Association between visceral, cardiac and sensorimotor polyneuropathies in diabetes mellitus

• Published in: Journal of diabetes and its complications Vol. 28; no. 3; pp. 370 - 377
• Main Authors: Søfteland, Eirik, Brock, Christina, Frøkjær, Jens B, Brøgger, Jan, Madácsy, László, Gilja, Odd H, Arendt-Nielsen, Lars, Simrén, Magnus, Drewes, Asbjørn M, Dimcevski, Georg
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2014; Elsevier Limited
• Subjects: Age; Aged; Autonomic Neuropathy; Autonomic Pathways - physiopathology; Case-Control Studies; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - physiopathology; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Diabetic Nephropathies - etiology; Diabetic Nephropathies - physiopathology; Dietary fiber; Endocrinology & Metabolism; Endocrinology and Diabetes; Endokrinologi och diabetes; Experimental; Female; Gastroenterologi; Gastroenterology and Hepatology; Gastrointestinal; Gastrointestinal Diseases - epidemiology; Gastrointestinal Diseases - physiopathology; Heart - innervation; Heart rate; Heart Rate - physiology; Heart Rate Variability; Humans; Hypesthesia - epidemiology; Hypesthesia - physiopathology; Male; Middle Aged; Pain; Patients; Peripheral Nerves - physiopathology; Peripheral Neuropathy; Polyneuropathies - etiology; Polyneuropathies - physiopathology; Prevalence; Quality of Life; Sensorimotor Cortex - physiopathology; Sensory perception; Skin - innervation; Standard deviation; Studies; Viscera - innervation; Visceral; Autonomic Neuropathy; Pain; Experimental; Visceral; Diabetes; Gastrointestinal; Peripheral Neuropathy; Heart Rate Variability
• ISSN: 1056-8727; 1873-460X; 1873-460X
• DOI: 10.1016/j.jdiacomp.2013.10.009

Abstract Aims Gastrointestinal complaints are common in diabetes mellitus. However, its association to peripheral sensorimotor and autonomic neuropathies is not well investigated. The aim was to assess skin, muscle, bone and visceral sensitivity in diabetes patients with sensorimotor neuropathy, and correlate these with gastrointestinal symptoms and degree of cardiac autonomic neuropathy. Methods Twenty patients with sensorimotor neuropathy (65% type 2 diabetes, aged 58.3 ± 12.0 years, diabetes duration 15.8 ± 10.0 years) and 16 healthy controls were recruited. Cutaneous sensitivity to von Frey filaments, mechanical allodynia, muscle/bone/rectosigmoid sensitivities, and heart rate variability were examined. Gastrointestinal symptom scores (PAGI-SYM) and health-related quality of life (SF-36) were also recorded. Results Patients displayed hypesthesia to von Frey filaments ( p = 0.028), but no difference to muscle and bone pain sensitivities. Also, patients were hyposensitive to multimodal rectal stimulations (all p < 0.05), although they suffered more gastrointestinal complaints. Heart rate variability was reduced in the patient cohort. Rectal mechanical and cutaneous sensitivities correlated (p < 0.001), and both were associated with heart rate variability as well as PAGI-SYM and SF-36 scores ( p < 0.01). Conclusions In diabetic sensorimotor neuropathy there is substantial evidence of concomitant cutaneous, cardiac and visceral autonomic neuropathies. The neuropathy may reduce quality of life and explain the higher prevalence of gastrointestinal complaints.