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(MPT) RK University, Rajkot, PT, PhD, Dean, RK University, Rajkot, MPT, Rajkot, Gujarat.
ABSTRACT
Background: Diabetes mellitus is characterised by inability of the body to
metabolize glucose properly. The prevalence of diabetes is rapidly rising all over the
globe at an alarming rate. As IDDM and NIDDM shows effect on central nervous
system, peripheral nervous system, autonomic nervous system, cardiovascular
system and other physiological system. A common complication due to the IDDM
and NIDDM includes peripheral neuropathy, retinopathy, nephropathy and vascular
complication. Insulin and non-insulin dependent diabetes mellitus both affect the
peripheral nervous system depending on the duration of exposure and blood glucose
level. Aim: Neurophysiological changes in context to duration of exposure in insulin
dependent and non insulin dependent diabetes mellitus Materials and Method: 120
healthy individuals with IDDM and NIDDM were included screened with SF-36, with
age limit between 25 to 60 years. Those individuals having a history of
hospitalization in last 1 year, acute fever, present history of radiculopathy and open
wound were excluded. Nerve conduction studies of common peroneal, tibial and
sural nerves were examined in both groups. Distal Latency, NCV and CMAP/SNAP
were taken as outcome measures. Result and Discussion: Bio-statistical analysis
has been done using Mann-Whitney test. Result suggest that long duration of
exposure has significant (p<0.05) effect on neurophysiological changes compare to
short duration of exposure in IDDM and NIDDM. With longer exposure of diabetes,
there is increase in latency, decrease in amplitude and NCV. Conclusion: long
duration of exposure shows significant Neurophysiological changes compare to short
duration of exposure in IDDM and NIDDM.
Keywords: Insulin dependent diabetes mellitus (IDDM), Non-insulin dependent
diabetes mellitus (NIDDM), Nerve conduction velocity (NCV)
Introduction:
Diabetes
characterised
mellitus
by
is
chronic
and
vascular
diabetes
.carbohydrate,
peripheral
and
protein
Insulin
complication.
mellitus,
both
affect
nervous
[5]
the
system
significantly.
distressing
complete
quality
or
near-total
insulin
of
of
life.
Diabetic
all
the
The
chronic
presence
of
neuropathy
is
peripheral
impaired
insulin
increased
glucose
secretion,
and
[1]
production.
diabetic
peripheral
toes. [6]
Electrophysiological
have
10]
have
million
by
2025
unless
urgent
dependent
and
revealed
studies
number
of
nerve
conduction
changes.[13, 14]
system,
The
prevalence
of
diabetic
musculoskeletal
4]
the
and
cardiovascular
system.
[3,
risk
of
developing
diabetic
diabetes.
skin
resistance
was
reduced
by
conduction examination.
of
the
study
is
to
diabetes mellitus.
Review
Arindam
of
[16]
related
literatures:
[17]
had
study
which
included
120
Surface
extensor
limb
Radiculopathy,
history
of
recordings
digitorum
for
common
brevis
and
examination,
the
surface
tendoachilles
records
nerve
to
the
lower
border
Result:
of
anterior
to
navicular
tuberosity.
DURATION
In years
1(>10 Years)
2 (<10Years)
A1 (n-21)
15.29 2.76
A2 (n-19)
5.95 1.9
Mann Whitney test (P < 0.05)
B1 (n-14)
11.29 1.07
B2 (n-66)
5.5 2.01
Mann Whitney test (P < 0.05)
Latency
SURAL NERVE
SNAP
NCV
ms
m/s
3.89 0.59
3.08 0.67
0.0002*
3.61 0.74
3.05 0.55
0.0001*
6.41 2.64
14.47 5.68
0.0001*
8.02 3.83
15.48 5.48
0.0001*
38.76 2.91
41.74 2.51
0.0004*
39.35 2.28
42.71 2.32
0.0003*
PERONEAL NERVE
Latency
CMAP
NCV
ms
mv
m/s
5.150.6
4.361.44
382.65
5.40.61
3.531.17
37.483.16
A2 (<10Years)
Mann Whitney test
(P < 0.05)
B1 (>10 Years)
4.410.62
6.151.29
40.131.75
4.640.62
5.260.77
39.632.04
0.0025*
0.0002*
0.0024*
0.0003*
0.0001*
0.0030*
5.090.66
4.441.21
38.262.5
5.340.68
3.691.2
37.692.29
B2 (<10Years)
4.460.62
6.371.07
40.291.7
4.60.57
5.190.58
39.921.66
Mann Whitney
test (P < 0.05)
0.002*
0.0002*
0.0028*
0.0003*
0.0001*
0.004*
significant
on
short duration.
[17]
effect
short
duration.
exposure
has
Long
more
duration
of
reduction
in
reduction in NCV.
Discussion:
Duration
of
individuals
and
that
sensory
neuropathy
is
more
open
having
wound
history
were
of
excluded.
subjects
who
using
hyperglycemias,
shunted
the
in
especially
accumulation
damage
leading
in
those
glucose
of
to
sorbitol
segmental
Mann-Whitney
test.
Distal
Result
and
neurophysiological
individuals
with
long
exposure
must
be
consideration
for
findings,
duration
taken
of
duration of exposure.
into
promotion,
secondary complications
exposure.
References:
6.
7.
8.
9.
5. Mamta, Abigail, Catherine et al.
Peripheral
Neuropathy
in
Adolescents and Young Adults