The effects of the physical procedures in patients with diabetic neuropathy

Vesna Grbović; Srdjan Stefanović; Svetlana Djukić; Jasmin Nurković; Natasa Zdraković Petrović; Katarina Parezanović Ilić; Ana S Divjak; Aleksandra Jurišić Škevin

doi:10.2298/VSP170429165G

Vesna Grbović University of Kragujevac, Faculty of Medical Sciences, Department of Physical Medicine and Rehabilitation, Kragujevac, Serbia
Srdjan Stefanović University of Kragujevac, Faculty of Medical Sciences, Department of Pharmacology and Toxicology, Kragujevac, Serbia
Svetlana Djukić Clinical Center Kragujevac, Kragujevac, Serbia
Jasmin Nurković State University of Novi Pazar, Department of Biomedical Sciences, Novi Pazar, Serbia
Natasa Zdraković Petrović Center Kragujevac, Kragujevac, Serbia
Katarina Parezanović Ilić Clinical Center Kragujevac, Kragujevac, Serbia
Ana S Divjak University of Kragujevac, Faculty of Medical Sciences, Department of Physical Medicine and Rehabilitation, Kragujevac, Serbia
Aleksandra Jurišić Škevin Clinical Center Kragujevac, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP170429165G

Keywords: diabetic neuropathies, physical therapy modelaties, treatment outcome

Abstract

Abstract

Background/Aim. Neuropathy represents the most frequent complication in the patients with diabetes mellitus (DM). Symmetric distal sensorimotor polyneuropathy (DSP), which represents the most frequent type of diabetic neuropathy, is present in 30% of hospitalized diabetic patients. The aim of our study was to compare the effects of physical therapy (PT) and alpha-lipoic acid (ALA) supplementation on pain reduction and quality of life improvement in the DSP patients. Methods. The study was performed on 60 adult patients with DM type 2 and DSP. The patients were randomly divided into 2 groups: group A (n = 30) was treated by PT and group B (n = 30) was treated by ALA. The study lasted 6 months during which 3 diagnostic-therapeutic cycles were performed. To asses their pain before and after every of 3 cycles, we used visual analog scale (VAS). We also evaluated quality of life before the 1st and after the 3rd cycle with the European Quality of Life Questionnaire (EQ-5D-3L). To analyze results between groups we used mixed between-within subjects ANOVA and statistical significance was set on p < 0.05. Results. Pain intensity showed statistically significant influence of both PT and ALA (λ = 0.028; p < 0.001). A statistically significant difference between the effects of those two therapy modalities was observed (F = 4.78; p < 0.05): PT reduced pain to the greater extent than ALA. A statistically significant improvement was found in the domain of pain/discomfort both in the group A (η = 0.54, p < 0.001) and group B (η = 0.57, p < 0.001), as well as anxiety/depression (group A: η = 0.32, p = 0.008; group B: η = 0.22, p < 0.019) and EQ-VAS (both groups, p < 0.05). Conclusion. Our research showed that physical therapy had a greater influence in pain reduction than alpha-lipoic acid in the patients with DSP.

References

REFERENCES

Shenoy AM. Guidelines in practice: treatment of painful dia-betic neuropathy.Continuum (Minneap Minn) 2012; 18(1): 192–8.

Shaw JE, Zimmet PZ, Gries FA, Ziegler D. Epidemiology of dia-betic neuropathy. In: Gries FA, Cameron NE, Low PA, Ziegler D, editors. Textbook of Diabetic Neuropathy. New York: Thieme; 2003. p. 64–82.

van Dieren S, Beulens JW, van der Schouw YT, Grobbee DE, Neal B. The global burden of diabetes and its complications: An emerging pandemic. Eur J Cardiovasc Prev Rehabil 2010; 17(Suppl 1): S3–8.

Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, et al. Diabetic neuropathies: Update on definitions, diagnostic criteria, estimation of severity, and treat-ments. Diabetes Care 2010; 33(10): 2285–93.

Shakher J, Stevens MJ. Update on the management of diabetic polyneuropathies. Diabetes Metab Syndr Obes. 2011; 4: 289–305.

Casellini CM, Vinik AI. Clinical manifestations and current treatment options for diabetic neuropathies. Endocr Pract 2007; 13(5): 550–66.

Poh ZX, Goh KP. A current update on the use of alpha lipoic acid in the management of type 2 diabetes mellitus. Endocr Metab Immune Disord Drug Targets 2009; 9(4): 392–8.

Vallianou N, Evangelopoulos A, Koutalas P. Alpha-lipoic Acid and diabetic neuropathy. Rev Diabet Stud 2009; 6(4): 230–6.

EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 1990; 16(3): 199–208.

EuroQol Group. EuroQol: EQ-5D-3L User Guide: Basic infor-mation on how to use EQ-5D-3L instrument. Version 4.0. 2011. P. 1–24.

Solli O, Stavem K, Kristiansen I. Health-related quality of life in dia¬betes: The associations of complications with EQ-5D scores. Health Qual Life Outcomes 2010; 8: 18.

Forst T, Nguyen M, Forst S, Disselhoff B, Pohlmann T, Pfützner A. Impact of low frequency transcutaneous electrical nerve stimulation on symptomatic diabetic neuropathy using the new Salutaris device. Diabetes Nutr Metab 2004; 17(3): 163–8.

Hajdu L, Naumović N, Lalić I, Todorovski Z, Kević S. The neuro-protective effects of alpha-lipoic acid in the treatment of dia-betic polyneuropathy Medicina danas 2005; 4(1–2): 159–63. (Serbian)

Kumar D, Marshall HJ. Diabetic peripheral neuropathy: Amelio¬ration of pain with transcutaneous electrostimulation. Diabetes Care 1997; 20(11): 1702–5.

Julka IS, Alvaro M, Kumar D. Beneficial effects of electrical sti-mulation on neuropathic symptoms in diabetes patients. J Foot Ankle Surg 1998; 37(3): 191–4.

Bosi E, Conti M, Vermigli C, Cazzetta G, Peretti E, Cordoni MC, et al. Effectiveness of frequency-modulated electromagnetic neu¬ral stimulation in the treatment of painful diabetic neuro-pathy. Diabetologia 2005; 48(5): 817–23.

Bosi E, Bax G, Scionti L, Spallone V, Tesfaye S, Valensi P, et al. Fre¬quency-modulated electromagnetic neural stimulation (FREMS) as a treatment for symptomatic diabetic neuropathy: Results from a double-blind, randomised, multicentre, long-term, placebo-controlled clinical trial. Diabetologia 2013; 56(3): 467–75.

Armstrong DG, Lavery LA, Fleischli JG, Gilham KA. Is electrical stimulation effective in reducing neuropathic pain in patients with diabetes. J Foot Ankle Surg 1997; 36(4): 260–3.

Oyibo SO, Breislin K, Boulton AJ. Electrical stimulation therapy through stocking electrodes for painful diabetic neuropathy: a double blind, controlled crossover study. Diabet Med 2004; 21(8): 940–4.

Balducci S, Iacobellis G, Parisi L, Di Biase N, Calandriello E, Leon¬etti F, et al. Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Complications 2006; 20(4): 216–23.

Fisher MA, Langbein WE, Colins EG, Williams K, Corzine L. Physiological improvements with moderate exercise in type II diabetic neuropathy. Electromyogr Clin Neurophysiol 2007; 47: 23–8.

Kahn J. Principles and practice of electrotherapy. 4th ed. New York: Churchill Livingstone; 2000.

Ivanov KM, Miasnikova NV, Ovchinnikova TI, Sizova TP, Cheme-zova TP. The use of transcutaneous electrostimulation in the treatment of diabetic angioneuropathy. Vopr Kurortol Fizioter Lech Fiz Kult 1998; (2): 30–1.

Han JS, Chen XH, Sun SL, Xu XJ, Yuan Y, Yan SC, et al. Effect of low- and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin A immunoreactivity in human lumbar CSF. Pain 1991; 47(3): 295–8. PubMed PMID: 1686080

Garrison DW, Foreman RD. Effects of transcutaneous electrical nerve stimulation (TENS) on spontaneous and noxiously evoked dorsal horn cell activity in cats with transected spinal cords. Neurosci Lett 1996; 216(2): 125–8.

Dubinsky RM, Miyasaki J. Assessment: efficacy of transcutane-ous electric nerve stimulation in the treatment of pain in neu-rologic disorders (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2010; 74(2): 173–6.

Cheing GL, Luk ML. Transcutaneous electrical nerve stimula-tion for neuropathic pain. J Hand Surg Br 2005; 30(1): 50–5.

Gossrau G, Wähner M, Kuschke M, Konrad B, Reichmann H, Wiede¬mann B, et al. Microcurrent transcutaneous electric nerve stimulation in painful diabetic neuropathy: A randomized pla-cebo-controlled study. Pain Med 2011; 12(6): 953–60.

Jin DM, Xu Y, Geng DF, Yan TB. Effect of transcutaneous elec¬trical nerve stimulation on symptomatic diabetic peripheral neuropathy: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2010; 89(1): 10–5.

Musaev AV, Guseinova SG, Imamverdieva SS. The use of pulsed electromagnetic fields with complex modulation in the treat-ment of patients with diabetic polyneuropathy. Neurosci Be-hav Physiol 2003; 33(8): 745–52.

Graak V, Chaudhary S, Bal BS, Sandhu JS. Evaluation of the effi¬cacy of pulsed electromagnetic field in the management of patients with diabetic polyneuropathy. Int J Diabetes Dev Ctries 2009; 29(2): 56–61.

Weintraub MI, Herrmann DN, Smith GA, Backonja MM, Cole SP. Pulsed electromagnetic fields to reduce diabetic neuropathic pain and stimulate neuronal repair: A randomized controlled trial. Arch Phys Med Rehabil 2009; 90(7): 1102–9.

Kluding PM, Pasnoor M, Singh R, Jernigan S, Farmer K, Rucker J, et al. The effect of exercise on neuropathic symptoms, nerve function, and cutane-ous innervation in people with diabetic peripheral neuropathy. J Diabetes Complication 2012; 26(5): 424–9.

Mijnhout G, Kollen BJ, Alkhalaf A, Kleefstra N, Bilo HJ. Alpa li-poic acid for symp-tomatic periferal neuropathy in patients with diabetes: A meta-analysis of randomized controlled trials. Int J Endocrinol 2012; 2012: 456279.

Barclay L. Alpha-Lipoic Acid Helpful in Diabetic Neuropathy. Diabetes Care 2003; 26: 770–6.

Ziegler D, Nowak H, Kempler P, Vargha P, Low PA. Treatment of symptomatic diabetic polyneuropathy with the antioxidant al¬pha-lipoic acid: A meta-analysis. Diabet Med 2004; 21(2): 114–21.

Ziegler D, Low PA, Boulton AJ, Vinik AI, Freeman R, Samigullin R, al. Effect of 4-year antioxidant treatment with al-pha-lipoic acid in diabetic polyneuropathy: The NATHAN 1 Trial. Dia¬betes 2007; 56(Suppl 1): A2.

Bertolotto F, Massone A. Combination of alpha lipoic acid and su¬peroxide dismutase leads to physiological and symptomatic improvements in diabetic neuropathy. Drugs R D 2012; 12(1): 29–34.

Patel N, Mishra V, Patel P, Dikshit RK. A study of the use of car¬bamazepine, pregabalin and alpha lipoic acid in patients of diabetic neuropathy. J Diabetes Metab Disord 2014; 13: 62.

Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The preva-lence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care 2001; 24(6): 10069–78.

Musselman DL, Betan E, Larsen H, Phillips LS. Relationship of de¬pression to diabetes types 1 and 2: Epidemiology, biology, and treatment. Biol Psychiatry 2003; 54(3): 317–29.

Luscombe FA. Health-related quality of life measurement in type 2 diabetes. Value Health 2000; 3(Suppl 1): 15–28.

Watkins K, Connell CM. Measurement of health-related QOL in diabetes mellitus. Pharmacoeconomics 2004; 22(17): 1109–26.

Anderson RM, Fitzgerald JT, Wisdom K, Davis WK, Hiss RG. A comparison of global versus disease-specific quality-of-life measures in patients with NIDDM. Diabetes Care 1997; 20(3): 299–305.

Grandy S, Fox KM; SHIELD Study Group. Change in health status (EQ-5D) over 5 years among individuals with and with-out type 2 diabetes mellitus in the SHIELD longitudinal study. Health Qual Life Outcomes 2012; 10: 99.

Wróbel MP, Szymborska-Kajanek A, Wystrychowski G, Biniszkiewicz T, Sieroń-Stołtny K, Sieroń A, et al. Impact of low frequency pulsed magnetic fields on pain intensity, quality of life and sleep disturbances in patients with painful diabetic polyneuro¬pathy. Diabetes Metab 2008; 34(4 Pt 1): 349–54.

Zanuso S, Balducci S, Jimenez A. Physical activity, a key factor to quality of life in type 2 diabetic patients. Diabetes Metab Res Rev 2009; 25 Suppl 1: S24–8.