Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy

Abstract

Purpose In this review, we highlight the current concepts in the effects of diabetic peripheral neuropathy (DPN) in skeletal muscle. We discuss the lack of effective pharmacological treatments and the role of physical exercise intervention in limb protection and symptom reversal. We also highlight the importance of Magnetic Resonance Imaging (MRI) techniques in providing a mechanistic understanding of the disease and helping develop targeted treatments. Methods This review provides a comprehensive reporting on the effects of DPN in the skeletal muscle of diabetic patients. It also provides an update on the most recent trials of exercise intervention targeting DPN pathology. Lastly, we report on emerging MRI techniques that have shown promise in providing a mechanistic understanding of DPN and can help improve the design and implementation of clinical trials in the future. Findings Impairments in lower limb muscles reduce functional capacity and contribute to altered gait, increased fall risk, and impaired balance in patients with DPN. This is an important concern for DPN patients as their falls are very likely to be injurious, and lead to bone fractures, poorly healing wounds, and chronic infections that may require amputation. Preliminary studies have shown that moderate intensity exercise programs are well tolerated by patients with DPN. They can improve their cardiorespiratory function and can partially reverse some of the DPN symptoms. MRI has the potential to bring new mechanistic insights into the effects of DPN as well as to objectively measure small changes in DPN pathology as a result of intervention. Implications Non-invasive exercise intervention is particularly valuable in DPN due to its safety, low cost, and potential to augment pharmacological interventions. As we gain a better mechanistic understanding of the disease, more targeted and effective interventions can be designed.

Nerve dysfunction leads to muscle morphological abnormalities in chronic inflammatory demyelinating polyneuropathy assessed by MRI

“…Although these structural nerve abnormalities are apparent, few studies have explored the effect on skeletal muscles. In a few related studies, our findings are supported by one that found muscle disruptions in Charcot–Marie‐Tooth neuropathy (Pareyson et al ) and some that have shown declines in skeletal muscle quantity and quality in patients with diabetic peripheral neuropathy (Moore et al ; Parasoglou et al ). Thus, reductions in muscle quantity and quality are likely driven by CIDP‐related neural factors, such as motor axon loss (Gilmore et al ) and impaired neural signaling perhaps related to nerve lesions or segmental demyelination as reported in prior studies that presumably lead to accelerated muscle atrophy (Pitarokoili et al ).…”

Multicomponent Exercise Improves Hemodynamic Parameters and Mobility, but Not Maximal Walking Speed, Transfer Capacity, and Executive Function of Older Type II Diabetic Patients

“…However, executive dysfunction is probably not the only factor responsible for the reduced TUG scores observed in the current study since T2DM progression synergistically with prolonged hyperglycemia exposure is known to result in diabetic peripheral neuropathy, which is associated with several deficiencies in the morphology and functioning of the skeletal muscle—such as denervation-reinnervation process and loss of motor axons and nerve excitability and conduction (i.e., demyelination)—resulting in accelerated muscle atrophy and fatigue and loss of muscle strength and power (i.e., muscle weakness), consequently reducing motor function (e.g., walking, climbing stairs) [ 2 – 4 ].…”

“…The progression of T2DM leads to the development of poor outcomes, such as diabetic peripheral neuropathy, which is known by its deleterious effects on muscle architecture and functioning, reducing muscular functionality (e.g., mobility, transfer capacity) [ 2 – 4 ].…”

Consumo De Oxigênio Estimado Em Amputados Unilaterais De Membros Inferiores

“…Revista Saúde e Pesquisa, v. 11, n. 3, p. 451-457, setembro/dezembro 2018 -ISSN 1983-1870 -e-ISSN 2176-9206 com maior frequência no GNT (85,7%) quando comparado ao GT (21,4%), e maior frequência de DM. Evidência demonstra que o DM promove a redução do VO 2 , além de resultar em diminuição da capacidade cardiorrespiratória e da tolerância ao exercício 18,20 . Isso ocorre pela insuficiência e/ou utilização incorreta da insulina, o que pode acarretar em uma série de distúrbios relacionados à síntese da glicose ingerida dos alimentos, prejudicando sua utilização como energia pelo nosso organismo 19,21 .…”