174
VOLUME 7 NUMBER 4 • NOVEMBER 2010
JOURNAL UPDATE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Journal update: Focus on neuropathy
EPIDEMIOLOGY OF NEUROPATHY
Better skin microvascularisation
may explain lower rates of diabetic
neuropathy in Asian Indians
This cross-sectional study in the UK of age-
and gender-matched adults with type 2 dia-
betes found higher mean scores of nerve
conduction velocity in Asian Indians. This
was explained by their shorter height, fewer
pack-years smoked and higher transcutane-
ous oxygen levels.
Peripheral vascular function was more
favourable in the Indian group even when
adjustment was made for smoking status,
height, and lipid, glucose and blood pres-
sure levels. Small-fibre neuropathy was less
prevalent in this first-generation Asian Indian
group compared to the European patients.
In conclusion, healthier peripheral vascu-
lar function was the key modifiable determi-
nant of protection from neuropathy in Asian
Indians, with independent contributions
from low smoking rates and shorter height.
Source: Abbott CA,
et al
. Explanations for the lower rates
of diabetic neuropathy in Indian Asians versus Europeans.
Diabetes Care
2010;
33
(6): 1325–1330.
Even Greenlanders at home are
experiencing increased levels
of diabetic and microvascular
complications
Nuuk, the capital of Greenland, with its
15 000 inhabitants has a single primary
healthcare centre serving all the city dwell-
ers. Most patients with type 2 diabetes are
seen between two and four times per year.
Patient data is stored electronically, provid-
ing a useful record of the prevalence of dia-
betes and its complications.
Greenlanders who leave Greenland are
vulnerable to diabetes, as are many immi-
grant people to urban cultures.
This is the first study of complications and
risk factors among Greenlanders and Danes
living in Nuuk. The majority of the Green-
land type 2 diabetics (57%) were diagnosed
within the last three years; 91% of patients
had a BMI
≥
25 kg/m
2
, 42% had one or
more first-degree relatives with diabetes,
43% smoked, 70% were categorised as
leading a very physically active lifestyle and
60% described a healthy dietary pattern.
Sixty-eight per cent of all the patients suf-
fered from at least one complication – 51%
neuropathy, 14% retinopathy, 10% mac-
rovascular complication and 43% micro-
albuminura. The number of complications
correlated with the duration of diabetes and
low physical activity.
Source: Pedersn ML, Lynge AR, Jacobsen JL. Micro and
macrovascular complications among Greenlanders and
Danes with type 2 diabetes mellitus in Nuuk Greenland.
Int J Circumpolar Hlth
2010;
69
(2): 195–207.
DIAGNOSIS OF NEUROPATHY
Monofilament examination can
predict incident diabetic neuropathy
This four-year prospective study was under-
taken to determine the specific monofila-
ment examination scores that can predict
the development of diabetic neuropathy.
Although there are limitations to the speci-
ficity of the prediction, the strongest asso-
ciation of DNP was with a lower baseline
monofilament score (3.7
±
2.5 out of a
score of 8). This association was stronger
than male gender, longer diabetes duration,
taller height and higher blood pressure.
The optimal threshold score for risk of
incident neuropathy was less than or equal
to five sensate stimuli out of eight, with
72% sensitivity and 64% specificity. This
study confirms the value of the monofila-
ment examination as a simple diabetic neu-
ropathy screening instrument generalisable
to the clinical setting.
Source: Perkins BA, Orszag A, Ngo M,
et al
. Prediction
of incident diabetic neuropathy using the monofilament
examination: a 4-year prospective study.
Diabetes Care
2010;
33
(7): 1549–1554.
Presence of painful DNP should
increase vigilence for presence of
autonomic neuropathy
An investigation using spectral heart rate
variability determined by ECG has shown
that painful diabetic neuropathy (DPN) is
associated with significantly greater auto-
nomic dysfunction than painless DPN.
Using this 5-min ECG test is simple and
serves as a sensitive tool to detect auto-
nomic dysfunction. This study was under-
taken in type 1 diabetic patients without
any complicating cardiac problems or left
ventricular dysfunction.
Source: Gandi RA, Marques JL, Selvarajah D, Emery CJ,
Tesfaye S. Painful diabetic neuropathy is associated with
greater autonomic dysfunction than painless diabetic
neuropathy.
Diabetes Care
2010;
33
(7): 1585–1590.
TREATMENT OF NEUROPATHY
Progression of microvascular
complications delayed in South
African CDE-attending cohort
The extensive database of the more than
250 CDE centres was examined to assess
outcomes of this multi-practice model. The
clinical records of 1 520 type 1 and 8 026
type 2 diabetes patients who had been in
the programme were evaluated for hospital
admission rates, glycaemic control (HbA
1c
)
and microvascular complications.
Progression of microvascular complica-
tions was delayed and a major reduction
in hospital admission rates for both acute
metabolic emergencies and all causes was
recorded. At five years, the HbA
1c
was 7.7%
for type 1 patients (down from 9.2% at
enrolment) and 7.4% for the type 2 diabetic
patients (down from 8.8% at enrolment).
Source: Distiller LA, Brown MA, Joffe BI, Kramer BD.
Striving for the impossible dream: a community-
based multi-practice collaborative model of diabetes
management.
Diabet Med
2010;
27
(2): 197–202.
Task shifting (from doctors to
nurses) in diabetes care in sub-
Saharan Africa
A thorough review of all Medline-published
data on task shifting/nurse-led care in hyper-
tension and diabetes in South Africa forms
the basis of this interesting article in Pubmed
Central. With highlighted references, this
review provides data often thought to be
missing with regard to the African situation.
This is an essential read for all involved in
improving diabetic outcomes in our region.
Source: Lekoubou A,
et al
. Hupertension, diabetes
mellitus and task-shifting in their management in sub-
Saharan Africa.
Int J Environ Res Publ Hlth
2010;
7
(2):
353–363.
Registered FDA homeopathic drug
(Neuragen PN) shows benefit in
double-blind study of neuropathic
pain
In a study of neuropathic pain manifest-
ing as foot-sole pain in an all-cause neu-
ropathy group, this combination of five
homeopathic oils provided significant pain
