• Clinical Pain
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• 제19권1호
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• pp.32-35
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• 2020

Treatment-induced neuropathy in diabetes (TIND) is a reversible neuropathy that occurs in patients with diabetes, usually after a fast improvement in glycemic control. TIND is defined as the sudden onset of neuropathic pain or autonomic dysfunction with a large improvement in glycemic control (glycated hemoglobin [HbA1c] level of ≥ 2% over 3 months). We report the first case of a 24-year-old woman with type 1 diabetes mellitus who developed TIND in Korea. Her HbA1c level had decreased from 16.7% to 7.3% within a 3-month period. She developed acute-onset, severe, and continuous burning pain affecting her back and lower extremities. She was administered tapentadol (50 mg), pregabalin (75 mg), and vitamin B with minerals twice daily for neuropathic pain. She complained of orthostatic hypotension; thus, midodrine (2.5 mg) and anti-embolic stockings were prescribed. She almost completely recovered 6 months after the onset. A physician should be aware of TIND and gradually reduce HbA1c levels to prevent the occurrence of TIDN. They must also try to provide relief from severe pain or autonomic dysfunction and emphasize on an almost complete recovery.

• 한국전문물리치료학회지
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• 제5권3호
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• pp.11-20
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• 1998

The purposes of this study were to determine the effect of different degrees of severity of diabetic neuropathy on balance function, and to evaluate dynamic balance and functional performance in diabetes patients. Twenty-four subjects with diabetes mellitus were divided into three groups according to results of sensory nerve conduction study. All subjects were evaluated for dynamic balance which was measured using computerized dynamic posturography, and functional performance which was measured using the Berg balance scale. One-way analysis of variance was used to determine whether there were any statistically differences of dynamic balance function and functional performance among the three groups. The Spearrnan's rank correlation was used to determine statistical significance between dynamic balance and age. The results were as follows: 1. Dynamic balance measured using computerized dynamic posturography was significantly lower in the no response group than in the normal amplitude group (p<0.05). 2. Functional performance tested by the Berg balance scale was not statistically different among the three groups (p>0.05). 3. an inverse relationship was found between dynamic balance measured using computerized dynamic posturography and age (r=-0.68, p<0.05). These results suggest that patients with severe diabetic neuropathy have loss of dynamic balance function. Therefore, patients with severe diabetic neuropathy need to have their balance evaluated and receive appropriate education.

• International journal of advanced smart convergence
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• 제9권1호
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• pp.37-46
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• 2020

Cerebral vascular surgery can damage patients' motor and sensory nerves; therefore, neuromonitoring is performed intraoperatively. Patients with diabetes often have peripheral neuropathy and may be prone to nerve damage during surgery. This study aimed to identify factors that should be considered when diabetic patients undergo intraoperative neuromonitoring during brain vascular surgery and to present new criteria. Methods: In patients with and without diabetes who underwent cerebrovascular surgery (n = 30/group), we compared the intraoperative stimulation intensity, postoperative motor power and sensory, glycated hemoglobin (HbA1c) and glucose levels, and imaging findings. Results: Fasting glucose, blood glucose, and HbA1c levels were 10%, 12.1%, and 9.7%, respectively; they were higher in patients with than in patients without diabetes. Two patients with diabetes had weakness, and 10 required increased Somato sensory evoked potential (SSEP) stimulation, while in 16, motor power recovered over time rather than immediately. The non-diabetic group had no weakness after surgery, but 10 patients required more increased SSEP stimulation. The diabetic group showed significantly more abnormal test results than the non-diabetic group. Conclusion: For patients with diabetes undergoing surgery with intraoperative neuromonitoring, whether diabetic peripheral neuropathy is present, their blood glucose level and the anesthetic used should be considered.

• Journal of Acupuncture Research
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• 제32권4호
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• pp.17-27
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• 2015

Objectives : The purpose of this study is to evaluate the correlation between HbA1c and pain intensity in diabetic peripheral neuropathy patients, and to compare the difference between two groups divided by the risk of complications. Methods : The participants were 46 men and women suffering from neuropathic pain diagnosed with diabetes mellitus who visited the Hospital of Traditional Korean Medicine, Semyung University from June, 2014 to August, 2015. Age, duration of diabetes mellitus, numeric rating scale(NRS), and Michigan neuropathy screening instrument(MNSI) were used as evaluation tools. Results : 1. In all 46 cases, there were no significant correlations between HbA1c and age, duration of diabetes mellitus, NRS, MNSIQ, or MNSIE. 2. Among 23 cases with a high risk of complications (more than 7.0 % of HbA1c, group A), there were no significant correlations between HbA1c and age, duration of diabetes mellitus, NRS, MNSIQ, or MNSIE. 3. Among 23 cases with a low risk of complications(less than 7.0 % of HbA1c, group B), there were no significant correlations between HbA1c and age, duration of diabetes mellitus, NRS, MNSIQ, or MNSIE. 4. Means of duration of diabetes mellitus, NRS, MNSIQ, and MNSIE were higher in group A than group B, but there were no significant correlations in statistics. Conclusions : This study could not find statistically significant correlations between pain intensity and HbA1c in diabetic peripheral neuropathy patients, so more studies are required in the future.

• 한국식품영양학회지
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• 제21권4호
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• pp.430-435
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• 2008

The main cause of diabetic neuropathy, one of the most debilitating complications, is the chronic hyperglycemia, the increase sorbitol or the decrease of nerve growth factor(NGF). NGF, a protein, plays a major role in the development and maintenance of peripheral nervous system. Systemic administration of NGF prevents manifestations of neuropathy in rodent models of diabetic neuropathy. In the previous investigation, we report the hypoglycemia effect of Dioscorea rhizoma extract(DRE) in diabetic mice. The present study shows protective effect of DRE on diabetic neuropathy by induction of NGF protein. We investigated the NGF level in salivary gland and sciatic nerve of normal mouse and the effect of DRE on sciatic nerve conductivity and thermal hyperalgesia test in Type 2 db/db mouse. DRE increased endogenous NGF level in salivary gland and sciatic nerve of mouse. And sensory nerve conductivity velocity(SNCV), motor nerve conductivity velocity(MNCV) and thermal hyperalgesia increased in DRE treatment mice compared with control group. On the basis of our results, we conclude that DRE increase induction of endogenous NGF level and have protective effect on diabetic neuropathy by induction of NGF. Therefore, we propose that long-term use of DRE might help prevention of diabetes-associated complication; diabetic neuropathy.

• Annals of Clinical Neurophysiology
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• 제10권2호
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• pp.101-103
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• 2008

Many neurologists, particularly whose subspecialty is in peripheral neurology, may agree that patients with peripheral neuropathy often complain of the "restless legs" symptoms. These symptoms seem to share the typical features of the so-called "restless legs syndrome (RLS)", i.e., unpleasant sensations in the leg/feet, worsening in the evening or at night, and the partial relief of the positive sensory symptoms by the movements such as walking, shaking or rubbing. In fact, a higher incidence of RLS was reported among the neuropathic patients, and peripheral neuropathy was found to be more prevalent in patients with RLS than in general population. Moreover, RLS share many risk factors with peripheral neuropathy such as diabetes, uremia, amyloidosis and cryoglobulinemia, which suggests that peripheral neuropathy may play a pathophysiologic role in the development of RLS.

• 근관절건강학회지
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• 제17권1호
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• pp.35-46
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• 2010

Purpose: The purpose of this study was to test the effect of 12-week Tai Chi exercise on glucose control, peripheral nerve modulation, and perceived health for Type 2 diabetic patients with neuropathy. Methods: A pretest posttest design with a nonequivalent control group, 44 diabetic patients with neuropathy were recruited from an outpatient clinic of a university hospital and assigned into Tai Chi or Control groups. The Tai Chi exercise was based on Tai Chi for Diabetes program developed by Lam (2006) and performed one hour for each session twice a week for 12 weeks. Outcome variables were HbA1c, Michigan Neuropathy Screening Instrument scores and perceived health. A total of 25 patients completed both measures of pretest and posttest. Results: The study participants were 67 years old in average, diagnosed by DM for more than 15 years. Those who participated in 12-week Tai Chi exercise (n=13) significantly improved in HbA1c (t=2.23, p=.035) and perceived health (t=-2.28, p=.032) than the control group (n=12). Conclusion: Tai Chi exercise may improve glucose control and health status in patients with Type II diabetes. Further study with larger sample size would be necessary to confirm the effect of Tai Chi on peripheral nerve modulation.

• Annals of Clinical Neurophysiology
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• 제21권1호
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• pp.36-43
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• 2019

Background: Diabetic peripheral polyneuropathy (DPN) is associated with a variety of symptoms. Nerve conduction studies (NCSs) are considered to be the gold standard of nerve damage assessments, but these studies are often dissociated from the subjective symptoms observed in DPN patients. Thus, the aim of the present study was to investigate the correlations between NCS parameters and neuropathic symptoms quantified using the Michigan Neuropathy Screening Instrument (MNSI). Methods: Patients with type 2 diabetes mellitus (T2DM) with or without symptoms of neuropathy were retrospectively enrolled. Demographic data, clinical laboratory data, MNSI score, and NCS results were collected for analysis; DPN was diagnosed based on the MNSI score (${\geq}3.0$) and abnormal NCS results. Pearson's correlation coefficients were used to evaluate the relationships between MNSI score and NCS variables. Results: The final analyses included 198 patients (115 men and 83 women) with a mean age of $62.6{\pm}12.7$ years and a mean duration of diabetes of $12.7{\pm}8.4$ years. The mean MNSI score was 2.8 (range, 0.0-9.0), and 69 patients (34.8%) were diagnosed with DPN. The MNSI score was positively correlated with the median motor nerve latency and negatively correlated with the median motor, ulnar sensory, peroneal, tibial, and sural nerve conduction velocities (NCVs). When the patients were categorized into quartiles according to MNSI score, peroneal nerve conduction velocity was significantly lower in the second MNSI quartile than in the first MNSI quartile (p = 0.001). A multivariate analysis revealed that the peroneal NCV was independently associated with MNSI score after adjusting for age, sex, and glycosylated hemoglobin A1c (HbA1c) levels. Conclusions: The present results indicate that a decrease in peroneal NCV was responsible for early sensory deficits in T2DM patients.

• 월간당뇨
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• 통권288호
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• pp.68-71
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• 2013

• The Korean Journal of Medicine
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• 제99권4호
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• pp.210-218
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• 2024

목적: 자율신경계 합병증과 같은 당뇨 합병증을 갖고 있는 환자들에게 있어 위장관계 증상은 매우 흔한 편이다. 그러나 당뇨 합병증이 발병하기 전에 위장관계 증상의 유병률이 어떤지는 명확히 알려져 있지 않다. 방법: Rome III 기준에 의거해 내분비내과를 찾은 환자들에게 기능성 위장장애에 관한 증상 설문조사를 실시하였다. 조사 영역은 기능성 소화 불량과 과민성 대장증후군, 기능성 변비에 관련된 질문들로 구성하였다. 결과: 당뇨 전단계, 당뇨병성 신경병증을 가지고 있지 않은 당뇨병 환자들, 당뇨병성 신경병증을 가진 당뇨병 환자군에 있어서 기능성 위장장애의 유병률은 각각 기능성 소화 불량의 경우 16.52%, 27.27% 그리고 23.53%, 과민성 대장증후군의 경우 8.70%, 11.68% 그리고 16.81%, 기능성 변비의 경우 8.85%, 11.85% 그리고 15.25%로 확인되었다. 하위 분류분석에서 식후 포만감과 조기 만복감과 같은 증상을 보이는 식후고통증후군의 유병률이 명치통증증후군보다 좀 더 높게 확인되었다. 기능성 변비에 관련된 하위 분류 분석에 있어 항문직장 폐쇄감이 있거나 배변을 돕기 위한 부가 처치가 필요한 경우와 같은 골반 출구 폐쇄 증상의 유병률이 서행성 변비 증상의 경우보다 더 높게 확인되었다. 결론: 기능성 위장장애의 유병률은 전반적으로 당뇨병이 더 심해짐에 따라 더욱 증가한다. 하지만 당뇨병과 연관된 위장관계 증상은 그 합병증이 발생하기 오래전부터 발생하게 된다. 따라서 이를 미리 확인하여 적절한 치료와 조치를 취할 필요가 있겠다.