scholarly journals Quick and Simple Evaluation of Sudomotor Function for Screening of Diabetic Neuropathy

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Chittaranjan S. Yajnik ◽  
Vaishali V. Kantikar ◽  
Amol J. Pande ◽  
Jean P. Deslypere
Keyword(s):  
Clinical Signs ◽  
Cardiac Autonomic Neuropathy ◽  
Diabetic Patients ◽  
Perception Threshold ◽  
New Device ◽  
Sudomotor Function ◽  
Sweat Function ◽  
Michigan Neuropathy Screening Instrument ◽  
Simple Evaluation ◽  
Hands And Feet

Objective. The aim of this study was to compare SUDOSCAN, a new device to evaluate sweat function (reflecting peripheral small C-fiber status), with conventional measures of peripheral and cardiac neuropathy in patients with type 2 diabetes. Methods. 265 diabetic patients were tested for symptoms and clinical signs of neuropathy using Michigan Neuropathy Screening Instrument (MNSI), vibration perception threshold (VPT) using biothesiometer, and cardiac autonomic neuropathy (CAN) using Ewing’s protocol. Sudomotor function was investigated with SUDOSCAN through measurement of electrochemical skin conductance (ESC) of hands and feet. Lower ESC is suggestive of sudomotor dysfunction. Results. Lower ESC at feet was significantly associated both with increasing symptoms (MNSI A) and increasing score on physical abnormalities (MNSI B). Lower ESC at feet was also significantly associated with increasing VPT by biothesiometry (P<0.01), and with higher number of abnormal CAN results (P<0.05). ESC was associated with postural fall in blood pressure (sympathetic abnormality) (P<0.05), but not with heart rate variability (HRV) tests (parasympathetic abnormalities). Conclusions. Sudomotor dysfunction testing may be a simple test to alert physicians to peripheral nerve and cardiac sympathetic dysfunction. Ease of performance could make it useful in a busy diabetic clinic. Further studies with hard clinical outcomes are indicated.

scholarly journals Impaired Hypoxic Ventilatory Drive Induced by Diabetic Autonomic Neuropathy, A Cause of Misdiagnosed Severe Cardiac Events. Brief Report of Two Cases.

2020 ◽  
Author(s):  
Louis Schubert ◽  
Suzanne Laroche ◽  
Agnès Hartemann ◽  
Olivier Bourron ◽  
Franck Phan
Keyword(s):  
Respiratory Failure ◽  
Sudden Cardiac Death ◽  
Autonomic Neuropathy ◽  
Cardiac Death ◽  
Clinical Signs ◽  
Cardiac Autonomic Neuropathy ◽  
Diabetic Patients ◽  
Cardiac Events ◽  
Cardiorespiratory Arrest ◽  
Ventilatory Drive

Abstract Background: Sudden cardiac death are twice more frequent in diabetic patients with cardiac autonomic neuropathy. Sudden cardiac death etiologies remain unclear and no recommendation are made to identify factor associated with cardiorespiratory arrest in diabetic patients. We hypothesized, from two clinical cases, that impaired hypoxic ventilatory drive, induced by diabetic autonomic neuropathy, is a cause of misdiagnosed severe cardiac events.Case presentation: We describe the cases of two patients with isolated low blood saturation on pulse oximeter during the systematic nurse check-up (77% and 85% respectively) contrasting with the absence of any complaint as well as any dyspnea, polypnea or other respiratory insufficiency signs observed during the clinical examination. Arterial blood gas measurements subsequently confirmed that blood saturation was low and that both patients were indeed hypoxemic. Patient 1 suffered of vascular overload complicated by cardiac arrest caused by hypoxemia in light of the quick recovery observed after ventilation. Pulmonary edema was diagnosed in patient 2. The common denominator of these 2 cases described in this brief report is the absence of respiratory failure clinical signs contrasting with the presence of confirmed hypoxemia. Also, in both cases, such absence of precursory signs seems to be induced by an impaired ventilatory drive to hypoxemia. This appears to be related to the autonomic diabetic neuropathy encountered in those 2 patients.Conclusions: Therefore, we describe, in this brief report, cardiac autonomic neuropathy as a cause of impaired hypoxic ventilatory drive involved in severe acute cardiorespiratory events in two type 1 diabetic patients. We assume that altered response to hypoxemia due to cardiac autonomic neuropathy and non-functional central neurological breathing command could play a key role in sudden deaths among diabetic patients. A point to emphasize is that hypoxemia can be easily missed since no clinical signs of respiratory failure are reported in these two clinical cases. Systematic screening of cardiac autonomic neuropathy in diabetic patients and proactive detection of impaired hypoxic ventilatory drive for early management (e.g. treatment of hypoxemia) should be systematically undertaken in diabetic patients to prevent its dramatic consequences such as cardiorespiratory arrest and death.

scholarly journals Impaired hypoxic ventilatory drive induced by diabetic autonomic neuropathy, a cause of misdiagnosed severe cardiac events: brief report of two cases

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Louis Schubert ◽  
Suzanne Laroche ◽  
Agnès Hartemann ◽  
Olivier Bourron ◽  
Franck Phan
Keyword(s):  
Respiratory Failure ◽  
Autonomic Neuropathy ◽  
Clinical Signs ◽  
Diabetic Autonomic Neuropathy ◽  
Cardiac Autonomic Neuropathy ◽  
Diabetic Patients ◽  
Cardiac Events ◽  
Cardiorespiratory Arrest ◽  
Ventilatory Drive ◽  
Clinical Cases

Abstract Background Sudden cardiac deaths are twice more frequent in diabetic patients with cardiac autonomic neuropathy. Sudden cardiac death etiologies remain unclear and no recommendations are made to identify factors associated with cardiorespiratory arrest in diabetic patients. We hypothesized, from two clinical cases, that impaired hypoxic ventilatory drive, induced by diabetic autonomic neuropathy, is a cause of misdiagnosed severe cardiac events. Case presentation We describe the cases of two patients with isolated low blood saturation on pulse oximeter during the systematic nurse check-up (77% and 85% respectively) contrasting with the absence of any complaint such as dyspnea, polypnea or other respiratory insufficiency signs observed during the clinical examination. Arterial blood gas measurements subsequently confirmed that blood oxygen saturation was low and both patients were indeed hypoxemic. Patient 1 suffered from vascular overload complicated by cardiac arrest caused by hypoxemia in light of the quick recovery observed after ventilation. Pulmonary edema was diagnosed in patient 2. The common denominator of these 2 cases described in this brief report is the absence of respiratory failure clinical signs contrasting with the presence of confirmed hypoxemia. Also, in both cases, such absence of precursory signs seems to be induced by an impaired ventilatory drive to hypoxemia. This appears to be related to the autonomic diabetic neuropathy encountered in those 2 patients. Conclusions Therefore, we describe, in this brief report, cardiac autonomic neuropathy as a cause of impaired hypoxic ventilatory drive involved in severe acute cardiorespiratory events in two type 1 diabetic patients. We assume that altered response to hypoxemia due to cardiac autonomic neuropathy and non-functional central neurological breathing command could play a key role in sudden deaths among diabetic patients. An important point is that hypoxemia can be easily missed since no clinical signs of respiratory failure are reported in these two clinical cases. Systematic screening of cardiac autonomic neuropathy in diabetic patients and proactive detection of impaired hypoxic ventilatory drive for early management (e.g. treatment of hypoxemia) should be systematically undertaken in diabetic patients to prevent its dramatic consequences such as cardiorespiratory arrest and death.

scholarly journals Cardiac Affection in Type 1 Diabetic Patients in Relation to Omentin

2015 ◽  
Vol 3 (4) ◽  
pp. 699-704 ◽  
Author(s):  
Soha M. Abd El Dayem ◽  
Ahmed A. Battah ◽  
Amal El Shehaby
Keyword(s):  
Type 1 Diabetes ◽  
Regression Analysis ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Stepwise Multiple Regression ◽  
Cardiac Autonomic Neuropathy ◽  
Control Group ◽  
Diabetic Patients ◽  
Stepwise Multiple Regression Analysis

AIM: To evaluate cardiac affection in type 1 diabetes in relation to Omentin.PATIENTS AND METHODS: Sixty two diabetics and 30 volunteer of the same age and sex were included as a control group. Blood sample was taken for assessment of omentin and oxidized low density lipoprotein (OxLDL), glycosylated hemoglobin (HbA1) and lipid profile. Urine sample was taken for assessment of albumin/ creatinine ratio. 24 hour holter was also done. T-test, simple correlation followed by stepwise multiple regression analysis was used for analysis of data.RESULTS: Parameters of 24 hour holter were significantly lower in diabetics. Omentin was significantly lower, while OxLDL were significantly higher than controls. RMSSD, ST deviation and OxLDL were the parameters related to omentin by stepwise multiple regression analysis in diabetics.CONCLUSION: Diabetic patients had a cardiac autonomic neuropathy. A significant reduction of omentin and elevation OxLDL imply that they influence glucose metabolism in type 1 diabetes. Omentin had a significant relation to 24 hr holter which may reflect its role in cardiac affection. Omentin and OxLDL had a role in renal affection.

A Prospective Study of Predictors for Foot Ulceration in Type 2 Diabetes

2001 ◽  
Vol 91 (7) ◽  
pp. 343-350 ◽  
Author(s):  
T. Kästenbauer ◽  
S. Sauseng ◽  
G. Sokol ◽  
M. Auinger ◽  
K. Irsigler
Keyword(s):  
Prospective Study ◽  
Plantar Pressure ◽  
Alcohol Intake ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Perception Threshold ◽  
Foot Ulceration ◽  
Daily Alcohol Intake ◽  
A Prospective Study

One hundred eighty-seven type 2 diabetic patients without a history of foot ulceration were followed for a mean period of 3.6 years to investigate the incidence of foot ulceration in a diabetes cohort and to analyze risk factors for foot ulceration by multivariate means. During the study, 10 subjects developed 18 forefoot ulcerations. In multivariate logistic regression, significant predictors for foot ulceration were an elevated vibration perception threshold (VPT) (relative risk [RR] = 25.4), an increased plantar pressure (RR = 6.3), and daily alcohol intake (RR = 5.1). This is the first prospective study to demonstrate plantar pressure and daily alcohol intake as predictors of foot ulceration among patients without previous ulceration. Further, VPT could be confirmed as the strongest predictor for foot ulceration, and it was clearly demonstrated that the more pronounced severity of complications occurred among subjects with elevated VPT. (J Am Podiatr Med Assoc 91(7): 343-350, 2001)

scholarly journals Cardiac autonomic neuropathy in diabetic patients

2019 ◽  
Author(s):  
Adriana Robles-Cabrera ◽  
Bruno Estañol ◽  
Ruben Fossion ◽  
Ana Rivera ◽  
Alejandro Frank
Keyword(s):  
Autonomic Neuropathy ◽  
Cardiac Autonomic Neuropathy ◽  
Diabetic Patients

Diagnosis and Prevalence of Onychomycosis in Diabetic Neuropathic Patients

2009 ◽  
Vol 99 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Isabelle J. Dumont
Keyword(s):  
Diabetic Neuropathy ◽  
Potassium Hydroxide ◽  
Diagnostic Methods ◽  
Diabetic Patients ◽  
Full Cohort ◽  
Perception Threshold ◽  
Predictive Values ◽  
Entire Cohort ◽  
The Mean

Background: An observational study was conducted to assess the prevalence of onychomycosis in clinically suspected diabetic neuropathic patients and to assess the reliability of the diagnosis. Methods: One hundred successive type 1 and 2 diabetic patients with diabetic neuropathy were followed. Diabetic neuropathy was defined by a vibration perception threshold greater than 25 V and onychomycosis by clinical diagnosis. Samples of the most affected nail were taken. Potassium hydroxide testing and culture were performed. Photographs of the nails were used by two dermatologists for diagnosis. Results: The mean ± SE age was 62.3 ± 11.4 years for the 20 onychomycotic patients and 60.3 ± 10.4 years for the entire cohort; 14 onychomycotic patients (70%) were male versus 56 in the full cohort (56%) (P &lt; .05). The prevalence of onychomycosis was 20% (culture and potassium hydroxide test positive) and 24% (culture positive). Twenty or 30 patients were positive by the potassium hydroxide test, depending on the investigator. The most frequent pathogen found was Trichophyton rubrum (11 of 20 patients; 55%). The positive predictive values of the dermatologist’s diagnoses were 57.8% and 35.6%, and the negative predictive values were 85.0% and 90.5%. The two expert’s results were significantly different (P &lt; .05). Conclusions: The diagnosis of onychomycosis is difficult to make. The diagnostic methods commonly used are not satisfactory. If onychomycosis is dangerous for the diabetic foot, a better diagnostic method is needed. (J Am Podiatr Med Assoc 99(2): 135–139, 2009)

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