Cross sectional study to evaluate the effect of duration of type 2 diabetes mellitus on the nerve conduction velocity in diabetic peripheral neuropathy

Hussain, Gauhar; Rizvi, S. Aijaz Abbas; Singhal, Sameer; Zubair, Mohammad; Ahmad, Jamal

doi:10.1016/j.dsx.2013.02.003

Cited by 35 publications

(33 citation statements)

References 11 publications

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“…Essentially, as patients with sensory neuropathy cannot feel when they contact the ground/step, they may be inaccurate in the initiation of appropriate muscular responses. Furthermore, neuropathy patients commonly exhibit a variety of motor deficits in the muscle, including reduced motor nerve conduction velocity, denervation of motor units (predominantly in type II muscle fibers), reduced muscle volume, and impaired contractile properties as a result of nonenzymatic glycation (21)(22)(23)(24). The combination of these factors is expected to impact on muscle response and subsequently slow the speed at which strength can be generated at the affected joints.…”

Section: Discussionmentioning

confidence: 99%

Contributory Factors to Unsteadiness During Walking Up and Down Stairs in Patients With Diabetic Peripheral Neuropathy

et al. 2014

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OBJECTIVEAlthough patients with diabetic peripheral neuropathy (DPN) are more likely to fall than age-matched controls, the underlying causative factors are not yet fully understood. This study examines the effects of diabetes and neuropathy on strength generation and muscle activation patterns during walking up and down stairs, with implications for fall risk. RESEARCH DESIGN AND METHODSSixty-three participants (21 patients with DPN, 21 diabetic controls, and 21 healthy controls) were examined while walking up and down a custom-built staircase. The speed of strength generation at the ankle and knee and muscle activation patterns of the ankle and knee extensor muscles were analyzed. RESULTSPatients with neuropathy displayed significantly slower ankle and knee strength generation than healthy controls during stair ascent and descent (P < 0.05). During ascent, the ankle and knee extensor muscles were activated significantly later by patients with neuropathy and took longer to reach peak activation (P < 0.05). During descent, neuropathic patients activated the ankle extensors significantly earlier, and the ankle and knee extensors took significantly longer to reach peak activation (P < 0.05). CONCLUSIONSPatients with DPN are slower at generating strength at the ankle and knee than control participants during walking up and down stairs. These changes, which are likely caused by altered activations of the extensor muscles, increase the likelihood of instability and may be important contributory factors for the increased risk of falling. Resistance exercise training may be a potential clinical intervention for improving these aspects and thereby potentially reducing fall risk.Diabetic peripheral neuropathy (DPN) is a chronic complication of diabetes, affecting up to 50% of older patients (1,2). It is characterized by sensory loss in the lower limbs, altered sense of joint position, and impaired muscular function, which can result in alterations to gait (1-5). Patients with neuropathy are five times more likely to fall than age-matched controls, with over half of patients reporting at least one fall per year (6,7). Falls while walking down stairs account for 60% of all fall-related deaths, making this activity 10 times more hazardous than level-ground walking (8).

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Section: Discussionmentioning

confidence: 99%

Contributory Factors to Unsteadiness During Walking Up and Down Stairs in Patients With Diabetic Peripheral Neuropathy

et al. 2014

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“…44 It has been known for 50 years that DM is associated with slower nerve conduction velocity. 45 Slower conduction velocities have been reported in the tibial nerve, 40,46,47 peroneal nerve 46–48 and median nerve. 42,46 In some cases, peroneal nerve responses in DPN cannot be detected.…”

Section: The Effects Of Dpn On Skeletal Muscle Functionmentioning

confidence: 98%

“…45 Slower conduction velocities have been reported in the tibial nerve, 40,46,47 peroneal nerve 46–48 and median nerve. 42,46 In some cases, peroneal nerve responses in DPN cannot be detected. 49 Declines in femoral nerve conduction have also been reported in diabetic patients without overt signs of neuropathy.…”

Section: The Effects Of Dpn On Skeletal Muscle Functionmentioning

confidence: 98%

“…Although smaller sensory fibers play a large role early in the development of DPN and thus play a greater role in early DPN compared to larger motor nerve fibers, motor nerve conduction velocity is reduced with further progression of DPN. 40,42,46–49 Minimally invasive skin biopsies can assess intraepidermal fiber density, but they have shown considerable variability, even among controls, and their invasive nature remains a burden for patients and researchers. 123,124 Corneal confocal microscopy has shown early promising results for non-invasive detection and stratification of the severity of DPN.…”

Section: Current Limitations In Assessing Intervention Efficacy In Dpnmentioning

confidence: 99%

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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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“…Knowing this provides clinicians and patients with prognostic information. In a study of 86 patients with Type 2 DM, including patients with and without clinical evidence of DSP, lower extremity NCS were worse with increasing clinical severity and duration of symptoms . Another study showed that NCS correlated well with diabetes duration, fasting blood glucose, and glycated hemoglobin level .…”

Section: Introductionmentioning

confidence: 97%

AANEM policy statement on electrodiagnosis for distal symmetric polyneuropathy

2017

Muscle and Nerve

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Electrodiagnostic (EDX) studies are often very helpful in the diagnosis and management of patients who have or are suspected to have Distal Symmetric Polyneuropathy (DSP). However, EDX studies may not be appropriate in every situation. There are five common scenarios in which EDX studies are likely to be beneficial: (1) determining primary and alternative diagnoses; (2) determining severity, duration and prognosis of disease; (3) evaluating risk of associated problems; (4) determining the effect of medications; and (5) evaluating the effect of toxic exposures. Muscle Nerve 57: 337-339, 2018.

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Cross sectional study to evaluate the effect of duration of type 2 diabetes mellitus on the nerve conduction velocity in diabetic peripheral neuropathy

Cited by 35 publications

References 11 publications

Contributory Factors to Unsteadiness During Walking Up and Down Stairs in Patients With Diabetic Peripheral Neuropathy

Contributory Factors to Unsteadiness During Walking Up and Down Stairs in Patients With Diabetic Peripheral Neuropathy

Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy

AANEM policy statement on electrodiagnosis for distal symmetric polyneuropathy

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