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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 94-97

The association between duration of illness, body mass index and diabetic neuropathy of median and ulner nerve in Bikaner region


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

Date of Web Publication4-Jan-2019

Correspondence Address:
Jitendra Kumar Acharya
S P Medical College, Bikaner, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AIHB.AIHB_8_17

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  Abstract 


Introduction: Diabetes Mellitus (DM) is a chronic disorder of the metabolism of glucose, lipids and proteins caused by a defect in insulin action or secretion. This metabolic disorder is responsible for chronic complications that affect macro and microcirculation.The manifestations of microvascular complications are more frequently found in the eyes, kidneys, and nerves, and those of macrovascular disease, in heart, brain, and leg arteries. Chronic metabolic disorder diabetes mellitus is fast growing global problem with huge social, health and economic consequences. Materials and Methods: The study was planned in Physiology Department in close collaboration with Department of Medicine (Diabetic Section), Sardar Patel Medical College, Bikaner & Associated Group of Hospital. 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 Sardar Patel Medical College, Bikaner & Associated Group of Hospital, Bikaner. Control and subject were similar in sex and age. Results: We observed that Mean age in 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). We observed that the mean FBS in study group was 101.63 ± 25.20 mg% wwhile in control group it was 97.52 ± 19.53 mg% and the difference was found statistically insignificant (P > 0.05). The mean median nerve in study group was 51.68 ± 4.01 m/s and in control group it was 57.64 ± 4.52 m/s and the difference was found statistically highly significant (P < 0.001) and mean value of ulnar nerve in study group was 53.56 ± 3.53 m/s and in control group it was 60.73 ± 5.99 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 median, ulnar diabetic patients as compared to control. Nerve conduction velocities also decrease with increasing age, increased duration of disease, increased BMI.

Keywords: Body mass index, diabetes mellitus, median, ulnar nerve


How to cite this article:
Soni E, Soni P, Acharya JK. The association between duration of illness, body mass index and diabetic neuropathy of median and ulner nerve in Bikaner region. Adv Hum Biol 2019;9:94-7

How to cite this URL:
Soni E, Soni P, Acharya JK. The association between duration of illness, body mass index and diabetic neuropathy of median and ulner nerve in Bikaner region. Adv Hum Biol [serial online] 2019 [cited 2020 Oct 27];9:94-7. Available from: https://www.aihbonline.com/text.asp?2019/9/1/94/249526




  Introduction Top


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

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 are considered the main risk factor for amputation.[2]

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

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

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


  Materials and Methods Top


Subject selection and grouping

The study was planned in the Department of Physiology in close collaboration with Department of Medicine (Diabetic Section), Sardar Patel Medical College, Bikaner and Associated Group of Hospital. A total of 100 subjects for study from the diabetic center were chosen. Institutional ethical clearance was obtained before the commencement of study from Ethical Committee of Sardar Patel Medical College, Bikaner and Associated Group of Hospital, Bikaner, no.ad/ec 21.

We examined 100 control subjects with no diabetes. Control and subject were similar in sex and age.

Health assessment

A complete history of the patient, clinical examination, laboratory investigation, etc., on a proforma. 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: 55-040W002-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 patient coming from outdoor of diabetic research center.

Data collection

  1. Population - Clients who are attending outdoor patients with complaints of diabetes
  2. Sample size - 100 samples 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 subject was suitably recorded and prepare master sheet as per objective of the plan of study.

Statistical analysis

The mean and standard deviation of quantitative parameters were calculated using SPSS software for comparison of means, the t-test was applied, and probability was calculated at the respective degree of freedom by IBM SPSS (SPSS Inc., Chicago, USA). For the qualitative character, the frequency distribution was ascertained from Master chart and the square (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, whereas 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 the patients in the study group were came from an urban area (71%), whereas most of the patients in control group were came from a 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)

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Table 2: Distribution of cases according to residential area

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In the present study, a 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

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Table 4: Distribution of cases according to dietary habit

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In our study observed that the mean HbA1C in the 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 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 hemoglobin (mg%)

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Table 6: Distribution of cases according to peroneal nerve

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Table 7: Distribution of cases according to tibial nerve

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  Discussion Top


The present study was conducted in the Department of Physiology and Psychiatry, S. P. Medical College attached to P.B.M. associated group of hospitals, Bikaner.

Laswrence and Locke et al.[10] in JAMA neurology 1961, studied 240 patients divided into 3 groups on the 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 this study, we have seen that out of total 100 study group patients, 21% and 79% of patients had their ulnar nerve <50 and 51–60 m/s, respectively, while out of total 100 control cases, 50% of patients each had their ulnar nerve 51–60 and >60 m/s. This showed decreased in nerve conduction velocities. Mean ulnar NCV in study group 53.56 ± 3.53 and in control group 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, whereas in control group, out of total 100 subjects, 77% and 23% of patients had their peroneal nerve between 46–55 and >55 m/s, respectively. Mean peroneal nerve in the study group was 42.26 ± 1.95 m/s, whereas 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 the study group had their tibial nerve <45 m/s, whereas in control group, out of total 100 subjects, 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, whereas 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 United Kingdom Hospital, clinical population done by Young et al.[11] including 6487 diabetic patients showed 53.9% of male, median age 59 years (range 18–90 year), 37.4% type 1 DM with the median duration of 8 years. The prevalence of diabetic peripheral neuropathy increase with age from 5% (3.1%–6.9%) in 22–29 years age group to 44.2% (41.1–47.35) in the 72–79 years 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, among study group 6.6% of patients had their duration of illness 6–10 years, whereas 16%, 10% and 8% of patients had duration of illness 11–15 years, >15 years and <15 years, respectively, and among control group, out of 100 patients, 44% of subjects had their duration of illness 6–10 years followed by 40%, 11%, and 5% 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, 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 the study, maximum number of patients were vegetarian in both control and study groups (82% and 85%, respectively).

The study published by Ghazanfari et al.[14] the comparison of HbA1C and fasting blood sugar (FBS) tests in general population concluded that FBS sound more reliable to separate diabetics from non-diabetics subject 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 the present 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, 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 GT in patient with sensory neuropathy. Muscle Nerve 2001;24:1229-31.  Back to cited text no. 9
    
10.
Laswrence 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]



 

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