Influence of continuous subcutaneous insulin infusion (CSII) treatment on diabetic somatic and autonomic neuropathy

Abstract

Near-normal plasma daily glucose profile was induced by Continuous Subcutaneous Insulin Infusion (CSII) treatment in order to evaluate its influence on diabetic somatic and autonomic neuropathy. Twelve insulin-dependent diabetic subjects with somatic neuropathy were studied before and after a short term CSII treatment of 10 days. Four out of these subjects, all affected by autonomic neuropathy, were followed for 1 yr with controls every four months. Metabolic equilibrium was monitored by mean daily plasma glucose (MPDG) profile and by Glycosylated Hemoglobin (GHb) evaluation. Somatic neuropathy was studied assessing conduction velocity at peroneal motor (PMCV) nerve, ulnar motor (UMCV), ulnar sensory (USCV) and sural sensory (SSCV) nerves. Autonomic neuropathy was assessed by means of a battery of five cardiovascular autonomic tests: Valsalva Manoeuvre (VR), Deep Breathing (DB), Lying-to-Standing (LS), Sustained HandGrip (SHG) and Postural Hypotension (PH). Short-term CSII treatment induced a near normalization of metabolic parameters, a significant improvement in VR (p less than 0.05) and DB (p less than 0.01) values, but no changes in NCV. The prolongation of CSII treatment in 4 subjects induced a significant (p less than 0.05) improvement in VR, DB and LS values and in PMCV and UMCV after 4 months. This improvement did not increase with the longer CSII treatment (1 yr).(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of 8 years of strict glycaemic control on peripheral nerve function in IDDM patients: the Oslo Study

“…It is however still uncertain whether strict control of hyperglycaemia can prevent the occurrence and progression of polyneuropathy in patients with long-standing diabetes [10,11]. Several short-term studies have demonstrated improvement of nerve conduction velocity in newly-diagnosed patients undergoing intensive insulin injection therapy [12][13][14] and in patients treated with continuous subcutaneous insulin infusion [15][16][17][18].…”

Effect of pancreatic and/or renal transplantation on diabetic autonomic neuropathy

“…Once it has developed the patient has a poor prognosis (Ewing and Clarke 1986;Watldns 1990). Various forms of treatment such as continuous subcutaneous insulin infusion (Fedele et al 1984) or aldose-reductase inhibitors (Jaspan et al 1983) showed some improvement of autonomic neuropathy, but these interventions were short. With the increasing success of pancreas transplantation the fate of neuropathy can be studied prospectively for much longer.…”

Changes in autonomic nervous function during the 4‐year follow‐up in middle‐aged diabetic and nondiabetic subjects initially free of coronary heart disease

“…In contrast, in a 5-year follow-up study of NIDDM patients [23], whilst heart rate variation decreased and diastolic blood pressure response during isometric handgrip became more abnormal, these changes were not associated with glycaemic control of diabetes. Supporting the finding that hyperglycemia causes changes in autonomic nervous function, Federe et al [6] showed in 12 patients with IDDM that even a short-term treatment for 10 days with continuous subcutaneous insulin infusion improved Valsalva ratio and heart rate variation. In several studies cardiovascular autonomic dysfunction or the deterioration of autonomic nervous function has been related to poor glycaemic control [8,9,14,15].…”

“…It rarely causes any symptoms [1,2], but is associated with increased risk of death [3][4][5]. Previous studies have mainly dealt with patients with insulin-dependent diabetes mellitus (IDDM) [6][7][8][9][10][11][12][13][14][15] or with series of diabetic patients without distinction between IDDM and non-insulin-dependent diabetes (NIDDM) [16][17][18][19], and only a few studies have focused on patients with NIDDM [20][21][22][23]. Therefore, limited information is available on the occurrence and progression of autonomic nervous dysfunction in NIDDM.…”