Severe Early-Onset Polyneuropathy in Insulin-Dependent Diabetes Mellitus

Saïd, Gérard; Goulon‐Goeau, Catherine; Slama, G.; Tchobroutsky, G

doi:10.1056/nejm199205073261905

Cited by 118 publications

(67 citation statements)

References 15 publications

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“…Thus the present study confirms the early occurrence of unmyelinated fibre degeneration, but because of the proximal site of the biopsy, also shows significant regeneration. Similar changes have been seen in the unmyelinated fibres of five diabetic patients with an exceptionally severe early onset neuropathy [34] and in diabetic patients with severe neuropathy [10,31]. Small fibres appear to be prone to early damage but retain the ability to repair themselves even in chronic end-stage neuropathy [10,31].…”

Section: Discussionsupporting

confidence: 68%

“…We have previously demonstrated a significant reduction in endoneurial capillary density and endoneurial microangiopathy in patients with mild diabetic neuropathy [13] and in a limited group of patients with minimal diabetic neuropathy [12]. Endoneurial microangiopathy has been observed in a group of relatively young diabetic patients with an acute onset of neuropathy [34] and in small numbers of diabetic patients without evidence of neuropathy [38,39]. We have recently demonstrated significant endoneurial microangiopathy in patients with impaired glucose tolerance, specifically in the patients with neuropathy [40].…”

Section: Discussionmentioning

confidence: 91%

“…In addition axonal atrophy and axo-glial dysjunction have also been demonstrated in some [31,32] but not in other [20,21,33] studies. Unmyelinated fibres demonstrate both degeneration and regeneration in a variety of clinical syndromes of diabetic neuropathy [10,11,31,34]. However, the majority of studies have been performed in patients with advanced diabetic neuropathy and thus do not define the early changes associated with the development of neuropathy.…”

Section: Discussionmentioning

confidence: 99%

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Sural nerve pathology in diabetic patients with minimal but progressive neuropathy

et al. 2005

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Aims/hypothesis: The early pathological features of human diabetic neuropathy are not clearly defined. Therefore we quantified nerve fibre and microvascular pathology in sural nerve biopsies from diabetic patients with minimal neuropathy. Methods: Twelve diabetic patients underwent detailed assessment of neuropathy and fascicular sural nerve biopsy at baseline, with repeat assessment of neuropathy 8.7±0.6 years later. Results: At baseline, neuropathic symptoms, neurological deficits, quantitative sensory testing, cardiac autonomic function and peripheral nerve electrophysiology showed minimal abnormality, which deteriorated at follow-up. Myelinated fibre density, fibre and axonal area, and g-ratio were normal but teased fibre studies showed paranodal abnormalities (p<0.001), segmental demyelination (p<0.01) and remyelination (p<0.01) without axonal degeneration. Unassociated Schwann cell profile density (p<0.04) and unmyelinated axon density (p<0.001) were increased and axon diameter was decreased (p<0.007). Endoneurial capillaries demonstrated basement membrane thickening (p<0.006), endothelial cell hyperplasia (p<0.004) and a reduction in luminal area (p<0.007). Conclusions/interpretation: The early pathological features of human diabetic neuropathy include an abnormality of the myelinated fibre Schwann cell and unmyelinated fibre degeneration with regeneration. These changes are accompanied by a significant endoneurial microangiopathy.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Sural nerve pathology in diabetic patients with minimal but progressive neuropathy

et al. 2005

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“…lower extremities are predominantly involved in diabetic neuropathy presumably because of a length-dependent degeneration of nerve fibers (25,26). If neuropathy is a factor, skeletal muscle function is more likely to be affected in the lower extremities than in the upper extremities.…”

Section: Statistical Analysesmentioning

confidence: 99%

Accelerated Loss of Skeletal Muscle Strength in Older Adults With Type 2 Diabetes

Park

Goodpaster²,

Strotmeyer³

et al. 2007

Diabetes Care

644

481

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OBJECTIVE -It has been shown that adults with either long-standing type 1 or type 2 diabetes had lower skeletal muscle strength than nondiabetic adults in cross-sectional studies. The aim of the study was to investigate longitudinal changes of muscle mass and strength in community-dwelling older adults with and without type 2 diabetes.RESEARCH DESIGN AND METHODS -We examined leg and arm muscle mass and strength at baseline and 3 years later in 1,840 older adults aged 70 -79 years in the Health, Aging, and Body Composition Study. Regional muscle mass was measured by dual energy X-ray absorptiometry, and muscle strength was measured using isokinetic and isometric dynamometers.RESULTS -Older adults with type 2 diabetes (n ϭ 305) showed greater declines in the leg muscle mass (Ϫ0.29 Ϯ 0.03 vs. Ϫ0.23 Ϯ 0.01 kg, P Ͻ 0.05) and strength (Ϫ16.5 Ϯ 1.2 vs. Ϫ12.4 Ϯ 0.5 Nm, P ϭ 0.001) compared with older adults without diabetes. Leg muscle quality, expressed as maximal strength per unit of muscle mass (Newton meters per kilogram), also declined more rapidly in older adults with diabetes (Ϫ1.6 Ϯ 0.2 vs. Ϫ1.2 Ϯ 0.1 Nm/kg, P Ͻ 0.05). Changes in arm muscle strength and quality were not different between those with and without diabetes. Rapid declines in leg muscle strength and quality were attenuated but remained significant after controlling for demographics, body composition, physical activity, combined chronic diseases, interleukin-6, and tumor necrosis factor-␣.CONCLUSIONS -In older adults, type 2 diabetes is associated with accelerated loss of leg muscle strength and quality. Diabetes Care 30

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“…1 Data for volitionally assessed P Imax and P Emax , and sniff nasal (SnPna) and transdiaphragmatic (SnPdi) pressures in diabetic patients (all, white hatched bars; NDS<6, solid grey bars; NDS≥6, grey hatched bars) and controls (solid white bars). Error bars, 95% CI of the mean conflicting results of reduced sniff pressures in diabetic patients [10] and rare cases of respiratory muscle weakness representing the predominant manifestation of diabetic polyneuropathy [34][35][36][37] have also been reported.…”

Section: Discussionmentioning

confidence: 99%

Diabetic polyneuropathy is associated with respiratory muscle impairment in type 2 diabetes

et al. 2007

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Aims/hypothesis Diabetes has a major negative effect on intensive care unit outcome. This has been partly attributed to impaired respiratory neuromuscular function. However, data on respiratory neuromuscular involvement in diabetes are lacking. This study therefore aimed to assess respiratory neuromuscular function related to diabetic polyneuropathy in patients with type 2 diabetes. Methods Respiratory neuromuscular function was assessed by the use of volitional tests and twitch mouth (TwPmo) and twitch transdiaphragmatic (TwPdi) pressures during non-volitional bilateral anterior magnetic phrenic nerve stimulation in 21 male type 2 diabetic patients without pulmonary disease and in 23 healthy, well-matched controls (forced expiratory volume in 1 s 103±11 vs 103±12% predicted; p=0.9). Results Both volitionally assessed maximal inspiratory and expiratory mouth pressures, and sniff nasal and transdiaphragmatic pressures were comparable between diabetic patients and controls (p>0

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Severe Early-Onset Polyneuropathy in Insulin-Dependent Diabetes Mellitus

Abstract: Early-onset symptomatic polyneuropathy in patients with diabetes mellitus is characterized by the loss of both myelinated and unmyelinated nerve fibers. Spontaneous axonal regeneration is remarkably frequent, even when neuropathy is severe.

Cited by 118 publications

References 15 publications

Sural nerve pathology in diabetic patients with minimal but progressive neuropathy

Sural nerve pathology in diabetic patients with minimal but progressive neuropathy

Accelerated Loss of Skeletal Muscle Strength in Older Adults With Type 2 Diabetes

Diabetic polyneuropathy is associated with respiratory muscle impairment in type 2 diabetes

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