•  
  •  
 

Abstract

Introduction. Diabetic peripheral neuropathy (DPN) in the lower extremity caused by complications of diabetes in the microvascular which can damage nerve in the lower extremity. Then, it is necessary to be aware of the process of aterosclerosis elsewhere, both in the macro and microvascular arteries in the lower extremity. This study was conducted to assess the association of the degree of diabetic peripheral neuropathy assessed by Toronto clinical scoring system (TCSS) with the process of atherosclerosis in the blood vessels of the lower extremity, both macrovascular with ankle brachial index (ABI) and toe brachial index (TBI), as well as microvascular with transcutaneus partial oxygen pressure (TcPO2 ) in patients with type 2 diabetes mellitus. Methods. Cross-sectional study was carried out in patients with type 2 DM with DPN with TCSS values> 5 in the Integrated Cardiac Polyclinic, Endocrine and Metabolic Polyclinic, and Internal Medicine Polyclinics at Cipto Mangunkusumo Hospital. Data were obtained from interviews, medical records, as well as ABI, TBI and, TcPO2 examinations. Bivariate analysis of each variable was performed using Spearman test. Results. Total of 36 subjects who met the selection criteria were included in the study, the average age was 62 years (SD 9.2) with 20 (55.6%) of whom were women and the median duration of diabetes was 12 years. Based on bivariate analysis with the Spearman test, there was a statistically significant negative correlation with moderate correlation coefficient between the degree of diabetic peripheral neuropathy assessed by TCSS with ABI (r = -0.475, p = 0.003) and TBI (r = -0.421, p = 0.010). The TcPO2 examination also found a statistically significant negative correlation with moderate correlation coefficient (r = -0.399, p = 0.016). Conclusion. There is a statistically significant negative correlation between the degree of diabetic peripheral neuropaty with ABI, TBI, and TcPO2 examinations.

References

1. Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther. 2008;88(11):1254-64. 2. Katirji B, Kaminski HJ, Ruff RL. Neuromuscular disorders in clinical practice. Berlin, Germany: Springer Science & Business Media; 2013. 3. Bril V, Perkins BA. Validation of the Toronto clinical scoring system for diabetic polyneuropathy. Diabetes Care. 2002;25(11):2048-52. 4. Perkins BA, Olaleye D, Zinman B, Bril V. Simple screening tests for peripheral neuropathy in the diabetes clinic. Diabetes Care. 2001;24(2):250-6. 5. Aboyans V, Ricco J-B, Bartelink M-LEL, et al. 2017 ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS) document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, . Eur Heart J. 2017;39(9):763-816. 6. Høyer C, Sandermann J, Petersen LJ. The toe-brachial index in the diagnosis of peripheral arterial disease. J Vasc Surg. 2013;58(1):231- 8. 7. Suzuki. How to diagnose peripheral arterial disease. Podiatrytoday. 2007;20(April):54-65. 8. Badan Penelitian dan Pengembangan Kesehatan. Riset kesehatan dasar 2018. Jakarta: Kementerian Kesehatan Republik Indonesia; 2018. 9. Rhee SY, Guan H, Liu ZM, Cheng SW, Waspadji S, Palmes P, et al. Multi-country study on the prevalence and clinical features of peripheral arterial disease in Asian type 2 diabetes patients at high risk of atherosclerosis. Diabetes Res Clin Pract. 2007;76(1):82-92. 10. Murabito JM, D’Agostino RB, Silbershatz H, Wilson PWF. Intermittent claudication: a risk profile from the Framingham Heart Study. Circulation. 1997;96(1):44-9. 11. Rabia K, Khoo EM. Prevalence of peripheral arterial disease in patients with diabetes mellitus in a primary care setting. Med J Malaysia. 2007;62(2):130-3. 12. Kostev K, Jockwig A, Hallwachs A, Rathmann W. Prevalence and risk factors of neuropathy in newly diagnosed type 2 diabetes in primary care practices: A retrospective database analysis in Germany and UK. Prim Care Diabetes. 2014;8(3):250-5. 13. Regensteiner JG, Golden S, Anton B, Barrett-Connor. Sex differences in the cardiovascular consequences of diabetes mellitus a scientific statement from the American Heart Association. Circulation. 2015;132(25):2424-47. 14. Wenger NK. Sex differences in the cardiovaskuler consequences of diabetes melitus. Cardiology. 2016;134: 78. 15. Fisher MR. American Diabetes Association: peripheral arterial disease in people with diabetes. Diabetes Care. 2013;26:3333-41. 16. Perkumpulan Endokrinologi Indonesia. Konsensus pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia 2015. Jakarta: Perkumpulan Endokrinologi Indonesia; 2015. 17. Kownator S, Cambou J-P, Cacoub P, Léger P, Luizy F, Herrmann MA, et al. Prevalence of unknown peripheral arterial disease in patients with coronary artery disease: data in primary care from the IPSILON study. Arch Cardiovasc Dis. 2009;102(8-9):625-31. 18. Sihombing B. Prevalensi penyakit arteri perifer pada populasi penyakit diabetes melitus di puskesmas kota Medan [Tesis]. Medan: Universitas Sumatera Utara; 2008. 19. Simatupang M, Pandelaki K, Panda AL. Hubungan antara penyakit arteri perifer dengan faktor risiko kardiovaskular pada pasien dm tipe 2. e-CliniC. 2013;1(1):7-12. 20. Cheema S, Maisonneuve P, Zirie M, Jayyousi A, Alrouh H, Abraham A, et al. Risk factors for microvascular complications of diabetes in a high-risk middle east population. J Diabetes Res. 2018(2018):8964027. 21. Soewondo P, Soegondo S, Suastika K, Pranoto A, Soeatmadji DW, Tjokroprawiro A. The DiabCare Asia 2008 study--outcomes on control and complications of type 2 diabetic patients in Indonesia. Med J Indones. 2010;19(4):235-44. 22. Selvin E, Wattanakit K, Steffes MW, Coresh J, Sharrett AR. HbA1c and peripheral arterial disease in diabetes: the atherosclerosis Risk in Communities study. Diabetes Care. 2006;29(4):877-82. 23. Feldman EL. Oxidative stress and diabetic neuropathy: a new understanding of an old problem. J Clin Invest. 2003;111(4):431-3. 24. Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. 2004;141(6):421-431. 25. Chandrashekar S, Kalaivani V. Peripheral arterial diseases in type 2 diabetes mellitus: a cross-sectional study using ankle-brachial index. 2018;7(1):5-8. 26. Midolo Y, Gatt A, Chockalingam N, Formosa C. Agreement of clinical tests for the diagnosis of. Prim Care Diabetes. 2018;13(1):82-6. 27. Meijer VE De, Sant P Van, Spronk S. Reference value of transcutaneous oxygen measurement in diabetic patients compared with nondiabetic patients. J Vasc Surg. 2008;48(2):382- 8. 28. Brasileiro ACL, Oliveira DC de, Victor EG, Oliveira DAG, Batista LL. Association between ankle-brachial index and carotid atherosclerotic disease. Arq Bras Cardiol. 2013;100(5):422-8. 29. Spångéus A, Wijkman M, Lindström T, Engvall JE, Östgren CJ, Nystrom FH, et al. Toe brachial index in middle aged patients with diabetes mellitus type 2: not just a peripheral issue. Diabetes Res Clin Pract. 2013;100(2):195-202. 30. Aso Y, Okumura K, Inoue T, Matsutomo R, Yoshida N, Wakabayashi S, et al. Results of blood inflammatory markers are associated more strongly with toe-brachial index than with ankle-brachial index in patients with type 2 diabetes. Diabetes Care. 2004;27(6):1381-6. 31. Young MJ, Veves A, Walker MG, Boulton AJM. Correlations between nerve function and tissue oxygenation in diabetic patients: further clues to the aetiology of diabetic neuropathy? Diabetologia. 1992;35(12):1146-50. 32. Deng W, Dong X, Zhang Y, Jiang Y, Lu D, Wu Q, et al. Transcutaneous oxygen pressure (TcPO 2): a novel diagnostic tool for peripheral neuropathy in type 2 diabetes patients. Diabetes Res Clin Pract. 2014;105(3):336-43. 33. Udovichenko OV, Chernova EG, Dadova LV, Belyaeva AV, Nosenko EM, Ladygina DO, et al. Transcutaneous pO2 measurement on plantar foot surface: establishing the reference range. Diabet Foot J. 2017;20(4):239–43.

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.