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Rheology of Diabetes Mellitus
Published in Gordon D. O. Lowe, Clinical Blood Rheology, 2019
Diabetic peripheral neuropathy is a complex and varied clinical entity.73 Symmetrical sensory and autonomic neuropathies are characterized histologically by segmental demyelination and axonal degeneration and are considered to have a metabolic etiology, hemodynamic factors probably making a negligible contribution. By contrast, mononeuropathies may have a vascular basis. Here, isolated or multiple involvement of cranial or peripheral nerves occurs either abruptly or insidiously, and damage may be sensory, motor, or mixed. Palsies of the third and sixth cranial nerves, and ulnar, radial, median, femoral, and peroneal nerves are the most common. Occlusion of intraneural blood vessels with fibrin and cellular material has been described74 in association with these lesions implicating the possible etiological importance of hemorheological factors. Intravascular thrombi have also been found in cerebral blood vessels in patients dying during diabetic ketoacidosis,75 and the very high levels of blood viscosity and impaired erythrocyte deformability found in ketoacidosis may be of importance in these cases.
Chronic Hyperglycemia Impairs Vision, Hearing, and Sensory Function
Published in Robert Fried, Richard M. Carlton, Type 2 Diabetes, 2018
Robert Fried, Richard M. Carlton
Sensory symptoms start in the toes and over time affect the upper limbs in a distribution classically described as a “stocking and glove” pattern. Motor involvement is not typically seen in the early stages of diabetic peripheral neuropathy but patients describe a range of sensory symptoms that may include loss of pain sensation or insensitivity, tingling, “pins and needles” sensation, burning, “electric shocks,” painful sensations to an inoffensive stimulus, and increased sensitivity to painful stimuli.
Epidemiology, Risks, and Health-Care Expenditures for Diabetes and Its Complications
Published in Emmanuel Opara, NUTRITION and DIABETES, 2005
The health-care cost of problems related to the diabetic foot, the most common cause of hospitalization in patients with diabetes, is estimated to be more than $1 billion annually (73). In 2003, the total annual cost of diabetic peripheral neuropathy and its complications were estimated to be between $4.6 and $13.7 billion (74). In large cohort studies, prevalence rates for neuropathy have ranged from 7.5 percent at time of diagnosis of diabetes, to 50 percent 25 years after initial diagnosis (75). It is present in more than 80 percent of diabetic patients with foot lesions (73). Poor glycemic control is associated with an increased risk for neuropathy and amputation (76). In one study, a HbA1c > 13.4 was associated with 2.2 relative risk of amputation (76). In another study, a 50 mg/dl increase in the mean random glucose was associated with a 1.6 OR for amputation (76). Diabetic peripheral neuropathy predisposes to foot ulceration and lower-extremity amputation (74). The presence of peripheral neuropathy is associated with eightfold to eighteenfold higher risk of ulceration and twofold to fifteenfold higher risk of amputation (76). The incidence of self-reported foot ulcers in people with diabetes is 2.4 percent to 2.6 percent per year (76). The prevalence of foot ulcers ranges from 4 percent to 10 percent, and it is estimated in the U.S. that 15 percent of patients with diabetes will develop foot ulceration at least once during their lifetime (74, 76, 77).
Relationship between complications of type 2 diabetes and thyroid nodules
Published in Current Medical Research and Opinion, 2023
Xuexue Zhang, Xujie Wang, Jian Liu, Yuying Xu, Jiwei Zhang, Qiuyan Li
Diabetic peripheral neuropathy is a common chronic complication of diabetes, affecting approximately 30-50% diabetic patients19. Previous study has revealed that vascular endothelial growth factor (VEGF), which promote angiogenesis in the nervous system and has neurotrophic effects, was associated with an increased risk of diabetic peripheral neuropathy20. Also, clinical trial have showed that elevated serum VEGF level in patients with diabetic peripheral neuropathy compared to those without21. Importantly, VEGF is synthesized by follicular cells and promotes the proliferation of thyroid vascular endothelial cells, directly or indirectly contributing to nodule formation22. Moreover, overexpression of VEGF is a main factor in retinal neovascularization and vascular leakage. Furthermore, the expression of proliferating cell nuclear antigen (PCNA), a marker of cell proliferation, is consistent with the state of DNA synthesis, and can be used to evaluate cell proliferation23. Interestingly, PCNA overexpression is observed in patients with diabetic retinopathy or thyroid nodules24,25. These findings were in line with our results indicating that a significantly increased risk of thyroid nodules in patients with diabetic peripheral neuropathy and eye disorder.
Contribution of ankle-brachial index measurement in screening for arteriopathy obliterans of the lower limbs in type 2 diabetics
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2022
Sitraka Angelo Raharinavalona, Rija Eric Raherison, Thierry Razanamparany, Dally Rasoaniana, Radonirina Lazasoa Andrianasolo, Andrinirina Dave Patrick Rakotomalala
The diagnosis of retinopathy is made in the presence of abnormalities on examination of the vitreous and the fundus after pupillary dilation. The presence of diabetic nephropathy is attested from a bundle of arguments associating microalbuminuria and/or proteinuria, with or without elevation of serum creatinine, and the presence of diabetic retinopathy. The diagnosis of diabetic peripheral neuropathy is suggested by symmetrical distal sensory symptoms beginning in the lower limbs and/or impaired foot sensitivity on examination with a 10 g monofilament. The existence of ischaemic stroke and ischaemic heart disease was confirmed respectively by the cerebral scanner, and the elevation of ultrasensitive troponin with an abnormality on the electrocardiogram in terms of repolarization disorder and/or on the transthoracic echocardiography in terms of kinetic disorder. The diabetic foot was evoked in the presence of trophic disorders following nerve, arterial and often infectious damage occurring on the foot of a diabetic.
Prevalence of diabetic peripheral neuropathy among type II diabetic patients in King Fahd University Hospital, Khobar, Kingdom of Saudi Arabia
Published in Hospital Practice, 2021
Noor Ahmed Jatooi, Amal Shehab A Alsulaiman, Norah Jamal Alromaih, Batool Abdullah Albahrani, Ibtisam Mohammed Alkhattaf, Fatimah Alyami, Kawthar Ahmed Alabdrabalrasol
This study showed that DPN affects 37.4% of type II diabetic patients at King Fahd University Hospital in Saudi Arabia. Moreover, in assessing the association between the prevalence of DPN and the socio-demographic factors; HbA1c level was significantly associated with DPN. Whereas FBG level and DM duration were significant predictors of DPN risk according to the multivariate regression analysis. In addition, age, gender, nationality, and BMI level were neither significantly associated or significant predictors of DPN. The importance of detecting diabetic peripheral neuropathy lies on the disastrous consequences and poor outcomes including but not limited to, falls, foot ulceration which can lead to infection or gangrene and eventually foot amputation. Moreover, patients with uncontrolled diabetes mellitus are at high risk to develop autonomic neuropathy including; gastroparesis, urinary incontinence, and sudden cardiac death. Thus, physicians treating diabetes should be aware of the importance of DPN screening and management plan; in order to reduce the complications and the health-care burden associated with the disease. [35,36]