Clinical and neurological features of different variants of peripheral polyneuropathy in patients with type 2 diabetes mellitus

Authors

DOI:

https://doi.org/10.15587/2519-4798.2024.324683

Keywords:

diabetes mellitus, polyneuropathy, neurological examination, electroneuromyographic examination, pain syndrome, sensitivity, symmetry

Abstract

The aim: to determine the clinical and neurological features of polyneuropathies depending on the pathomorphological type of peripheral nerve damage in patients with type 2 diabetes mellitus (DM).

Materials and methods: We examined 96 patients who were being treated in the endocrinology department of the University Hospital of KhNMU, with a diagnosis of type 2 DM and a complication - peripheral polyneuropathy (PNP). All patients completed a general clinical and neurological examination, assessment of the severity of polyneuropathic syndrome using specialized scales, and electroneuromyographic examination to assess the morpho-functional type of peripheral nerve damage.

Results: All patients were divided into three groups according to the results of electroneuromyographic examination: group 1 - axonal type (n = 37); group 2 - demyelinating type (n = 29); group 3 - mixed (axonal-demyelinating) type (n = 30). Further, during the study, depending on the morphofunctional type of peripheral nerve damage, the clinical and neurological status of patients and the results of valid scales (TSS, NIS LL, MNSI, The pain DETECT questionnaire, the VAS analogue scale) were analyzed. The symmetry of neurological symptoms and clinical and neurological status disorders in patients with different types of peripheral neuropathy were also investigated.

Conclusions: The study showed that patients with axonal PNP in type 2 DM are more characterized by subjective neurological symptoms and reduced reflexes. In patients with a demyelinating type of PNP, impaired vibration sensitivity, decreased muscle strength in the extremities, and increased tendon reflexes of the lower extremities predominate. Patients with mixed types of PNP complain more of symptoms characteristic of axonal damage, and impaired vibration sensitivity and decreased muscle strength are also observed

Author Biographies

Daryna Sushetska, Kharkiv National Medical University

PhD Student

Department of Neurology

Olena Tovazhnyanska, Kharkiv National Medical University

Doctor of Medical Sciences, Professor. Head of Department

Department of Neurology

References

  1. Panou, T., Gouveri, E., Papazoglou, D., Papanas, N. (2024). The role of novel inflammation-associated biomarkers in diabetic peripheral neuropathy. Metabolism Open, 24, 100328. https://doi.org/10.1016/j.metop.2024.100328
  2. Zhang, D., Huang, Y., Guan, Y., Zhang, X., Pan, P., Yan, X. et al. (2024). Characterization of changes in the resting-state intrinsic network in patients with diabetic peripheral neuropathy. Scientific Reports, 14 (1). https://doi.org/10.1038/s41598-024-80216-5
  3. Yang, Z., Zhao, S., Lv, Y., Xiang, L., Zhang, X., Feng, Z. et al. (2024). A New Quantitative Neuropad for Early Diagnosis of Diabetic Peripheral Neuropathy. Diabetes/Metabolism Research and Reviews, 40 (8). https://doi.org/10.1002/dmrr.70010
  4. Hsieh, P., Ro, L., Chu, C., Liao, M., Chang, H., Kuo, H. (2024). Relationship between nerve ultrasonography image and electrophysiology in diabetic polyneuropathy. Journal of Diabetes Investigation, 16 (2), 257–264. Portico. https://doi.org/10.1111/jdi.14353
  5. Mendoza-Romo, M. Á., Ortiz-Martinez, A. Y., Fabela-Mendoza, K., García-Hernández, J. A., Acuña-López, M. A., Miramontes-Zapata, M. (2021). Manifestaciones clínicas y alteraciones electroneuromiográficas en pacientes con diabetes tipo 2 y polineuropatía Revista Médica del Instituto Mexicano del Seguro Social, 59 (3), 224–232.
  6. Singh, A., Kukreti, R., Saso, L., Kukreti, S. (2022). Mechanistic Insight into Oxidative Stress-Triggered Signaling Pathways and Type 2 Diabetes. Molecules, 27 (3), 950. https://doi.org/10.3390/molecules27030950
  7. Poitras, T. M., Munchrath, E., Zochodne, D. W. (2021). Neurobiological Opportunities in Diabetic Polyneuropathy. Neurotherapeutics, 18 (4), 2303–2323. https://doi.org/10.1007/s13311-021-01138-y
  8. Hernyák, M., Tóth, L. I., Csiha, S., Molnár, Á., Lőrincz, H., Paragh, G. et al. (2024). Kallistatin as a Potential Marker of Therapeutic Response During Alpha-Lipoic Acid Treatment in Diabetic Patients with Sensorimotor Polyneuropathy. International Journal of Molecular Sciences, 25 (24), 13276. https://doi.org/10.3390/ijms252413276
  9. Han, G., Hu, K., Luo, T., Wang, W., Zhang, D., Ouyang, L. et al. (2025). Research progress of non-coding RNA regulating the role of PANoptosis in diabetes mellitus and its complications. Apoptosis. https://doi.org/10.1007/s10495-024-02066-w
  10. Souayah, N., Chong, Z. Z., Patel, T., Nasar, A., Pahwa, A., W Sander, H. (2024). Regression equation analysis enhances detection of conduction slowing beyond axonal loss in diabetic neuropathy. Heliyon, 10 (21), e39712. https://doi.org/10.1016/j.heliyon.2024.e39712
  11. Abd Razak, N. H., Idris, J., Hassan, N. H., Zaini, F., Muhamad, N., Daud, M. F. (2024). Unveiling the Role of Schwann Cell Plasticity in the Pathogenesis of Diabetic Peripheral Neuropathy. International Journal of Molecular Sciences, 25 (19), 10785. https://doi.org/10.3390/ijms251910785
  12. Zhang, X., Zhong, G., Jiang, C., Ha, X., Yang, Q., Wu, H. (2024). Exploring the potential anti-diabetic peripheral neuropathy mechanisms of Huangqi Guizhi Wuwu Decoction by network pharmacology and molecular docking. Metabolic Brain Disease, 40(1). https://doi.org/10.1007/s11011-024-01474-w
  13. Ziegler, D., Hanefeld, M., Ruhnau, K. J., Meissner, H. P., Lobisch, M., Schütte, K., Gries, F. A. (1995). Treatment of symptomatic diabetic peripheral neuropathy with the anti-oxidant α‐lipoicacido. Diabetologia, 38 (12), 1425–1433. https://doi.org/10.1007/bf00400603
  14. Bril, V. (1999). NIS-LL: The Primary Measurement Scale for Clinical Trial Endpoints in Diabetic Peripheral Neuropathy. European Neurology, 41(Suppl. 1), 8–13. https://doi.org/10.1159/000052074
  15. Moghtaderi, A., Bakhshipour, A., Rashidi, H. (2006). Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy. Clinical Neurology and Neurosurgery, 108 (5), 477–481. https://doi.org/10.1016/j.clineuro.2005.08.003
  16. Freynhagen, R., Baron, R., Gockel, U., Tölle, T. R. (2006). painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Current Medical Research and Opinion, 22 (10), 1911–1920. https://doi.org/10.1185/030079906x132488
  17. Vaeggemose, M., Pham, M., Ringgaard, S., Tankisi, H., Ejskjaer, N., Heiland, S. et al. (2017). Magnetic Resonance Neurography Visualizes Abnormalities in Sciatic and Tibial Nerves in Patients With Type 1 Diabetes and Neuropathy. Diabetes, 66 (7), 1779–1788. https://doi.org/10.2337/db16-1049
  18. Sierra-Silvestre, E., Smith, R. E., Andrade, R. J., Kennedy, B., Coppieters, M. W. (2024). Microstructural changes in the median and ulnar nerve in people with and without diabetic neuropathy in their hands: A cross-sectional diffusion MRI study. European Journal of Radiology, 181, 111721. https://doi.org/10.1016/j.ejrad.2024.111721
  19. Chang, M. C., Yang, S. (2023). Diabetic peripheral neuropathy essentials: a narrative review. Annals of Palliative Medicine, 12 (2), 390–398. https://doi.org/10.21037/apm-22-693
  20. Ferraz de Oliveira, I., Correia, I., Urzal, J., Cruz, S., Aldomiro, F. (2022). Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Diabetes: A Case Report. Cureus, 14 (9), e29390. https://doi.org/10.7759/cureus.29390
  21. Li, J., Niu, B., Wang, X., Hu, H., Cao, B. (2017). A case report of hereditary neuropathy with liability to pressure palsies accompanied by type 2 diabetes mellitus and psoriasis. Medicine, 96 (19), e6922. https://doi.org/10.1097/md.0000000000006922
  22. Ettinger, L. R., Boucher, A., Simonovich, E. (2018). Patients with type 2 diabetes demonstrate proprioceptive deficit in the knee. World Journal of Diabetes, 9 (3), 59–65. https://doi.org/10.4239/wjd.v9.i3.59
  23. Maras, O., Dulgeroglu, D., Cakci, A. (2021). Ankle Proprioception in Patients with Type 2 Diabetes Mellitus. Journal of the American Podiatric Medical Association, 111 (4). https://doi.org/10.7547/18-178
  24. Miyashita, A., Kobayashi, M., Yokota, T., Zochodne, D. (2023). Diabetic Polyneuropathy: New Strategies to Target Sensory Neurons in Dorsal Root Ganglia. International Journal of Molecular Sciences, 24 (6), 5977. https://doi.org/10.3390/ijms24065977
  25. Stępień, J., Pastuszak, Ż. (2023). Distal symmetrical polyneuropathy in diabetes mellitus patients: Proposition of a new scoring system based on electroneurography findings. Advances in Clinical and Experimental Medicine, 33 (4), 379–385. https://doi.org/10.17219/acem/168504
Clinical and neurological features of different variants of peripheral polyneuropathy in patients with type 2 diabetes mellitus

Published

2024-12-26

How to Cite

Sushetska, D., & Tovazhnyanska, O. (2024). Clinical and neurological features of different variants of peripheral polyneuropathy in patients with type 2 diabetes mellitus. ScienceRise: Medical Science, (4 (61), 11–19. https://doi.org/10.15587/2519-4798.2024.324683

Issue

Section

Medical Science