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Sensors (Basel, Switzerland) Aug 2023Diabetic foot ulcers, which are a common complication of diabetes, can have a negative impact on a person's physical and mental health, including an increased risk of... (Review)
Review
Diabetic foot ulcers, which are a common complication of diabetes, can have a negative impact on a person's physical and mental health, including an increased risk of depression. Patients suffering from depression are less likely to keep up with diabetic foot care, thus increasing the risk of developing ulcers. However, with the use of artificial intelligence (AI), at-home patient care has become easier, which increases adherence. To better understand how new technologies, including machine learning algorithms and wearable sensors, might improve patient adherence and outcomes, we conducted a literature review of several sensor technologies, including SmartMat© and Siren Care© socks for temperature, SurroSense Rx/Orpyx© for pressure, and Orthotimer© for adherence. An initial search identified 143 peer-reviewed manuscripts, from which we selected a total of 10 manuscripts for further analysis. We examined the potential benefits of personalized content and clinician support for those receiving mobile health interventions. These findings may help to demonstrate the current and future utility of advanced technologies in improving patient adherence and outcomes, particularly in the context of diabetes management and the link between behavior and complications in diabetes, such as diabetic foot ulcers.
Topics: Humans; Artificial Intelligence; Diabetes Mellitus; Diabetic Foot; Machine Learning
PubMed: 37571682
DOI: 10.3390/s23156898 -
Frontiers in Cellular Neuroscience 2023Schwann cells (SCs) have a critical role in the peripheral nervous system. These cells are able to support axons during homeostasis and after injury. However, mutations... (Review)
Review
Schwann cells (SCs) have a critical role in the peripheral nervous system. These cells are able to support axons during homeostasis and after injury. However, mutations in genes associated with the SCs repair program or myelination result in dysfunctional SCs. Several neuropathies such as Charcot-Marie-Tooth (CMT) disease, diabetic neuropathy and Guillain-Barré syndrome show abnormal SC functions and an impaired regeneration process. Thus, understanding SCs-axon interaction and the nerve environment in the context of homeostasis as well as post-injury and disease onset is necessary. Several neurotrophic factors, cytokines, and regulators of signaling pathways associated with proliferation, survival and regeneration are involved in this process. Preclinical studies have focused on the discovery of therapeutic targets for peripheral neuropathies and injuries. To study the effect of new therapeutic targets, modeling neuropathies and peripheral nerve injuries (PNIs) and are useful tools. Furthermore, several protocols have been designed using SCs and neuron cell lines to evaluate these targets in the regeneration process. SCs lines have been used to generate effective myelinating SCs without success. Alternative options have been investigated using direct conversion from somatic cells to SCs or SCs derived from pluripotent stem cells to generate functional SCs. This review will go over the advantages of these systems and the problems associated with them. In addition, there have been challenges in establishing adequate and reproducible protocols to recapitulate repair SC-neuron interactions observed . So, we also discuss the mechanisms of repair SCs-axon interactions in the context of peripheral neuropathies and nerve injury (PNI) and . Finally, we summarize current preclinical studies evaluating transgenes, drug, and novel compounds with translational potential into clinical studies.
PubMed: 37900588
DOI: 10.3389/fncel.2023.1248922 -
Frontiers in Public Health 2023The anticipation of diabetes-related complications remains a challenge for numerous T2DM patients, as there is presently no effective method for early prediction of...
BACKGROUND
The anticipation of diabetes-related complications remains a challenge for numerous T2DM patients, as there is presently no effective method for early prediction of these complications. This study aims to investigate the association between renal function-related indicators and the occurrence of peripheral neuropathy and retinopathy in individuals diagnosed with type 2 diabetes mellitus (T2DM) who currently have normal renal function.
METHODS
Patients with T2DM who met the criteria were selected from the MMC database and divided into diabetic peripheral neuropathy (DPN) and diabetic retinopathy (DR) groups, with a total of 859 and 487 patients included, respectively. Multivariate logistic regression was used to analyze the relationship between blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), urine albumin(ALB), albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and diabetic peripheral neuropathy and retinopathy. Spearman correlation analysis was used to determine the correlation between these indicators and peripheral neuropathy and retinopathy in diabetes.
RESULTS
In a total of 221 patients diagnosed with DPN, we found positive correlation between the prevalence of DPN and eGFR (18.2, 23.3, 35.7%, < 0.05). Specifically, as BUN (T1: references; T2:OR:0.598, 95%CI: 0.403, 0.886; T3:OR:1.017, 95%CI: 0.702, 1.473; < 0.05) and eGFR (T1: references; T2:OR:1.294, 95%CI: 0.857, 1.953; T3:OR:2.142, 95%CI: 1.425, 3.222; < 0.05) increased, the odds ratio of DPN also increased. Conversely, with an increase in Cr(T1: references; T2:OR:0.86, 95%CI: 0.56, 1.33; T3:OR:0.57, 95%CI: 0.36, 0.91; < 0.05), the odds ratio of DPN decreased. Furthermore, when considering sensitivity and specificity, eGFR exhibited a sensitivity of 65.2% and specificity of 54.4%, with a 95% confidence interval of 0.568-0.656.
CONCLUSION
In this experimental sample, we found a clear positive correlation between eGFR and DPN prevalence.
Topics: Humans; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Risk Factors; Diabetic Neuropathies; Creatinine; Correlation of Data; Retinal Diseases; Kidney; Albumins
PubMed: 38174078
DOI: 10.3389/fpubh.2023.1302615 -
CNS Neuroscience & Therapeutics Apr 2024Diabetic peripheral neuropathy (DPN) constitutes a debilitating complication associated with diabetes. Although, the past decade has seen rapid developments in... (Review)
Review
BACKGROUND
Diabetic peripheral neuropathy (DPN) constitutes a debilitating complication associated with diabetes. Although, the past decade has seen rapid developments in understanding the complex etiology of DPN, there are no approved therapies that can halt the development of DPN, or target the damaged nerve. Therefore, clarifying the pathogenesis of DPN and finding effective treatment are the crucial issues for the clinical management of DPN.
AIMS
This review is aiming to summary the current knowledge on the pathogenesis of DPN, especially the mechanism and application of inflammatory response.
METHODS
We systematically summarized the latest studies on the pathogenesis and therapeutic strategies of diabetic neuropathy in PubMed.
RESULTS
In this seminal review, the underappreciated role of immune activation in the progression of DPN is scrutinized. Novel insights into the inflammatory regulatory mechanisms of DPN have been unearthed, illuminating potential therapeutic strategies of notable clinical significance. Additionally, a nuanced examination of DPN's complex etiology, including aberrations in glycemic control and insulin signaling pathways, is presented. Crucially, an emphasis has been placed on translating these novel understandings into tangible clinical interventions to ameliorate patient outcomes.
CONCLUSIONS
This review is distinguished by synthesizing cutting-edge mechanisms linking inflammation to DPN and identifying innovative, inflammation-targeted therapeutic approaches.
Topics: Humans; Diabetic Neuropathies; Insulin; Inflammation; Treatment Outcome; Signal Transduction; Diabetes Mellitus
PubMed: 37795833
DOI: 10.1111/cns.14477 -
Diabetologia Dec 2023Our aim was to investigate structural changes of cutaneous Schwann cells (SCs), including nociceptive Schwann cells (nSCs) and axons, in individuals with diabetic...
AIMS/HYPOTHESIS
Our aim was to investigate structural changes of cutaneous Schwann cells (SCs), including nociceptive Schwann cells (nSCs) and axons, in individuals with diabetic polyneuropathy. We also aimed to investigate the relationship between these changes and peripheral neuropathic symptoms in type 1 diabetes.
METHODS
Skin biopsies (3 mm) taken from carefully phenotyped participants with type 1 diabetes without polyneuropathy (T1D, n=25), type 1 diabetes with painless diabetic polyneuropathy (T1DPN, n=30) and type 1 diabetes with painful diabetic polyneuropathy (P-T1DPN, n=27), and from healthy control individuals (n=25) were immunostained with relevant antibodies to visualise SCs and nerve fibres. Stereological methods were used to quantify the expression of cutaneous SCs and nerve fibres.
RESULTS
There was a difference in the number density of nSCs not abutting to nerve fibres between the groups (p=0.004) but not in the number density of nSCs abutting to nerve fibres, nor in solitary or total subepidermal SC soma number density. The overall dermal SC expression (measured by dermal SC area fraction and subepidermal SC process density) and peripheral nerve fibre expression (measured by intraepidermal nerve fibre density, dermal nerve fibre area fraction and subepidermal nerve fibre density) differed between the groups (all p<0.05): significant differences were seen in participants with T1DPN and P-T1DPN compared with those without diabetic polyneuropathy (healthy control and T1D groups) (all p<0.05). No difference was found between participants in the T1DPN and P-T1DPN group, nor between participants in the T1D and healthy control group (all p>0.05). Correlational analysis showed that cutaneous SC processes and nerve fibres were highly associated, and they were weakly negatively correlated with different neuropathy measures.
CONCLUSIONS/INTERPRETATION
Cutaneous SC processes and nerves, but not SC soma, are degenerated and interdependent in individuals with diabetic polyneuropathy. However, an increase in structurally damaged nSCs was seen in individuals with diabetic polyneuropathy. Furthermore, dermal SC processes and nerve fibres correlate weakly with clinical measures of neuropathy and may play a partial role in the pathophysiology of diabetic polyneuropathy in type 1 diabetes.
Topics: Humans; Diabetic Neuropathies; Diabetes Mellitus, Type 1; Nerve Fibers; Peripheral Nerves; Schwann Cells
PubMed: 37728731
DOI: 10.1007/s00125-023-06009-z -
Healthcare (Basel, Switzerland) Nov 2023Diabetic peripheral neuropathy (DPN) is the primary complication in patients with diabetes mellitus, characterized by loss of sensation and function in the lower limbs.... (Review)
Review
Diabetic peripheral neuropathy (DPN) is the primary complication in patients with diabetes mellitus, characterized by loss of sensation and function in the lower limbs. Virtual reality (VR) and/or sensory feedback (FB) therapy has shown positive effects in other neurologic conditions such as stroke. However, consensus regarding their effectiveness in the DPN population is lacking. This study aims to analyze existing scientific evidence about the effects of VR and/or FB on improving gait and balance and reducing the risk of falls in patients with DPN (pwDPN). A thorough search was conducted in scientific databases including PubMed, Scopus, and EMBASE, up until November 2023. CMSQ, the PEDro scale, and the Cochrane Collaboration's tool were used to assess the methodological quality and risk of bias of the studies. A total of 10 studies were selected for qualitative analysis, with three contributing information to the meta-analysis. The combined results suggest a positive trend in favor of VR and FB rehabilitation; however, significant differences were not observed in balance (SMD = -0.81, 95% CI = -1.90, 0.29; = 0.15; I = 86%) or gait speed improvements (MD = -1.05, 95% CI = -2.96, 0.85; = 0.28; I = 89%). Therefore, further randomized controlled studies are still needed to achieve stronger conclusions regarding the benefits of VR and/or FB in pwDPN.
PubMed: 38063604
DOI: 10.3390/healthcare11233037 -
Lipids in Health and Disease Jul 2023The prevalence of microvascular complications in type 2 diabetes mellitus (T2DM) is increasing. The effect of lipid profiles on diabetic microvascular complications...
BACKGROUND
The prevalence of microvascular complications in type 2 diabetes mellitus (T2DM) is increasing. The effect of lipid profiles on diabetic microvascular complications remains debated. This research aimed to study the correlation between lipid profiles and microvascular complications.
METHODS
This retrospective cross-sectional study included 1096 T2DM patients. The patients were divided into the control, diabetic retinopathy (DR), nephropathy (DKD), and peripheral neuropathy (DPN) groups based on the existence of corresponding complications. The lipid profiles were analyzed, and the effect on complications was assessed by logistic regression.
RESULTS
Compared with the control group, the diabetic microvascular complications group had a higher dyslipidemia rate. The rate of high TGs increased significantly with an increasing number of complications. High TG levels contributed to the risk of DKD, DR, and DPN [odds ratios (ORs): 2.447, 2.267, 2.252; 95% confidence interval: 1.648-3.633, 1.406-3.655, 1.472-3.445]. In the age (years) > 55, T2DM duration (years) > 10, and HbA1c (%) ≥ 7 groups, the risk of high TGs was higher for DKD (ORs: 2.193, 2.419, 2.082), DR (ORs: 2.069, 2.317, 1.993), and DPN (ORs: 1.811, 1.405, 1.427).
CONCLUSION
High TG levels increase the risk of diabetic microvascular complications, and patients with older age, longer T2DM duration, and higher HbA1c levels are recommended to keep lipid levels more strictly.
Topics: Humans; Diabetes Mellitus, Type 2; Risk Factors; Cross-Sectional Studies; Triglycerides; Retrospective Studies; Glycated Hemoglobin; Diabetic Retinopathy; Diabetic Nephropathies; Diabetic Neuropathies
PubMed: 37517996
DOI: 10.1186/s12944-023-01873-5 -
CNS Neuroscience & Therapeutics Oct 2023Oxidative stress mediates the pathophysiology of diabetic neuropathy (DN) with activation of apoptotic pathway and reduction of autophagy. Arctigenin (ARC) is a natural...
BACKGROUND
Oxidative stress mediates the pathophysiology of diabetic neuropathy (DN) with activation of apoptotic pathway and reduction of autophagy. Arctigenin (ARC) is a natural lignan isolated from some plants of the Asteraceae family that shows antioxidant property. The present study aimed to explore the mechanistic neuroprotective effect of ARC on animal model for DN.
METHODS
DN was induced using streptozotocin (STZ) at a dose of 45 mg/kg, i.p, for five consecutive days and ARC was administered orally (25 or 50 mg) for 3 weeks. The mechanical sensitivity and thermal latency were determined using von Frey and hotplate, respectively. Beclin, p62, and LC3 were detected as markers for autophagy by western blot. Levels of reduced glutathione, lipid peroxides, and activities of catalase and superoxide dismutase were detected as readout for oxidative stress. Apoptotic parameters and histopathological changes were revealed in all experimental groups.
RESULTS
The present study showed deterioration of the function and structure of neurons as a result of hyperglycemia. Oxidative stress and impaired autophagy were observed in diabetic neurons as well as the activation of apoptotic pathway. ARC improved the behavioral and histopathological changes of diabetic mice. ARC combated oxidative stress through diminishing lipid peroxidation and improving the activity of antioxidant enzymes. This was concomitant by reducing the biomarkers of apoptosis. ARC augmented the expression of Beclin and LC3 while it lessened the expression of p62 indicating the activation of autophagy. These findings suggest that ARC can ameliorate DN by combating apoptosis and oxidative stress and improving autophagy.
Topics: Mice; Animals; Antioxidants; Streptozocin; Diabetes Mellitus, Experimental; Oxidative Stress; Lignans; Apoptosis; Diabetic Neuropathies; Autophagy
PubMed: 37170684
DOI: 10.1111/cns.14249 -
Journal of Chiropractic Medicine Dec 2023The purpose of this scoping review was to explore the effects of neural mobilization (NM) on outcomes in adults with diabetic peripheral neuropathy (DPN). (Review)
Review
OBJECTIVE
The purpose of this scoping review was to explore the effects of neural mobilization (NM) on outcomes in adults with diabetic peripheral neuropathy (DPN).
METHODS
Five databases were searched-PubMed, Web of Science (Web of Science Core Collection), Physiotherapy Evidence Database (PEDro), and Scopus-from inception to January 2022. The studies included were randomized controlled trials, pre-post single group design, multiple case studies, controlled case studies, quasi-experimental studies, and single case studies, which are published in full text in English.
RESULTS
Six studies were included in this review, and most were of low-level evidence. The sample size of the studies ranges from 20 to 43, except for 1 case study, with a total of 158 participants in all the studies combined. In 4 out of 6 studies, only NM was given, whereas in 2 studies, NM was used along with other treatment strategies. The tibial nerve was the most studied nerve, whereas 1 study administered NM to nerves of the upper limbs, and only 1 trial examined the sciatic nerve. The outcomes included the Michigan Neuropathy Screening Instrument questionnaire, nerve conduction velocity, vibration perception threshold, heat/cold perception threshold, weight-bearing asymmetry and range of motion of lower limb, quality of life, and magnetic imaging changes.
CONCLUSION
At present, only a few low-level studies exist on the use of NM for the treatment of adults with DPN. The evidence for use of NM on DPN is still limited and insufficient.
PubMed: 38205228
DOI: 10.1016/j.jcm.2023.10.002 -
BMC Endocrine Disorders Oct 2023Peripheral neuropathy is not only the most prevalent consequence of diabetes but also the main reason for foot ulceration, disability, and amputation. Therefore, the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Peripheral neuropathy is not only the most prevalent consequence of diabetes but also the main reason for foot ulceration, disability, and amputation. Therefore, the current study aims to determine the effectiveness of oral clonidine and gabapentin on peripheral neuropathy in diabetic patients.
METHODS
This 12-week, randomized, and parallel-group trial was conducted to compare the efficacy of oral clonidine and gabapentin with gabapentin alone in diabetic patients in southwest Iran during the first half of 2021. Thirty patients with type 2 diabetes with peripheral neuropathy as assessed by a visual analog scale (VAS) and divided into two groups of 15 patients, treated for up to three months. The data were analyzed using SPSS-21 software. In order to report the results, descriptive indices, independent t-test, one-way analysis of covariance (ANCOVA) and analysis of variance with repeated measures were used.
RESULTS
The mean and standard deviation of the age of the participants in the clonidine + gabapentin group was equal to 50.20 ± 7.44, and in the gabapentin group was equal to 50.47 ± 7.57 (t = 0.10, P-value = 0.923). This research showed a significant difference between the clonidine + gabapentin group and with gabapentin group in terms of neuropathic pain and the severity of neuropathic pain (P < 0.001).
CONCLUSIONS
According to this research results, clonidine + gabapentin can reduce neuropathic pain and the severity of neuropathic pain in diabetic patients. Therefore, it is recommended that healthcare professionals with diabetes expertise prescribe these medications to reduce neuropathic pain and its severity.
TRIAL REGISTRATION
This study was registered in the Iranian Clinical Trials System with the ID (IRCT20211106052983N1) on 14/01/2022.
Topics: Humans; Gabapentin; Iran; Clonidine; Analgesics; Diabetes Mellitus, Type 2; gamma-Aminobutyric Acid; Diabetic Neuropathies; Amines; Cyclohexanecarboxylic Acids; Neuralgia
PubMed: 37845651
DOI: 10.1186/s12902-023-01486-0