Stefan Kopf1, Jan B Groener2, Zoltan Kender2, Thomas Fleming2, Sandra Bischoff3, Johann Jende4, Carsten Schumann5, Stefan Ries5, Martin Bendszus4, Sigrid Schuh-Hofer6, Rolf-Detlef Treede6, Peter P Nawroth7. 1. University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany. Electronic address: stefan.kopf@med.uni-heidelberg.de. 2. University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany. 3. University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany. 4. University Hospital of Heidelberg, Department of Neuroradiology, Heidelberg, Germany. 5. NeuroCentrum Odenwald, Darmstadt, Germany. 6. Medical Faculty Mannheim, Department of Neurophysiology, University of Heidelberg, Mannheim, Germany. 7. University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; Joint Heidelberg-ICD Translational Diabetes Program, Helmoltz-Zentrum, Munich, Germany.
Abstract
AIMS: The aim of the study was to assess whether quantitative-sensory-testing could be used to evaluate prevalence and predictors of diabetic neuropathy (DPNP) in patients with pre-diabetes and type 2 diabetes. METHODS: Twenty-eight pre-diabetics and 108 patients with type 2 diabetes were evaluated using neuropathy-deficit-score (NDS), neuropathy-symptom-score (NSS), nerve-conduction-studies (NCS), short-QST-protocol to examine small fibers and the comprehensive QST-battery (long-QST) according to the German Research Network on Neuropathic Pain protocol. RESULTS: Long-QST revealed a DPNP-prevalence of 71% in pre-diabetics and 95% in patients with type 2 diabetes, while according to NDS it was only 11% and 63%, and NCS missed 58% of patients with DPNP. Small and medium fibers were similarly affected in both groups, while large fiber deficits were significantly more common in type 2 diabetes (p < 0.01). Complete loss of function in all fibers was significantly higher in patients with type 2 diabetes than in pre-diabetics (26% vs. 11%, p < 0.05). Hyperalgesia was slightly increased in pre-diabetes than in type 2 diabetes (57% vs. 43%, p = n.s.). However, NSS only showed significant associations with large fiber deficits. Logistic regression analyses revealed that age (OR 1.14[1.05/1.24]) and albuminuria (OR 12.8[1.52/107.3]) were independent predictors for the presence of DPNP. CONCLUSIONS: DPNP is much more prevalent in patients with pre-diabetes and type 2 diabetes and clinical routine tests may miss the majority of affected patients. Age and albuminuria, but not HbA1c, appear to be significantly associated with DPNP. CLINICAL TRIAL REGISTRATION: NCT03022721.
AIMS: The aim of the study was to assess whether quantitative-sensory-testing could be used to evaluate prevalence and predictors of diabetic neuropathy (DPNP) in patients with pre-diabetes and type 2 diabetes. METHODS: Twenty-eight pre-diabetics and 108 patients with type 2 diabetes were evaluated using neuropathy-deficit-score (NDS), neuropathy-symptom-score (NSS), nerve-conduction-studies (NCS), short-QST-protocol to examine small fibers and the comprehensive QST-battery (long-QST) according to the German Research Network on Neuropathic Pain protocol. RESULTS: Long-QST revealed a DPNP-prevalence of 71% in pre-diabetics and 95% in patients with type 2 diabetes, while according to NDS it was only 11% and 63%, and NCS missed 58% of patients with DPNP. Small and medium fibers were similarly affected in both groups, while large fiber deficits were significantly more common in type 2 diabetes (p < 0.01). Complete loss of function in all fibers was significantly higher in patients with type 2 diabetes than in pre-diabetics (26% vs. 11%, p < 0.05). Hyperalgesia was slightly increased in pre-diabetes than in type 2 diabetes (57% vs. 43%, p = n.s.). However, NSS only showed significant associations with large fiber deficits. Logistic regression analyses revealed that age (OR 1.14[1.05/1.24]) and albuminuria (OR 12.8[1.52/107.3]) were independent predictors for the presence of DPNP. CONCLUSIONS:DPNP is much more prevalent in patients with pre-diabetes and type 2 diabetes and clinical routine tests may miss the majority of affected patients. Age and albuminuria, but not HbA1c, appear to be significantly associated with DPNP. CLINICAL TRIAL REGISTRATION: NCT03022721.
Authors: Osama Alsheikh; Sultan Alzaaidi; Jose M Vargas; Eman Al-Sharif; Mohammed Alrajeh; Mohammad A AlSemari; Abdulrahman Alhommadi; Anoud Alsaati; Nouf Aljwaiser; Eman Alshahwan; Mona Abdulhafiz; Rashad Elsayed; Wolfgang G K Müller-Lierheim Journal: Saudi J Ophthalmol Date: 2022-06-13
Authors: Varo Kirthi; Anugraha Perumbalath; Emily Brown; Sarah Nevitt; Ioannis N Petropoulos; Jamie Burgess; Rebecca Roylance; Daniel J Cuthbertson; Timothy L Jackson; Rayaz A Malik; Uazman Alam Journal: BMJ Open Diabetes Res Care Date: 2021-05
Authors: Gysbert-Botho van Setten; Oliver Stachs; Bénédicte Dupas; Semra Akkaya Turhan; Berthold Seitz; Herbert Reitsamer; Karsten Winter; Jutta Horwath-Winter; Rudolf F Guthoff; Wolfgang G K Müller-Lierheim Journal: J Clin Med Date: 2020-11-24 Impact factor: 4.241
Authors: Jamie Burgess; Bernhard Frank; Andrew Marshall; Rashaad S Khalil; Georgios Ponirakis; Ioannis N Petropoulos; Daniel J Cuthbertson; Rayaz A Malik; Uazman Alam Journal: Diagnostics (Basel) Date: 2021-01-24
Authors: Johann M E Jende; Zoltan Kender; Christoph Mooshage; Jan B Groener; Lucia Alvarez-Ramos; Jennifer Kollmer; Alexander Juerchott; Artur Hahn; Sabine Heiland; Peter Nawroth; Martin Bendszus; Stefan Kopf; Felix T Kurz Journal: Front Neurosci Date: 2021-03-03 Impact factor: 4.677
Authors: Inês Preguiça; André Alves; Sara Nunes; Pedro Gomes; Rosa Fernandes; Sofia D Viana; Flávio Reis Journal: Nutrients Date: 2020-01-18 Impact factor: 5.717
Authors: Cristina Naranjo; María Dueñas; Carlos Barrera; Guillermo Moratalla; Inmaculada Failde Journal: Int J Environ Res Public Health Date: 2020-11-03 Impact factor: 3.390