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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this article we describe differences in early metabolic abnormalities between type 1 and type 2 diabetic polyneuropathy (DPN), and how these differences lead to milder initial functional defects in type 2 diabetes, despite the same hyperglycemic exposures. This early reversible metabolic phase is progressively overshadowed by structural degenerative changes eventually resulting in nerve fiber loss. In comparison, the late structural phase of DPN affects type 1 diabetes more severely. Progressive axonal atrophy and loss is hence expressed to a larger extent in type 1 diabetes. In addition, type 1 DPN is characterized by paranodal degenerative changes not seen in type 2 DPN. These differences can be related to the differences in insulin action and signal transduction affecting the expression of neurotrophic factors and their receptors in type 1 diabetes. Downstream effects on neuroskeletal and adhesive proteins, their posttranslational modifications, and nociceptive peptides underlie the more severe resultant pathology in type 1 DPN. These differences in underlying mechanisms should be seriously considered in the future design of interventional paradigms to combat these common conditions.
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PMID:Diabetic neuropathy differs in type 1 and type 2 diabetes. 1715 5

A 57-year-old Caucasian man presented with diaphragmatic paralysis and type 2 diabetes. He had severe orthopnea that remained unchanged for 1 year. He was later diagnosed with distal symmetric polyneuropathy and was started on topiramate. Within 26 weeks of treatment, the patient showed improvement in diaphragmatic function and regrowth of intraepidermal nerve fibers, accompanied by improvement in respiratory and peripheral neuropathy symptoms. Topiramate may prove to be an effective agent in the treatment of nonremitting diaphragmatic paralysis and regrowth of intraepidermal nerve fibers.
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PMID:Reversal of phrenic nerve palsy with topiramate. 1718 76

This study sought to determine the sensitivity of sural sensory action amplitude (SAP) and peroneal motor conduction velocity (MCV) for differentiating the status of other nerve conduction velocities and identifying important correlates of diabetic polyneuropathy. Subjects (n = 708) with type 2 diabetes from one community completed a preliminary questionnaire. Among the 298 subjects with positive questionnaire results, 272 completed nerve conduction tests. The means of 6 nerve conduction velocities of subjects with both SAP and MCV abnormalities were compared to those of normal controls. The mean conduction velocities of all motor and sensory nerves were slower (p < 0.05) in subjects with polyneuropathy than without polyneuropathy. Important known correlates of diabetic polyneuropathy can also be identified by this electrophysiological definition. The sural SAP and peroneal MCV together serve as a good diagnostic for diabetic polyneuropathy and can be used as a simplified criterion in field studies.
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PMID:Simplified electrodiagnostic criteria of diabetic polyneuropathy in field study (KCIS No. 14). 1721 87

Restless legs syndrome (RLS) is a sensorimotor disorder characterised by a complaint of an almost irresistible urge to move the legs. RLS is diagnosed clinically by means of the four essential criteria of the International Restless Legs Syndrome Study Group. In doubtful cases, neurophysiological examinations, such as polysomnography and/or a suggested immobilisation test, can be performed to confirm a clinical suspicion of RLS. Several other conditions may present sensorimotor complaints with features similar to RLS; a careful sleep history is required to avoid a misdiagnosis. Three different scales have been validated to assess the severity of RLS. In the general population, RLS prevalence ranges from 0.1% to 11.5%, with a high number of patients affected by a primary form of the sleep disturbance (70%-80%). However, several clinical conditions have been associated with RLS, such as iron deficiency, uraemia, pregnancy and polyneuropathy. Furthermore, recent studies show that RLS may be associated also to type 2 diabetes mellitus and to multiple sclerosis. RLS has a negative impact on sleep, cognitive functions, quality of life and mental status. Higher awareness of RLS among physicians is required; it remains an underdiagnosed clinical condition.
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PMID:Restless legs syndrome: diagnosis, epidemiology, classification and consequences. 1723 30

The objective of the present study was to establish the frequency of psychiatric comorbidity in a sample of diabetic patients with symmetric distal polyneuropathy (SDPN). Sixty-five patients with type 2 diabetes mellitus were selected consecutively to participate in the study at Instituto Estadual de Diabetes e Endocrinologia. All patients were submitted to a complete clinical and psychiatric evaluation, including the Portuguese version of the structured clinical interview for DSM-IV, the Beck Depression Inventory, the Neuropathy Symptom Score, and Neuropathy Disability Score. SDPN was identified in 22 subjects (33.8%). Patients with and without SDPN did not differ significantly regarding sociodemographic characteristics. However, a trend toward a worse glycemic control was found in patients with SDPN in comparison to patients without SDPN (HbA1c = 8.43 +/- 1.97 vs 7.48 +/- 1.95; P = 0.08). Patients with SDPN exhibited axis I psychiatric disorders significantly more often than those without SDPN (especially anxiety disorders, in general (81.8 vs 60.0%; P = 0.01), and major depression--current episode, in particular (18.2 vs 7.7%; P = 0.04)). The severity of the depressive symptoms correlated positively with the severity of SDPN symptoms (r = 0.38; P = 0.006), but not with the severity of SDPN signs (r = 0.07; P = 0.56). In conclusion, the presence of SDPN seems to be associated with a trend toward glycemic control. The diagnosis of SDPN in diabetic subjects seems also to be associated with relevant psychiatric comorbidity, including anxiety and current mood disorders.
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PMID:Comorbidity of psychiatric disorders and symmetric distal polyneuropathy among type II diabetic outpatients. 1727 65

The World Health Organization (WHO) predicts there will be 300 million people world-wide with diabetes mellitus by 2025. Currently it is estimated that there are 20 and 60 million people suffering from diabetes mellitus in North America and Europe, respectively. Within this huge population of diabetic persons approximately 50% will develop some form of sensory polyneuropathy, which involves the dying back of distal axons and a failure of axons to regenerate. This leads to incapacitating pain, sensory loss and poor wound healing. The end result is lower extremity amputation with approximately 90,000 diabetes-related amputations occurring each year in North America and the expectation of a 5-fold increase over the next 10 years due to increased incidence of type 2 diabetes. Abnormal neuronal Ca(2+) homeostasis and impaired mitochondrial function have been implicated in numerous CNS and PNS diseases including diabetic sensory neuropathy. The endoplasmic reticulum (ER), in part, regulates cellular Ca(2+) homeostasis and this process is linked to regulation of mitochondrial function and activity of anti-apoptotic signal transduction pathways. Here we review the current state of research regarding role of Ca(2+) dyshomeostasis and mitochondrial physiology in neuronal dysfunction in diabetes. The central impact of diabetes-induced alteration of Ca(2+) handling on sensory neurone function is discussed and related to abnormal ER performance. New results are presented showing suboptimal Ca(2+) concentration in the ER lumen in association with reduced SERCA2 expression in sensory neurones from type 1 diabetic rats. We hypothesize that deficits in neurotrophic factor support, specifically linked to diabetes-induced lowered expression of insulin and neurotrophin-3, triggers alterations of sensory neurone phenotype that are critical for the development of abnormal Ca(2+) homeostasis and associated mitochondrial dysfunction. The role of hyperglycaemia in diabetes is also discussed and we propose that high glucose concentration may impact at other sites to contribute to the heterogeneous aetiology of nerve damage in diabetes.
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PMID:Mitochondrial malfunction and Ca2+ dyshomeostasis drive neuronal pathology in diabetes. 1819 Nov 98

Type 2 diabetes mellitus is a disease that affects a rapidly increasing number of patients. Most patients with Type 2 diabetes will develop vascular complications. This may be microvascular disease, such as nephropathy, retinopathy or polyneuropathy, and also macrovascular disease, such as coronary heart disease, stroke or peripheral artery disease. Optimal control of elevated blood glucose levels will reduce the symptoms of hyperglycemia and help to prevent the development of complications. In addition, treatment of hypertension and lipid disturbances has been shown to reduce the incidence and severity of vascular complications significantly. The current treatment goals focus on adequate and aggressive treatment of these three risk factors. The central dogma for treatment of blood glucose, blood pressure and cholesterol levels is 'the lower the better'. Ongoing trials evaluate the effect of further lowering these treatment goals and of specific types of medication on cardiovascular events.
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PMID:Type 2 diabetes mellitus: prevention of macrovascular complications. 1832 94

The prevalence of depression is three times greater in people with type 2 diabetes than in the general population. In these patients, the course of this disease is more severe, the duration of therapy is longer and the rate of recurrent relapses is higher. Diabetes mellitus often occurs in the patients with previously diagnosed depression, and also diabetics being in the course of therapy used to be affected with depression. A special correlation was pointed at between complications diabetes such as macroangiopathy, retinopathy, polyneuropathy and incidence of depression. The coincidence of these diseases can be the cause of deterioration of diabetes. Treating these patients often require psychotherapy or both pharmacotherapy and psychotherapy. Selective serotonin reuptake inhibitors (SSRI) are the drugs of choice in the pharmacological treatment of depression. These drugs contribute to lowering the level of glycaemia, lowering the rate of HbA1c, increasing the sensitivity to insulin and they improve cognitive functions. Except decreasing libido they do not cause arrhythmias, hypotonia, urine retention or disturbances of emptying the stomach.
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PMID:[Depression in patients with type 2 diabetes mellitus--clinical and therapeutical implications]. 1835 Jul 20

The authors report a patient with type II diabetes mellitus and an inflammatory polyneuropathy. The association is discussed and the importance of diagnosing treatable neuropathies in the diabetic patient is emphasized.
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PMID:Inflammatory polyneuropathy in the setting of diabetes mellitus. 1863 53

Multifocal motor neuropathy with conduction block (MMNcb) is a relatively rare disease characterized clinically by asymmetric limb weakness with spared sensation and electrophysiologically by persistent focal motor conduction block. We present the case of a 40-year-old male patient with six-year history of progressive, asymmetric weakness of upper and lower extremities without sensory symptoms. Electroneurography revealed definite or probable motor conduction block in several nerves. However, features of axonal lesion of sensory fibres were also found. Laboratory studies were unremarkable apart from an abnormal glucose tolerance test, and type 2 diabetes was diagnosed. In the presented case the differential diagnosis should take into consideration MMNcb with coexisting diabetic sensory polyneuropathy and multifocal acquired demyelinating sensory and motor neuropathy (MADSAM).
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PMID:Multifocal motor neuropathy with conduction block with sensory fibre involvement in a diabetic patient. Case report. 1865 34


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