Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention

Selvarajah, Dinesh; Kar, Debasish; Khunti, Kamlesh; Davies, Melanie J.; Scott, A. R.; Walker, Jeremy; Tesfaye, Solomon

doi:10.1016/s2213-8587(19)30081-6

Cited by 299 publications

(302 citation statements)

References 148 publications

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“…As one of QST computerized devices, the Vibration Sensory Analyzer VSA-3000 (Medoc) was designed to assess vibration. VPT assessed by VSA-3000 has been most commonly used in detecting peripheral neuropathy (9,(12)(13)(14)(19)(20)(21)(22)(23). Recent studies showed that QST using VSA-3000 (or other devices) was also a useful adjunct measurement with good reliability of detection thresholds in central nervous system diseases (6,(24)(25)(26)(27)(28).…”

Section: Introductionmentioning

confidence: 99%

VSA-3000: A Quantitative Vibration Sensation Testing Device for Patients With Central Nervous System Injury

2020

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Objective: To investigate the effect of using Vibration Sensory Analyzer-3000 (VSA-3000) in patients with impaired vibration sensation caused by central nervous system injury. Design: Prospective observational study. Setting: A university hospital for the research and clinical practice of rehabilitation. Subjects: Sixty patients (30 stroke and 30 spinal cord injury) were recruited, aged between 20 and 71 years old, under stable medication. Interventions: Not applicable. Main Measure: VSA-3000 threshold test, tuning fork test and somatosensory evoked potential (SSEP) measurement. Results: Test-retest reliability was determined based on data collected from 60 subjects, and the intraclass correlation coefficient (ICC) for vibration perception thresholds (VPTs) was in the "substantial" range. The kappa value between VSA-3000 and SSEP was 0.877, which was higher than that of tuning fork (κ = 0.732). VSA-3000 had good diagnostic accuracy with a sensitivity of 94.8%, specificity of 92.9%, and positive-predictive value of 93.8% and negative-predictive value of 94.0%, each value was higher than that of tuning fork. The area under the receiver operating characteristic curve (AUC) of VSA-3000 was 0.95 (95% CI: 0.91 to 0.98) and that of tuning fork was 0.89 (95% CI: 0.85 to 0.95), and there was a significant difference between the two values (P = 0.0216). The types of injury and age were the independent correlates of the VPTs. Conclusion: The present study provides preliminary evidence that VSA-3000 is a non-invasive and convenient quantitative testing instrument with good diagnostic accuracy, and it may be useful as a screening tool for assessing impaired vibration sensation caused by central nerve injury.

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Section: Introductionmentioning

confidence: 99%

VSA-3000: A Quantitative Vibration Sensation Testing Device for Patients With Central Nervous System Injury

2020

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“…It should also be emphasized that each neurological modality assesses different aspects of diabetic neuropathy, since other tests assess small fiber integrity and other tests large fiber integrity. Sudomotor dysfunction as a result of small fibers damage develops early in the course of DM before large fiber damage and sensory loss (9,10,36,37). SWF assesses large fiber function, the Ipswich touch test both small and large fiber function, pinprick and temperature tests assess small fiber function and vibration tests assess large fiber function.…”

Section: Discussionmentioning

confidence: 99%

Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study

et al. 2020

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Research Question: Previous cross-sectional studies have shown an association between sudomotor dysfunction and diabetic foot ulceration (DFU). The aim of this prospective multicenter study was to determine the role of dryness of foot skin and of established neurological modalities in the prediction of risk for foot ulceration in a cohort of individuals with diabetes mellitus (DM). Design: The study was conducted from 2012 to 2017. A total of 308 subjects with DM without history of DFU or critical limb ischemia completed the study. Diabetic neuropathy was assessed using the neuropathy symptom score (NSS) and neuropathy disability score (NDS). In a subset of participants, vibration perception threshold (VPT) was evaluated. Dryness of foot skin was assessed by the visual indicator plaster method (IPM). The diagnostic performance of the above neurological modalities for prediction of DFU was tested by receiver operating characteristic curve (ROC) analysis. Results: During the 6-year follow-up, 55 patients (annual ulceration incidence 2.97%) developed DFU. Multivariate Cox-regression analysis after controlling for the effect of age, gender, and DM duration demonstrated that the risk (hazard ratio, 95% confidence intervals) of DFU increased significantly with either abnormal IPM (3.319, 1.460-7.545, p = 0.004) or high (≥6) NDS (2.782, 1.546-5.007, p = 0.001) or high (≥25 volts) VPT (2.587, 1.277-5.242, p = 0.008). ROC analysis showed that all neurological modalities could discriminate participants who developed DFU (p < 0.001). IPM testing showed high sensitivity (0.86) and low specificity (0.49), while high vs. low NDS and VPT showed low sensitivity (0.40 and 0.39, respectively) and high specificity (0.87 and 0.89, respectively) for identification of patients at risk for DFU. Panagoulias et al. Skin Dryness and Foot Ulceration Conclusion: Dryness of foot skin assessed by the IPM predicts the development of DFU. IPM testing has high sensitivity, whereas high NDS and VPT have high specificity in identifying subjects at risk for DFU. The IPM can be included in the screening methods for identification of the foot at risk.

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“…4,5 Current therapeutic strategies for DPN, including pathogenesis-oriented and symptomatic therapies, are of limited efficacy. 6,7 This suggests that effective treatments to decrease the incidence of DPN remain to be discovered. Therefore, it is imperative to explore new mechanisms underlying DPN.…”

Section: Introductionmentioning

confidence: 99%

<p>Long Non-Coding RNAs Regulate Inflammation in Diabetic Peripheral Neuropathy by Acting as ceRNAs Targeting miR-146a-5p</p>

Feng

et al. 2020

DMSO

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Background: Long non-coding RNAs (lncRNAs), as competing endogenous RNAs (ceRNAs), can regulate various pathophysiological processes by binding competitively to microRNAs at the post-transcription level. Our previous work demonstrated that miR-146a-5p was lowly expressed in diabetic peripheral neuropathy (DPN) rats. However, the ceRNA network in DPN mediated by lncRNAs and miR-146a-5p remains to be explored. Methods: Two groups of rats (n=4 per group), a type 2 diabetes (T2DM) group and a DPN group, were used in this study. Sciatic nerve conduction velocity (NCV) of each rat was determined at the 6th and the 12th week. LncRNA microarray analysis was performed in the sciatic nerve of DPN and T2DM rats. Based on the TargetScan algorithm and the miRanda database, we determined the differentially expressed (DE) lncRNAs bound to miR-146a-5p. Furthermore, we verified the DE lncRNAs potentially bound to miR-146a-5p by qRT-PCR. The genes targeted by miR-146a-5p were identified by bioinformatics prediction and experimental techniques. Results: We found 413 DE lncRNAs between DPN and T2DM rats (|log2FC| ≥ 2 and adjust P ≤ 0.05). Eight DE lncRNAs were predicted to bind to miR-146a-5p by both algorithms, of which four were verified by qRT-PCR. TRAF6, IRAK1, and SMAD4 were identified as miR-146a-5p targeted genes and were predominantly enriched in the inflammatory signaling pathway. Conclusion: LncRNAs may contribute to the pathogenesis of DPN by regulating inflammation through functioning as ceRNAs of miR-146a-5p.

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Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention

Cited by 299 publications

References 148 publications

VSA-3000: A Quantitative Vibration Sensation Testing Device for Patients With Central Nervous System Injury

VSA-3000: A Quantitative Vibration Sensation Testing Device for Patients With Central Nervous System Injury

Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study

<p>Long Non-Coding RNAs Regulate Inflammation in Diabetic Peripheral Neuropathy by Acting as ceRNAs Targeting miR-146a-5p</p>

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