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The evolving natural history of neurophysiologic function in patients with well‐controlled diabetes
Author(s) -
Gibbons Christopher H.,
Freeman Roy,
Tecilazich Francisco,
Dinh Thanh,
Lyons Thomas E.,
Gnardellis Charalambos,
Veves Aristidis
Publication year - 2013
Publication title -
journal of the peripheral nervous system
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1
H-Index - 67
eISSN - 1529-8027
pISSN - 1085-9489
DOI - 10.1111/jns5.12021
Subject(s) - medicine , diabetes mellitus , laser doppler velocimetry , axon reflex , sural nerve , reflex , population , diabetic neuropathy , prospective cohort study , cardiology , anesthesia , physical medicine and rehabilitation , surgery , blood flow , endocrinology , environmental health
This study aimed to investigate prospective changes to neurophysiologic function over 3 years in patients with well‐controlled diabetes. Sixty‐two subjects had neurologic examinations, symptom scores, autonomic testing, nerve conduction studies, quantitative sensory testing, and laser‐Doppler flowmetry at 18‐month intervals for 3 years. During the study, there was a 1 µV decrease in sural amplitude (p < 0.05), an increase in monofilament detection threshold of 0.36 g (p < 0.001), and a decrease in the axon‐reflex vasodilation in the foot (p < 0.005) and forearm (p < 0.05). There was an increase in symptoms of distal hypersensitivity (p < 0.005) but no change in neuropathy frequency or severity. Our findings suggest that laser‐Doppler flowmetry, a test of small fiber function, can detect the largest neurophysiologic change over time in groups of patients with diabetes. Sural nerve amplitude and monofilament thresholds may be more effective at detecting change in individual patients. Other tests of neurophysiologic function may require longer periods of time and greater numbers of participants to detect a difference. We conclude that patients with well‐controlled diabetes and optimal medical management of comorbid risk factors have low rates of neuropathy development and progression although the clinical relevance of this finding to the general population of individuals with diabetes is unknown.