• The Journal of Korean Physical Therapy
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• v.30 no.6
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• pp.224-228
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• 2018

Purpose: The most common cause of plantar ulceration is an excessive plantar pressure in patients with peripheral neuropathy. Foot orthosis and therapeutic footwear have been used to decrease the plantar pressure and prevent the plantar ulceration in in diabetes patients. We investigated whether protective sock with functional insoles reduce plantar pressure while walking in 17 diabetes patients. Methods: An in-shoe measurement device was used to measure the peak plantar pressure while walking. Peak plantar pressure data were collected while walking under two conditions: 1) wearing diabetic sock and 2) wearing the protective sock with functional insoles. Each subject walked 3 times in 10-m corridor under three conditions, and data were collected in 3 steps in the middle of corridor with in right and left feet, respectively. Pared t-test was used to compare the peak plantar pressures in three plantar areas under these two conditions. Results: The protective sock with functional insoles significantly reduced the peak plantar pressure on the lateral rearfoot, but significantly increased the peak plantar pressure on the middle forefoot, and medial midfoot (p<0.05). However, there were not significant in medial and lateral forefoot, lateral midfoot, and medial rearfoot between diabetic sock and the protective sock conditions (p>0.05). Conclusion: The protective sock with functional insoles reduced plantar pressures in the rearfoot and supported the medial longitudinal arch. However, it is necessary to change the position of metatarsal pad in the insole design of forefoot area to prevent diabetic foot ulceration.

• Journal of Korean Foot and Ankle Society
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• v.15 no.4
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• pp.232-239
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• 2011

Purpose: Diabetic foot ulcer is one of the most important diabetic complications because it increases the risk of amputations. Moreover, it lowers the quality of patients' life and increases the social medical expenses. Authors analyzed risk factors of intractable diabetic foot ulcer using retrospective study. Materials and Methods: From January 2007 to December 2010, 40 patients who could not achieve complete healing despite more than 12 weeks of proper management among who had been diagnosed and treated as diabetic foot ulcer at our hospital were included and evaluated retrospectively. We compared the risk factors between two groups who were finally treated by amputation and non-amputation. Results: The sample was composed of 31 male patients (77.5%) and 9 female patients (22.5%). Comorbidity including hypertension and hyperlipidemia were 77.5% and 80% each. By Wagner classification, 30 patients (80%) had ulcerative lesion over the grade 3. From bacteriology results, 29 patients (72.5%) had polybacteria infection. 35 patients (87.5%) had neuropathy and 26 patients (65%) had vascular stenosis at least one level. The mean initial ankle-brachial index and toe-brachial index were 0.982 and 0.439. In comparison between amputation group and non-amputation group, ulcer severity, number of stenotic vessel and initial ankle-brachial index/toe-brachial index had statistical significance. Conclusion: The most commonly risk factor of intractable diabetic foot ulcer was peripheral neuropathy reaching 87.5% of cases. In comparison with non-amputation group, ulcer severity according to Wagner classification, number of stenotic vessel and initial ankle-brachial index/toe-brachial index were demonstrated as a risk factor of amputation in intractable diabetic foot ulcer.

• Science of Emotion and Sensibility
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• v.19 no.4
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• pp.111-118
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• 2016

Patients with type 2 diabetes mellitus can complain of abnormal sensation and pain which derived from the peripheral nerve damage. Various words used to be describe abnormal sense and pain, such as sharp, hot, dull, cold, sensitive, and itch. To diagnose diabetic peripheral neuropathy, several screening instruments (Neuropathic Pain Scale, NPS; Michigan Neuropathy Screening Instruments, MNSI) and electrophysiological study can be used. In this study, we aim to analyze and compare the clinical and electrophysiological characteristics of 11 patients with diabetes mellitus and abnormal sense/pain (Disease Group, DG) and 10 patients with diabetes mellitus and normal sense (Control Group, CG). In addition, we aim to reveal correlation between NPS subscore and electrophysiological parameters. As a result, the scores of NPS and MNSI in DG were significantly higher. In nerve conduction study, median motor nerve and peroneal nerve showed significant functional change. Also, median motor nerve, posterior tibial nerve and sural nerve showed negative correlation as NPS subscore increased. These results mean increased pain can be associated with abnormal nerve function. It needs to be further explored for larger size of subjects to get confirmative results.

• Annals of Clinical Neurophysiology
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• v.5 no.2
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• pp.181-186
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• 2003

Background: Somatosensory evoked potential (SSEP) is valuable for the evaluation of the central pathway. However, peripheral neuropathy sometimes renders the test useless by preventing the conduction from reaching the CNS. We postulated that the peripheral conduction problems could be overcome by proximal stimulation in SSEP and wanted to verify this in the study. Methods: Twenty patients with diabetic sensorimotor polyneuropathy were included. SSEP was elicited by stimulating the median and posterior tibial nerves. We compared the effect of distal and proximal stimulations in each SSEP in the aspect of presence/absence and various latencies of resultant waves. Results: Among the 40 cases, proximal stimulation caused reappearance of subsided waves in 10 cases (25%). In the median nerve SSEP, proximal stimulation made EN1 and CN2 visible which were not evident when distally stimulated. In the posterior tibial nerve SSEP, there was also improvement of forming waves when proximally stimulated. Conclusions: In the diabetic polyneuropathy, proximal stimulation of SSEP is more effective than the conventional distal stimulation in evaluating central pathway.

• Journal of Korean Academy of Nursing
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• v.51 no.3
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• pp.280-293
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• 2021

Purpose: This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM). Methods: This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients' electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow-Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples. Results: The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ² = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years. Conclusion: The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.

• Journal of Life Science
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• v.30 no.3
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• pp.250-259
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• 2020

Diabetes is a well-known risk factor for dementia and cognitive impairment. Diabetic polyneuropathy (DPN) is the most prevalent microvascular complication in type 2 diabetes mellitus (T2DM) patients. The purpose of this study was to evaluate the relation between diabetic peripheral polyneuropathy and cognitive factors in T2DM patients. Retrospective chart review of type 2 diabetic patients with results of a nerve conduction study (NCS) and a neurocognitive study. A total of 19 patients were included. DPN was defined using data from a nerve conduction study: a score of less than 24 in the Korean version of the Mini-Mental State Examination (K-MMSE) was considered as an indicator of cognitive impairment (CI). The mean age of the 19 patients was 71.6±5.0 years. The mean duration of diabetes was 8.4±9.1 years, and the mean HbA1c level was 8.1±1.8%. DPN was present in 7 of the 19 patients. Based on the K-MMSE score, CI was diagnosed in eight patients. The mean K-MMSE scores and the prevalence of CI was not different between the groups with and without DPN. There was no significant difference in DPN prevalence between the groups with and without CI. Education was significantly correlated with cognitive factors. Only the digit span-forward among the cognitive factors showed a significant negative correlation with nerve conduction velocity. In conclusion, the longer education period was associated with higher cognitive function and no significant correlation was observed between diabetic peripheral neuropathy and cognitive dysfunction in type 2 diabetic patients. Further prospective research is needed in the future.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.34 no.2
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• pp.80-85
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• 2021

Objectives : The purpose of this study is to report on the treatment of wound dressing in patients with diabetic foot ulcers in the dermatology clinic of Korean medicine. Methods : First, sufficient marginal resection of the ulcer and necrotic tissue on the foot of a patient with diabetic peripheral neuropathy was performed. Inflammation was treated with Anti-inflammatory pharmacopuncture solution, and dressings were applied for one month using Cornu Cervi Parvum pharmacopuncture solution, and Haeboo ointment for granulation tissue formation and skin regeneration. Results : After 10 days of the treatment, the formation of new granulation tissue was observed in the necrotic tissue area, and the extent of the lesion decreased sharply from the 14th day. On the 40th day, epithelialization progressed so that the treatment was terminated, and complete keratinization of the site was observed at follow-up 3 weeks after the end of the treatment. Conclusions : In the treatment of wound dressings in diabetic foot ulcer patients, marginal resection treatment with the application of pharmacopuncture solution and herbal ointment showed good effect.

• Diabetes and Metabolism Journal
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• v.42 no.6
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• pp.519-528
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• 2018

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.

• Annals of Clinical Neurophysiology
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• v.12 no.1
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• pp.21-26
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• 2010

Background: Although quantitative sensory test (QST) is being used with increasing frequency for measuring sensory thresholds in clinical practice and epidemiologic studies, there has been no age-matched normative data in Korean adults. The objective of this study is to evaluate the value of QST in diabetic polyneuropathy with normal range in Korean adults. Methods: The Computer Aided Sensory Examination IV 4,2 (WR Medical Electronics Co., Stillwater, Minnesota, U.S.A.), with 4,2,1 stepping algorithm was used to determine vibration and cold perception threshold in 70 normal controls and 19 patients with diabetic polyneuropathy aged from 21 to 79 years. The data were used to define age-matched upper and lower normal limits and normal range of side to side difference. We also evaluated the duration of diabetes, serum HbA1C level, and findings of nerve conduction study (NCS) and QST in patients with diabetic polyneuropathy. Results: In normal adults, sensory thresholds slightly increased with age, and a slight side-to-side difference was observed. The diagnostic sensitivity of QST was not higher than NCS in patients with diabetic polyneuropathy (36.8% vs. 42.1%, p=0.716), especially among elderly patients. Conclusions: QST might be used as a complementary test for NCS in the diagnosis of diabetic polyneuropathy. Although the QST is a simple method for the evaluation of peripheral nerve function, there are some limitations. Most of all, because the QST measuring is dependent on the subjective response of patients, the degree of concentration and cooperation of the patients can significantly affect the result. And thus, attention should be paid during the interpretation of QST results in patients with peripheral neuropathy.

• The Journal of the Korea Contents Association
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• v.10 no.10
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• pp.237-245
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• 2010

Nerve conduction studies (NCS) are the most objective measure of nerve function and essential for the diagnosis of sub-clinical neuropathy in diabetes mellitus and diabetic polyneuropathy (DPN). This study evaluates the characteristic of electrophysiological abnormalities in DPN. Electrodiagnostic data from 120 patients with diabetic polyneuropathies and 77 control subjects were reviewed. Motor nerve conduction velocities (MNCV), distal motor latencies (DML), compound muscle action potential (CMAP) amplitudes, No potential frequency and conduction block were analyzed. Data were normalized based on normative reference values, and the proportion of nerves with abnormal values in the lower and upper limbs were evaluated. DPN was systemic demyelinating peripheral polyneuropathy and more severe abnormal nerve conduction was found in lower limbs than in upper limbs. The abnormal degree was more severe in peroneal nerve. It was no statistically significant difference of conduction block in control and DPN group. Our findings suggest that DPN had more common and severe peroneal nerve involvement in the motor nerve conduction studies (MNCS). These findings have important implications for the electrophysiological evaluation of DPN.