A new approach to identifying the effect of diabetic peripheral neuropathy on the ability to drive safely

© 2020 The Authors The purpose of this study was to estimate the potential for impaired driving performance in current drivers with diabetic peripheral neuropathy compared to healthy controls. We analysed, using a driving simulator, three important aspects of driving - use of the accelerator pedal, steering wheel and eye-steering coordination - to test for any differences, and then to integrate these findings to identify a unique pattern of changes in people driving with diabetic peripheral neuropathy. Patients with diabetic peripheral neuropathy displayed differences in use of the accelerator pedal compared to healthy control drivers (p < 0.05) which could be a direct consequence of their sensorimotor impairment due to diabetic peripheral neuropathy. Drivers with DPN used the more extreme high and low positions of the pedal to a greater extent than the Control group who exhibited a more graded use of the accelerator pedal over the mid-range. Eye-steering coordination was also different in drivers with diabetic peripheral neuropathy (p < 0.05) and, as it improved during the second drive, becoming closer to healthy drivers’ values, the occasional loss of control experienced during driving reduced. These insights demonstrate that diabetic peripheral neuropathy affects multiple aspects of driving performance suggesting the need for an integrated approach to evaluate the potential for driving safely in this population

Reduced vitamin D levels in painful diabetic peripheral neuropathy

Aim: Recent studies have reported an association between low vitamin D levels and diabetic peripheral neuropathy. However, many of these did not differentiate between people with painful diabetic peripheral neuropathy and those with painless diabetic peripheral neuropathy, or assess major confounding factors including sunlight exposure and daily activity. Our study addressed these limitations and evaluated vitamin D levels in people with carefully phenotyped diabetic peripheral neuropathy and controls. Methods: Forty-five white Europeans with Type 2 diabetes and 14 healthy volunteers underwent clinical and neurophysiological assessments. People with Type 2 diabetes were then divided into three groups (17 with painful diabetic peripheral neuropathy, 14 with painless diabetic peripheral neuropathy and 14 with no diabetic peripheral neuropathy). All had seasonal sunlight exposure and daily activity measured, underwent a lower limb skin biopsy and had 25-hydroxyvitamin D measured during the summer months, July to September. Results: After adjusting for age, BMI, activity score and sunlight exposure, 25-hydroxyvitamin D levels (nmol/l) (se) were significantly lower in people with painful diabetic peripheral neuropathy [painful diabetic peripheral neuropathy 34.9 (5.8), healthy volunteers 62.05 (6.7), no diabetic peripheral neuropathy 49.6 (6.1), painless diabetic peripheral neuropathy 53.1 (6.2); ANCOVAP = 0.03]. Direct logistic regression was used to assess the impact of seven independent variables on painful diabetic peripheral neuropathy. Vitamin D was the only independent variable to make a statistically significant contribution to the model with an inverted odds ratio of 1.11. Lower 25-hydroxyvitamin D levels also correlated with lower cold detection thresholds (r = 0.39, P = 0.02) and subepidermal nerve fibre densities (r = 0.42, P = 0.01). Conclusions: We have demonstrated a significant difference in 25-hydroxyvitamin D levels in well-characterized people with painful diabetic peripheral neuropathy, while accounting for the main confounding factors. This suggests a possible role for vitamin D in the pathogenesis of painful diabetic peripheral neuropathy. Further prospective and intervention trials are required to prove causality between low vitamin D levels and painful diabetic peripheral neuropathy

The Correlation between Lifestyle and the Severity of Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) is a significant complication of diabetes mellitus (DM), whose incidence is consistently increasing from year to year. Lifestyle is a considerable risk factor for increasing DM complications. To prevent the occurrence of DPN, it is necessary to carry out a more in-depth analysis of the correlation between lifestyle and DPN. The purpose of this study was to determine the correlation between lifestyle and the severity of diabetic peripheral neuropathy. The research design was a case-control study. The sampling technique used was sequential sampling. Respondents in this study were 94 people divided into two groups: 47 as the case group and 47 as the control group. Based on the Chi-Square test of the relationship between lifestyle and the severity of diabetic peripheral neuropathy, p-value = 0.000 &lt; (0.05) OR=10.084; 95% CI=3.712-27.395). It could be concluded that there was a correlation between lifestyle and the severity of diabetic peripheral neuropathy. This research could be a learning material and additional knowledge for respondents regarding the importance of improving a healthy lifestyle in every nursing intervention to prevent an increase in the number of degenerative diseases, especially DM, and reduce the incidence of diabetic peripheral neuropathy

FACTORS RELATED TO DIABETIC PERIPHERAL NEUROPATHY

Diabetic mellitus is a crhonic disease and have a complications. One of the complication is diabetic peripheral neuropathy. 60-70% patient with diabetic mellitus also has diabetic peripheral neuropathy. Factors that contribute of diabetic peripheral neuropathy incident are length of diabetes, ages, and poor of glucose control. This study aims to knew correlate beetwen length of diabetes with diabetic peripheral neuropathy incident.Methodology: This study used cross sectional design with 79 respondents and recruited by simple random sampling methode. Data were collected from patients with diabetic mellitus. Diabetic peripheral neuropathy was measured by diabetic neuropathy symptom (DNS) . Chi square test analysis showed no significant correlate beetwen age and length of diabetes with diabetic peripheral neuropathy incident (p value > 0.05). It can be inferred that age and length of diabetes aren’t risk factor that contributed diabetic peripheral neuropathy incident. Therefore, need more reseacrh to correlate beetwen diabetic peripheral neuropathy incident with the other factors

THE ROLE OF PHARMACISTS IN EVALUATING AND INTERVENING THE PATIENTS WITH DIABETIC NEUROPATHY

Diabetic neuropathies is the presence of and/or signs of peripheral nerve dysfunctions in people with diabetes after the exclusion of other causes. The purpose of this study was to estimate the prevalence and risk factors for diabetic peripheral neuropathy, to evaluate the score of neuropathy, and also to determine the effect of pharmacist intervention towards diabetic neuropathy patients at Gatot Soebroto Hospital Jakarta in 2013. Data about socio-demographic characters, age, duration of diabetic, blood glucose, blood pressure, cardiovascular diseases, lifestyle BMI and smoking were collected. Pharmacist intervention was given to increase patient information about diabetic neuropathy and its risks factors. There were 59 respondents involved in this study. It can be found that 15.3% respondents had mild diabetic peripheral neuropathy, 1.7% had moderate diabetic peripheral neuropathy, 1.7% had severe diabetic peripheral neuropathy, and as much as  81,4% respondents had no neuropathy. There was a correlation (but not statistically significant) between diabetic peripheral neuropathy and its' risks factors such as ages, duration of diabetes, sex, cardiovascular disease (hypertension, cardiac disease)and lifestyle(smoking habit and body mass index). Pharmacist intervention showed an increase on the patients knowledge about diabetic neuropathy and also a significant decrease on the patient's blood glucose level (P˂0,05).Keywords : diabetic neuropathy, pharmacist role, prevalence, score, risk factors, blood glucose

LENGTH OF DIABETES, DIABETIC PERIPHERAL NEUROPATHY

Introduction: Diabetic mellitus is a metabolic disease. Diabetic mellitus also a crhonic disease and have a complications. One of the complication is diabetic peripheral neuropathy. 60-70% patient with diabetic mellitus also has diabetic peripheral neuropathy. Factors that contribute of diabetic peripheral neuropathy incident are length of diabetes, ages, and poor of glucose control. This study aims to knew correlate beetwen length of diabetes with diabetic peripheral neuropathy incident. Method: This study used cross sectional design with 79 respondents and recruited by simple random sampling methode. Data were collected from patients with diabetic mellitus. Diabetic peripheral neuropathy was measured by diabetic neuropathy symptom (DNS). Results: Chi square test analysis showed no significant correlate beetwen length of diabetes with diabetic peripheral neuropathy incident (p value > 0.05). Discussion: It can be inferred that length of diabetes is not only one risk factors that contributed diabetic peripheral neuropathy incident. Therefore, need more reseacrh to correlate beetwen diabetic peripheral neuropathy incident with the other factors. Key words: diabetic mellitus, diabetic peripheral neuropathi, length of diabete

Diabetic Peripheral Neuropathy

Diabetic autonomic neuropathies (DAN) are clinical syndromes resulting from impairments of the autonomic nervous system in patients with diabetes mellitus. Since the autonomic nervous system innervates most body organs, any or all of those organs may be affected by DAN. A high index of suspicion is the best diagnostic tool. Proper management, with patient and family education in its center, improves the quality of life of persons with DAN. Undiagnosed and ignored, DAN could cause severe disability and even death.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68591/2/10.1177_014572178701300208.pd

The Correlation between Malondialdehyde and Nerve Growth Factor Serum Level with Diabetic Peripheral Neuropathy Score

AIM: This study was conducted to identify malondialdehyde (MDA) serum level, nerve growth factor (NGF) serum level, diabetic peripheral neuropathy score and the correlation between MDA and NGF serum level with diabetic peripheral neuropathy score. METHODS: A cross-sectional study was conducted to observe diabetic patients in the internal medicine department in Dr M. Djamil Hospital, Padang, Indonesia. The MDA serum level was measured using Beuge method with thiobarbituric acid. The NGF serum level was analysed using ELISA method. Diabetic peripheral neuropathy score was defined when history score in Michigan Neuropathy Screening Instrument (MNSI) ≥ 7 and physical assessment score in MNSI &gt; 2. RESULTS: Thirty subjects with diabetes has diabetic peripheral neuropathy score 3.53 (± 0.91), MDA serum level 2.16 (± 2.89) nmol/ml, and NGF serum level 10.56 (± 2.89) pg/dl. There were significant correlations between the MDA serum level and the diabetic peripheral neuropathy score (r = 0.364, p = 0.048), and between the NGF serum level with the diabetic peripheral neuropathy score (r = -0.59, p = 0.001). CONCLUSION: There are high MDA serum level and low NGF serum level in patients with diabetic peripheral neuropathy. Low NGF serum level plays a bigger role than high MDA serum level in diabetic peripheral neuropathy

Altered joint moment strategy during stair walking in diabetes patients with and without peripheral neuropathy

© 2016 The Authors. Aim: To investigate lower limb biomechanical strategy during stair walking in patients with diabetes and patients with diabetic peripheral neuropathy, a population known to exhibit lower limb muscular weakness. Methods: The peak lower limb joint moments of twenty-two patients with diabetic peripheral neuropathy and thirty-nine patients with diabetes and no neuropathy were compared during ascent and descent of a staircase to thirty-two healthy controls. Fifty-nine of the ninety-four participants also performed assessment of their maximum isokinetic ankle and knee joint moment (muscle strength) to assess the level of peak joint moments during the stair task relative to their maximal joint moment-generating capabilities (operating strengths). Results: Both patient groups ascended and descended stairs slower than controls (p < 0.05). Peak joint moments in patients with diabetic peripheral neuropathy were lower (p < 0.05) at the ankle and knee during stair ascent, and knee only during stair descent compared to controls. Ankle and knee muscle strength values were lower (p < 0.05) in patients with diabetic peripheral neuropathy compared to controls, and lower at knee only in patients without neuropathy. Operating strengths were higher (p < 0.05) at the ankle and knee in patients with neuropathy during stair descent compared to the controls, but not during stair ascent. Conclusion: Patients with diabetic peripheral neuropathy walk slower to alter gait strategy during stair walking and account for lower-limb muscular weakness, but still exhibit heightened operating strengths during stair descent, which may impact upon fatigue and the ability to recover a safe stance following postural instability

FAKTOR RESIKO NEUROPATI PERIFER DIABETIK PADA PASIEN DIABETES MELITUS TIPE 2 : TINJAUAN LITERATUR

Type 2 diabetes mellitus is one of the chronic diseases that has increased globally and is a cause of various organ dysfunction such as diabetic peripheral neuropathy. Early detection of diabetic peripheral neuropathy and identification of risk factors can reduce the morbidity of diabetic peripheral neuropathy. This literature review was written to present the risk factors of diabetic peripheral neuropathy in type 2 diabetes mellitus patients. Literature search was conducted to obtain appropriate articles through the electronic database Medline, Cinahl, Proquest, and Clinical Key with &nbsp;keywords: &nbsp;prevalence of diabetic peripheral neuropathy, risk factors and type 2 diabetes mellitus. The results obtained 16 articles according to the topic and through a review, it is known that risk factors of &nbsp;diabetic peripheral neuropathy in type 2 diabetes mellitus patients are old age, male sex, duration of diabetes mellitus, poor glycemic control, retinopathy, nephropathy, and risk factors of cardiovascular diseases such as: obesity, overweight, hypertension,and &nbsp;dyslipidemia