Abstract
Diabetic neuropathy is the most dreadful complication of poorly controlled long standing diabetes mellitus, ending up in amputation in worst cases. This underscores the value of early detection and intervention of diabetic neuropathy. The objective of present study is to look for early changes in nerve conduction in patients not exhibiting symptoms of diabetic neuropathy as compared to the symptomatic patients.
Materials & Methods: In a group of 34 patients with mean age of 59 years and asymptomatic for diabetic peripheral neuropathy, nerve conduction studies were conducted along with FBS, HbA1c and compared the same parameters with a group of 52 patients with mean age of 56 years and symptomatic for diabetic neuropathy patients. Results of nerve conduction studies in both the groups are statistically compared with normal established reference values as well as between them. The number of cases demonstrating abnormal test parameters in the given groups is statistically analyzed using chi-square test.
Results: Results of the study confirmed that there is a decline in conduction velocity to an extent of 6m/sec on the average mostly in lower limb sensory nerves in symptomatic diabetic neuropathy patients. Even in diabetic subjects not reporting any symptoms of neuropathies, in 30% of cases there is decline in lower limb sensory conduction velocities to varying extents compared to the normal reference values.
Conclusion: Nerve conduction studies even in asymptomatic cases may prove to be valuable indices of progression to full blown diabetic neuropathy in due course and help initiate prophylactic measures to retard its progress.
Keywords: Type II Diabetes mellitus, DN, DPN, NCS, NCV, HbA1c, ADA.
References
1. Mohan V, Sandeep S, Deepa R, Shah B & Varghese C. Epidemiology of type 2 diabetes: Indian scenario, Indian J Med Res 125, March 2007, pp 217-230.
2. Rema M, Deepa R, Mohan V. Prevalence of retinopathy at diagnosis among Type 2 diabetic patients attending a diabetic centre in South India. Br J Ophthalmol 2000; 84: 1058-1060.
3. Ramachandran A, Snehalatha C, Satyavani K, Latha E, Sasikala R, Vijay V. Prevalence of vascular complications and their risk factors in type 2 diabetes. J Assoc Physicians India 1999; 47:1152- 1156.
4. Mc Carty D, Zimmet P. Diabetes 1994 – 2010, Global Estimates and Projections. Melbourne: International Diabetes Institute; 1994.
5. Boulton A J, Cavanagh PR, Rayman G. The foot in diabetes. 4th Ed. John Wiley & Sons Ltd; 2006.
6. Report and recommendations of San Antonio conference on diabetic neuropathy. Neurology 1988; 38:1161-1165.
7. American Diabetes Association. Standards of medical care in diabetes (Position statement) [Published correction appears in diabetes care. 2005; 28:990]. Diabetes care. 2005; 28 (suppl 1):S4-S36.
8. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diab Care 2004; 27(1): 5-10.
9. American Diabetes Association. Standards of medical care in diabetes. Diab Care 2008; 31: 12-54.
10. Nathan D. Long-term complications of Diabetes mellitus. N Engl J Med 1993; 328:1676 – 1685.
11. Dyck P J, O’Brien P C. Meaningful degrees of prevention or improvement of nerve conduction in controlled clinical trials of diabetic neuropathy. Diabetes care 1989; 12:649 – 652.
12. Tkac I, Bril V. Glycemic control is related to the electrophysiologic severity of diabetic peripheral sensory motor polyneuropathy. Diabetes care 1998; 21:1749-1752.
13. Hoffman – snyder C, Smith B E, Ross M A, et al. Value of the Oral Glucose Tolerance Test in the Evaluation of Chronic Idiopathic Axonal Polyneuro-pathy. Arch Neural 2006; 63:1075-1079.
14. Perkins B A, Bril V. Diabetic neuropathy: a review emphasizing diagnostic methods. Clin Neurophysiol 2003; 114: 1167-1175.
15. Franssen H, van den Bergh PY. Nerve conduction studies in polyneuropathy: practical physiology and patterns of abnormality. Acta Neurol Belg 2006; 106:73-81.
16. Sangiorgio L, Iemmolo R, Le-Moli R, et al. Diabetic neuropathy: prevalence, concordance between clinical and electrophysiological testing and impact of risk factors. Panminerva-Med 1997;39:1-5.
17. Fedele D, Comi G, Coscelli C, et al. Amulticenter study on the prevalence of Diabetic neuropathy in Italy. Italian Diabetic Neuropathy Committee. Diabetes Care 1997; 20:836 – 843.
18. Moaz A. Mojaddidi, Moutasem Aboonq, Omar M AL Nozha, Abdulkadir Allam, Mohamed Fath EL-Bab. Early diagnosis of diabetic neuropathy in almadinah almunawwarah, Journal of Taibah University Medical Sciences 2011; 6(2): 121-131.
19. Vinik A I, Park T S, Stansberry K B and Pittenger G L (2000): Diabetic neuropathies. Diabetologia; 43: 957–973.
20. Vondrova H, Bartos V, Skibova J, et al. Factors affecting the incidence and severity of polyneuropathy in type 1 diabetes mellitus. CasLekCesk.1990; 129(32):1004-1008.
21. Rota E, Quadri R, Fanti E, Poglio F, Paolasso I, Ciaramitaro P, et al. Clinical and electrophysiological correlations in type 2 diabetes mellitus at diagnosis. Diabetes Res Clin Pract 2007; 76:152 – 154.
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.178
