Diabetic Neuropathies

Boulton, Andrew J.M.; Ai, Vinik; Arezzo, Joseph C.; Bril, Vera; Feldman, Eva L.; Freeman, Roy; Malik, Rayaz A.; Maser, Raelene E.; Sosenko, Jay M.; Ziegler, Dan

doi:10.2337/diacare.28.4.956

Cited by 1,710 publications

(1,423 citation statements)

References 22 publications

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“…In line with current recommendations, CAN was defined as the presence of two or more abnormal tests [28,29]. Due to technical artefacts or ectopic beats during recording or a hypoglycaemic episode during the preceding 24 h, nine participants were excluded from the analyses of HRV and blood pressure variability.…”

Section: Study Populationmentioning

confidence: 99%

Early autonomic dysfunction in type 1 diabetes: a reversible disorder?

et al. 2009

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Aims/hypothesis Cardiac autonomic neuropathy is associated with increased morbidity and mortality rates in patients with type 1 diabetes. The prevalence of early autonomic abnormalities is relatively high compared with the frequency of manifest clinical abnormalities. Thus, early autonomic dysfunction could to some extent be functional and might lead to an organic disease in a subgroup of patients only. If this is true, manoeuvres such as slow deep-breathing, which can improve baroreflex sensitivity (BRS) in normal but not in denervated hearts, could also modify autonomic modulation in patients with type 1 diabetes, despite autonomic dysfunction.Methods We compared 116 type 1 diabetic patients with 36 matched healthy control participants and 12 hearttransplanted participants with surgically denervated hearts. Autonomic function tests and spectral analysis of heart rate and blood pressure variability were performed. BRS was estimated by four methods during controlled (15 breaths per minute) and slow deep-breathing (six breaths per minute), and in supine and standing positions. Results Conventional autonomic function tests were normal, but resting spectral variables and BRS were reduced during normal controlled breathing in patients with type 1 diabetes. However, slow deep-breathing improved BRS in patients with type 1 diabetes, but not in patients with surgically denervated hearts. Standing induced similar reductions in BRS in diabetic and control participants. Conclusions/interpretation Although we found signs of increased sympathetic activity in patients with type 1 diabetes, we also observed a near normalisation of BRS with a simple functional test, indicating that early autonomic derangements are to a large extent functional and potentially correctable by appropriate interventions.

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Section: Study Populationmentioning

confidence: 99%

Early autonomic dysfunction in type 1 diabetes: a reversible disorder?

et al. 2009

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“…Diabetic peripheral neuropathy (DPN) can remain undetected and dormant, leading to serious complications1, 2. The most common variety of diabetic peripheral neuropathy is a chronic, symmetrical, length‐dependent, sensorimotor polyneuropathy defined as distal symmetric polyneuropathy (DSPN).…”

Section: Introductionmentioning

confidence: 99%

Sudoscan is an effective screening method for asymptomatic diabetic neuropathy in Chinese type 2 diabetes mellitus patients

Mao

Liu

Qiao

et al. 2016

J of Diabetes Invest

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Aims/IntroductionThe aim of the present study was to use the sudomotor function test, Sudoscan, as a screening method for the evaluation of asymptomatic diabetic distal symmetric polyneuropathy in Chinese type 2 diabetes patients. As a result, more attention could be paid to those asymptomatic patients who could be easily neglected and underdiagnosed in everyday clinic.Materials and MethodsA total of 394 Chinese type 2 diabetes patients were enrolled and tested for symptoms and clinical signs of neuropathy using the Neurological Symptom Score, Neuropathy Disability Score, and vibration perception threshold. Sudoscan was carried out, and the results were collected as the measurement of the electrochemical skin conductance of both hands and feet.ResultsIn the present study, we found that the abnormal rate of Sudoscan results in patients with asymptomatic neuropathy was higher than those without neuropathy and those with symptomatic neuropathy. This study also showed that lower electrochemical skin conductance at the feet was significantly associated with increasing symptoms, Neurological Symptom Score (r = −0.124, P < 0.05), Neuropathy Disability Score (r = −0.3, P < 0.01) and vibration perception threshold value (r = −0.18, P < 0.05). Logistic analysis showed that age (odds ratio 1.042, 95% confidence interval 1.014−1.071, P < 0.05) and feet electrochemical skin conductance levels (odds ratio 0.98, 95% confidence interval 0.962–0.993, P < 0.01) were independently associated with diabetic distal symmetric polyneuropathy.ConclusionsSudoscan might be a promising tool to screen asymptomatic diabetic distal symmetric polyneuropathy in Chinese patients with type 2 diabetes mellitus.

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“…Diabetic neuropathy is roughly classified into three types: (i) chronic sensorimotor distal symmetric polyneuropathy (DSPN); (ii) diabetic autonomic neuropathy (DAN); and (iii) focal and multifocal neuropathies, according to a statement by the American Diabetes Association 12 . Although DSPN and DAN are specific complications of diabetes, focal and multifocal neuropathies are not.…”

Section: Introductionmentioning

confidence: 99%

Pro198Leu missense polymorphism of the glutathione peroxidase 1 gene might be a common genetic predisposition of distal symmetric polyneuropathy and macrovascular disease in Japanese type 2 diabetic patients

Matsuno

Sasaki

Yamasaki

et al. 2011

Journal of Diabetes Investigation

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Aims/Introduction: We have previously reported that the Pro198Leu missense polymorphism in the glutathione peroxidase 1 (GPx‐1) gene was associated with frequent macrovascular disease (MVD). Our goal was to examine whether the GPx‐1 genotype is associated with diabetic neuropathy.Materials and Methods: We determined the GPx‐1 genotype in 173 Japanese type 2 diabetic patients who received medical interviews, physical examinations, nerve conduction studies, quantitative vibratory perception (QVP), head‐up tilt and heart rate variability tests by polymerase chain reaction‐restriction fragment‐length polymorphism. Diabetic sensorimotor distal symmetric polyneuropathy (DSPN) and diabetic autonomic neuropathy (DAN) were evaluated separately. DSPN and DAN were defined by two or more abnormalities of neuropathic leg symptoms, diminished Achilles tendon reflexes or impaired QVP in toes, and two autonomic dysfunctions, respectively. The association of the GPx‐1 genotype with DSPN, DAN, MVD and other clinical manifestations was analyzed.Results: The prevalence of DSPN, impaired QVP and painful leg cramps in patients having a genotype with Pro/Leu at the codon 198 (Pro/Leu type) was significantly higher than those with Pro/Pro type. As a result of multivariate analyses that contained the GPx‐1 genotype as an independent variable, the Pro/Leu type was extracted as a significant risk factor of DSPN, QVP impairment and MVD. The statistical significance did not disappear, even after proteinuria, retinopathy and a history of MVD were introduced as independent variables. In contrast, the GPx‐1 genotype was not associated with DAN.Conclusions: The Pro198Leu missense polymorphism of the GPx‐1 gene might have a common genetic predisposition to DSPN and MVD. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00127.x, 2011)

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Diabetic Neuropathies

Cited by 1,710 publications

References 22 publications

Early autonomic dysfunction in type 1 diabetes: a reversible disorder?

Early autonomic dysfunction in type 1 diabetes: a reversible disorder?

Sudoscan is an effective screening method for asymptomatic diabetic neuropathy in Chinese type 2 diabetes mellitus patients

Pro198Leu missense polymorphism of the glutathione peroxidase 1 gene might be a common genetic predisposition of distal symmetric polyneuropathy and macrovascular disease in Japanese type 2 diabetic patients

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