الفهرس 
DIABETIC NEUROPATHYOnly 14 pages are availabe for public view
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Abstract
D
iabetic peripheral neuropathy (DPN) is a common complication estimated to affect 30-50% of individuals with diabetes. It is the most frequent and annoying complication of diabetes mellitus (DM), leading to the greatest morbidity and mortality and giving rise to a huge economic trouble for diabetes care, 2-3% develop a foot ulcer annually.
Nerve conduction studies (NCS) is used to evaluate the conduction of electrical impulses down peripheral nerves. The test should be considered and performed only after a careful history and physical examination. In addition to, sensory and motor nerve conduction studies involve analysis of specific parameters, including latency, conduction velocity, and amplitude.
Glycated albumin (GA) is a laboratory test that has gained some importance for glycemic monitoring in DM in the last decades. It reflects short-term glycemia due to the half life time of the albumin, which is approximately 3 weeks. GA will be forming of AGEs under hyperglycaemic conditions which has been linked with the development of diabetic neuropathy, so GA can been sensitive for diabetic complication as diabetic neuropathy. Also, GA is not affected by the presence of hemolytic processes and abnormal Hb as HbA1c.
The aim of the present study was to evaluate the relationship between Glycated albumin and peripheral diabetic neuropathy.
The present study is cross-section study was conducted on 40 patients with diabetes mellitus, who were collected from outpatient clinic in Ain Shams University Hospitals and national institute of diabetes and endocrinology (NIDE), from May to September 2017.
This study was conducted on 40 subjects, the subjects were divided into 2 groups:
group (I): 20 patients with diabetes mellitus complicated with diabetic neuropathy.
group (II): 20 patients with diabetes mellitus not complicated with diabetic neuropathy.
All subjects were submitted to the following:
1- Full history:
Detailed history was taken from the patients including personal history as age, gender with duration of diabetes and treatment for diabetes.
2- Clinical examination including:
Vital data, BMI, neurological examination and fundus examination.
3- Lab testing:
• Fasting blood glucose and 2 hours post prandial blood glucose (mg/dl).
• Glycated hemoglobin levels (HbA1c) (%).
• Glycated albumin (GA).
• Liver functions as ALT, AST and albumin.
• Serum creatinine.
• Estimation of GFR.
4- Nerve conduction velocity tests: to confirm diabetic neuropathy or not.
Results:
The present study showed that
• On comparing the studied groups regarding demographic and clinical characteristics showed that: Group-I (diabetic patients with diabetic neuropathy) had significantly higher age, duration of DM, BMI. Group-I had significantly higher oral and mixed treatment and lower insulin treatment. In addition to Group-I had significantly advanced retinopathy, higher SBP and DBP (P<0.001, P<0.001, P= 0.007, P=0.003, P<0.001, P=0.005, P=0.012) respectively.
• On comparing the studied groups regarding laboratory findings (using Independent t- test) showed that: Group-I had significantly higher HbA1c, glycated albumin, AST& creatinine and significantly lower eGFR (P<0.001, P<0.001, P=0.037, P=0.004, P<0.001) respectively.
• On comparing the studied groups regarding parameters of nerve conduction velocity test (using Independent t-test) showed that: Group-I had significantly higher nerve latency and significantly lower nerve amplitude& conduction velocity (P=0.002, P<0.001, P<0.001) respectively.
• On studying the Correlation between HbA1c and glycated albumin with demographic& clinical characteristics (Using Pearson correlation): It found that there were no significant correlations between HbA1c& glycated albumin with age, body mass index, diabetes duration, systolic blood pressure and diastolic blood pressure (P Value >0.05).
• On studying the Correlation between HbA1c and glycated albumin with laboratory findings (Using Pearson correlation): It found that there were no significant correlations between HbA1c& glycated albumin with fasting blood glucose, 2 hour post prandial blood glucose, ALT, AST, albumin in both groups (P >0.05). However, there was a highly significant positive correlation between HbA1c and creatinine in group I (P=0.019) and a highly significant negative correlation with eGFR in group I (P<0.001).
• On studying the Correlation between HbA1c and glycated albumin with neural findings (Using Pearson correlation) It found that glycated albumin was positive correlation with nerve latency RTML (P<0.001), RPML (P=0.005), RSSL (P<0.001) and negative correlations with nerve amplitude RTMA (P<0.001), RPMA (P=0.015), RSSA (P=0.027) and with nerve conduction velocity RTMCV (P<0.001), RPMCV (P=0.038), RSSCV (P<0.001).
• On comparison between diabetic neuropathy types regarding glycemic findings in group-I (using ANOVA test with post hoc Tukey HSD):It found that demyelinted type of diabetic neuropathy (n=5) significantly had highest FBG (P=0.031), 2PPBG (P=0.039) and glycated albumin (P=0.033) and no significant HbA1c (P=0.199) however in axonal and mixed types of diabetic neuropathy showed no significant different regards FBG, 2PPBG, HbA1c and glycated albumin (P>0.05).
• On comparison between cases with and without diabetic retinopathy regarding glycemic findings in group I (using Independent t-test):It found that cases with diabetic retinopathy in group I significantly had higher HbA1c (P=0.004) and glycated albumin (P=0.016).
• On comparison between cases with positive and negative pinprick test regarding glycemic findings in group I (using Independent t-test): It found that cases with positive pinprick test in group I significantly had lower glycated albumin (P=0.013).
• On diagnostic performance of glycemic findings in diagnosing diabetic neuropathy: It found that Glycated albumin significantly had perfect diagnostic performance in diagnosing neuropathy, while HbA1c had significant moderate diagnostic performance.