• Users Online: 688
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 28-31

The effect of diabetes on nerve–muscle conduction of tibial and peroneal nerve association with habit and habitat in Bikaner Region


1 Department of Physiology, S P Medical College, Bikaner, Rajasthan, India
2 Department of Microbiology, JLN Medical College, Ajmer, Rajasthan, India
3 Department of Dentistry, S P Medical College, Bikaner, Rajasthan, India

Date of Web Publication4-Jan-2019

Correspondence Address:
Jitendra Kumar Acharya
Department of Dentistry, S P Medical College, Bikaner, Rajasthan
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AIHB.AIHB_9_17

Rights and Permissions
  Abstract 


Introduction: Diabetes is due to defect in Beta cell of islets of Langerhans, that is seen in pancreas. This defect is responsible for disturbance in blood glucose level. Other factors which are also responsible includes diet, hereditary, immunological factor, lack of exercise etc., The damage to nerves in DM has been assumed to be a result of the interaction of metabolic defects complicated by vasa nervorum abnormalities. Nerve conduction velocity, are standard measurement used to confirm the presence or absence of diabetic neuropathy. In Nerve conduction velocity study common nerves that are studied are common peroneal nerve, tibial nerve and sural nerve. Materials and Methods: The study was planned in Physiology Department in close collaboration with Department of Medicine (Diabetic Section), S.p.mc. Bikaner. A total of 100 subjects for study from diabetic centre, were selected. Institutional ethical clearance was taken before commencement of study from ethical committee of our institution. Results: In present study, maximum number of patients were non-smokers in both study and control groups (87% and 91% respectively) and this difference was found statistically insignificant (P > 0.05). We observed that the patients were vegetarian in both study and control groups and this difference was found statistically insignificant (P > 0.05). The mean peroneal nerve in study group was 42.26 ± 1.95 m/s and in control group it was 52.05 ± 4.78 m/s and the difference was found statistically highly significant (P < 0.001) and mean value of tibial nerve in study group was 41.71 ± 2.29 m/s and in control group it was 49.84 ± 2.67 m/s and the difference was found statistically highly significant (P < 0.001). Conclusion: In our study, we concluded that nerve conduction velocities decreases in tibial and common peroneal nerve in diabetic patients as compared to control. Nerve conduction velocities also decrease with increasing age, increased HbA1C >6.5%.

Keywords: Diabetes, nerve conduction, peroneal nerve, tibial


How to cite this article:
Soni E, Soni P, Acharya JK. The effect of diabetes on nerve–muscle conduction of tibial and peroneal nerve association with habit and habitat in Bikaner Region. Adv Hum Biol 2019;9:28-31

How to cite this URL:
Soni E, Soni P, Acharya JK. The effect of diabetes on nerve–muscle conduction of tibial and peroneal nerve association with habit and habitat in Bikaner Region. Adv Hum Biol [serial online] 2019 [cited 2019 Sep 18];9:28-31. Available from: http://www.aihbonline.com/text.asp?2019/9/1/28/249528




  Introduction Top


Diabetes is due to defect in beta cell of  Islets of Langerhans More Details, that is, seen in pancreas. This defect is responsible for disturbance in blood glucose level. Other factors which are also responsible include diet, hereditary, immunological factor and lack of exercise.

The damage to nerves in diabetes mellitus (DM) has been assumed to be a result of the interaction of metabolic defects complicated by vasa nervorum abnormalities. Neuropathic disorders may affect both somatic and autonomic nervous functions.[1] In peripheral nerves, such injuries cause loss of protective sensation impairing patient's ability to perceive incipient or even apparent ulcerations in the feet that is considered a main risk factor for amputation.[2]

Abdominal obesity[3],[4] and hypertension[5],[6],[7] are most consistent complaint with polyneuropathy. Study will be conducted to investigate polyneuropathy in diabetic patients with the help of nerve conduction velocity.

Appropriate treatment of risk factor in patients may give comfort to patients. Nerve conduction velocity is standard measurement used to confirm the presence or absence of diabetic neuropathy. Nerve conduction velocity was contrasted with the newer techniques of measurement of alternating current, perceptions and threshold, in assessing the severity of neuropathy. In nerve conduction velocity study, common nerves that are studied are median, ulnar nerve, common peroneal nerve, tibial nerve and sural nerve.

In India, lack of proper health infrastructure, rapid ignorance and absence of mean approach to management of diabetes are ad hoc. Almost 50% of diabetes are not diagnosed until 10 years, after onset of disease, so this fact has created a great enthusiasm in our mind to go through this work. The aim of our study to assess the utility of nerve conduction velocity as a tool for early detection of diabetic polyneuropathy.


  Materials and Methods Top


Subject selection and grouping

The study was planned in Physiology Department in close collaboration with Department of Medicine (Diabetic Section), Sardar Patel Medical College, Bikaner and Associated Group of Hospital. A total of 100 participants for the study from diabetic centre, were selected. Institutional ethical clearance was obtained before commencement of the study from Ethical Committee of Sardar Patel Medical College, no.ad/ec 32 Bikaner and Associated Group of Hospital, Bikaner.

We examined 100 controls with no diabetes. Control and patient were similar in sex and age.

Health assessment

Complete history of patient, clinical examination, laboratory investigation, etc., on a pro forma. Screening of celiac disease and oral glucose tolerance test[8],[9] were done.

Nerve conduction studies were made in a standard way using Medel Surgery EMG and EP system (Software version 11; part number: 55-040 W002-B) examination was performed in Department of Physiology, Sardar Patel Medical College, Bikaner in a room with constant temperature.

Collection and classification of data

Source of data

Male and female patients coming from outdoor of Diabetic Research Centre were evaluated for the study.

Data collection

  1. Population - Clients who are attending outdoor patients with complaints of diabetes.
  2. Sample size - 100 samples were selected for the study
  3. Sampling criteria.


Inclusion criteria

  • Client who are attending to outdoor patients with DM.


Exclusion criteria

  • Client who are not willing to participate
  • Clients with other associated disease.


Value of various parameters that present character in respect of sample and control was suitably recorded and prepare master sheet as per objective of plan of the study.

Statistical analysis

The mean and standard deviation of quantitative parameters were calculated using IBM SPSS Version 18 (SPSS Inc., Chicago, USA). for comparison of means, the t-test was applied and probability was calculated at respective degree of freedom by SPSS. For qualitative character, the frequency distribution was ascertained from master chart and the Chi-square test was applied using SPSS software. For qualitative data, two-tailed, unpaired Student's t-test was applied using SPSS software.


  Results Top


We observed that mean age in the study group was 52.66 ± 10.86, while in control group, mean age was 32.06 ± 14.08 and this difference was found statistically highly significant (P < 0.001) [Table 1]. The most of patients in study group were came from urban area (71%), while most of the patients in control group were came from rural area (73%). On applying Chi-square test, the difference was found statistically highly significant (P < 0.001) [Table 2].
Table 1: Distribution of cases according to age group (years)

Click here to view
Table 2: Distribution of cases according to residential area

Click here to view


In the present study, maximum number of patients were non-smokers in both study and control groups (87% and 91%, respectively) and this difference was found statistically insignificant (P > 0.05) [Table 3]. We observed that the patients were vegetarian in both study and control groups (85% and 82%, respectively), and this difference was found statistically insignificant (P > 0.05) [Table 4].
Table 3: Distribution of cases according to smoking habit

Click here to view
Table 4: Distribution of cases according to dietary habit

Click here to view


In our study observed that the mean glycated haemoglobin (HbA1C) in study group was 7.97 ± 1.33, and in control group, it was 7.42 ± 0.95 and the difference was found statistically significant (P < 0.05) [Table 5]. The mean peroneal nerve in the study group was 42.26 ± 1.95 m/s, and in control group, it was 52.05 ± 4.78 m/s and the difference was found statistically highly significant (P < 0.001) [Table 6] and mean value of tibial nerve in study group was 41.71 ± 2.29 m/s, and in control group, it was 49.84 ± 2.67 m/s and the difference was found statistically highly significant (P < 0.001) [Table 7].
Table 5: Distribution of cases according to glycated haemoglobin (mg%)

Click here to view
Table 6: Distribution of cases according to peroneal nerve

Click here to view
Table 7: Distribution of cases according to tibial nerve

Click here to view



  Discussion Top


The present study was conducted in the Department of Physiology and Psychiatry, Sardar Patel Medical College attached to PBM. Associated Group of Hospitals, Bikaner.

Lawrence and Locke,[10] in JAMA neurology 1961, studied 240 patients divided into three groups on clinical ground and nerve conduction velocities (Group A patients studied for ulnar nerve, Group B patients studied for common peroneal nerve and Group C patients studied for tibial nerve). All the three groups had decreased in nerve conduction velocities. In our study, we have seen that out of total 100 study group patients, 21% and 79% patients had their ulnar nerve <50 and 51–60 m/s, respectively, while out of total 100 control cases, 50% patients each had their ulnar nerve 51–60 and >60 m/s. This showed decrease in nerve conduction velocities. Mean ulnar nerve conduction velocity in study group was 53.56 ± 3.53 and in control group was 60.73 ± 5.99, and between study and control group, the difference was found statistically highly significant.

In the present study, according to peroneal nerve studies, all the patients (100%) of study group had their peroneal nerve <45 m/s, while in control group, out of total 100 participants, 77% and 23% patients had their peroneal nerve between 46–55 and >55 m/s, respectively. Mean peroneal nerve in study group was 42.26 ± 1.95 m/s, while in control group, mean peroneal nerve was 52.05 ± 4.78 m/s. This shows that the difference between study and control groups was statistically highly significant (P < 0.001).

According to tibial nerve studies, all the patients (100%) of study group had their tibial nerve <45 m/s, while in control group, out of total 100 participants, 96% and 4% patients had their tibial nerve between 46–55 and >55 m/s, respectively. Mean tibial nerve in study group was 41.71 ± 2.29 m/s, while in control group, mean tibial nerve was 49.84 ± 2.67 m/s. This shows that the difference between study and control groups was statistically highly significant (P < 0.001).

A study on diabetic polyneuropathy in the United Kingdom Hospital, clinical population done by Young et al.[11] including 6487 diabetic patients showed 53.9% male, median age 59 years (range 18–90 years), 37.4% type 1 DM with the median duration of 8 years. The prevalence of diabetic peripheral neuropathy increases with age from 5% (3.1%–6.9%) in 22–29-year age group to 44.2% (41.1–47.35) in the 72–79-year age group, whereas in our study, the mean age was 52.66 ± 10.86 (study group) and 23.06 ± 14.08 (control group). The percentage of male in our study was 60% (study group) and 56% (control group) which was almost similar to the value (535) observed by Young et al.[11]

While in our present study out of 100 patients, amongst study group, 6.6% patients had their duration of illness 6–10 years, while 16%, 10% and 8% patients had duration of illness 11–15 years, >15 years and <15 years, respectively, and amongst control group, out of 100 patients, 44% participants had their duration of illness 6–10 years, followed by 40%, 11% and % patients had their duration of illness <5, 11–15 and >15 years, respectively. In general, NCV and amplitude of nerves are inversely proportional to age, but in diabetic individuals, the decrease is more pronounced.

The study published by Willi et al.,[12] in JAMA 2007, showed that the risk of DM was greater for heavy smokers (>20 cigarettes, relative risk [RR]: 1.61; 95% confidence interval [CI]: 1.43–1.80) than for light smokers (RR: 1.29; 95% CI: 1.13–1.48) and lower for former smokers (RR: 1.23; 95% CI: 1.14–1.33) compared with active smokers consistent with a dose-response phenomenon. In our study, a maximum number of patients were non-smokers in both study and control groups (87% and 91%, respectively).

A study published by Tonstad et al.[13] in diabetic care 2009 stated that the prevalence of type 2 DM increased from 2.9% in vegetarian to 7.6% in non-vegetarian, prevalence was intermediate in participants consuming lacto-ovo (3.2%), pesco (4.8%) or semi-vegetarian (6.15) diets. In our study, a maximum number of patients were vegetarian in both control and study groups (82% and 85%, respectively).

In the study published by Ghazanfari et al.,[14] the comparison of HbA1C and fasting blood sugar tests in general population concluded that fasting blood sugar sound more reliable to separate diabetics from non-diabetics participant than HbA1C. Although the optimum cut-off point of HbA1C was >6.15%, its precision was comparable with the conventional cut-off point of >6%. In another study conducted by Herman et al.[15] showed that in total population, the point of intersection of the lower and upper components that minimised misclassification for fasting and 2 h glucose and HbA1C were 7.2 mmol/l (129 mg/dl) and 11.5 mmol/l (207 mg/dl), 6.7%, respectively.


  Conclusion Top


In our study, we concluded that nerve conduction velocities decrease in tibial and common peroneal nerve in diabetic patients as compared to control. Nerve conduction velocities also decrease with increasing age and increased HbA1C ≥ 6.5%.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Consensus statement: Report and recommendations of the San Antonio Conference on Diabetic Neuropathy. American Diabetes Association American Academy of Neurology. Diabetes Care 1988;11:592-7.  Back to cited text no. 1
    
2.
Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet 2003;361:1545-51.  Back to cited text no. 2
    
3.
Lee CM, Huxley RR, Wildman RP, Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: A meta-analysis. J Clin Epidemiol 2008;61:646-53.  Back to cited text no. 3
    
4.
Jonk AM, Houben AJ, de Jongh RT, Serné EH, Schaper NC, Stehouwer CD, et al. Microvascular dysfunction in obesity: A potential mechanism in the pathogenesis of obesity-associated insulin resistance and hypertension. Physiology (Bethesda) 2007;22:252-60.  Back to cited text no. 4
    
5.
Cho DY, Mold JW, Roberts M. Further investigation of the negative association between hypertension and peripheral neuropathy in the elderly: An Oklahoma physicians resource/Research network (OKPRN) Study. J Am Board Fam Med 2006;19:240-50.  Back to cited text no. 5
    
6.
Sumner CJ, Sheth S, Griffin JW, Cornblath DR, Polydefkis M. The spectrum of neuropathy in diabetes and impaired glucose tolerance. Neurology 2003;60:108-11.  Back to cited text no. 6
    
7.
Dharmashankar K, Widlansky ME. Vascular endothelial function and hypertension: Insights and directions. Curr Hypertens Rep 2010;12:448-55.  Back to cited text no. 7
    
8.
Hoffman-Snyder C, Smith BE, Ross MA, Hernandez J, Bosch EP. Value of the oral glucose tolerance test in the evaluation of chronic idiopathic axonal polyneuropathy. Arch Neurol 2006;63:1075-9.  Back to cited text no. 8
    
9.
Novella SP, Inzucchi SE, Goldstein JM. The frequency of undiagnosed diabetes and impaired glucose tolerance in patients with idiopathic sensory neuropathy. Muscle Nerve 2001;24:1229-31.  Back to cited text no. 9
    
10.
Lawrence DG, Locke S. Motor nerve conduction velocity in diabetes. Arch Neurol 1961;5:483-9.  Back to cited text no. 10
    
11.
Young MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia 1993;36:150-4.  Back to cited text no. 11
    
12.
Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J. Active smoking and the risk of type 2 diabetes: A systematic review and meta-analysis. JAMA 2007;298:2654-64.  Back to cited text no. 12
    
13.
Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care 2009;32:791-6.  Back to cited text no. 13
    
14.
Ghazanfari Z, Haghdoost AA, Alizadeh SM, Atapour J, Zolala F. A comparison of hbA1c and fasting blood sugar tests in general population. Int J Prev Med 2010;1:187-94.  Back to cited text no. 14
    
15.
Herman WH, Thompson TJ, Visscher W, Aubert RE, Engelgau MM, Liburd L, et al. Diabetes mellitus and its complications in an African-American community: Project DIRECT. J Natl Med Assoc 1998;90:147-56.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed512    
    Printed65    
    Emailed0    
    PDF Downloaded78    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]