scholarly journals Does the blood glucose control have an effect on the success of the painful diabetic neuropathy treatment?

2018 ◽  
Vol 75 (6) ◽  
pp. 552-557
Author(s):  
Olivera Jovanikic ◽  
Gordana Andjelic ◽  
Milan Lepic ◽  
Dusica Mirkovic ◽  
Bojan Jovanovic ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Blood Glucose ◽  
Diabetic Neuropathy ◽  
Glucose Control ◽  
Procaine Hydrochloride ◽  
Painful Diabetic Neuropathy ◽  
Pain Symptom ◽  
Excellent Outcome ◽  
Before And After ◽  
The Impact

Background/Aim. Diabetic neuropathy (DN) is the basic complication of diabetes, associated with impared glucoregulation, metabolic distrurbances, microvascular vessel damage and increased cardiovascular risk. We monitored the impact of glucoregulation on the efficacy of painful diabetic neuropathy (PDN) treatment, when all pharmaceutical treatment options were exhausted. Methods. Patients (n = 53, both gender, average age 68.3 ? 12.6) with PDN resistant to the pharmacotherapy were treated with the ultrasound- guided local anesthetic (0.5% procaine hydrochloride, 1% lidocaine, 0.25% levobupivacaine) blocks. Neuropathy was confirmed in accordance with the applicable European Federation of Neurological Societies (EFNS) criteria. Glycosylated hemoglobin (HbA1C) and blood glucose levels were monitored before and after therapy and one month after the treatment. Neuropathic pain was confirmed by Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) or Douleur neuropathique (DN4) or pain DETECT scales. The pain intensity was assessed by Visual analog scale, Neuropathic pain symptom and Neuropathic pain symptom inventory (VAS, NPS and NPSI, respectively) scales before and after therapy and one month after the treatment. The efficacy of the therapy was assessed as: excellent result (> 50% of pain loss), good result (30%?49% of pain loss and the therapy does not work (< 30% of pain loss). The correlation between glucoregulation and the outcome was examined. Results. Because the values of glycenia and HbA1c were not different among patients treated with different local anesthetics, they were presented together. All patients had elevated blood glucose and HbA1C levels before (8.23 ? 2.77 mmol/L and 8.53% ? 2.48% respectively), after (8.43 ? 2.461 mmol/L and 8.85% ? 2.87%, respectively) and one month after the treatment (8.49 ? 2.22 mmol/L and 8.51% ? 2.09%, respectively). The loss of the pain was not result of the decrease in blood glucose and HbA1C blood levels. VAS, NPS, NPSI values were the following before the therapy: 81.53 ? 11.62 mm; 62.00 ? 13.04; 53.40 ? 17.63, respectively; after the therapy: 29.00 ? 9.23 mm; 13.79 ? 6.65; 11.83 ? 7.93, respectively; and one month later: 26.15 ? 8.41 mm; 12.68 ? 6.03; 9.81 ? 7.64, respectively]. There was no correlation between glucoregulation and excellent outcome. Conclusion. Even though the disturbance of glucose control is the key factor for the progression of PDN, it is not significant for the outcome of the pain treatment. New investigations are required.

scholarly journals Saline versus 5% dextrose in water as a drug diluent for critically ill patients: a retrospective cohort study

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Yukari Aoyagi ◽  
Takuo Yoshida ◽  
Shigehiko Uchino ◽  
Masanori Takinami ◽  
Shoichi Uezono
Keyword(s):  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Control ◽  
Blood Glucose Control ◽  
Kidney Injury ◽  
Saline Group ◽  
Significant Difference ◽  
The Impact ◽  
Electrolyte Abnormalities

Abstract Background The choice of intravenous infusion products for critically ill patients has been studied extensively because it can affect prognosis. However, there has been little research on drug diluents in this context. The purpose of this study is to evaluate the impact of diluent choice (saline or 5% dextrose in water [D5W]) on electrolyte abnormalities, blood glucose control, incidence of acute kidney injury (AKI), and mortality. Methods This before-after, two-group comparative, retrospective study enrolled adult patients who stayed for more than 48 h in a general intensive care unit from July 2015 to December 2018. We changed the default diluent for intermittent drug sets in our electronic ordering system from D5W to saline at the end of 2016. Results We included 844 patients: 365 in the D5W period and 479 in the saline period. Drug diluents accounted for 21.4% of the total infusion volume. The incidences of hypernatremia and hyperchloremia were significantly greater in the saline group compared to the D5W group (hypernatremia 27.3% vs. 14.6%, p < 0.001; hyperchloremia 36.9 % vs. 20.4%, p < 0.001). Multivariate analyses confirmed the similar effects (hypernatremia adjusted odds ratio (OR), 2.43; 95% confidence interval (CI), 1.54–3.82; hyperchloremia adjusted OR, 2.09; 95% CI, 1.31–3.34). There was no significant difference in the incidences of hyperglycemia, AKI, and mortality between the two groups. Conclusions Changing the diluent default from D5W to saline had no effect on blood glucose control and increased the incidences of hypernatremia and hyperchloremia.

Controlled-release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy

Pain ◽  
2003 ◽  
Vol 105 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Peter C.N. Watson ◽  
Dwight Moulin ◽  
Judith Watt-Watson ◽  
Allan Gordon ◽  
John Eisenhoffer
Keyword(s):  
Randomized Controlled Trial ◽  
Neuropathic Pain ◽  
Controlled Release ◽  
Diabetic Neuropathy ◽  
Controlled Trial ◽  
Painful Diabetic Neuropathy ◽  
Randomized Controlled

scholarly journals 280. Burden of Hyperglycemia in Patients Receiving Dexamethasone for Severe COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S245-S246
Author(s):  
Kirk B Fetters ◽  
Stephen Judge ◽  
Timothy Hatlen ◽  
Eric Daar
Keyword(s):  
Blood Glucose ◽  
Medical Center ◽  
Severe Disease ◽  
Standard Of Care ◽  
Diabetic Patients ◽  
Before And After ◽  
Dexamethasone Therapy ◽  
Hospital Resources ◽  
The Impact ◽  
Research Grant

Abstract Background Previous studies demonstrated the adverse impact corticosteroids can have on blood glucose homeostasis in both diabetics and non-diabetics. This raises concern for corticosteroid use in severe COVID-19 where the population is enriched for those at highest risk of severe disease, such as diabetics and patients with obesity. Previous studies of dexamethasone in COVID-19 were limited by the inability to assess steroid-induced hyperglycemia or the impact of hyperglycemia on hospital resources. Objective The study aimed to describe the clinical characteristics, management, and outcomes related to hyperglycemia, before and after dexamethasone therapy was used as the standard of care in patients with severe COVID-19. Methods We performed a pre/post retrospective study of patients with severe COVID-19 pneumonia admitted from May to July 2020 to Harbor-UCLA Medical Center. 126 patients were evaluated. 64 received dexamethasone and 62 did not. To quantify the effect of dexamethasone on diabetic vs. non-diabetic patients, we documented the average blood glucoses and frequency of correctional insulin doses required by each patient group (diabetic with and without dexamethasone, non-diabetic with and without dexamethasone). Results While dexamethasone was associated with higher median blood glucose and more frequent correctional insulin dosing in diabetic patients, there was minimal effect of dexamethasone on hyperglycemia in non-diabetic patients. Furthermore, while non-diabetic patients receiving dexamethasone required more doses of correctional insulin per day vs non-diabetic patients not receiving dexamethasone (0.3 doses per day vs 0.1 doses per day), the frequency of correctional insulin doses required by non-diabetics on dexamethasone remained low at 0.3 doses per day. Conclusion NIH COVID-19 guidelines recommend administering dexamethasone only if the patient is in a monitored setting. Our data support the NIH concerns that outpatients with diabetes receiving steroids are at risk for hyperglycemic complications. However, contrary to the NIH guidelines, our data suggest that patients without diabetes receiving steroids are at low risk for complications due to hyperglycemia and a majority do not require monitoring. Disclosures Eric Daar, MD, Gilead (Consultant)Gilead (Research Grant or Support)Merck (Research Grant or Support)Merck (Consultant)ViiV (Research Grant or Support)

Topical Ketamine Cream in the Treatment of Painful Diabetic Neuropathy

2012 ◽  
Vol 102 (3) ◽  
pp. 178-183 ◽  
Author(s):  
James M. Mahoney ◽  
Vassilios Vardaxis ◽  
Joshua L. Moore ◽  
Andrew M. Hall ◽  
Kyle E. Haffner ◽  
...  
Keyword(s):  
Diabetic Neuropathy ◽  
Treatment Time ◽  
Diabetic Patients ◽  
Double Blind Study ◽  
Painful Diabetic Neuropathy ◽  
Double Blind ◽  
Significant Treatment ◽  
Before And After ◽  
Pain Characteristics ◽  
Topical Ketamine

Background: Painful diabetic neuropathy remains a difficult pathologic condition to manage effectively despite numerous pharmacologic interventions. A randomized, placebo-controlled, double-blind study was undertaken to determine whether topical 5% ketamine cream is effective in reducing the pain of diabetic neuropathy. Methods: Seventeen diabetic patients completed the study. The Michigan Neuropathy Screening Instrument was used to determine whether the neuropathy was likely caused by the diabetic condition. Hemoglobin A1c levels were measured before treatment. Patients applied 1 mL of either ketamine cream or placebo cream for 1 month. The intensity of seven different pain characteristics was evaluated before and after treatment. A two-way repeated analysis of variance design was used to test for differences between treatments and within patients (time). Results: We found no significant treatment main effect, but pain improved significantly over time in both groups. There was no statistical interaction effect (treatment ×time) in any of the pain characteristics, indicating that pain improved in the two treatment groups similarly with time. Conclusions: The 5% topical ketamine cream was no more effective than was placebo in relieving pain caused by diabetic neuropathy. (J Am Podiatr Med Assoc 102(3): 178–183, 2012)

scholarly journals Pharmacological Modulation of Rate-Dependent Depression of the Spinal H-Reflex Predicts Therapeutic Efficacy against Painful Diabetic Neuropathy

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 283
Author(s):  
Corinne A. Lee-Kubli ◽  
XiaJun Zhou ◽  
Corinne G. Jolivalt ◽  
Nigel A. Calcutt
Keyword(s):  
Neuropathic Pain ◽  
Diabetic Neuropathy ◽  
Gabaa Receptor ◽  
Gabab Receptor ◽  
Diabetic Rats ◽  
H Reflex ◽  
Painful Diabetic Neuropathy ◽  
Painful Neuropathy ◽  
Inhibitory Function ◽  
Rate Dependent

Impaired rate-dependent depression (RDD) of the spinal H-reflex occurs in diabetic rodents and a sub-set of patients with painful diabetic neuropathy. RDD is unaffected in animal models of painful neuropathy associated with peripheral pain mechanisms and diabetic patients with painless neuropathy, suggesting RDD could serve as a biomarker for individuals in whom spinal disinhibition contributes to painful neuropathy and help identify therapies that target impaired spinal inhibitory function. The spinal pharmacology of RDD was investigated in normal rats and rats after 4 and 8 weeks of streptozotocin-induced diabetes. In normal rats, dependence of RDD on spinal GABAergic inhibitory function encompassed both GABAA and GABAB receptor sub-types. The time-dependent emergence of impaired RDD in diabetic rats was preceded by depletion of potassium-chloride co-transporter 2 (KCC2) protein in the dorsal, but not ventral, spinal cord and by dysfunction of GABAA receptor-mediated inhibition. GABAB receptor-mediated spinal inhibition remained functional and initially compensated for loss of GABAA receptor-mediated inhibition. Administration of the GABAB receptor agonist baclofen restored RDD and alleviated indices of neuropathic pain in diabetic rats, as did spinal delivery of the carbonic anhydrase inhibitor acetazolamide. Pharmacological manipulation of RDD can be used to identify potential therapies that act against neuropathic pain arising from spinal disinhibition.

The impact of blood glucose control on fetal growth in gestational diabetes

1997 ◽  
Vol 176 (1) ◽  
pp. S182
Author(s):  
MY Divon ◽  
K Feisullin ◽  
A Bernstein ◽  
S Scarpelli ◽  
D Sherer ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Gestational Diabetes ◽  
Fetal Growth ◽  
Glucose Control ◽  
Blood Glucose Control ◽  
The Impact

Synergistic Effects of Vitamin D and Mindfulness Training in Pain Severity, Pain-Related Disability and Neuropathy-Specific Quality of Life Dimensions in Painful Diabetic Neuropathy: A Randomized Clinical Trial with Placebo-controlled

2020 ◽  
Author(s):  
Roya taghadosi nia ◽  
mohammadreza davoudi ◽  
Seyyed Mojtaba Ahmadi ◽  
Amir Abbas Taheri
Keyword(s):  
Quality Of Life ◽  
Vitamin D ◽  
Neuropathic Pain ◽  
Diabetic Neuropathy ◽  
Mindfulness Training ◽  
Pain Severity ◽  
Oral Dosage ◽  
Life Questionnaire ◽  
Painful Diabetic Neuropathy

Abstract Background: This study aimed to examining Synergistic effect of Vitamin D (VD) Supplement and mindfulness on neuropathic pain severity, Pain-Related Disability and Neuropathy-Specific Quality of Life dimensions in painful diabetic neuropathy.Methods: In this randomized controlled trial, totally 225 patients with painful diabetic neuropathy were randomly allocated to five groups: (1) mindfulness and placebo, (2) placebo, (3) mindfulness, (4) VD, and (5) mindfulness and VD. Mindfulness training includes twelves sessions and VD patients received a daily four thousand IU oral dosage (four capsules) with 28,000 IU vitamin D weekly for 12 weeks. Laboratory analyses, Sun exposure time, Vitamin D intake, BMI and Physical activity measured in pre-test and posttest. Pain-Related Disability measured with The Pain Disability Index (PDI). For other outcome variables Neuropathy Specific Quality of Life questionnaire and Neuropathic pain severity scale was utilized.Results: In baseline, measures were not different among the groups. At the end-of-treatment, for outcome variables results showed improvement in all groups except the “placebo” group. About other groups, there was not any difference between VD and mindfulness groups (in and not combined with placebo). However, “VD + mindfulness” has a greater improvement rather than VD and mindfulness groups (P<0.05). Moreover, both protocols have no significant effects on, FBS, BMI and energy intakes (P>0.05).Conclusion: Combining VD and mindfulness can reduce pain severity and pain-related disability, so with these changes patients improve their quality of life.

Analgesic effects of mad honey (grayanotoxin) in mice models of acute pain and painful diabetic neuropathy

2013 ◽  
Vol 33 (2) ◽  
pp. 130-135 ◽  
Author(s):  
A Gunduz ◽  
I Eraydin ◽  
S Turkmen ◽  
O F Kalkan ◽  
S Turedi ◽  
...  
Keyword(s):  
Experimental Study ◽  
Neuropathic Pain ◽  
Diabetic Neuropathy ◽  
Acute Pain ◽  
Diabetic Mouse ◽  
Thermal Stimulus ◽  
Painful Diabetic Neuropathy ◽  
Mice Model ◽  
Painful Neuropathy ◽  
Mad Honey

Objectives: The aim of this experimental study was to investigate the effects of mad honey (grayanotoxin, GTX), used in complementary medicine for a variety of purposes besides being food, on pain thresholds in normal mice as model for acute pain and diabetic mouse as model for neuropathic pain. Methods: Hind paw withdrawal pain threshold to thermal stimulus was measured with a plantar analgesia meter in a mice model using healthy intact animals for acute pain and streptozotocin-induced diabetic animals for chronic neuropathic pain. Time and dose-dependent effects of intraperitoneally (i.p.) administered GTX were investigated in both acute and neuropathic pain. Results: In the acute pain model, administration of GTX caused a dose- and time-dependent marked increase in the pain latency values. In diabetic mice, which had markedly increased threshold to pain, GTX (0.1 mg/kg, i.p.) restored the mean pain latencies by decreasing from the pre-GTX treatment values of 3.2 ± 0.6 to 3.0 ± 0.9s at 10 min, 3.2 ± 0.6s at 20 min, 3.4 ± 0.6s at 30 min, 2.6 ± 0.5s at 60 min and 2.4 ± 0.6s ( p < 0.05) at 100 min. Conclusion: The results from this experimental study indicate that GTX exhibits significant analgesic activity and has potential benefits against painful diabetic neuropathy. This is compatible with the widespread use of GTX containing mad honey for alleviating pain. Further studies involving long-term applications are needed for a more decisive conclusion regarding the usefulness of GTX as an analgesic, especially in the treatment of painful neuropathy.

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