Combining cutaneous silent periods with quantitative sudomotor axon reflex testing in the assessment of diabetic small fiber neuropathy

Kamel, Jordan; Vogrin, Simon; Knight-Sadler, ROry; Willems, N.K.; Seiderer, Linda; Cook, Mark; MacIsaac, RJ; Roberts, Leslie

doi:10.1016/j.clinph.2014.09.011

Cited by 19 publications

(25 citation statements)

References 25 publications

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“…Summary of studies The majority of studies were carried out in European populations (n = 7) [25,[36][37][38][39][40][41]; other locations were China (n = 1) [42], Brazil (n = 1) [43], USA (n = 1) [44] and Australia (n = 1) [45]. The studies sample sizes ranged from 52 to 1638 participants [25,[36][37][38][39][40][41][42][43][44][45][46][47]. All studies included tests of cardiac autonomic function.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Study design and participants Eight studies were cross sectional [25,36,37,39,[41][42][43][44], two were cohort studies [38,40] and one was a prospective observational study [45]. CAN prevalence data were presented for a total of 1730 participants with prediabetes, 1999 participants with NGT and 702 participants with predominantly type 2 diabetes.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…CAN prevalence data were presented for a total of 1730 participants with prediabetes, 1999 participants with NGT and 702 participants with predominantly type 2 diabetes. The mean age of participants in the studies varied from 39 years to 65 years [25,[36][37][38][39][40][41][42][43][44][45]. In general, there was similar recruitment of participants based on sex.…”

Section: Study Characteristicsmentioning

confidence: 99%

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The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review

et al. 2020

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Aims/hypothesis Cardiac autonomic neuropathy (CAN) is independently associated with silent myocardial ischaemia, major cardiovascular events, myocardial dysfunction and cardiovascular mortality. Several studies have highlighted the increased prevalence of CAN in prediabetes (impaired glucose tolerance and/or impaired fasting glucose). Considering the exponential rise of prediabetes, we aimed to determine the prevalence of CAN through a systematic literature review. Methods This systematic review was registered with PROSPERO (CRD42019125447). An electronic literature search was performed using MEDLINE, EMBASE, PubMed, Web of Science, Scopus and Cochrane databases. Published full text, English language articles that provide CAN prevalence data of studies in individuals with prediabetes and aged over 18 years were included. Prevalence data for normal glucose tolerance and diabetes were also extracted from the selected articles, if present. All articles were screened by two independent reviewers using a priori criteria. Methodological quality and risk of bias were evaluated using a critical appraisal tool. Results Database searches found 4500 articles; subsequently, 199 full text articles were screened, 11 of which fulfilled the inclusion criteria (4431 total participants, 1730 people with prediabetes, 1999 people with normal glucose tolerance [NGT] and 702 people with predominantly type 2 diabetes). Six of the selected studies reported definite CAN prevalence data (9–39%). Only a single large population-based study by Ziegler et al (KORA S4 study, 1332 participants) determined definite CAN based on two or more positive autonomic function tests (AFTs), with a mean prevalence of 9% in all prediabetes groups (isolated impaired glucose tolerance 5.9%; isolated impaired fasting glucose 8.1%; impaired fasting glucose plus impaired glucose tolerance 11.4%), which was higher than NGT (4.5%). This study is most likely to provide a reliable population-specific estimate of CAN in prediabetes. There was a higher than expected prevalence of CAN in prediabetes (9–38%) when compared with normal glucose tolerance (0–18%) within the same studies (n = 8). There was a wide prevalence of possible CAN based on one positive AFT (n = 5). There was heterogeneity between the studies with variations in the definition of CAN, methodology and characteristics of the populations, which likely contributed to the diversity of prevalence estimates. The overall risk of bias was low. Conclusions/interpretation There is a higher than expected prevalence of CAN in prediabetes. Early detection of CAN in prediabetes through population screening needs careful consideration in view of the excess morbidity and mortality risk associated with this condition.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review

et al. 2020

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“… 19 20 These are among several other methods to assess various small fibre types, and as each individual test may have a relatively low sensitivity, a combination of modalities is usually preferable to better assess small nerve fibre function. 21 …”

Section: Introductionmentioning

confidence: 99%

Omega-3 polyunsaturated fatty acid supplementation for improving peripheral nerve health: protocol for a systematic review

et al. 2018

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IntroductionDamage to peripheral nerves occurs in a variety of health conditions. Preserving nerve integrity, to prevent progressive nerve damage, remains a clinical challenge. Omega-3 polyunsaturated fatty acids (PUFAs) are implicated in the development and maintenance of healthy nerves and may be beneficial for promoting peripheral nerve health. The aim of this systematic review is to assess the effects of oral omega-3 PUFA supplementation on peripheral nerve integrity, including both subjective and objective measures of peripheral nerve structure and/or function.Methods and analysisA systematic review of randomised controlled trials that have evaluated the effects of omega-3 PUFA supplementation on peripheral nerve assessments will be conducted. Comprehensive electronic database searches will be performed in Ovid MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), US National Institutes of Health Clinical Trials Registry and the WHO International Clinical Trials Registry Platform. The title, abstract and keywords of identified articles will be assessed for eligibility by two reviewers. Full-text articles will be obtained for all studies judged as eligible or potentially eligible; these studies will be independently assessed by two reviewers to determine eligibility. Disagreements will be resolved by consensus. Risk of bias assessment will be performed using the Cochrane Collaboration risk of bias tool to appraise the quality of included studies. If clinically meaningful, and there are a sufficient number of eligible studies, a meta-analysis will be conducted and a summary of findings table will be provided.Ethics and disseminationThis is a systematic review that will involve the analysis of previously published data, and therefore ethics approval is not required. A manuscript reporting the results of this systematic review will be published in a peer-reviewed journal and may also be presented at relevant scientific conferences.PROSPERO registration number CRD42018086297.

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“… 11 Several studies have suggested that the findings of the QSART are frequently abnormal in clinically suspected SFN 11 12 and diabetic SFN. 13 The QSART also plays an additive role in diagnosing SFN when combined with other tests. 13 14 15 …”

Section: Introductionmentioning

confidence: 99%

Comparison of Somatic and Sudomotor Nerve Fibers in Type 2 Diabetes Mellitus

et al. 2017

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Background and PurposeThe objective of this study was to find a sensitive method for the early detection of diabetic polyneuropathy (DPN) and determine the relationship between the functions of somatic and autonomic small nerve fibers in DPN.MethodsPatients with type 2 diabetes mellitus and DPN based on clinical symptoms, signs, intraepidermal nerve fiber density (IENFD), and findings in the quantitative sudomotor axon reflex test (QSART) were enrolled retrospectively. Neurological examinations and nerve conduction studies were performed on all patients. Heart-rate variability during deep breathing (DB ratio) and the Valsalva maneuver (Valsalva ratio) were used to quantify the cardiovagal function. Patients were divided into two groups: 1) normal nerve conduction, defined as small-fiber neuropathy (SFN) and 2) abnormal nerve conduction, defined as mixed-fiber neuropathy.ResultsIn total, 82 patients were enrolled (age: 60.7±10.7 years, mean±SD). A decreased IENFD was the most frequent abnormality across all of the patients, followed by abnormalities of the QSART and cardiovagal function. A decreased IENFD was more sensitive than the QSART, DB ratio, and Valsalva ratio for detecting diabetic SFN. The DB ratio was significantly correlated with the duration of diabetes mellitus and clinical symptoms and signs. There was no correlation between the IENFD and the findings of the QSART for the distal leg.ConclusionsMeasuring the IENFD was a more sensitive method than the QSART for the early detection of DPN. The degree of involvement of the somatic small nerve fibers and sudomotor nerve fibers was independent in DPN.

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Combining cutaneous silent periods with quantitative sudomotor axon reflex testing in the assessment of diabetic small fiber neuropathy

Cited by 19 publications

References 25 publications

The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review

The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review

Omega-3 polyunsaturated fatty acid supplementation for improving peripheral nerve health: protocol for a systematic review

Comparison of Somatic and Sudomotor Nerve Fibers in Type 2 Diabetes Mellitus

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