Seepana Gopi, P. Jagadeesh
BACKGROUND India has one of the highest prevalence of T2DM in the world. It is estimated that by the year 2030 there are will be nearly 80 million Indians with T2DM in the country. Although neuropathy is an extensively studied complication in patients with DM; however, the neuropathy risk in pre-diabetes and in newly diagnosed diabetes has not been well characterized. The aim and objective of the study is assess and characterize the early electrophysiological signs of peripheral neuropathy and to evaluate the prevalence autonomic neuropathy in diabetic patients at diagnosis in comparison with controls. MATERIALS AND METHODS The study was conducted on 38 subjects and 28 age-matched Controls. Diabetes was defined using WHO Criteria. Neuropathy was evaluated by nerve conduction studies performed on bilateral medial ulnar, peroneal, tibial, dorsal sural and medial Planter nerve conductions using conventional techniques. Neuropathy was also evaluated by autonomic function tests for both parasympathetic (testing heart rate variation with deep breathing, standing 15:30 ratio and Valsalva manoeuvre) and sympathetic (testing postural hypotension and blood pressure variation after sustained hand grip) using automated CAN system analyser. RESULTS Neuropathy present in 16 (42.1%) cases and in 2 (7.1%) controls, and 21 (55.3%) cases when medial plantar and dorsal sural are considered. Total 25 members (65%) showed alteration in some form of NCS parameter. Dorsal sural (16 subjects (42.1%)) and medial plantar (15 subjects (39.5)) are two most commonly involved nerves among cases, followed by medial motor (13 subjects (34.2%)). Means of both sensory and motor distal latencies are higher and CMAPs, SNAPs and CVs are lower in subjects with neuropathy than without neuropathy among all tested, though only some parameters are statistically significant. Early and definite autonomic neuropathy is present in 8 (21.1%) and 2 (5.3%) cases respectively. CONCLUSION Electrophysiological evaluation of diabetics in the early stage of disease can detect abnormalities of peripheral and autonomic nerves system. Assessment of medial plantar and dorsal sural NCS increases the sensitivity in the detection of neuropathy. Early and definite autonomic dysfunction can be seen in newly diagnosed diabetic patients.
