclogram provided by the software packages failed as a classifier. While the BI captures both DPN-related balance and other balance disorders, the changing geometry of the cyclogram in diabetics appears to be DPN-specific.
Collapse
Affiliation(s)
- Franz Konstantin Fuss
- Chair of Biomechanics, Faculty of Engineering Science, University of Bayreuth, D-95440 Bayreuth, Germany; (Y.W.); (A.M.T.)
- Division of Biomechatronics, Fraunhofer Institute for Manufacturing Engineering and Automation IPA, D-95447 Bayreuth, Germany
| | - Adin Ming Tan
- Chair of Biomechanics, Faculty of Engineering Science, University of Bayreuth, D-95440 Bayreuth, Germany; (Y.W.); (A.M.T.)
- Faculty of Health, Arts and Design, Swinburne University, Melbourne, VIC 3000, Australia
| | - Yehuda Weizman
- Chair of Biomechanics, Faculty of Engineering Science, University of Bayreuth, D-95440 Bayreuth, Germany; (Y.W.); (A.M.T.)
| |
Collapse
|
|
12
|
Ming A, Schubert T, Marr V, Hötzsch J, Stober S, Mertens PR. Video game-based application for fall risk assessment: a proof-of-concept cohort study. EClinicalMedicine 2024; 78:102947. [PMID: 39677357 PMCID: PMC11638629 DOI: 10.1016/j.eclinm.2024.102947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 10/31/2024] [Accepted: 11/04/2024] [Indexed: 12/17/2024] Open
Abstract
Background Fall(s) are a significant cause of morbidity and mortality especially amongst elderly with polyneuropathy and cognitive decline. Conventional fall risk assessment tools are prone to low predictive values and do not address specific vulnerabilities. This study seeks to advance the development of an innovative, engaging fall prediction tool for a high-risk cohort diagnosed with diabetes. Methods In this proof-of-concept cohort study, between July 01, 2020, and May 31, 2022, 152 participants with diabetes performed clinical examinations to estimate individual risks of fall (timed "up and go" (TUG) test, dynamic gait index (DGI), Berg-Balance-Scale (BBS)) and participated in a video game-based fall risk assessment with sensor-equipped insoles as steering units. The participants engaged in four distinct video games, each designed to address capabilities pertinent to prevent fall(s): skillfulness, reaction time, sensation, endurance, balance, and muscle strength. Data were collected during both, seated and standing gaming sessions. By data analyses using binary machine learning models a classification of participants was achieved and compared with actual fall events reported for the past 24 months. Findings Overall 22 out of 152 participants (14.5%) underwent at least one episode of fall during the past 24 months. Adjusted risk classification accuracies of TUG, DGI, and BBS reached 58.7%, 58.3%, and 47.5%, respectively. Data analyses from gaming sessions in seated and standing positions yielded two models with six predictors from the four games with accuracies of 82.8% and 88.6% (area under the receiver-operating-characteristic curve 0.84 (95% confidence interval (CI): 0.77-0.91) and 0.91 (95% CI: 0.85-0.97), respectively). Key capabilities that were distinctly different between the groups related to endurance (0.6 ± 0.1 vs. 0.5 ± 0.2; p = 0.03) and balance (0.7 ± 0.2 vs. 0.6 ± 0.2; p = 0.05). The AI-driven analysis allowed to extract a list of game features that showed highly significant predictive values, e.g., reaction times in specific task, deviation from ideal steering routes in parcours and pressure-related parameters. Interpretation Thus, video game-based assessment of fall risk surpasses traditional clinical assessment tools and scores (e.g., TUG, DGI, and BBS) and may open a novel resource for patient evaluation in the future. Further research with larger, heterogeneous cohorts is needed to validate these findings and especially predict future fall risk probabilities in clinical as well as outpatient settings. Funding This project was funded by the Ministry of Science, Economics, and Digitalization of the State of Saxony-Anhalt and the European Fund for Regional Development under the Autonomy in Old Age Program (Funding No: ZS/2016/05/78615, ZS/2018/12/95325) and Healthy Cognition and Nerve function (HeyCoNer, ZS/2023/12/183088).
Collapse
Affiliation(s)
- Antao Ming
- University Clinic for Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Tanja Schubert
- University Clinic for Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Vanessa Marr
- University Clinic for Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jaqueline Hötzsch
- University Clinic for Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Sebastian Stober
- Artificial Intelligence Lab, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Peter R. Mertens
- University Clinic for Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| |
Collapse
|
|
13
|
Martin B, Hensley J, Vatcheva K, Baker K. The Effect of Diabetic Neuropathy on the Frequency of Joint Replacement in the Rio Grande Valley. Cureus 2024; 16:e71652. [PMID: 39553028 PMCID: PMC11567693 DOI: 10.7759/cureus.71652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2024] [Indexed: 11/19/2024] Open
Abstract
Background Research has suggested that bone health may be impaired in patients with diabetic neuropathy, with a potential increased risk of fracture. Here, we sought to evaluate the frequency of joint replacements in individuals with and without DN. Our work may allow for prophylaxis to prevent further deterioration in bone health and reduce the necessity of surgical procedures. Methods We conducted a retrospective chart review, from 2019 through 2023, using the UTHealth Rio Grande Valley electronic medical records system. We evaluated odds ratios of fracture history in patients with DN, other diabetic complications, or diabetes (n=10,416). Multiple confounders were considered from patient characteristics, including age, sex, ethnicity, and county of residence. Statistical tests were performed with a significance level of 0.05 to further evaluate our data. Results We observed that there was no significant difference in the distribution of joint replacement across patients with DN, other diabetic complications, or diabetes. Ethnicity and sex were found to not significantly affect the odds of joint replacement. However, older individuals were significantly more likely to have joint replacement than younger individuals (p=0.0004). Conclusion Our results suggest that joint replacement frequency was not increased in diabetic populations in the Rio Grande Valley. Thus, we suggest that interventions to promote bone health should not be limited to specific diabetic patient groups. Further studies should be conducted to determine the exact mechanisms by which bone is affected by DN to allow for improved knowledge and care of bone health in DN patients.
Collapse
Affiliation(s)
- Blake Martin
- School of Medicine, The University of Texas Rio Grande Valley, Edinburg, USA
| | - Jared Hensley
- School of Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, USA
| | - Kristina Vatcheva
- Biostatistics and Epidemiology, University of Texas Rio Grande Valley School of Medicine, Edinburg, USA
| | - Kelsey Baker
- Neuroscience, The University of Texas Rio Grande Valley, Edinburg, USA
| |
Collapse
|
|
14
|
Gaur A, Varatharajan S, Balan Y, Taranikanti M, John NA, Umesh M, Ganji V, Medala K. Brain-derived neurotrophic factor (BDNF) and other neurotrophic factors in type 2 diabetes mellitus and their association with neuropathy. Ir J Med Sci 2024; 193:2287-2292. [PMID: 38806878 DOI: 10.1007/s11845-024-03716-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with increased risk of morbidity and premature mortality due to its various complications. In an Indian study, the prevalence of diabetic peripheral neuropathy (DPN) in type 2 diabetic subjects was shown to be 29.2%. There is increasing evidence that a deficiency of nerve growth factor (NGF) in diabetes, as well as the calcitonin gene-related peptide (CGRP), may also contribute to the development of DPN. The aim of the current study was to evaluate nerve growth factor levels with neuropathy in type 2 DM. MATERIALS AND METHODS Forty healthy controls and 40 patients with type 2 DM were recruited; they were asked to report to Dept. of Physiology for initial history taking, general examination and neuropathy examination. A total of 5 mL of blood was collected for neurotrophic factor estimation as well as glycemic profile estimation. RESULTS The brain-derived neurotrophic factor (BDNF) values were significantly lower in the DM group whereas the insulin levels were also quite high in DM. The hot thresholds for both the upper limb and lower limb were greater in the DM group suggesting the impending neuropathy. Similarly, the Michigan scores were also greater in the DM group. The neuropathy parameters especially the Michigan A and B and the hot thresholds were positively correlated with duration of DM and glucose profile. CONCLUSION The neurotrophic factors especially BDNF are drastically reduced in DM patients and are negatively associated with neuropathy, and hence, BDNF can be utilized as a therapeutic target to treat and prevent neuropathy.
Collapse
Affiliation(s)
- Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, 508126, India.
| | - Sakthivadivel Varatharajan
- Department of General Medicine, All India Institute of Medical Sciences, Bibinagar, Telangana, 508126, India
| | - Yuvaraj Balan
- Department of Biochemistry, All India Institute of Medical Sciences, Madurai, India
| | - Madhuri Taranikanti
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, 508126, India
| | - Nitin Ashok John
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, 508126, India
| | - Madhusudhan Umesh
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, 508126, India
| | - Vidya Ganji
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, 508126, India
| | - Kalpana Medala
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, 508126, India
| |
Collapse
|
|
15
|
Tilahun E, Workina A, Habtamu A, Tufa H, Abebe F, Fikadu A, Atomsa F. Survival, incidence, and predictors of diabetic neuropathy among type 2 diabetic patients in hospitals of Addis Ababa. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1386426. [PMID: 38756386 PMCID: PMC11096570 DOI: 10.3389/fcdhc.2024.1386426] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/10/2024] [Indexed: 05/18/2024]
Abstract
Background Diabetic neuropathy is a very common complication of diabetes mellitus. Thus, measuring the incidence of diabetic neuropathy is a key element in tracking the progress of epidemics of diabetes mellitus and an indication of early accessibility for healthcare in terms of type 2 diabetic patients. Objective To assess survival, incidence, and predictors of diabetic neuropathy among type 2 diabetic patients in hospitals of Addis Ababa from June 25 to August 25, 2023. Methods An institutional-based retrospective follow-up study design was used among newly diagnosed type 2 diabetic patients at hospitals of Addis Ababa. A chart review tool that contains socio-demographic, clinical, and comorbidity characteristics, biochemical characteristics, and the status of type 2 patients was used. A cleaned data was exported from Epi-data manager 4.6 version to SPSS version 25 for analysis. Bivariate Cox regression analysis was done to identify predictors of diabetic neuropathy at a 95% confidence level. Result A total of 414 type 2 diabetic patients were included in the study. Of these, 97 (23.4%) developed diabetic neuropathy. Variables like having hypertension (AHR 11.25, 95% CI 3.73-33.93), anemia (AHR 4.18, 95% CI 1.78-9.82), high-density lipoprotein < 40 mg/dl (AHR 5.07, 95% CI 1.38-18.67), high creatinine level (AHR 14.67, 95% CI 4.27-50.40), diabetic retinopathy (AHR 4.32, 95% CI 1.32-14.18), and diabetic nephropathy (AHR 2.50, 95% CI 1.09-6.57) were associated with the incidence of diabetic neuropathy. The mean time to develop diabetic neuropathy was 4.94 years, CI (4.50-5.38), and the mean survival time was 6.61 years. Conclusion The incidence of diabetic neuropathy was high relative to other studies. Variables like having hypertension, anemia, high-density lipoprotein, high creatinine level, diabetic retinopathy, and diabetic nephropathy were predictors of diabetic neuropathy. The mean time to develop diabetic neuropathy was 5 years, with a survival mean time of 7 years.
Collapse
Affiliation(s)
- Eden Tilahun
- National Public Emergency Contact Center, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abdata Workina
- School of Nursing, Jimma University, Jimma, Oromia, Ethiopia
| | | | - Hailu Tufa
- National Public Emergency Contact Center, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fikadu Abebe
- School of Midwifery, Jimma University, Jimma, Oromia, Ethiopia
| | - Ayele Fikadu
- Department of Emergency and Critical Care, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | |
Collapse
|
|
16
|
Roohi TF, Mehdi S, Aarfi S, Krishna KL, Pathak S, Suhail SM, Faizan S. Biomarkers and signaling pathways of diabetic nephropathy and peripheral neuropathy: possible therapeutic intervention of rutin and quercetin. Diabetol Int 2024; 15:145-169. [PMID: 38524936 PMCID: PMC10959902 DOI: 10.1007/s13340-023-00680-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/30/2023] [Indexed: 03/26/2024]
Abstract
Diabetic nephropathy and peripheral neuropathy are the two main complications of chronic diabetes that contribute to high morbidity and mortality. These conditions are characterized by the dysregulation of multiple molecular signaling pathways and the presence of specific biomarkers such as inflammatory cytokines, indicators of oxidative stress, and components of the renin-angiotensin system. In this review, we systematically collected and collated the relevant information from MEDLINE, EMBASE, ELSEVIER, PUBMED, GOOGLE, WEB OF SCIENCE, and SCOPUS databases. This review was conceived with primary objective of revealing the functions of these biomarkers and signaling pathways in the initiation and progression of diabetic nephropathy and peripheral neuropathy. We also highlighted the potential therapeutic effectiveness of rutin and quercetin, two plant-derived flavonoids known for their antioxidant and anti-inflammatory properties. The findings of our study demonstrated that both flavonoids can regulate important disease-promoting systems, such as inflammation, oxidative stress, and dysregulation of the renin-angiotensin system. Importantly, rutin and quercetin have shown protective benefits against nephropathy and neuropathy in diabetic animal models, suggesting them as potential therapeutic agents. These findings provide a solid foundation for further comprehensive investigations and clinical trials to evaluate the potential of rutin and quercetin in the management of diabetic nephropathy and peripheral neuropathy. This may contribute to the development of more efficient and comprehensive treatment approaches for diabetes-associated complications.
Collapse
Affiliation(s)
- Tamsheel Fatima Roohi
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore, Karnataka 570015 India
| | - Seema Mehdi
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore, Karnataka 570015 India
| | - Sadaf Aarfi
- Department of Pharmaceutics, Amity University, Lucknow, Uttar Pradesh India
| | - K. L. Krishna
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore, Karnataka 570015 India
| | - Suman Pathak
- Department of Dravyaguna, Govt. Ayurvedic Medical College, Shimoga, Karnataka 577 201 India
| | - Seikh Mohammad Suhail
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore, Karnataka 570015 India
| | - Syed Faizan
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore, Karnataka 570015 India
| |
Collapse
|
|
17
|
Khalil MAM, Sadagah NM, Tan J, Syed FO, Chong VH, Al-Qurashi SH. Pros and cons of live kidney donation in prediabetics: A critical review and way forward. World J Transplant 2024; 14:89822. [PMID: 38576756 PMCID: PMC10989475 DOI: 10.5500/wjt.v14.i1.89822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/11/2023] [Accepted: 01/16/2024] [Indexed: 03/15/2024] Open
Abstract
There is shortage of organs, including kidneys, worldwide. Along with deceased kidney transplantation, there is a significant rise in live kidney donation. The prevalence of prediabetes (PD), including impaired fasting glucose and impaired glucose tolerance, is on the rise across the globe. Transplant teams frequently come across prediabetic kidney donors for evaluation. Prediabetics are at risk of diabetes, chronic kidney disease, cardiovascular events, stroke, neuropathy, retinopathy, dementia, depression and nonalcoholic liver disease along with increased risk of all-cause mortality. Unfortunately, most of the studies done in prediabetic kidney donors are retrospective in nature and have a short follow up period. There is lack of prospective long-term studies to know about the real risk of complications after donation. Furthermore, there are variations in recommendations from various guidelines across the globe for donations in prediabetics, leading to more confusion among clinicians. This increases the responsibility of transplant teams to take appropriate decisions in the best interest of both donors and recipients. This review focuses on pathophysiological changes of PD in kidneys, potential complications of PD, other risk factors for development of type 2 diabetes, a review of guidelines for kidney donation, the potential role of diabetes risk score and calculator in kidney donors and the way forward for the evaluation and selection of prediabetic kidney donors.
Collapse
Affiliation(s)
- Muhammad Abdul Mabood Khalil
- Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia
| | - Nihal Mohammed Sadagah
- Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia
| | - Jackson Tan
- Department of Nephrology, RIPAS Hospital Brunei Darussalam, Brunei Muara BA1710, Brunei Darussalam
| | - Furrukh Omair Syed
- Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia
| | - Vui Heng Chong
- Division of Gastroenterology and Hepatology, Department of Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BA1710, Brunei Darussalam
| | - Salem H Al-Qurashi
- Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia
| |
Collapse
|
|
18
|
Ming A, Lorek E, Wall J, Schubert T, Ebert N, Galatzky I, Baum AK, Glanz W, Stober S, Mertens PR. Unveiling peripheral neuropathy and cognitive dysfunction in diabetes: an observational and proof-of-concept study with video games and sensor-equipped insoles. Front Endocrinol (Lausanne) 2024; 15:1310152. [PMID: 38495786 PMCID: PMC10941030 DOI: 10.3389/fendo.2024.1310152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Background Proactive screening for cognitive dysfunction (CD) and peripheral neuropathy (PNP) in elderly patients with diabetes mellitus is essential for early intervention, yet clinical examination is time-consuming and prone to bias. Objective We aimed to investigate PNP and CD in a diabetes cohort and explore the possibility of identifying key features linked with the respective conditions by machine learning algorithms applied to data sets obtained in playful games controlled by sensor-equipped insoles. Methods In a cohort of patients diagnosed with diabetes (n=261) aged over 50 years PNP and CD were diagnosed based on complete physical examination (neuropathy symptom and disability scores, and Montreal Cognitive Assessment). In an observational and proof-of-concept study patients performed a 15 min lasting gaming session encompassing tutorials and four video games with 5,244 predefined features. The steering of video games was solely achieved by modulating plantar pressure values, which were measured by sensor-equipped insoles in real-time. Data sets were used to identify key features indicating game performance with correlation regarding CD and PNP findings. Thereby, machine learning models (e.g. gradient boosting and lasso and elastic-net regularized generalized linear models) were set up to distinguish patients in the different groups. Results PNP was diagnosed in 59% (n=153), CD in 34% (n=89) of participants, and 23% (n=61) suffered from both conditions. Multivariable regression analyses suggested that PNP was positively associated with CD in patients with diabetes (adjusted odds ratio = 1.95; 95% confidence interval: 1.03-3.76; P=0.04). Predictive game features were identified that significantly correlated with CD (n=59), PNP (n=40), or both (n=59). These features allowed to set up classification models that were enriched by individual risk profiles (i.e. gender, age, weight, BMI, diabetes type, and diabetes duration). The obtained models yielded good predictive performance with the area under the receiver-operating-characteristic curves reaching 0.95 for CD without PNP, 0.83 for PNP without CD, and 0.84 for CD and PNP combined. Conclusions The video game-based assessment was able to categorize patients with CD and/or PNP with high accuracy. Future studies with larger cohorts are needed to validate these results and potentially enhance the discriminative power of video games.
Collapse
Affiliation(s)
- Antao Ming
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Elisabeth Lorek
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Janina Wall
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Tanja Schubert
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Nils Ebert
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Imke Galatzky
- University Clinic for Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Anne-Katrin Baum
- University Clinic for Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Wenzel Glanz
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Sebastian Stober
- Artificial Intelligence Lab, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Peter R. Mertens
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| |
Collapse
|
|
19
|
Sathienluckana T, Palapinyo S, Yotsombut K, Wanothayaroj E, Sithinamsuwan P, Suksomboon N. Expert consensus guidelines for community pharmacists in the management of diabetic peripheral neuropathy with a combination of neurotropic B vitamins. J Pharm Policy Pract 2024; 17:2306866. [PMID: 38333576 PMCID: PMC10851824 DOI: 10.1080/20523211.2024.2306866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
This consensus guidance is for community pharmacists in diabetic peripheral neuropathy (DPN) management with a combination of neurotropic B vitamins. A multidisciplinary team including endocrinology, neurology, and pharmacy from Thailand discussed and aligned the practical scheme of DPN management in the community pharmacy setting, using the literature review and having face-to-face meeting. Five major statements have been endorsed as consensus recommendations for DPN care with strong acknowledgment. The aims of DPN management included reducing symptoms and the risk of complications, minimising adverse reactions from treatment regimens, and improving patients' knowledge and adherence to the treatment strategies. An initial screening process using a 7 items interview of Douleur Neuropathique 4 (DN4) questionnaire should be implemented to identify patients at risk of developing DPN. Subsequently, pharmacologic, and non-pharmacologic treatment should be employed based on patient-centered care. An interesting approach is combination of neurotropic B vitamins, which may be used as monotherapy or combination therapy to control DPN symptoms. The combined therapy potentially exhibits a synergistic effect and improves patient adherence. The consensus would be further considered in context of harmonisation of routine practice and country requirements.
Collapse
Affiliation(s)
| | - Sirinoot Palapinyo
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Kitiyot Yotsombut
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | | | | | | |
Collapse
|
|
20
|
Partha Sarathi CI, Sinha A, Rafati Fard A, Bhatti F, Rujeedawa T, Ahmed S, Akhbari M, Bhatti A, Nouri A, Kotter MR, Davies BM, Mowforth OD. The significance of metabolic disease in degenerative cervical myelopathy: a systematic review. Front Neurol 2024; 15:1301003. [PMID: 38375465 PMCID: PMC10876002 DOI: 10.3389/fneur.2024.1301003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Degenerative cervical myelopathy (DCM) is a form of chronic spinal cord injury, with a natural history of potential for progression over time. Whilst driven by mechanical stress on the spinal cord from degenerative and congenital pathology, the neurological phenotype of DCM is likely to be modified by multiple systemic factors. The role of metabolic factors is therefore of interest, particularly given that ischaemia is considered a key pathological mechanism of spinal cord injury. The objective was therefore to synthesise current evidence on the effect of metabolism on DCM susceptibility, severity, and surgical outcomes. Methods A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English, with a focus on DCM and metabolism, including diabetes, cardiovascular disease, anaemia, and lipid profile, were eligible for inclusion. Risk of methodological bias was assessed using the Joanna Briggs Institute (JBI) critical assessment tools. Quality assessments were performed using the GRADE assessment tool. Patient demographics, metabolic factors and the relationships between metabolism and spinal cord disease, spinal column disease and post-operative outcomes were assessed. Results In total, 8,523 papers were identified, of which 57 met criteria for inclusion in the final analysis. A total of 91% (52/57) of included papers assessed the effects of diabetes in relation to DCM, of which 85% (44/52) reported an association with poor surgical outcomes; 42% of papers (24/57) discussed the association between cardiovascular health and DCM, of which 88% (21/24) reported a significant association. Overall, DCM patients with diabetes or cardiovascular disease experienced greater perioperative morbidity and poorer neurological recovery. They were also more likely to have comorbidities such as obesity and hyperlipidaemia. Conclusion Metabolic factors appear to be associated with surgical outcomes in DCM. However, evidence for a more specific role in DCM susceptibility and severity is uncertain. The pathophysiology and natural history of DCM are critical research priorities; the role of metabolism is therefore a key area for future research focus. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42021268814.
Collapse
Affiliation(s)
- Celine Iswarya Partha Sarathi
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Amil Sinha
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Amir Rafati Fard
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Faheem Bhatti
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Tanzil Rujeedawa
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Shahzaib Ahmed
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Melika Akhbari
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Aniqah Bhatti
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Mark R. Kotter
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin M. Davies
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Oliver D. Mowforth
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
|
21
|
Gaur A, Varatharajan S, Katta R, Taranikanti M, John NA, Umesh M, Ganji V, Medala K. Assessment of Neuropathy by Temperature Threshold Testing in Type 2 Diabetes Mellitus. Int J Appl Basic Med Res 2024; 14:54-59. [PMID: 38504834 PMCID: PMC10947757 DOI: 10.4103/ijabmr.ijabmr_397_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/05/2024] [Accepted: 01/19/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Diagnosing diabetic neuropathy is a challenge at times as it is asymptomatic. Diagnosing diabetic neuropathy involves the use of quantitative sensory testing, nerve conduction study, and autonomic testing. Tempearture threshold testing (TTT) can aid in diagnosing small fiber neuropathy at early stages. This study aimed to assess the small fiber neuropathy using TTT in diabetes mellitus (DM) and correlate with age, duration of diabetes, and lipid profile. MATERIALS AND METHODS The study was commenced after obtaining ethics approval from the institute ethics committee. The study participants included 100 patients with type 2 DM of both genders between the ages of 40 and 65 years. The glycemic status and lipid profile were noted along with physical examination. Neuropathy assessment was done using Michigan Neuropathy Screening Instrument (MNSI) and TTT. RESULTS The prevalence of small fiber neuropathy based on TTT was 63%. The lipid profile was similar in both the groups. The MNSI B scale had significantly higher scores in the neuropathy group. In the neuropathy group, the thresholds for hot were significantly greater in all four limbs and cold were significantly lower. Age and years of DM were positively correlated with the neuropathy. Hot threshold in the lower limb had shown a strong positive correlation. CONCLUSION The age and duration of diabetes are independent risk factors for diabetic peripheral neuropathy. Small fiber neuropathy is a prequel to the motor neuropathy. Hot threshold testing in the lower limb is more sensitive than cold threshold testing for diagnosing small fiber neuropathy.
Collapse
Affiliation(s)
- Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Roja Katta
- Department of Physiology, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | - Madhuri Taranikanti
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Nitin Ashok John
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Madhusudhan Umesh
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vidya Ganji
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Kalpana Medala
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| |
Collapse
|
|
22
|
Marchesi N, Fahmideh F, Pascale A, Allegri M, Govoni S. Neuropathic Pain in Aged People: An Unresolved Issue Open to Novel Drug Approaches, Focusing on Painful Diabetic Neuropathy. Curr Neuropharmacol 2024; 22:53-64. [PMID: 37550909 PMCID: PMC10716885 DOI: 10.2174/1570159x21666230807103642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/17/2023] [Accepted: 03/15/2023] [Indexed: 08/09/2023] Open
Abstract
A majority of older patients suffer from neuropathic pain (NP) that significantly alters their daily activities and imposes a significant burden on health care. Multiple comorbidities and the risk of polypharmacy in the elderly make it challenging to determine the appropriate drug, dosage, and maintenance of therapy. Age-dependent processes play a contributing role in neuropathy given that diabetic neuropathy (DN) is the most common form of neuropathy. This narrative review is mainly focused on the drug treatment approach for neuropathy-associated pain in aged people including both drugs and dietary supplements, considering the latter as add-on mechanism-based treatments to increase the effectiveness of usual treatments by implementing their activity or activating other analgesic pathways. On one hand, the limited clinical studies assessing the effectiveness and the adverse effects of existing pain management options in this age segment of the population (> 65), on the other hand, the expanding global demographics of the elderly contribute to building up an unresolved pain management problem that needs the attention of healthcare providers, researchers, and health authorities as well as the expansion of the current therapeutic options.
Collapse
Affiliation(s)
- Nicoletta Marchesi
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Foroogh Fahmideh
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Alessia Pascale
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Massimo Allegri
- Ensemble Hospitalier de la Cote - Centre Lemanique d'antalgie et Neuromodulation, Morges, Switzerland
| | - Stefano Govoni
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| |
Collapse
|
|
23
|
Arora H, Bode A, Avula S, Naik R, Palleti S, Chandramohan D. Unilateral foot drop due to prone positioning in COVID-19: A case report. Clin Case Rep 2023; 11:e8287. [PMID: 38084357 PMCID: PMC10710528 DOI: 10.1002/ccr3.8287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/27/2023] [Accepted: 11/18/2023] [Indexed: 08/13/2024] Open
Abstract
KEY CLINICAL MESSAGE Understanding the complications arising from prone positioning following mechanical ventilation during management of acute respiratory distress from COVID-19. ABSTRACT Acute respiratory distress syndrome (ARDS) resulting from coronavirus disease 2019 (COVID-19) has been one of the well-known complications of the disease since it was first reported in 2020. Mechanical ventilation for severe ARDS has been widely utilized for the management of such patients. Prone positioning (PP) is associated with improved oxygenation and overall outcomes in both intubated and non-intubated patients. However, there are several complications associated with this procedure, including compressive neuropathies. In this article, we report a case of unilateral foot drop following mechanical ventilation and PP during the management of ARDS from COVID-19.
Collapse
Affiliation(s)
| | - Anna Bode
- Burrell College of Osteopathic MedicineLas CrucesNew MexicoUSA
| | - Sreekant Avula
- University of Minnesota, Twin CitiesMinneapolisMinnesotaUSA
| | - Roopa Naik
- Geisinger Wyoming Valley Medical CenterWilkes‐BarrePennsylvaniaUSA
| | | | | |
Collapse
|
|
24
|
Debele GR, Kuse SA, Kefeni BT, Geda A, Jifar WW, Kitila KM, Hajure M. Why too soon? Predictors of time to diabetic peripheral neuropathy among newly diagnosed diabetes mellitus patients: a multicenter follow-up study at health-care setting of Ethiopia. Arch Public Health 2023; 81:186. [PMID: 37865762 PMCID: PMC10589986 DOI: 10.1186/s13690-023-01202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 10/12/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Due to the rising number of diabetic patients, the burden of diabetic peripheral neuropathy (DPN) is clearly posing a major challenge to the long-term viability of the health-care system. Despite this, most DPN epidemiological research in eastern Africa, including Ethiopia, has so far been limited to survey studies. Thus, we determined the incidence of DPN and its predictors among diabetic patients in tertiary health-care setting of southwest Ethiopia. METHODS A multicenter retrospective follow-up study was carried out on 567 randomly selected diabetic patients. Data were entered using Epi-Data v4.6 and analyzed using R v4.0.4. The survival curves were estimated using the Kaplan-Meier, and compared using Log-rank test between groups of categorical variables. The PHA were evaluated using the Schoenfeld residuals test. Multivariable Gompertz proportional hazard model was used to examine the predictors of DPN at 5% level of significance. RESULTS Overall, of 567 DM patients 119 developed DPN with an incidence rate of 3.75, 95%CI [3.13, 4.49] per 100 PY. About 15.13% and 69% of DPN cases occurred within 2 and 5 years of DM diagnosis, respectively. In the multivariable Gompertz PH model, being female [AHR = 1.47; 95% CI (1.01, 2.15)], T2DM [AHR = 3.49 95% CI (1.82, 6.71)], having diabetic retinopathy [AHR = 1.9 95% CI (1.25, 2.91)], positive proteinuria [AHR = 2.22 95% CI (1.35, 3.65)], being obese [AHR = 3.94 95% CI (1.2, 12.89)] and overweight [AHR = 3.34 95% CI (1.09, 10.25)] significantly predicts the future risk of DPN. CONCLUSION Nearly, 7 in 10 of DPN cases occurred within short period of time (5 year) of DM diagnosis. Being female, T2DM, DR, positive proteinuria, obese and overweight significantly predicts the risk of DPN. Therefore, we recommend screening and early diagnosis of diabetes with its complication. While doing so, attention should be given for DM patients with DR and positive proteinuria at baseline.
Collapse
Affiliation(s)
- Gebiso Roba Debele
- Department of Public Health, College of Health Sciences, Mattu University, Mattu, Ethiopia.
| | - Samuel Abdisa Kuse
- Department of Midwifery, College of Health Sciences, Oda Bultum University, Chiro, Ethiopia
| | | | - Abdi Geda
- Department of Public Health, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Wakuma Wakene Jifar
- Department of Pharmacology, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Keno Melkamu Kitila
- Department of Public Health, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Mohammedamin Hajure
- Department of Psychiatry, College of Health Sciences, Mattu University, Mattu, Ethiopia
| |
Collapse
|
|
25
|
Wen W, Wei Y, Gao S. Functional nucleic acids for the treatment of diabetic complications. NANOSCALE ADVANCES 2023; 5:5426-5434. [PMID: 37822913 PMCID: PMC10563837 DOI: 10.1039/d3na00327b] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/26/2023] [Indexed: 10/13/2023]
Abstract
In recent decades, diabetes mellitus (DM) has become a major global health problem owing to its high prevalence and increased incidence of diabetes-associated complications, including diabetic wounds (DWs), diabetic nephropathy, metabolic syndrome, diabetic retinopathy, and diabetic neuropathy. In both type 1 and type 2 diabetes, tissue damage is organ-specific, but closely related to the overproduction of reactive oxygen species (ROS) and hyperglycaemia-induced macrovascular system damage. However, existing therapies have limited effects on complete healing of diabetic complications. Fortunately, recent advances in functional nucleic acid materials have provided new opportunities for the treatment and diagnosis of diabetic complications. Functional nucleic acids possess independent structural functions that can replace traditional proteases and antibodies and perform specific biological non-genetic functions. This review summarises the current functional nucleic acid materials reported for the treatment of diabetic complications, including tetrahedral framework nucleic acids (tFNAs), short interfering RNA (siRNA), micorRNA (miRNA), locked nucleic acids, antisense oligonucleotides (ASOs), and DNA origami, which may assist in the development of novel nucleic acids with new functions and capabilities for better healing of diabetic complications.
Collapse
Affiliation(s)
- Wen Wen
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University Chengdu 610041 Sichuan China
| | - Yuzi Wei
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University Chengdu 610041 Sichuan China
| | - Shaojingya Gao
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University Chengdu 610041 Sichuan China
| |
Collapse
|
|
26
|
Gelaw NB, Muche AA, Alem AZ, Gebi NB, Chekol YM, Tesfie TK, Tebeje TM. Development and validation of risk prediction model for diabetic neuropathy among diabetes mellitus patients at selected referral hospitals, in Amhara regional state Northwest Ethiopia, 2005-2021. PLoS One 2023; 18:e0276472. [PMID: 37643198 PMCID: PMC10465000 DOI: 10.1371/journal.pone.0276472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 07/23/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Diabetic neuropathy is the most common complication in both Type-1 and Type-2 DM patients with more than one half of all patients developing nerve dysfunction in their lifetime. Although, risk prediction model was developed for diabetic neuropathy in developed countries, It is not applicable in clinical practice, due to poor data, methodological problems, inappropriately analyzed and reported. To date, no risk prediction model developed for diabetic neuropathy among DM in Ethiopia, Therefore, this study aimed prediction the risk of diabetic neuropathy among DM patients, used for guiding in clinical decision making for clinicians. OBJECTIVE Development and validation of risk prediction model for diabetic neuropathy among diabetes mellitus patients at selected referral hospitals, in Amhara regional state Northwest Ethiopia, 2005-2021. METHODS A retrospective follow up study was conducted with a total of 808 DM patients were enrolled from January 1,2005 to December 30,2021 at two selected referral hospitals in Amhara regional state. Multi-stage sampling techniques were used and the data was collected by checklist from medical records by Kobo collect and exported to STATA version-17 for analysis. Lasso method were used to select predictors and entered to multivariable logistic regression with P-value<0.05 was used for nomogram development. Model performance was assessed by AUC and calibration plot. Internal validation was done through bootstrapping method and decision curve analysis was performed to evaluate net benefit of model. RESULTS The incidence proportion of diabetic neuropathy among DM patients was 21.29% (95% CI; 18.59, 24.25). In multivariable logistic regression glycemic control, other comorbidities, physical activity, hypertension, alcohol drinking, type of treatment, white blood cells and red blood cells count were statistically significant. Nomogram was developed, has discriminating power AUC; 73.2% (95% CI; 69.0%, 77.3%) and calibration test (P-value = 0.45). It was internally validated by bootstrapping method with discrimination performance 71.7 (95% CI; 67.2%, 75.9%). It had less optimism coefficient (0.015). To make nomogram accessible, mobile based tool were developed. In machine learning, classification and regression tree has discriminating performance of 70.2% (95% CI; 65.8%, 74.6%). The model had high net benefit at different threshold probabilities in both nomogram and classification and regression tree. CONCLUSION The developed nomogram and decision tree, has good level of accuracy and well calibration, easily individualized prediction of diabetic neuropathy. Both models had added net benefit in clinical practice and to be clinically applicable mobile based tool were developed.
Collapse
Affiliation(s)
- Negalgn Byadgie Gelaw
- Department of Public Health, Mizan Aman College of Health Sciences, Mizan-Aman, Ethiopia
| | - Achenef Asmamaw Muche
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Bekele Gebi
- Department of Internal Medicine, School of Medicine, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Yazachew Moges Chekol
- Department of Health Information Technology, Mizan Aman College of Health Sciences, Mizan-Aman, Ethiopia
| | - Tigabu Kidie Tesfie
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tsion Mulat Tebeje
- Unit of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| |
Collapse
|
|
27
|
Kababie-Ameo R, Gutiérrez-Salmeán G, Cuellar CA. Evidence of impaired H-reflex and H-reflex rate-dependent depression in diabetes, prediabetes and obesity: a mini-review. Front Endocrinol (Lausanne) 2023; 14:1206552. [PMID: 37476495 PMCID: PMC10354514 DOI: 10.3389/fendo.2023.1206552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/12/2023] [Indexed: 07/22/2023] Open
Abstract
Diabetes Mellitus is a public health problem associated with complications such as neuropathy; however, it has been proposed that these may begin to develop during prediabetes and may also be present in persons with obesity. Diabetic peripheral neuropathy is the presence of signs and/or symptoms of peripheral nerve dysfunction in people living with diabetes, which increases the risk of developing complications and has a deleterious impact on quality of life. As part of the therapeutic protocol for diabetes, screening tests to identify peripheral neuropathy are suggested, however, there are no recommendations for people with prediabetes and obesity without symptoms such as pain, numbness, or paresthesias. Moreover, clinical screening tests that are usually used to recognize this alteration, such as tendon reflex, temperature sensation, and pressure and vibration perception, might be subjective as they depend on the evaluator's experience thus the incorrect application of these tests may not recognize the damage to small or large-nerve fibers. Recent evidence suggests that an objective study such as the impairment of the rate-dependent depression of the H-reflex could be used as a biomarker of spinal disinhibition and hence may provide more information on sensorimotor integration.
Collapse
Affiliation(s)
- Rebeca Kababie-Ameo
- Facultad de Ciencias de la Salud, Universidad Anáhuac Mexico, Huixquilucan, Estado de Mexico, Mexico
| | - Gabriela Gutiérrez-Salmeán
- Facultad de Ciencias de la Salud, Universidad Anáhuac Mexico, Huixquilucan, Estado de Mexico, Mexico
- Centro de Especialidades del Riñon (CER), Naucalpan de Juarez, Estado de Mexico, Mexico
| | - Carlos A. Cuellar
- Escuela de Ciencias del Deporte, Universidad Anahuac Mexico, Huixquilucan, Estado de Mexico, Mexico
| |
Collapse
|
|
28
|
Nkonge KM, Nkonge DK, Nkonge TN. Screening for diabetic peripheral neuropathy in resource-limited settings. Diabetol Metab Syndr 2023; 15:55. [PMID: 36945043 PMCID: PMC10031885 DOI: 10.1186/s13098-023-01032-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Diabetic neuropathy is the most common microvascular complication of diabetes mellitus and a major risk factor for diabetes-related lower-extremity complications. Diffuse neuropathy is the most frequently encountered pattern of neurological dysfunction and presents clinically as distal symmetrical sensorimotor polyneuropathy. Due to the increasing public health significance of diabetes mellitus and its complications, screening for diabetic peripheral neuropathy is essential. Consequently, a review of the principles that guide screening practices, especially in resource-limited clinical settings, is urgently needed. MAIN BODY Numerous evidence-based assessments are used to detect diabetic peripheral neuropathy. In accordance with current guideline recommendations from the American Diabetes Association, International Diabetes Federation, International Working Group on the Diabetic Foot, and National Institute for Health and Care Excellence, a screening algorithm for diabetic peripheral neuropathy based on multiphasic clinical assessment, stratification according to risk of developing diabetic foot syndrome, individualized treatment, and scheduled follow-up is suggested for use in resource-limited settings. CONCLUSIONS Screening for diabetic peripheral neuropathy in resource-limited settings requires a practical and comprehensive approach in order to promptly identify affected individuals. The principles of screening for diabetic peripheral neuropathy are: multiphasic approach, risk stratification, individualized treatment, and scheduled follow-up. Regular screening for diabetes-related foot disease using simple clinical assessments may improve patient outcomes.
Collapse
|
|
29
|
Peripheral Nerve Denervation in Streptozotocin-Induced Diabetic Rats Is Reduced by Cilostazol. Medicina (B Aires) 2023; 59:medicina59030553. [PMID: 36984553 PMCID: PMC10057442 DOI: 10.3390/medicina59030553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Background and Objective: Our previous study demonstrated that consistent treatment of oral cilostazol was effective in reducing levels of painful peripheral neuropathy in streptozotocin-induced type I diabetic rats. As diabetic neuropathy is characterized by hyperglycemia-induced nerve damage in the periphery, this study aims to examine the neuropathology as well as the effects of cilostazol treatments on the integrity of peripheral small nerve fibers in type I diabetic rats. Materials and Methods: A total of ninety adult male Sprague-Dawley rats were divided into the following groups: (1) naïve (control) group; (2) diabetic rats (DM) group for 8 weeks; DM rats receiving either (3) 10 mg/kg oral cilostazol (Cilo10), (4) 30 mg/kg oral cilostazol (Cilo30), or (5) 100 mg/kg oral cilostazol (Cilo100) for 6 weeks. Pain tolerance thresholds of hind paws toward thermal and mechanical stimuli were assessed. Expressions of PGP9.5, P2X3, CGRP, and TRPV-1 targeting afferent nerve fibers in hind paw skin and glial cells in the spinal dorsal horn were examined via immunohistochemistry and immunofluorescence. Results: Oral cilostazol ameliorated the symptoms of mechanical allodynia but not thermal analgesia in DM rats. Significant reductions in PGP9.5-, P2X3-, CGRP, and TRPV-1-labeled penetrating nerve fibers in the epidermal layer indicated denervation of sensory nerves in the hind paw epidermis of DM rats. Denervation significantly improved in groups that received Cilo30 and Cilo100 in a dose-dependent manner. Cilostazol administration also suppressed microglial hyperactivation and increased astrocyte expressions in spinal dorsal horns. Conclusions: Oral cilostazol ameliorated hyperglycemia-induced peripheral small nerve fiber damage in the periphery of diabetic rats and effectively mitigated diabetic neuropathic pain via a central sensitization mechanism. Our findings present cilostazol not only as an effective option for managing symptoms of neuropathy but also for deterring the development of diabetic neuropathy in the early phase of type I diabetes.
Collapse
|
|
30
|
Chen XJ, Wang XF, Pan ZC, Zhang D, Zhu KC, Jiang T, Kong XK, Xie R, Sun LH, Tao B, Liu JM, Zhao HY. Nerve conduction velocity is independently associated with bone mineral density in type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2023; 14:1109322. [PMID: 36891057 PMCID: PMC9987338 DOI: 10.3389/fendo.2023.1109322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023] Open
Abstract
AIM This study investigated the association between nerve conduction velocity (NCV) and bone mineral density (BMD) in patients with type 2 diabetes mellitus (T2DM). METHODS This study retrospectively collected medical data of T2DM patients who underwent dual-energy X-ray absorptiometry and nerve conduction study at the Shanghai Ruijin Hospital, Shanghai, China. The primary outcome was the total hip BMD T-score. The main independent variables were motor nerve conduction velocities (MCVs), sensory nerve conduction velocities (SCVs), and composite Z-scores of MCV and SCV. T2DM patients were divided into total hip BMD T-scores < -1 and total hip BMD T-scores ≥ -1 groups. The association between the primary outcome and main independent variables was evaluated by Pearson bivariate correlation and multivariate linear regression. RESULTS 195 female and 415 male patients with T2DM were identified. In male patients with T2DM, bilateral ulnar, median, and tibial MCVs and bilateral sural SCVs were lower in the total hip BMD T-score < -1 group than T-score ≥ -1 group (P < 0.05). Bilateral ulnar, median, and tibial MCVs, and bilateral sural SCVs showed positive correlations with total hip BMD T-score in male patients with T2DM (P < 0.05). Bilateral ulnar and tibial MCVs, bilateral sural SCVs, and composite MCV SCV and MSCV Z-scores were independently and positively associated with total hip BMD T-score in male patients with T2DM, respectively (P < 0.05). NCV did not show significant correlation with the total hip BMD T-score in female patients with T2DM. CONCLUSION NCV showed positive association with total hip BMD in male patients with T2DM. A decline in NCV indicates an elevated risk of low BMD (osteopenia/osteoporosis) in male patients with T2DM.
Collapse
Affiliation(s)
- Xiao-jing Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-feng Wang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng-can Pan
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Deng Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ke-cheng Zhu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Jiang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-ke Kong
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Xie
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li-hao Sun
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bei Tao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-min Liu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Hong-yan Zhao, ; Jian-min Liu,
| | - Hong-yan Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Hong-yan Zhao, ; Jian-min Liu,
| |
Collapse
|
|
31
|
Awasthi A, Vishwas S, Gulati M, Corrie L, Kaur J, Khursheed R, Alam A, Alkhayl FF, Khan FR, Nagarethinam S, Kumar R, Arya K, Kumar B, Chellappan DK, Gupta G, Dua K, Singh SK. Expanding arsenal against diabetic wounds using nanomedicines and nanomaterials: Success so far and bottlenecks. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103534] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
|
32
|
Shubrook JH, Radin M, Ali SN, Chubb B, DiPietrantonio K, Collings H, Wyn R, Smith M. Preference for Type 2 Diabetes Therapies in the United States: A Discrete Choice Experiment. Adv Ther 2022; 39:4114-4130. [PMID: 35797004 PMCID: PMC9402769 DOI: 10.1007/s12325-022-02181-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/05/2022] [Indexed: 12/01/2022]
Abstract
Introduction Type 2 diabetes mellitus (T2DM) is a chronic condition associated with substantial clinical and economic burden. As multiple therapeutic options are available, patient preferences on treatment characteristics are key in T2DM therapeutic decision-making. This study aimed to determine the preferences of US patients with T2DM for therapies recommended for first pharmacologic intensification after metformin. Methods As part of a discrete choice experiment, an online survey was designed using literature review and qualitative interview findings. Eligibility was met by US patients with T2DM who were aged 18 years or older with an HbA1c ≥ 6.5%. Anonymized therapy profiles were created from six antidiabetic therapies including oral and injectable semaglutide, dulaglutide, empagliflozin, sitagliptin, and thiazolidinediones. Results Eligible patients (n = 500) had a mean HbA1c of 7.4%, and a mean BMI of 32.0 kg/m2, the majority of which (72.2%) were injectable-naïve. The treatment characteristic with greatest importance was mode and frequency of administration (35.5%), followed by body weight change (29.2%), cardiovascular event risk (19.1%), hypoglycemic event risk (9.9%), and HbA1c change (6.5%). An oral semaglutide-like profile was preferred by 91.9–70.1% of respondents depending on the comparator agent, and preference was significant in each comparison (p < 0.05); an injectable semaglutide-like profile was preferred by 89.3–55.7% of respondents in each comparison depending on the comparator agent. Conclusion Patients with T2DM in the USA are significantly more likely to prefer oral or injectable semaglutide-like profiles over those of key comparators from the glucagon-like peptide 1 receptor agonist, sodium-glucose cotransporter 2 inhibitor, dipeptidyl peptidase 4 inhibitor, and thiazolidinedione classes. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02181-7.
Collapse
Affiliation(s)
- Jay H Shubrook
- Primary Care Department, Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | | | - Sarah N Ali
- Novo Nordisk Pharma Ltd., Plainsboro, NJ, USA
| | | | | | | | | | | |
Collapse
|
|
33
|
Awasthi A, Gulati M, Kumar B, Kaur J, Vishwas S, Khursheed R, Porwal O, Alam A, KR A, Corrie L, Kumar R, Kumar A, Kaushik M, Jha NK, Gupta PK, Chellappan DK, Gupta G, Dua K, Gupta S, Gundamaraju R, Rao PV, Singh SK. Recent Progress in Development of Dressings Used for Diabetic Wounds with Special Emphasis on Scaffolds. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1659338. [PMID: 35832856 PMCID: PMC9273440 DOI: 10.1155/2022/1659338] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/19/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
Diabetic wound (DW) is a secondary application of uncontrolled diabetes and affects about 42.2% of diabetics. If the disease is left untreated/uncontrolled, then it may further lead to amputation of organs. In recent years, huge research has been done in the area of wound dressing to have a better maintenance of DW. These include gauze, films, foams or, hydrocolloid-based dressings as well as polysaccharide- and polymer-based dressings. In recent years, scaffolds have played major role as biomaterial for wound dressing due to its tissue regeneration properties as well as fluid absorption capacity. These are three-dimensional polymeric structures formed from polymers that help in tissue rejuvenation. These offer a large surface area to volume ratio to allow cell adhesion and exudate absorbing capacity and antibacterial properties. They also offer a better retention as well as sustained release of drugs that are directly impregnated to the scaffolds or the ones that are loaded in nanocarriers that are impregnated onto scaffolds. The present review comprehensively describes the pathogenesis of DW, various dressings that are used so far for DW, the limitation of currently used wound dressings, role of scaffolds in topical delivery of drugs, materials used for scaffold fabrication, and application of various polymer-based scaffolds for treating DW.
Collapse
Affiliation(s)
- Ankit Awasthi
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Bimlesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Jaskiran Kaur
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Sukriti Vishwas
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Rubiya Khursheed
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Omji Porwal
- Department of Pharmacognosy, Faculty of Pharmacy, Tishk International University-Erbil, Kurdistan Region, Iraq
| | - Aftab Alam
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj, 11942 KSA, Saudi Arabia
| | - Arya KR
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Leander Corrie
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Rajan Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Ankit Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Monika Kaushik
- Amity Institute of Pharmacy, Amity University Madhya Pradesh, Gwalior, Madhya Pradesh 474001, India
| | - Niraj Kumar Jha
- Department of Biotechnology, School of Engineering & Technology (SET), Sharda University, Plot No. 32-34 Knowledge Park III, Greater Noida, Uttar Pradesh 201310, India
| | - Piyush Kumar Gupta
- Department of Life Sciences, School of Basic Sciences and Research, Sharda University, Plot No. 32-34, Knowledge Park III, Greater Noida, 201310 Uttar Pradesh, India
- Department of Biotechnology, Graphic Era Deemed to be University, Dehradun, 248002 Uttarakhand, India
| | - Dinesh Kumar Chellappan
- Department of Life Sciences, School of Pharmacy, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Gaurav Gupta
- School of Pharmacy, Suresh Gyan Vihar University, Mahal Road, Jagatpura, Jaipur, India
- Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun, India
| | - Kamal Dua
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, NSW 2007, Australia
| | - Saurabh Gupta
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Rohit Gundamaraju
- ER Stress and Mucosal Immunology Lab, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia 7248
| | - Pasupuleti Visweswara Rao
- Department of Biomedical Sciences and Therapeutics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, 88400 Sabah, Malaysia
- Centre for International Relations and Research Collaborations, Reva University, Rukmini Knowledge Park, Rukmini Knowledge Park, Kattigenahili, Yelahanka, Bangalore, 560064, , Karnataka, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
| |
Collapse
|
|
34
|
Martínez-Ortega AJ, Muñoz-Gómez C, Gros-Herguido N, Remón-Ruiz PJ, Acosta-Delgado D, Losada-Viñau F, Pumar-López A, Mangas-Cruz MÁ, González-Navarro I, López-Gallardo G, Bellido V, Soto-Moreno AM. Description of a Cohort of Type 1 Diabetes Patients: Analysis of Comorbidities, Prevalence of Complications and Risk of Hypoglycemia. J Clin Med 2022; 11:1039. [PMID: 35207312 PMCID: PMC8875497 DOI: 10.3390/jcm11041039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Despite major medical advances, Type 1 Diabetes (T1D) patients still have greater morbimortality than the general population. Our aim was to describe our cohort of T1D patients and identify potential risk factors susceptible to prevention strategies. METHODS Cross-sectional, observational study, including T1D patients treated at our center, from 1 March 2017 to 31 March 2020. INCLUSION CRITERIA T1D, age > 14 years and signed informed consent. EXCLUSION CRITERIA diabetes other than T1D, age < 14 years and/or refusal to participate. RESULTS Study population n = 2181 (49.8% females, median age at enrollment 41 years, median HbA1c 7.7%; 38.24% had at least one comorbidity). Roughly 7.45% had severe hypoglycemia (SH) within the prior year. Macro/microvascular complications were present in 42.09% (5.83% and 41.14%, respectively). The most frequent microvascular complication was diabetic retinopathy (38.02%), and coronary disease (3.21%) was the most frequent macrovascular complication. The risk of complications was higher in males than in females, mainly macrovascular. Patients with SH had a higher risk of complications (OR 1.42; 1.43 in males versus 1.42 in females). CONCLUSIONS Our T1D population is similar to other T1D populations. We should minimize the risk of SH, and male patients should perhaps be treated more aggressively regarding cardiovascular risk factors.
Collapse
Affiliation(s)
- Antonio J. Martínez-Ortega
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
- Endocrine Diseases Laboratory, Institute of Biomedicine of Seville, Manuel Siurot Av., 41013 Seville, Spain
| | - Cristina Muñoz-Gómez
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Noelia Gros-Herguido
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Pablo Jesús Remón-Ruiz
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Domingo Acosta-Delgado
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Fernando Losada-Viñau
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Alfonso Pumar-López
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Miguel Ángel Mangas-Cruz
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Irene González-Navarro
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Gema López-Gallardo
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Virginia Bellido
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
| | - Alfonso Manuel Soto-Moreno
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Manuel Siurot Av., 41013 Seville, Spain; (C.M.-G.); (N.G.-H.); (P.J.R.-R.); (D.A.-D.); (F.L.-V.); (A.P.-L.); (M.Á.M.-C.); (I.G.-N.); (G.L.-G.); (V.B.); (A.M.S.-M.)
- Endocrine Diseases Laboratory, Institute of Biomedicine of Seville, Manuel Siurot Av., 41013 Seville, Spain
- Medicine Department, Faculty of Medicine, University of Sevilla, Dr. Fedriani Av., 41009 Seville, Spain
| |
Collapse
|
|
35
|
Helmy S, Emara T, Menem AA. Botulinum toxin type A for painful diabetic neuropathy: an open-label study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00315-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A large proportion of painful diabetic neuropathy cases either do not respond or are intolerant to the currently available oral and physical therapies. There is encouraging evidence from a small number of studies that those patients can improve using botulinum toxin injection. The aim of the study was to evaluate the effect of intradermal injection of botulinum toxin type A on painful diabetic neuropathy. Eight adult patients with diabetic peripheral neuropathy (DPN), confirmed by nerve conduction studies, were refractory to a minimum of two neuropathic pain treatments for 6 months or more were recruited. All cases received intradermal injection of 48 units of botulinum toxins—type A in each foot in 6×4 distribution. Follow-up was done after 8 weeks using the Neuropathic Pain Scale (NPS), Pittsburgh Sleep Quality Index (PSQI), and Overall Disability Sum Scale (ODSS).
Results
After 8 weeks, there was a significant change in NPS from 55.8 (7.8) to 38.5 (8.1) (p value 0.007), also there was significant improvement in ODDS from 4 (IQR, 2.25-4.75) to 2.5 (IQR, 0.5-3) (p value 0.01). However, there was no significant change in PSQI.
Conclusion
Botulinum toxin type A injection is a promising treatment option in Egyptian DPN adults in this study.
Collapse
|
|
36
|
TSH Combined with TSHR Aggravates Diabetic Peripheral Neuropathy by Promoting Oxidative Stress and Apoptosis in Schwann Cells. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:2482453. [PMID: 34804362 PMCID: PMC8601831 DOI: 10.1155/2021/2482453] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022]
Abstract
Subclinical hypothyroidism (SCH) is associated with diabetic peripheral neuropathy (DPN); however, the mechanism underlying this association remains unknown. This study is aimed at examining neurofunctional and histopathological alterations in a type 2 diabetes (T2DM) mouse model of SCH and investigating the impact of thyroid-stimulating hormone (TSH) in an in vitro DPN cell model established using RSC96 cells under high glucose (HG) and palmitic acid (PA) stimulation. Our results indicated that T2DM, in combination with SCH, aggravated abnormal glucose and lipid metabolism in T2DM and dramatically destroyed the peripheral nervous system by increasing paw withdrawal latency, decreasing motor nerve conduction velocity, and exacerbating ultrastructural deterioration of the damaged sciatic nerve caused by diabetes. Furthermore, the results of our in vitro experiments showed that TSH intensified HG/PA-induced RSC96 cell damage by inducing oxidative stress, mitochondrial dysfunction, and apoptosis. More importantly, TSHR knockout or inhibition of PA-induced TSHR palmitoylation could alleviate the apoptosis induced by TSH. Overall, in this study, the novel mechanisms by which TSH, as an independent risk factor for DPN progression, aggravating Schwann cell apoptosis and demyelination, are elucidated. These findings indicate that TSHR could be a potential target for both the prevention and treatment of DPN and, possibly, other microvascular diseases, and have implication in the clinical management of patients with DPN.
Collapse
|
|
37
|
Zinovyeva OE, Ostroumova TM, Koniashova MV, Gorbachev NA. Evaluation and treatment of peripheral nervous system dysfunction in patients with prediabetes. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2021. [DOI: 10.14412/2074-2711-2021-5-116-122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The worldwide prevalence of prediabetes is steadily increasing, with up to a third of patients already showing signs of diabetic neuropathy (DN). Prediabetes includes impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or a combination of both.Recent diagnostic criteria of prediabetes according to Russian, European, and American clinical guidelines are presented. The review covers the most common forms of DN in patients with prediabetes (distal symmetric sensory polyneuropathy, painful DN, cardiovascular autonomic neuropathy) and their prevalence. Recommended methods of DN screening are discussed: diagnostic scales, sensory testing, nerve conduction study, autonomic testing, corneal confocal microscopy. The results of studies evaluating instrumental methods for diagnosing peripheral nervous system (PNS) dysfunction in prediabetes are discussed. Management tactics in patients with prediabetes and PNS dysfunction should include non-pharmacological and pharmacological interventions. Combining a low-calorie diet and regular physical activity can delay the development of diabetes mellitus and reduce the severity of neuropathic pain. In patients with painful DN, the first-line therapy includes pregabalin, gabapentin, and duloxetine. Since there is no current data on the effect of hypoglycemic therapy on the risks of development and/or progression of DN in patients with prediabetes, antioxidants are considered pathogenetic therapy. Alpha-lipoic acid (Berlition®) in the management of patients with prediabetes is discussed.
Collapse
Affiliation(s)
- O. E. Zinovyeva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - T. M. Ostroumova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - M. V. Koniashova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - N. A. Gorbachev
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| |
Collapse
|
|
38
|
Kirthi V, Perumbalath A, Brown E, Nevitt S, Petropoulos IN, Burgess J, Roylance R, Cuthbertson DJ, Jackson TL, Malik RA, Alam U. Prevalence of peripheral neuropathy in pre-diabetes: a systematic review. BMJ Open Diabetes Res Care 2021; 9:9/1/e002040. [PMID: 34006607 PMCID: PMC8137250 DOI: 10.1136/bmjdrc-2020-002040] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/26/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
There is growing evidence of excess peripheral neuropathy in pre-diabetes. We aimed to determine its prevalence, including the impact of diagnostic methodology on prevalence rates, through a systematic review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive electronic bibliographic search was performed in MEDLINE, EMBASE, PubMed, Web of Science and the Cochrane Central Register of Controlled Trials from inception to June 1, 2020. Two reviewers independently selected studies, extracted data and assessed risk of bias. An evaluation was undertaken by method of neuropathy assessment. After screening 1784 abstracts and reviewing 84 full-text records, 29 studies (9351 participants) were included. There was a wide range of prevalence estimates (2%-77%, IQR: 6%-34%), but the majority of studies (n=21, 72%) reported a prevalence ≥10%. The three highest prevalence estimates of 77% (95% CI: 54% to 100%), 71% (95% CI: 55% to 88%) and 66% (95% CI: 53% to 78%) were reported using plantar thermography, multimodal quantitative sensory testing and nerve conduction tests, respectively. In general, studies evaluating small nerve fiber parameters yielded a higher prevalence of peripheral neuropathy. Due to a variety of study populations and methods of assessing neuropathy, there was marked heterogeneity in the prevalence estimates. Most studies reported a higher prevalence of peripheral neuropathy in pre-diabetes, primarily of a small nerve fiber origin, than would be expected in the background population. Given the marked rise in pre-diabetes, further consideration of targeting screening in this population is required. Development of risk-stratification tools may facilitate earlier interventions.
Collapse
Affiliation(s)
- Varo Kirthi
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Anugraha Perumbalath
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Emily Brown
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | | | - Jamie Burgess
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Rebecca Roylance
- Edge Hill University Library, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Timothy L Jackson
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Rayaz A Malik
- Research Division, Weill Cornell Medicine, Doha, Qatar
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Uazman Alam
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Division of Endocrinology, Diabetes & Gastroenterology, University of Manchester, Manchester, UK
- Pain Research Institute, University of Liverpool, Liverpool, UK
| |
Collapse
|
|
39
|
Gebabo TF, Zewdie TH, Shagaro SS, Haile F. Determinants of peripheral neuropathy among diabetic patients under follow-up in chronic care clinics of public hospitals at Gamo and Gofa zones, southern Ethiopia. PLoS One 2021; 16:e0246722. [PMID: 33592011 PMCID: PMC7886204 DOI: 10.1371/journal.pone.0246722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 01/25/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Peripheral neuropathy is a leading cause of morbidity and increased mortality among diabetic patients. It is characterized by significant deficits in vibration and tactile sensation. With an annual incidence of 2%, it affects as many as 110 million people worldwide. The aim of this study was to assess factors associated with peripheral neuropathy among diabetic patients in chronic care clinic in Gamo and Gofa zone, South Ethiopia. METHODS An institution- based unmatched case control study was employed among 528 randomly selected participants using a pre-tested, interviewer-administered, and structured questionnaire. Bivariate and multivariable logistic regression analysis was conducted to identifiy determinants of peripheral neuropathy using IBM SPSS version 25. RESULT The odds of being an urban dweller was 2.67 times higher among cases than controls [AOR = 2.67 (1.27, 5.63)]. The likelihood of fasting blood glucose level between 203 and 282 and 282 and above was 2.55 and 3.88 times higher among cases than controls [AOR = 2.55 (1.91, 7.16)] and [AOR = 3.88 (1.42, 10.60)] respectively. The probability of living with diabetes mellitus for 10 and more years was 3.88 times higher among cases than controls [AOR = 3.88 (1.42, 10.60)]. The odds of controlling glucose level after developing symptom was 5.33 times higher among cases than controls [AOR = 5.33 (1.28, 12.24)]. The probability of having high blood pressure was 2.36 times higher among cases than controls [AOR = 2.36 (1.26, 4.43)]. The likelihood of having a family history of complication from diabetes mellitus was 5.60 times higher among cases than controls [AOR = 5.60 (2.03, 15.43)]. The odds of exercising 3 times per week for 15 to 30 minutes and for less than 15 minutes were 2.96 and 4.92 times higher among cases than controls respectively [AOR = 2.96 (1.32, 6.61)] and AOR = 4.92, 95% CI (1.85, 13.04) respectively. The likelihood of having a waist circumference greater than or equal to 40 inch was 2.72 times higher among cases than controls [AOR = 2.72 (1.07, 6.94)]. CONCLUSION This study showed that residence, duration of diabetic mellitus, family history of complication from diabetic mellitus, level of fasting blood glucose, method of glycemic control, having a high blood pressure/hypertension/, frequency and duration of physical activity and waist circumference were found to be determinants of peripheral neuropathy. Thus, the concerned health authorities and health professionals should target on these factors in their efforts to prevent peripheral neuropathy among diabetics in the study area.
Collapse
Affiliation(s)
- Teshale Fikadu Gebabo
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Tadiwos Hailu Zewdie
- School of Medicine, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Sewunet Sako Shagaro
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Firehiwot Haile
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| |
Collapse
|
|
40
|
Prevalence of peripheral neuropathy among type 2 diabetes mellitus patients in a rural health centre in South India. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00885-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
|
41
|
Aleidan FAS, Ahmad BA, Alotaibi FA, Aleesa DH, Alhefdhi NA, Badri M, Abdel Gader AG. Prevalence and Risk Factors for Diabetic Peripheral Neuropathy Among Saudi Hospitalized Diabetic Patients: A Nested Case-Control Study. Int J Gen Med 2020; 13:881-889. [PMID: 33116780 PMCID: PMC7584505 DOI: 10.2147/ijgm.s273807] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/16/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To determine the prevalence and the risk factors of diabetic peripheral neuropathy (DPN) in hospitalized adult Saudi diabetics. METHODS This is a retrospective, nested case-control study conducted at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. All diabetic patients admitted to the hospital between the January 1, and December 31, 2018 were considered for inclusion in the study. Patients with DPN were identified and three controls per case were randomly selected from the remaining diabetic patients without peripheral neuropathy (PN). RESULTS A total of 2,096 adult diabetic patients were identified during the study period. Of these, 73 patients (3.5%) were confirmed to be suffering from DPN and 219 were included as controls. When comparing diabetic with the control cases, DPN cases were significantly older (p=0.002), had a significantly higher proportion of type 2 diabetes (p=0.023), chronic kidney disease (p<0.0001), cerebral vascular stroke (p=0.027), hypertension (p=0.005), dyslipidemia (p=0.002), peripheral vascular disease (p<0.0001), osteoarthritis (p=0.034), diabetic ketoacidosis (p=0.003), foot ulcers (p=0.006), gangrene (p=0.001), lower limb ischemia (p=0.001), increased duration with diabetic disease (p=0.031), increased BMI (p=0.003), higher serum creatinine (p<0.001) and lower serum albumin levels (p=0.035). In the multivariate logistic regression, only older age {odds ratio (OR) 1.02, 95% CI 1.01-1.04, p=0.031}, chronic kidney disease (OR 2.39, 95% CI 1.23-4.64, p=0.010) and peripheral vascular disease (OR 3.14, 95% CI 1.39-7.13, p=0.006) were independently associated with DPN. CONCLUSION This study identified several risk factors that contributed to the development of DPN in Saudis. These must be considered in strategies and campaigns aimed at risk reduction of cardiovascular and chronic diseases, and consequently progression of DPN.
Collapse
Affiliation(s)
- Fahad A S Aleidan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- College of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Banderi A Ahmad
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Farah A Alotaibi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Dalal H Aleesa
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nuha A Alhefdhi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Motasim Badri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdel Galil Abdel Gader
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|