Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes

Daousi, Christina; MacFarlane, I. A.; Woodward, Alan; Nurmikko, Turo; Bundred, Peter; Benbow, Susan J.

doi:10.1111/j.1464-5491.2004.01271.x

Cited by 420 publications

(299 citation statements)

References 34 publications

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“…Neuropathic pain develops in >30% of these patients, meaning that approximately one in six patients with diabetes develops a painful neuropathy [188][189][190] . Several drugs are approved for treatment of neuropathic pain in diabetes, but these drugs do not address the underlying pathogenic mechanisms.…”

Section: Schwann Cells In Diabetic Neuropathymentioning

confidence: 99%

Schwann cell interactions with axons and microvessels in diabetic neuropathy

et al. 2017

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The incidence of diabetes mellitus has increased dramatically over the past two to three decades. According to the International Diabetes Federation Diabetes Atlas, 415 million people worldwide had diabetes in 2015, and this number is expected to grow by 5% annually, predominantly as a result of increasing prevalence of type 2 diabetes. Furthermore, an estimated 100 million Europeans and 80 million Americans have impaired glucose tolerance or prediabetes. Few people die from acute diabetes in countries with comprehensive health care systems, but the disease is inflicting a huge medical, social and economic burden on society owing to the need for lifelong treatment of its systemic consequences and the insidious development of multi-organ damage.Peripheral neuropathy (BOXES 1,2) is a common but often neglected complication of long-term diabetes, and the lack of treatment options reflects an incomplete understanding of the pathogenic mechanisms. Hyperglycaemia is generally accepted as the primary pathogenic insult in type 1 and type 2 diabetic neuropathy, although roles are emerging for other factors, such as impaired insulin signalling, hypertension and dyslipidaemia (particularly for type 2 diabetes), which might precede overt hyperglycaemia 1 . Many preclinical studies, and occasional clinical studies, have indicated that diabetic neuropathy -like diabetic nephropathy and retinopathy -results from microvascular disease, with a focus on axonal degeneration as a consequence of ischaemia and/or hypoxia. This mechanism, however, is likely to be only one aspect of a more complex pathogenesis.The earliest descriptions of pathology in diabetic neuropathy indicated that Schwannopathy accompanied axonal degeneration. The majority of clinical and basic research in diabetic neuropathy since then has focused on the effects on neurons. However, accumulating data from research into the development and regeneration of the PNS has identified Schwann cells as equally indispensable components that maintain neuronal structure and function, nourish axons, and promote survival and growth upon injury. The early reports from 1979 that demonstrated morphological changes in Schwann cells in human diabetic neuropathy 2 are now supported by an increased awareness of molecular alterations in Schwann cells during diabetes 3 . Schwann cells express a wide range of receptors and, when they sense insults or danger signals, they upregulate synthesis and secretion of factors that stimulate neuroprotection, regrowth and remyelination, or factors that aggravate disease phenotypes 4 . The most recent studies have demonstrated that Schwann cells regulate many aspects of axonal function, so that disruption of their metabolism by diabetes results in the accumulation of neurotoxic intermediates and compromises production of neuronal support factors, contributing to axonal degeneration, endothelial dysfunction and diabetic neuropathy. Abstract | The prevalence of diabetes worldwide is at pandemic levels, with the number of patients increasing by 5% annu...

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Section: Schwann Cells In Diabetic Neuropathymentioning

confidence: 99%

Schwann cell interactions with axons and microvessels in diabetic neuropathy

et al. 2017

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“…Cardiovascular mortality and morbidity rates in diabetics have been reported by several studies as 2-4 times higher than in non-diabetic subjects. Different studies also indicate that foot ulcers in diabetic patients are linked to a higher mortality [13][14][15][16][17] . Furthermore diabetic foot represents an independent risk factor of morbidity in diabetic patients with a twice mortality rate due to cardiovascular disease in diabetic subjects with foot ulceration compared to those without foot ulceration [16,17] .…”

Section: Cardiovascular Morbidity In Patients With Dfsmentioning

confidence: 99%

“…In patients with an ABI < 0.90, the relative risk has been reported to be 1.25 (95%CI: 1.05, 1.47) for developing an ulcer vs diabetic patients with a normal ABI [14] . Lower limb ischaemia due to proximal arterial occlusive atherosclerosis is an important cause able to predispose to ulceration in more than 30% of cases [15] . Nevertheless a recent study reported that diabetic patients with PAD are more likely in comparison to non-diabetic subjects to have a distal occlusive arterial disease and an higher incidence of amputions and death related to cardiovascular causes [13] .…”

Section: Introductionmentioning

confidence: 99%

Diabetic foot syndrome: Immune-inflammatory features as possible cardiovascular markers in diabetes

Tuttolomondo

Maida

Pinto

2015

WJO

125

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“…The most commonly reported form of neuropathy is polyneuropathy, also called diabetic peripheral neuropathy, a common and debilitating complication of diabetes (2). Pain in the feet characterized as sharp, stabbing, or burning is observed in 16 -26% of diabetic patients (3,4). They also may complain of pain in response to normally nonpainful stimuli (allodynia).…”

mentioning

confidence: 99%

Impact of Disease Characteristics on the Efficacy of Duloxetine in Diabetic Peripheral Neuropathic Pain

et al. 2007

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OBJECTIVE -To evaluate the impact of baseline disease variables related to diabetes and diabetic neuropathy severity on efficacy and safety of duloxetine in the management of diabetic peripheral neuropathic pain.RESEARCH DESIGN AND METHODS -The impact of baseline conditions was evaluated using the data from three pooled placebo-controlled studies for combined duloxetine, doses of 60 mg q.d. and 60 mg b.i.d., versus placebo. The primary efficacy measure was the weekly mean of 24-h average pain severity, and night pain was the secondary measure. Safety and tolerability were assessed.RESULTS -There were no significant (P Ͼ 0.10) interactions of treatment by age (Ͻ65 or Ն65 years), type of diabetes (type 1 or type 2), duration of diabetes (median split Ͻ9.18 or Ն9.18 years), duration of diabetic neuropathy (Ͻ2, 2 to Ͻ6, or Ն6 years), severity of diabetic neuropathy (baseline Michigan Neuropathy Screening Instrument score Ͻ5 or Ն5), baseline A1C level (median split Ͻ7.6 or Ն7.6%), or baseline insulin use (yes/no). Significant interactions for both pain measures were observed in baseline pain subgroups (Brief Pain Inventory average pain, Ն6 and Ͻ6). Duloxetine was more effective in the subgroup with more pain. No significant association was found between any other subgroups (P Ͼ 0.10). Significant interactions (P Ͻ 0.1) occurred with treatment-emergent adverse events when stratified by subgroups.CONCLUSIONS -Pain severity but not variables related to diabetes or neuropathy may predict the effects of duloxetine in diabetic peripheral neuropathic pain. The efficacy of duloxetine is related to the initial pain severity and is generalizable across a broad spectrum of diabetic patients, including those with the highest severity of diabetes or neuropathy. Diabetes Care 30:664 -669, 2007

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Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes

Abstract: CPPN is common, often severe but frequently unreported and inadequately treated.

Cited by 420 publications

References 34 publications

Schwann cell interactions with axons and microvessels in diabetic neuropathy

Schwann cell interactions with axons and microvessels in diabetic neuropathy

Diabetic foot syndrome: Immune-inflammatory features as possible cardiovascular markers in diabetes

Impact of Disease Characteristics on the Efficacy of Duloxetine in Diabetic Peripheral Neuropathic Pain

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