Foot Muscle Energy Reserves in Diabetic Patients Without and With Clinical Peripheral Neuropathy

Dinh, Thanh; Doupis, John; Lyons, Thomas E.; Kuchibhotla, Sarada; Julliard, Walker; Gnardellis, Charalambos; Rosenblum, Barry I.; Wang, Xiaoen; Giurini, John M.; Greenman, Robert L.; Veves, Aristidis

doi:10.2337/dc09-0536

Cited by 19 publications

(21 citation statements)

References 11 publications

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“…Previous studies have demonstrated that peripheral neuropathy and fear of falling are linked to changes in gait performance, 4,26,31–34 and the present findings are in good agreement with these. Patients with DPN, for example, are known to adopt a conservative walking strategy, with a longer double-support phase and generally slower stride velocities compared with patients without DPN.…”

Section: Discussionsupporting

confidence: 93%

Fear of Falling Is Prevalent in Older Adults with Diabetes Mellitus But Is Unrelated to Level of Neuropathy

Kelly

Fleischer

Yalla

et al. 2013

Journal of the American Podiatric Medical Association

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Background Patients with diabetic peripheral neuropathy (DPN) demonstrate gait alterations compared with their nonneuropathic counterparts, which may place them at increased risk for falling. However, it is uncertain whether patients with DPN also have a greater fear of falling. Methods A voluntary group of older adults with diabetes was asked to complete a validated fear of falling questionnaire (Falls Efficacy Scale International [FES-I]) and instructed to walk 20 m in their habitual shoes at their habitual speed. Spatiotemporal parameters of gait (eg, stride velocity and gait speed variability) were collected using a validated body-worn sensor technology. Balance during walking was also assessed using sacral motion in the mediolateral and anteroposterior directions. The level of DPN was quantified using vibration perception threshold from the great toe. Results Thirty-four diabetic patients (mean ± SD: age, 67.6 ± 9.2 years; body mass index, 30.9 ± 5.7; hemoglobin A1c, 7.9% ± 2.3%) with varying levels of neuropathy (mean ± SD vibration perception threshold, 34.6 ± 22.9 V) were recruited. Most participants (28 of 34, 82%) demonstrated moderate to high concern about falling based on their FES-I score. Age (r = 0.6), hemoglobin A1c level (r = 0.39), number of steps required to reach steady-state walking (ie, gait initiation) (r = 0.4), and duration of double support (r = 0.44) were each positively correlated with neuropathy severity (P < .05). Participants with a greater fear of falling also walked with slower stride velocities and shorter stride lengths (r = −0.3 for both, P < .05). However, no correlation was observed between level of DPN and the participant’s actual concern about falling. Conclusions Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy.

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Section: Discussionsupporting

confidence: 93%

Fear of Falling Is Prevalent in Older Adults with Diabetes Mellitus But Is Unrelated to Level of Neuropathy

Kelly

Fleischer

Yalla

et al. 2013

Journal of the American Podiatric Medical Association

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“…Previous studies in our unit have shown foot muscle atrophy and reduced PCr levels in diabetic patients with diabetic neuropathy and increased Pi/PCr ratio at resting conditions in both non-neuropathic and neuropathic diabetic patients 18, 20, 32 . In the present study, no differences were observed at resting conditions among the four tested groups and this finding is in agreement with previous studies that included patients with PAD 1, 6 .…”

Section: Discussionmentioning

confidence: 59%

“…Phosphorus-31 MRS data was acquired at a temporal resolution of 6 sections during resting and exercise. Pi and PCr information was extracted from the data as previously published by our unit 18, 20 .…”

Section: Methodsmentioning

confidence: 99%

Postexercise phosphocreatine recovery, an index of mitochondrial oxidative phosphorylation, is reduced in diabetic patients with lower extremity complications

Tecilazich¹,

Dinh²,

Lyons³

et al. 2013

Journal of Vascular Surgery

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Objective To identify differences in the post-exercise phosphocreatine (PCr) recovery, an index of mitochondrial function, in diabetic patients with and without lower extremity complications. Research Methods and Design We enrolled healthy control subjects and three groups of T2DM patients: patients without complications, with peripheral neuropathy and both peripheral neuropathy and peripheral arterial disease. We employed Magnetic Resonance Spectroscopic (MRS) measurements to perform continuous measurements of phosphorous metabolites (PCr and Pi) during a 3-minute graded exercise at the level of the posterior calf muscles (gastrocnemius and soleus muscles). Micro- and macrovascular reactivity measurements were also performed. Results The resting Pi/PCr ratio and PCr at baseline and the maximum reached during exercise was similar in all groups. The post-exercise time required for recovery of Pi/PCr ratio and PCr levels to resting levels, an assessment of mitochondrial oxidative phosphorylation, was significantly higher in the diabetic patients with neuropathy and those with both neuropathy and PAD (p <0.01 for both measurements). These two groups had also higher levels of TNFα, (p<0.01) and G-CSF (p <0.05). Multiple regression analysis showed that only G-CSF, OPG and TNFα were significant contributing factors in the variation of the Pi/PCr ratio recovery time. No associations were observed between micro- and macrovascular reactivity measurements and Pi/Pcr ration or Pcr recovery time. Conclusions Mitochondrial oxidative phosphorylation is impaired only in T2DM patients with neuropathy whether PAD is present or not and is associated with the increased proinflammatory state that was observed in these groups.

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“…Resting levels of high energy phosphates are reduced in the diabetic foot. 71,72 Muscle oxidative capacity is reduced by over 50% in DPN compared to DM without neuropathy. 73 The reduced mitochondrial function in DPN is related to increased inflammatory cytokines.…”

Section: The Effects Of Dpn On Skeletal Muscle Functionmentioning

confidence: 99%

“…Resting levels of high energy phosphates are reduced in the diabetic foot. 71,72 Foot muscle atrophy has been shown to be accompanied by a reduction in 31P metabolites in the foot muscles in patients with DPN compared to diabetic patients without neuropathy, and healthy controls. 52 …”

Section: Non-invasive Mri Techniques To Assess Dpn Featuresmentioning

confidence: 99%

Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy

Parasoglou

Rao

Slade

2017

Clinical Therapeutics

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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.

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Foot Muscle Energy Reserves in Diabetic Patients Without and With Clinical Peripheral Neuropathy

Cited by 19 publications

References 11 publications

Fear of Falling Is Prevalent in Older Adults with Diabetes Mellitus But Is Unrelated to Level of Neuropathy

Fear of Falling Is Prevalent in Older Adults with Diabetes Mellitus But Is Unrelated to Level of Neuropathy

Postexercise phosphocreatine recovery, an index of mitochondrial oxidative phosphorylation, is reduced in diabetic patients with lower extremity complications

Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy

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