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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetic peripheral neuropathy is a secondary manifestation of diabetes mellitus. The purpose of this review of literature and case study is to increase the clinical physical therapist's understanding of diabetic peripheral neuropathy.
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PMID:Diabetic peripheral neuropathy: review of literature and case study. 83 73

Diabetic peripheral neuropathy is characterized by endoneurial capillary closure and by segmental demyelination and axonal degeneration in a spatial pattern consistent with ischemic damage. The increased permeability of human diabetic endoneurial capillaries to plasma proteins may contribute to the pathogenesis of these structural changes in peripheral nerve by further accelerating the rate at which plasma proteins are trapped by reactive nonenzymatic glycosylation products on long-lived proteins such as myelin. We have measured trapped immunoglobins (Ig) G and M on peripheral nerve myelin from diabetic and nondiabetic patients by an enzyme-linked immunosorbent assay to determine whether plasma proteins accumulate on nerves as they do in the glomerular matrix of diabetics. The amount of trapped IgG on brain myelin from these subjects was also determined. Peripheral nerve myelin from diabetics had on average greater than 14 times the amount of trapped IgM found in identically prepared samples from nondiabetics (0.90 +/- 0.2 vs. 0.06 +/- 0.004 OD/micrograms myelin protein) and greater than 4 times the amount of trapped IgG (6.40 +/- 1.92 vs. 1.5 +/- 0.25 OD/micrograms myelin protein). In contrast, no significant trapping of IgG was detected in any samples of brain myelin. This most likely reflects effective exclusion of IgG by the blood-brain barrier. These data suggest that excessive trapping of Igs and other plasma proteins by diabetic peripheral nerve myelin may contribute to the development of peripheral nerve damage, whereas the lack of such trapping by brain myelin may partly explain the rarity of diabetic central neuropathy.
Diabetes 1986 Sep
PMID:Trapped immunoglobulins on peripheral nerve myelin from patients with diabetes mellitus. 374 8

In 7 years, 809 Ethiopian patients have been seen in a diabetic clinic in Addis Ababa, of whom 105 have had diabetes for more than 15 years (none more than 30 years). Of those with "long term" diabetes 13 were Type 1 (insulin-dependent), 68 Type 2 (non-insulin-dependent) non-obese and 24 Type 2 obese; 28% had always taken insulin, and a further 19% required insulin after some years of oral therapy. Diabetic retinopathy was found in 38%, 27% had normal fundi, and 14% had cataracts so dense the fundi were obscured; for 21% fundal examination was not recorded. Cataracts were or had been present in 40% of patients, and caused more visual handicap than retinopathy. Thirty percent of patients had nephropathy. Diabetic peripheral neuropathy was found in 47%. Cardiac, foot and miscellaneous vascular complications were seen, but were much less common. Thirty-one patients (30%) died during the 7 years, the commonest cause of death being renal failure, but an encouraging proportion (61%) had no severely handicapping complications and were independent after more than 15 years of diabetes.
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PMID:Long-standing diabetes mellitus in Ethiopia: a survey of 105 patients. 664 88

Corneal epithelial lesions can be found in approximately one-half of asymptomatic patients with diabetes mellitus. These lesions are transient and clinically resemble the keratopathy seen in staphylococcal keratoconjunctivitis. Staphylococcal organisms, however, can be isolated in equal percentages from diabetic patients without keratopathy. Diabetic peripheral neuropathy was found to be related to the presence of diabetic keratopathy after adjusting for age with analysis of covariance. The strongest predictor of both keratopathy and corneal fluorescein staining was vibration perception threshold in the toes (P less than 0.01); and the severity of keratopathy was directly related to the degree of diminution of peripheral sensation. Other predictors of keratopathy were: reduced tear breakup time (P less than 0.03), type of diabetes (P less than 0.01), and metabolic status as indicated by c-peptide fasting (P less than 0.01). No significant relationships were found between the presence of keratopathy and tear glucose levels, endothelial cell densities, corneal thickness measurements, the presence of S epidermidis, or with duration of disease. It is our conclusion that asymptomatic epithelial lesions in the nontraumatized diabetic cornea can occur as a manifestation of generalized polyneuropathy and probably represent a specific form of corneal neuropathy.
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PMID:Diabetic corneal neuropathy. 667 64

During 18 years, 1976 to 1994, 43(1.9%) of the 2,250 patients registered in the Diabetic Clinic at Yekatit 12 Hospital, Addis Abeba, Ethiopia (six patients) required an amputation at diagnosis or during the course of diabetes mellitus. Male to female ratios was 2:1; eight patients had Type 1 and 35 Type 2 diabetes. Diabetic peripheral neuropathy was the underlying condition in at least 21 of the 43 patients; only five cases of ischaemic gangrene were seen. Mean ge at amputation was 37.4 +/- 8.7 years in Type 1 patients and 58.6 +/- 12.1 in Type 2. Twenty-three of the 43 are now dead, 12 of the deaths having been due to sepsis in patients who refused an amputation in the face of progressing gangrene. Eleven of the 43 still attend regularly up to 11 years after an amputation. Most patients who needed below-knee amputations did not regain independence because of difficulty obtaining prostheses.
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PMID:Amputations in patients attending a diabetic clinic in Addis Abeba, Ethiopia. 789 42

Diabetic peripheral neuropathy is one of the most common complications of diabetes. We present a case of necrotizing fasciitis in a 38 year old man with insulin dependent diabetes, who had been treated by an alternative therapist with a vacuum boot. The treatment resulted in ulcerations and later infection of the foot and ankle, which had to be treated by acute amputation. The story illustrates the risk of consulting alternative treatment when suffering from diabetic neuropathy or circulatory disturbances. We can therefore not recommend that patients of this kind receive treatment from any person without medical experience.
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PMID:[Purulent myofasciitis in a patient with diabetes treated with a vacuum boot by a zone therapist]. 832 69

Foot ulceration and lower limb amputation are still common complications of diabetes. Diabetic peripheral neuropathy and peripheral vascular disease are the most important etiologic factors, but there is a complex interplay between these abnormalities and a number of other contributory factors, such as altered foot pressures, limited joint mobility, glycemic control, ethnic background, and cardiovascular parameters. Identification of patients at high risk of ulceration is nevertheless simple, and education of such patients can achieve a major reduction in amputation and ulceration rates.
Diabetes 1997 Sep
PMID:The pathogenesis of diabetic foot problems: an overview. 928 1

Diabetic peripheral neuropathy is a common, painful, and disabling condition that is known to occur by two mechanisms: hyperglycemia and arterial blood flow occlusion. Pentoxifylline (Trental) functions by improving erythrocyte flexibility in blood vessels, which could increase the delivery of oxygen to occluded nerve vessels. This 1-year clinical trial was aimed at ascertaining the effects of pentoxifylline on diabetic sensory neuropathy. Fifty patients with type I or II diabetes were evaluated in a randomized, double-blind, parallel group and placebo-controlled study. Pentoxifylline effectiveness was evaluated by measuring glycated hemoglobin, blood pressure and current perception threshold (CPT). The CPT results showed no statistically significant effect of pentoxifylline on mean nerve sensory perception thresholds in ankle and toe at 5, 250 and 2000 Hz. There were no significant changes in glycated hemoglobin or in systolic and diastolic blood pressure during the trial. Thus, glycated hemoglobin and blood pressure did not explain the lack of pentoxifylline effect on diabetic neuropathy. In conclusion, pentoxifylline appears not to add benefits to the clinical treatment of diabetic sensory neuropathy of the lower extremity.
J Diabetes Complications
PMID:The effect of pentoxifylline on current perception thresholds in patients with diabetic sensory neuropathy. 933 9

Diabetic peripheral neuropathy is estimated to affect at least 30% of patients with diabetes mellitus. The appropriate management of this disturbance is essential if late-stage complications, such as foot ulceration and amputations, are to be avoided in these patients. The need for improvements in the clinical management of neuropathy in primary and outpatient hospital care resulted in the identification of an international consensus group to address the management of diabetic peripheral neuropathy by the practising clinician. The international consensus group included diabetologists, neurologists, primary care clinicians, diabetes specialist nurses and podiatrists. The outcome of this consensus group was endorsed by the Neurodiab Executive Committee. The International Guidelines describe the recommendations for the management of diabetes in primary care and in outpatient hospital care and include an annual review of diabetic patients. This should include a history of patient symptoms, the type of diabetes, lifestyle and social circumstances. In examination of the foot, the status of the skin (e.g. absence of sweating and presence of ulceration) immobility of joints, gait and footwear should be noted. Simple tests should be performed to assess peripheral sensation, including sensation to pinprick, light touch, vibration, pressure, and ankle reflexes should be checked. It is the objective of the guidelines document to provide clear and simple instructions for the diagnosis and management of neuropathy on an outpatient basis, in particular during annual review of the patient. Adoption of the guidelines should lead to improvements in the management of neuropathy.
Diabetes Metab 1998 Nov
PMID:Guidelines for diagnosis and outpatient management of diabetic peripheral neuropathy. European Association for the Study of Diabetes, Neurodiab. 988 Dec 34

Diabetic peripheral neuropathy (DPN) is one of the most commonly occurring major complications of diabetes. The disease may manifest in several clinical patterns: most frequently as distal symmetrical sensory polyneuropathy. Guidelines are available for the diagnosis of DPN by the primary care physician. These recommend that a review of diabetic patients, including a questionnaire and inspection and neurological examination of the feet, is undertaken annually. Techniques used for studying the disease process in clinical trials may include nerve conduction and quantitative sensory function tests, autonomic nervous system testing, post-ganglionic sudomotor function and skin biopsy. Current therapies for managing DPN are strict glycaemic control, palliative treatments and foot ulcer prevention. Future treatments aim to beneficially affect the underlying disease pathology and putative agents are currently being investigated.
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PMID:Diagnosis and management of diabetic peripheral neuropathy. 1002 22


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