Effect of polyneuropathy on development of unilateral diabetic foot ulcer

This study investigates polyneuropathy in patients with unilateral diabetic foot ulcer by using electrophysiological methods and discusses whether electrophysiological parameters are predictive of diabetic foot ulcer development. Materials and methods: Fifty-two diabetic patients with unilateral diabetic foot ulcers (31 females, 21 males; mean age of 58.5 years) were included in the study. Results: In the upper extremities, motor fibers were affected in 82% and sensorial fibers were affected in 85% of the subjects. In the lower extremities, motor fibers were affected in 90% of the subjects in the injured site and in 79% of the patients in the intact site, and sensorial fibers were affected in 100% of the patients bilaterally. H-reflex was delayed in 93.2% of the patients at the injured site and in 86.4% of the patients at the intact site. Sensorial fibers were affected more than motor fibers and the condition was more pronounced in the lower extremities. Conclusion: The electrophysiological data were statistically different between injured and healthy extremities (P < 0.005). Our data revealed that nerve conduction studies have an important value in predicting diabetic foot ulcers and even showed that development of ulceration could be prevented in clinically and neurophysiologically documented diabetic neuropathy.

Effect of polyneuropathy on development of unilateral diabetic foot ulcer

This study investigates polyneuropathy in patients with unilateral diabetic foot ulcer by using electrophysiological methods and discusses whether electrophysiological parameters are predictive of diabetic foot ulcer development. Materials and methods: Fifty-two diabetic patients with unilateral diabetic foot ulcers (31 females, 21 males; mean age of 58.5 years) were included in the study. Results: In the upper extremities, motor fibers were affected in 82% and sensorial fibers were affected in 85% of the subjects. In the lower extremities, motor fibers were affected in 90% of the subjects in the injured site and in 79% of the patients in the intact site, and sensorial fibers were affected in 100% of the patients bilaterally. H-reflex was delayed in 93.2% of the patients at the injured site and in 86.4% of the patients at the intact site. Sensorial fibers were affected more than motor fibers and the condition was more pronounced in the lower extremities. Conclusion: The electrophysiological data were statistically different between injured and healthy extremities (P < 0.005). Our data revealed that nerve conduction studies have an important value in predicting diabetic foot ulcers and even showed that development of ulceration could be prevented in clinically and neurophysiologically documented diabetic neuropathy.

___

  • Litzelman DK, Marriott DJ, Vinicor F. Independent physiological predictors of foot lesions in patients with NIDDM. Diabetes Care 1997; 20: 1273–8.
  • Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005; 293: 217–28.
  • Rota E, Quadri R, Fanti E, Isoardo G, Poglio F, Tavella A et al. Electrophysiological findings of peripheral neuropathy in newly diagnosed type II diabetes mellitus. J Peripher Nerv Syst 2005; 10: 348–53.
  • Özge A, Saraçoğlu M, Gürtekin Y, Erenoğlu NY, Akyatan MN. The sensitivity of sympathetic skin responses and standard electrophysiological methods in diagnosis of diabetic neuropathy. Electromyogr Clin Neurophysiol 2000; 40: 37–43.
  • Abbott CA, Vileikyte L, Williamson S, Carrington AL, Boulton AJM. Multicenter study of the incidence of and predictive risk factors for diabetic neuropathic foot ulceration. Diabetes Care 1998; 21: 1071–75.
  • Boulton AJM. The diabetic foot. In: Gries A, Cameron N, Low AP, Ziegler D, Anderson H, Arezzo JC et al., editors. Textbook of Diabetic Neuropathy. Stuttgart: Thieme; 2003. p.295–305.
  • Pham H, Armstrong DG, Harvey C, Harkless LB, Giurini JM, Veves A. Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care 2000; 23: 606–11.
  • Gergg EW, Sorlie P. Prevalence of lower extremity disease with and without diabetes. Diabetes Care 2004; 27: 1591–8.
  • Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA. Lower extremity amputation in people with diabetes. Epidemiology and prevention. Diabetes Care 1989; 12: 24–7.
  • Bellamy N. Principles of outcome assessment. In: Hochberg M, Silman A, Smolen J, Winblat M, Weisman M, editors. Rheumatology, 3rd ed. Toronto: Mosby; 2003. p.21–31.
  • O’Neal LW, Wagner FW. The Diabetic Foot. St Louis (MO): Mosby; 1983.
  • National Diabetes Data Group. Diabetes in America. Bethesda (MD): Department of Health and Human Services; 1995.
  • Demir S, Öğe A, Karaahmetoğlu S, Müftüoğlu O, Naldöken S. Diabetic osteopathy: who is at risk? Turk J Med Sci 2001; 31: 255–60.
  • Crawford F, Inkster M, Kleijnen J, Fahey T. Predicting foot ulcers in patients with diabetes: a systematic review and metaanalysis. QJM 2007; 100: 65–86.
  • Peters EJG, Lavery LA. Effectiveness of the diabetic foot risk classification system of the international working group on diabetic foot. Diabetes Care 2001; 24: 1442–7.
  • Dyck PJ. Detection, characterization and staging of polyneuropathy in diabetics. Muscle Nerve 1988; 11: 21–32.
  • Fedele D, Comi G, Coscelli C, Cucinotta D, Feldman EL, Ghirlanda G et al. A multicenter study on the prevalence of diabetic neuropathy in Italy. Italian Diabetic Neuropathy Committee. Diabetes Care 1997; 20: 836–43.
  • England JD, Gronseth GS, Franklin G, Miller RG, Asbury AK, Carter GT et al. Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2005; 64: 199–207.
  • Boulton AJM, Malik RA. Diabetic neuropathy. Prevention and treatment of diabetes and its complications. Med Clin North Am 1998; 82: 909–29.
  • Boulton AJ, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R et al. Diabetic Neuropathies. a statement by the American Diabetes Association. Diabetes Care 2005; 28: 956–62.
  • Bohchelian H, Klisarova AD, Koeva LA. Radioimmune imaging of diabetic foot infection - Tc-99m-labelled antigranulocyte antibody in combination with tc-99mmethylene diphosphonate bone scintigraphy. Turk J Med Sci 2002; 32: 255–9.
  • Carrington AL, Shaw JE, Van Schie CHM, Abbott CA, Vileikyte L, Boulton AJM. Can motor nerve conduction velocity predict foot problems in diabetic subjects over a 6-year outcome period? Diabetes Care 2002; 25: 2010–15.
  • Van Schie CHM, Vermigli C, Carrington AL, Boulton A. Muscle weakness and foot deformities in diabetes. Relationship to neuropathy and foot ulceration in Caucasian diabetic men. Diabetes Care 2004; 27: 1668–73.
  • Baba M, Ozaki I. Electrophysiological changes in diabetic neuropathy: from subclinical alterations to disabling abnormalities. Arch Physiol Biochem 2001; 109: 234–40.
  • Kihara M, Mitsui M, Nishikawa S, Nishimoto K, Takahashi M. Comparison of electrophysiologic and autonomic tests in sensory diabetic neuropathy. Clin Auton Res 1998; 8: 213–20.
  • Schüller TB, Hermann K, Baron R. Quantitative assessment and correlation of sympathetic, parasympathetic, and afferent small fiber function in peripheral neuropathy. J Neurol 2000; 247: 267–72.
  • Andreassen CS, Jakobsen J, Andersen H. A progressive late complication in diabetic distal symmetric polyneuropathy. Diabetes Care 2006; 55: 806–12.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: 6
  • Yayıncı: TÜBİTAK
Sayıdaki Diğer Makaleler

Prevalence of type 1 diabetes mellitus in school children 6 18 years old in Diyarbakır, Southeastern Anatolian Region of Turkey

Hüseyin DEMİRBİLEK, Mehmet Nuri ÖZBEK

Evaluation of the effects of desflurane and sevoflurane anesthesia on alveolar epithelial permeability by Tc-99m DTPA inhalation scintigraphy

Abdülkadir İSKENDER, Melih Engin ERKAN, Mesut ERBAŞ, Damla GÜÇLÜ GÜVEN, Gülbin SEZEN, Muhammet AŞIK, Yavuz DEMİRARAN, Mustafa YILDIRIM

Ankaferd Blood Stopper: Does it have a role in fracture healing?

Murat GÜNAY, Ramazan AMANVERMEZ, Gökhan KELEŞ

Protective effect of vardenafil on ischemia&#8211;reperfusion injury in rat ovary

Hatice BAŞ, Özlem KARA, Mustafa KARA, Dilek PANDIR

Influence of alpha lipoic acid on epithelial apoptosis in experimental periodontitis

Adem KARA, Sümeyra AKMAN, Tevfik DEMİRCİ, Taner ARABACI

Occurrence of depression during the postpartum period and risk factors that affect the development of the depression

Demet AKTAŞ, Füsun TERZİOĞLU

Investigation of oxidative and antioxidative status in patients with diabetic cataracts

Nagihan UĞURLU, Fatma YÜLEK, Şule Berk ERGUN, Mehmet Doğan AŞIK, Semra IŞIKOĞLU, Emine AKÇAY

Helicobacter pylori infection and relationship with gastric epithelial cell proliferation and apoptosis

Zühal GÜCİN, Tuğba ÇAKMAK, Nizamettin BAYYURT, Barik SALİH

One single-tube PCR assay to detect both CD17 (A>T) and IVS-II nt-654 (C>T) homozygous mutations of β-thalassemia

Qi LIU, Jun-Li WANG, Guo-Can YANG, Xue-Jun DONG, Zong-Xin WANG, Guo-Xing GE, Xiao-Feng GU

Effect of polyneuropathy on development of unilateral diabetic foot ulcer

Fatma Cansel KALEAĞASI, Kezban ASLAN, Hacer BOZDEMİR, Bekir Tamer TETİKER