Current glycaemic control has no impact on the advancement of diabetic neuropathy
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Diabetology Ward, Institute of Rural Health, Lublin, Poland
Institute of Public Health, Pope John Paul II State School of Higher Education, Biala Podlaska, Poland
Department of Functional Research, Institute of Rural Health, Lublin, Poland
Department of Hypertension and Diabetology, Medical University, Gdansk, Poland
Piotr Dziemidok   

Diabetology Ward, Institute of Rural Health, Lublin, Poland
Ann Agric Environ Med. 2012;19(4):742–745
The aim of the study was to assess the association between glycemic control understanding as a glycated haemoglobin level and indices of diabetic neuropathy.

We evaluated 204 patients with diabetes (type 1 – 29; type 2 – 175). Glycated haemoglobin was determined using The Diabetes Control and Complications Trial/ National Glycohemoglobin Standardization Program method. Evaluation of complaints from the lower extremities was based on the Neuropathy Syndrome Total Score questionnaire. We used a mono lament for evaluation of touch sensation (Semmes-Weinstein 5.07-10 g), a 128 Hz calibrated tune-fork for the vibration perception test, Tip-Therm to assess temperature sensation.

The mean glycated haemoglobin level was assessed on 8.53±1.87%. The mean Neuropathy Syndrome Total Score: 11.45±6.37. Decreased sensation of touch on both sides was determined in 30% of cases, decreased sensation of temperature in 59% and decreased sensation of vibration in 30%. For Neuropathy Syndrome Total Score and glycated haemoglobin the Pearson’s correlation test was 0.00910 (p≈0.99), Spearman’s rank correlation test was 0.00523 (p≈0.95). Persons with sensation deficits and neuropathy symptoms had not significantly higher (Neuropathy Syndrome Total Score, temperature sensation disturbances) and not significantly lower (vibration and touch) glycated haemoglobin level compared to patients without neuropathy.

There is no correlation between prevalence and advancement of sensorial neuropathy and current diabetes control in patients with long–term established diabetes.

Nicolucci A, Carinci F, Cavaliere D, Scorpiglione N, Belfiglio M, Labbrozzi D, et al. A meta-analysis of trials on aldose reductase inhibitors in diabetic peripheral neuropathy. The Italian Study Group. The St. Vincent Declaration. Diabet Med. 1996; 13: 1017-1026.
Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology 1993; 43: 817-824.
Abbott CA, Malik RA, van Ross ER, Kulkarni J, Boulton AJ. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care 2011; 34: 2220-2224.
Daousi C, MacFarlane IA, Woodward A, Nurmikko TJ, Bundred PE, Benbow SJ. Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. Diabet Med. 2004; 21: 976-982.
Boulton, AJ. The diabetic foot: a global view. Diabetes Metab Res Rev. 2000; 16 (suppl.1): 2–5.
Gonzalez, ER, Oley MA. e management of lower-extremity diabetic ulcers. Manag. Care Interface 2000; 13: 80-87.
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005; 2: 217-228.
Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care 1990; 13: 513-521.
Kulkarni J, Pande S, Morris J. Survival rates in dysvascular lower limb amputees. Int J Surg. 2006; 4: 217-221.
DCCT Research Group. The effects of intensive treatment of diabetes on the development and progression of long-term complications in insulin dependent diabetes mellitus. N Engl J Med. 1993; 329: 977-986.
DCCT/EDIC Research Group. Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA 2002; 287, 2563-2569.
Albers JW, Herman WH, Pop-Busui R, Feldman EL, Martin CL, Cleary PA, et al. Effects of prior intensive insulin treatment during the Diabetes Control and Complications Trial (DCCT) on peripheral neuropathy in type 1 diabetes during the Epidemiology of Diabetes Interventions and Complications (EDIC) Study. Diabetes Care 2010; 33: 1090-1096.
Stratton IM, Adler AI, Neil AW, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321: 405-412.
Bastyr, EJ 3 rd , Price KL, Bril V; MBBQ Study Group. Development and validity testing of the Neuropathy Total Symptom Score-6: questionnaire for the study of sensory symptoms of diabetic peripheral neuropathy. Clin Ther. 2005; 27: 1278–1294.
Charuruks N, Milintagas A, Watanaboonyoungcharoen P, Ariyaboonsiri C. Determination of reference intervals of HbA1C (DCCT/NGSP) and HbA1C (IFCC) in adults. J Med Assoc Thai. 2005; 88: 810-816.
Ziegler D, Hanefeld M, Ruhnau KJ, Meissner HP, Lobisch M, Schütte K, Gries FA. Treatment of symptomatic diabetic peripheral neuropathy with the anti-oxidant alpha-lipoidic acid. A 3-week multicentre randomized controlled trial (ALADIN Study). Diabetologia 1995; 38: 1425-1433.
Ametov AS, Barinov A, Dyck PJ, Hermann R, Kozlova N, Litchy WJ; SYDNEY Trial Study Group. The sensory symptoms of diabetic polyneuropathy are improved with α-lipoic acid: the SYDNEY trial. Diabetes Care 2003; 26: 770-776.
Ziegler D, Dannehl K, Wiefels K, Gries FA. Di¬erential effects of near-normoglycaemia for 4 years on somatic nerve dysfunction and heart rate variation in type 1 diabetic patients. Diabet Med. 1992; 9: 622-629.
Pisarczyk-Wiza D, Zozulińska-Ziółkiewicz D, Wysocki H, Wierusz-Wysocka B. Increase in glycaemia stimulates reactive oxygen species (ROS) production by polymorphonuclear neutrophils in type 2 diabetic patients. J Pre-Ciln Clin Res. 2011; 5(1):22-27.
DCCT Research Group. Effects of intensive diabetes treatment on nerve conduction in the Diabetes Control and Complications Trial. Ann Neurol. 1995; 38: 869-880.
Martin CL, Albers J, Herman WH, Cleary P, Waberski B, Greene DA, et al. Neuropathy among the diabetes control and complications trial cohort 8 years after trial completion. Diabetes Care 2006; 29: 340-344.
Stratton IM, Holman RR, Bulton AJM. Risk factors for neuropathy in UKPDS. Diabetologia 2004; 47, suppl 1: 47.
Ocubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Matoyoshi S. et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6 year study. Diabetes Res Clin Pract. 1995; 28: 103-117.
The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of Intensive Glucose Lowering in Type 2 Diabetes. N Engl J Med. 2008; 358: 2545-2559.
Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes. N Engl J Med. 2009; 360: 129-139.