Diabetes and Metabolism Journal

  • 제42권6호
  • /
  • Pages.519-528
  • /
  • 2018
  • /
  • 2233-6079(pISSN)
  • /
  • 2233-6087(eISSN)
대한당뇨병학회 (Korean Diabetes Association)
권호 표지
DOI QR코드

DOI QR Code

Patterns of Nerve Conduction Abnormalities in Patients with Type 2 Diabetes Mellitus According to the Clinical Phenotype Determined by the Current Perception Threshold

  • Park, Joong Hyun (Department of Neurology, Inje University Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Won, Jong Chul (Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine)
  • 투고 : 2018.04.23
  • 심사 : 2018.08.09
  • 발행 : 2018.12.30
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Clinical manifestations of diabetic peripheral neuropathy (DPN) vary along the course of nerve damage. Nerve conduction studies (NCS) have been suggested as a way to confirm diagnoses of DPN, but the results have limited utility for evaluating clinical phenotypes. The current perception threshold (CPT) is a complementary method for diagnosing DPN and assessing DPN symptoms. We compared NCS variables according to clinical phenotypes determined by CPT measurements. Methods: We retrospectively enrolled patients with type 2 diabetes mellitus who underwent both NCS and CPT tests using a neurometer. CPT grades were used to determine the clinical phenotypes of DPN: normoesthesia (0 to 1.66), hyperesthesia (1.67 to 6.62), and hypoesthesia/anesthesia (6.63 to 12.0). The Michigan Neuropathy Screening Instrument (MNSI) was used to determine a subjective symptom score. DPN was diagnosed based on both patient symptoms (MNSI score ${\geq}3$) and abnormal NCS results. Results: A total of 202 patients (117 men and 85 women) were included in the final analysis. The average age was 62.6 years, and 71 patients (35.1%) were diagnosed with DPN. The CPT variables correlated with MNSI scores and NCS variables in patients with diabetes. Linear regression analyses indicated that hypoesthesia was associated with significantly lower summed velocities and sural amplitudes and velocities, and higher summed latencies, than normoesthesia. Sural amplitude was significantly lower in patients with hyperesthesia than in patients with normoesthesia. Conclusion: NCS variables differed among patients with diabetes according to clinical phenotypes based on CPT and decreased sural nerve velocities was associated with hyperesthesia.

키워드

과제정보

연구 과제 주관 기관 : National Research Foundation of Korea

참고문헌

  1. American Diabetes Association. Standards of medical care in diabetes: 2016 abridged for primary care providers. Clin Diabetes 2016;34:3-21. https://doi.org/10.2337/diaclin.34.1.3
  2. Won JC, Kwon HS, Kim CH, Lee JH, Park TS, Ko KS, Cha BY. Prevalence and clinical characteristics of diabetic peripheral neuropathy in hospital patients with type 2 diabetes in Korea. Diabet Med 2012;29:e290-6. https://doi.org/10.1111/j.1464-5491.2012.03697.x
  3. Russell JW, Zilliox LA. Diabetic neuropathies. Continuum (Minneap Minn) 2014;20(5 Peripheral Nervous System Disorders):1226-40.
  4. Inceu GV, Veresiu IA. Measurement of current perception thresholds using the Neurometer(R): applicability in diabetic neuropathy. Clujul Med 2015;88:449-52.
  5. Koo BK, Ohn JH, Kwak SH, Moon MK. Assessment of diabetic polyneuropathy and autonomic neuropathy using current perception threshold in Korean patients with diabetes mellitus. Diabetes Metab J 2014;38:285-93. https://doi.org/10.4093/dmj.2014.38.4.285
  6. Matsutomo R, Takebayashi K, Aso Y. Assessment of peripheral neuropathy using measurement of the current perception threshold with the neurometer in patients with type 2 diabetes mellitus. J Int Med Res 2005;33:442-53. https://doi.org/10.1177/147323000503300410
  7. Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care 1994;17:1281-9. https://doi.org/10.2337/diacare.17.11.1281
  8. Neurotron Inc. Professional feasibility report: $Neurometer^{(R)}$ electrodiagnostic evaluation in neurology. Baltimore, MD 2010.
  9. Albers JW, Brown MB, Sima AA, Greene DA. Nerve conduction measures in mild diabetic neuropathy in the Early Diabetes Intervention Trial: the effects of age, sex, type of diabetes, disease duration, and anthropometric factors. Tolrestat Study Group for the Early Diabetes Intervention Trial. Neurology 1996;46:85-91. https://doi.org/10.1212/WNL.46.1.85
  10. England JD, Gronseth GS, Franklin G, Miller RG, Asbury AK, Carter GT, Cohen JA, Fisher MA, Howard JF, Kinsella LJ, Latov N, Lewis RA, Low PA, Sumner AJ; American Academy of Neurology; American Association of Electrodiagnostic Medicine; American Academy of Physical Medicine and Rehabilitation. Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2005;64:199-207. https://doi.org/10.1212/01.WNL.0000149522.32823.EA
  11. Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, Lauria G, Malik RA, Spallone V, Vinik A, Bernardi L, Valensi P; Toronto Diabetic Neuropathy Expert Group. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 2010;33: 2285-93. https://doi.org/10.2337/dc10-1303
  12. AAEM Equipment and Computer Committee; American Association of Electrodiagnostic Medicine. Technology review: the neurometer current perception threshold (CPT). Muscle Nerve 1999;22:523-31. https://doi.org/10.1002/(SICI)1097-4598(199904)22:4<523::AID-MUS16>3.0.CO;2-1
  13. Herman WH, Kennedy L. Underdiagnosis of peripheral neuropathy in type 2 diabetes. Diabetes Care 2005;28:1480-1. https://doi.org/10.2337/diacare.28.6.1480
  14. Vas PR, Sharma S, Rayman G. Comment on Breiner et al. Does the prevailing hypothesis that small-fiber dysfunction precedes large-fiber dysfunction apply to type 1 diabetic patients? Diabetes care 2014;37:1418-24. Diabetes Care 2014;37:e240-1. https://doi.org/10.2337/dc14-1258
  15. Jimenez-Cohl P, Grekin C, Leyton C, Vargas C, Villaseca R. Thermal threshold: research study on small fiber dysfunction in distal diabetic polyneuropathy. J Diabetes Sci Technol 2012; 6:177-83. https://doi.org/10.1177/193229681200600122
  16. Rendell MS, Dovgan DJ, Bergman TF, O'Donnell GP, Drobny EP, Katims JJ. Mapping diabetic sensory neuropathy by current perception threshold testing. Diabetes Care 1989;12:636-40. https://doi.org/10.2337/diacare.12.9.636
  17. Katims JJ, Long DM, Ng LK. Transcutaneous nerve stimulation. Frequency and waveform specificity in humans. Appl Neurophysiol 1986;49:86-91.
  18. Masson EA, Veves A, Fernando D, Boulton AJ. Current perception thresholds: a new, quick, and reproducible method for the assessment of peripheral neuropathy in diabetes mellitus. Diabetologia 1989;32:724-8. https://doi.org/10.1007/BF00274531
  19. Pop-Busui R, Herman WH, Feldman EL, Low PA, Martin CL, Cleary PA, Waberski BH, Lachin JM, Albers JW; DCCT/EDIC Research Group. DCCT and EDIC studies in type 1 diabetes: lessons for diabetic neuropathy regarding metabolic memory and natural history. Curr Diab Rep 2010;10:276-82. https://doi.org/10.1007/s11892-010-0120-8
  20. Takekuma K, Ando F, Niino N, Shimokata H. Prevalence of hyperesthesia detected by current perception threshold test in subjects with glucose metabolic impairments in a community. Intern Med 2002;41:1124-9. https://doi.org/10.2169/internalmedicine.41.1124
  21. The Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Intern Med 1995; 122:561-8. https://doi.org/10.7326/0003-4819-122-8-199504150-00001
  22. Tesfaye S, Wilhelm S, Lledo A, Schacht A, Tolle T, Bouhassira D, Cruccu G, Skljarevski V, Freynhagen R. Duloxetine and pregabalin: high-dose monotherapy or their combination? The “COMBO-DN study”: a multinational, randomized, double-blind, parallel-group study in patients with diabetic peripheral neuropathic pain. Pain 2013;154:2616-25. https://doi.org/10.1016/j.pain.2013.05.043
  23. Hendriksen PH, Oey PL, Wieneke GH, Bravenboer B, Banga JD. Subclinical diabetic neuropathy: similarities between electrophysiological results of patients with type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 1992;35:690-5. https://doi.org/10.1007/BF00400264
  24. Pastore C, Izura V, Geijo-Barrientos E, Dominguez JR. A comparison of electrophysiological tests for the early diagnosis of diabetic neuropathy. Muscle Nerve 1999;22:1667-73. https://doi.org/10.1002/(SICI)1097-4598(199912)22:12<1667::AID-MUS8>3.0.CO;2-W
  25. Zhang Y, Li J, Wang T, Wang J. Amplitude of sensory nerve action potential in early stage diabetic peripheral neuropathy: an analysis of 500 cases. Neural Regen Res 2014;9:1389-94. https://doi.org/10.4103/1673-5374.137593
  26. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009;41:1149-60. https://doi.org/10.3758/BRM.41.4.1149
  27. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-Year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008;359:1577-89. https://doi.org/10.1056/NEJMoa0806470
  28. Martin CL, Albers J, Herman WH, Cleary P, Waberski B, Greene DA, Stevens MJ, Feldman EL; DCCT/EDIC Research Group. Neuropathy among the diabetes control and complications trial cohort 8 years after trial completion. Diabetes Care 2006;29:340-4. https://doi.org/10.2337/diacare.29.02.06.dc05-1549

피인용 문헌

  1. Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention vol.7, pp.12, 2018, https://doi.org/10.1016/s2213-8587(19)30081-6
  2. γ-Linolenic Acid versus α-Lipoic Acid for Treating Painful Diabetic Neuropathy in Adults: A 12-Week, Double-Placebo, Randomized, Noninferiority Trial vol.44, pp.4, 2020, https://doi.org/10.4093/dmj.2019.0099
  3. Association between Sleep Quality and Painless Diabetic Peripheral Neuropathy Assessed by Current Perception Threshold in Type 2 Diabetes Mellitus vol.44, pp.None, 2020, https://doi.org/10.4093/dmj.2019.0219
  4. Supplementation with Korean Red Ginseng Improves Current Perception Threshold in Korean Type 2 Diabetes Patients: A Randomized, Double-Blind, Placebo-Controlled Trial vol.2020, pp.None, 2020, https://doi.org/10.1155/2020/5295328
  5. New Perspective in Diabetic Neuropathy: From the Periphery to the Brain, a Call for Early Detection, and Precision Medicine vol.10, pp.None, 2020, https://doi.org/10.3389/fendo.2019.00929
  6. The relationship between exacerbated diabetic peripheral neuropathy and metformin treatment in type 2 diabetes mellitus vol.11, pp.1, 2018, https://doi.org/10.1038/s41598-021-81631-8