Type of Diabetes Mellitus Has Influence on Electrophysiological Parameters

Introduction: Compulsory electromyoneurography (EMNG) analysis of all neurophysiological parameters, including the most sensitive parameter for early detection of diabetic polyneuropathy (cutaneous silent periods), in patients without subjective symptoms, and EMNG analysis demonstrates the existence of incipient signs for polynomial neuropathy due to which timely therapeutic approach is needed to prevent complications of diabetic disease and prevent irreversible changes in peripheral nerves.

Aim: Examine the influence of type diabetes mellitus, therapeutic modality, and gender of patients on neurophysiological parameters obtained by EMNG analysis.

Methods: The study included 90 patients with diabetes who were divided into three groups of 30, depending on the duration of the disease. Group 1 consisted of 30 respondents with type 2 diabetes mellitus and up to 5 years of disease duration. Group 2 consisted of 30 respondents with type 2 diabetes mellitus type and 5 to 10 years of disease duration. Group 3 consisted of 30 respondents with Type 1 diabetes mellitus. An electron-neurography analysis of peripheral nerve in the extremities was performed.

Results: Group 1 (50%) and group 2 (56.17%) respondents had statistically higher incidence of tingling than those in Group 3 (13.3%), p=0.004. Tingling was not statistically significantly different in relation to the examined groups (p=0.314). Reflexes were statistically the most preserved in Group 3 (86.7%), p = 0.001. Measurement of motor conductivity values at median nerve had a significant difference in all parameters (distal latency, amplitude, mean conduction velocity (MCV) and latency in the group with DM type 1, compared to respondents with DM type 2. The same significant difference between all parameters was found when testing peroneus nerve. When measuring motor velocity conductivity in ulnar nerve, there was no significant difference in amplitude, while DM1 type 1 patients had significant differences in values: distal latency and MCV p<0.0001, latency p<0.002. Measurement of sensory velocity was not statistically significant between patients with DM types 1 and 2. In relation to therapy, oral insulin therapy was not shown to be of statistical significance, except for tibialis amplitude measurements, where insulin-treated DM patients had a value amplitude of 12.96±1.48, and in oral therapy group less than 0.04 (p<0.05) 9.14±0.93. In the DM type 2 group no, neurophysiological parameters showed significant gender differences, while in respondents with DM type 2, where the disease lasted shorter, a significant gender difference was present in terms of motor velocity and sensory conductivity in all the nerves examines, except MCV in ulnar nerve. In the DM type 1 respondents, a significant gender difference was present in measuring MCV at tibial nerve and peroneus nerve (p <0.01 and p <0.02), as well as latency of MCV in H reflexes (p<0.01), in males was 56.25±1.03 and in females 32.89±0.47.

Conclusion: Diabetic polyneuropathy is significantly more present in patients older than 60 years who have type 2 diabetes mellitus (2/3 of those with a duration of 5 years or less and in ½ respondents with DM duration of less than 5 years), without any hesitation on the type of therapy. Measurement values of motor conductivity at median nerve had a significant difference in all parameters (distal latency, amplitude, MCV, and latency F) in the group with DM type 1. The same significant difference between all parameters was also found in n. peroneus. Distal latency values at sural nerve and tibial nerve, latency values and MCV in H reflexes, do not depend on DM type.