Introduction: Diabetic polyneuropathy (DPN) is a debilitating condition and associated with significant morbidity, including gait disturbances, reduced quality of life, and pain, that is often resistant to conventional treatments. Treatment of DPN is based on several major approaches, including risk factor management, intensive glycemic control, and symptomatic pain management. Although some authors argue that none of the existing treatment options are satisfactory, an alternative strategy is frequently overlooked: the use of a whole-food, plant-based diet. The aim of this review was to systematically investigate whether a whole-food, plant-based diet could beneficially affect patients suffering from type 2 diabetes and DPN. Methods: The electronic databases of PubMed and Google Scholar were searched using the keywords "plant-based," "vegetarian," "vegan," "diet," and "diabetic neuropathy." Results: Only a handful of studies investigated the effects of a plant-based diet on diabetic neuropathy. These studies suggest that a plant-based diet may alleviate pain in affected patients while significantly improving glycemic control, overweight, and serum lipids at the same time. Moreover, a plant-based diet appears to reduce the medication burden in affected patients. However, the results must be interpreted with caution, because the number of clinical trials is limited and all studies have important limitations with regard to their methodology. The dietary intervention was often combined with exercise and other supplemental factors, complicating the interpretation of results. Several potential mechanisms of action including improved blood flow and optimized intake of important nutrients were identified. These factors might complementarily contribute to improved perfusion in the endoneurial microvasculature, thus reducing local hypoxia and improving pain. Conclusion: Physicians should consider recommending a plant-based diet to patients suffering from DPN, as current studies show favorable effects in terms of pain management, glycemic control, and reduced medication needs. Further well-designed studies are required to confirm the results of this review. K E Y W O R D S diabetes, diabetic neuropathy, hemorheology, pain, plant-based diet, risk factor management, vegan, vegetarian This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Background: Lifestyle interventions, including dietary modifications, play a key role in the treatment of type 2 diabetes. By the second half of the last century, dietary oatmeal interventions had frequently been used in patients with diabetes; however, with the widespread introduction of insulin, this practice gradually fell into disuse. Within the last decades, the original oatmeal intervention, first described in 1903, has been modified towards a hypocaloric, low-fat, and plant-based intervention. Aim: The aim of this review was to investigate the current role of these adapted short-term dietary oatmeal interventions in the treatment of patients suffering from poorly-controlled type 2 diabetes. A special focus was put on opportunities for and barriers to its clinical implementation and its potential mechanisms of action. Methods: The electronic databases of PubMed and Google Scholar were searched using the keywords “oat,” “oats,” “oatmeal,” and “diabetes.” Results: While there are a limited number of clinical studies including hypocaloric short-term dietary oatmeal interventions, there is evidence that these interventions may lead to a significant decrease in mean blood glucose levels and a significant reduction of insulin dosage in patients suffering from poorly-controlled type 2 diabetes. Conclusion: Modified short-term dietary oatmeal interventions are an effective and economical tool in the treatment of patients suffering from poorly-controlled type 2 diabetes.

Background Immune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by low platelet counts and increased bleeding risk. The disease may be induced by other disorders, including malignancies, autoimmune diseases, infectious agents or drugs. However, ITP has also been described following vaccinations, such as the measles–mumps–rubella vaccination. In rare cases, ITP may occur in children who received a DTaP-IP (diphtheria, tetanus, acellular pertussis vaccine and inactivated poliovirus) vaccine. Hereinafter, we report the first well-documented cases of ITP in an adult patient in the temporal context of a DTaP-IP vaccination. Case presentation This case report attempts to capture the life-threatening picture of a 36-year-old otherwise healthy Caucasian woman with newly diagnosed severe immune thrombocytopenia in the temporal context of a DTaP-IP vaccination. Four days after receiving the vaccine, the women presented to her primary care physician with malaise, fever and recurrent epistaxis. Clinical examination revealed oral petechiae, ecchymoses, and non-palpable petechiae on both legs. The patient was immediately referred to a local hematology unit where she developed hematuria and an intestinal bleeding (WHO Bleeding Grade III) requiring multiple transfusions. After receiving oral corticosteroids and intravenous immunoglobulins, her platelets gradually recovered. Common causes of secondary ITP were ruled out by laboratory investigations, bone marrow and peripheral blood examinations. This raises the possibility of a (secondary) vaccination-associated thrombocytopenia. To the best of our knowledge, this is the first well-documented case of a DTaP-IP vaccination-related ITP in an adult patient in the English literature. Conclusion Although a causal connection between both entities may not be established, we would like to raise awareness in clinicians that ITP following DTaP-IP vaccinations is potentially not limited to children, but may also occur in adults. Users of DTaP-IP booster vaccines should be alert of the possibility of such adverse reactions.