Browsing by Subject "Diabetic Neuropathies"
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Item Aldose reductase inhibitor drugs: new hope for diabetic patients?(1989-01-05) Raskin, PhilipItem Diabetic neuropathy: a feel for the internist(1992-07-16) Raskin, PhilipItem Gamification of Exercise and Its Application for Fall Prevention Among Patients with Diabetes and Peripheral Neuropathy(2016-04-04) Martin, Elizabeth Monier; Nwariaku, Fiemu; Niwagaba, Lillian; Salazar, AdrianBACKGROUND: Individuals with diabetic peripheral neuropathy (DPN) often experience concomitant impaired proprioception and postural instability. Diminished peripheral sensory input, as found in DPN, has been associated with an increased risk of falling in elderly diabetics. Conventional balance training often consisting of Tai Chi, physiotherapy, and strength training has demonstrated an improvement in effective balance control for DPN patients, but these conditioning regimens do not provide visual feedback to help compensate for impaired proprioception. METHODS: In a randomized trial study, the efficacy of an innovative game-based balance and proprioception training program for patients with DPN was assessed through direct evaluation of changes in body sway before and after the exercise protocol using body worn sensor technology. Participants were randomized to either intervention or sham groupings. All participants' baseline gait and balance were assessed at the initial visit and again after four weeks. Twice weekly, the intervention group participated in a training regimen based on virtual simulation for a total of four weeks. Postural sway was assessed before and after each training session. The gaming exercise consisted of a series of ankle point-to-point reaching tasks as well as crossing a series of virtual obstacles of varying heights. During exercise training, the body-mounted sensors connected to the created program to produce real-time animation of lower extremity joint position for the participant to view on a computer monitor. RESULTS: Forty-one eligible subjects have been recruited to date; however, the results of 15 participants (Age: 56.3 ± 4.9, BMI: 30 ± 15 kg/m2) who completed the four-week exercise program have been reported. The preliminary results suggest that the active group reduced ankle sway by 76% (2.82 ± 2.8° to 0.66 ± 0.47°), hip sway by 81% (7.96 ± 9° to 1.48 ± 1.2°) and center of mass (COM) sway by 76% (0.69 ± 0.7° to 0.16 ± 0.11°) during eyes open balance assessment. Similar reductions during eyes closed assessments were observed with reductions of 50%, 24% and 45% for ankle, hip and COM sway, respectively. CONCLUSION: This research implemented a novel balance rehabilitation strategy for patients with diabetic peripheral neuropathy based on virtual reality technology that helps compensate for impaired joint proprioception. The method employed body sensors to generate an interactive user interface for real-time visual feedback based on ankle-joint motion, similar to a video game. The study provides evidence that visual illustration of extremity position in an interactive setting coupled with motor control tasks may be an effective rehabilitation method for postural instability in patients with diabetic peripheral neuropathy.Item Tear Biomarkers and Corneal Sensitivity as an Indicator of Neuropathy in Type 2 Diabetes(2020-05-01T05:00:00.000Z) Iyengar, Meera Farzana; Chang, Mary; Lingvay, Ildiko; Rajora, NilumBACKGROUND: Diabetic peripheral neuropathy (DPN) is a debilitating, progressive complication of type 2 diabetes. The high cost of management leads to amputations in approximately 6% of individuals with DPN in poor-resource settings due to medical noncompliance or lack of finances. Having an effective means of early detection of DPN is crucial for early intervention, which would have a major impact in alleviating its social, economic, and medical burden. OBJECTIVES: To explore the potential of 31 tear biomarkers involved in both corneal growth and development and inflammatory pathways in screening for diabetic peripheral neuropathy (DPN). Additionally, the utility of aesthesiometry for measuring corneal damage in DPN was assessed. METHODS: This screening test pilot study recruited 90 participants from a tertiary hospital in Lima, Peru. Participants were categorized into three groups based on diabetes and neuropathy status. Tears were collected on Schirmer strips, and proteins were measured by both ELISA and multiplex-bead assay. Corneal sensitivity was measured by aesthesiometry, and DPN was measured through vibration perception threshold testing. RESULTS: A total of 89 participants were included in the analysis. The mean age was 55.7+1.46, and 58.4% were female. After adjusting for potential confounders, MMP-9 and TGF-alpha levels showed a strong upward trend in participants with DPN when compared to those with diabetes alone, though not significant. Decreased corneal sensitivity, as measured by aesthesiometry, was negatively correlated with MMP-9 levels (p<0.01) in individuals with DPN. Aesthesiometry was significantly decreased in individuals with DPN when compared to participants with diabetes alone (p<0.01) and normal controls (p<0.01). CONCLUSIONS: Although tears are a simple and inexpensive resource with promise to help detect DPN, it is an insufficient standalone tool for detecting DPN based on the present study. Aesthesiometry is a simple, inexpensive, and accurate method to assess corneal damage associated with DPN, and its integration into screening practices has potential to improve detection of DPN in poor-resource settings.Item [UT Southwestern Medical Center News](2008-07-08) Rian, Russell