Diabetes mellitus is most prevalent non communicable disease across all social strata in India and is debilitating, with complications that produce severe morbidity and mortality in people. Diabetic neuropathy is common and very severe complication deserving due prompt recognition and care. The study was undertaken to find out positive correlation of peripheral neuropathy severity and duration of diabetes.

To evaluate the positive correlation of peripheral neuropathy severity and duration of diabetes

A prospective study of diabetic peripheral neuropathy patients admitted in OP and IP of SMCH between January 2019 to February 2019

✓To study the clinical pattern of peripheral neuropathy in diabetic patients 

✓To study the CMAP and SNAP amplitudes and latency of peripheral nerves in lower limbs 

✓To study the f minimum latency of peripheral nerves in lower limbs

✓To correlate the electrophysiological outcome with duration of diabetes

This study shows that the neuropathic involvement increases with age of the subjects. Sensory axonopathy occurs earlier by motor and sensory axonopathy. There is no significant sex predilection for pattern of neuropathy. So in our study, there is obvious involvement of sensory neuropathy in the form of axonopathy with decreased amplitude and NC.

Conclusion

The most common pattern of involvement of neuropathy in our study subjects were sensory or sensorimotor axonal neuropathy. The severity of neuropathy increased with the age of the patient.

Neuropathy is among the most frequent and disabling complication of diabetes mellitus. As with other major diabetic complications, pathogenesis remains enigmatic and its therapy controversial. The prevalence of neuropathy appears to correlate with duration and severity of hypoglycaemic in both type-1 and type-2 DM. A pathogenic. A pathogenic role for metabolic alterations of insulin deficiency is well established for diabetic nerve that are consequences of elevated ambient glucose concentration have been established.

The patient were screened for diabetes based on the American Diabetes association criteria for diabetes mellitus. Then patients under went detailed general examination and neurological examination. All the patients were subjected to nerve conduction study (NCS) of lower limb by selecting two sensory (sural nerve and superficial nerve) and two motor nerves (Tibial nerve and common peroneal nerve) with Allengers Medicare Pvt Ltd Scorpio model for EMG, EP and NCS under the guidance of neurophysiologist. The findings were recorded.

DETAIL OF NCS RECORDING

All studies were performed with surface electrodes on physio-pac single channel polygraph with NCV, using the standardized technique. The nerves were stimulated using 0.1 ms electrical pulses with anintensity sufficient to elicit maximal amplitude of compound muscle action potiential and sensory nerve action potential. Onset latency, conduction velocity, amplitude and F minimal responses were measured. For the F response, 10 stimuli is given at frequency of 1/s. A F wave is defined as an action potential of amplitude ≥20µV

The latency to onset of the first deflection from the baseline was marked for each trace and the shortest latency (minimal F – wave latency) was determined. In addition, F- wave persistence (number of stimuli eliciting F-waves) was determined. For each nerve study was conducted on both the sides of subjects would be assessed based on the pattern of involvement of neuropathy, motor sensory axonopathy and sensory axonopathy.

Nerve conduction study was carried out on patients of Diabetes mellitus in Saveetha Medical Hospital of duration from January 2019 to February 2019

In this Study, the patient’s with diabetes were assed with nerve conduction. Nerve conduction changes associated with diabetic Neuropathy include decrease in amplitude, conduction velocity and prolongation in latency. Axonal loss reflects smaller amplitude changes and slowing of conduction velocity could be the result of a combination of segmental demyelination, loss of fastest conduction axons, and metabolic alterations.

Statistical Analysis was applied to study the difference between motor and sensory nerves parameters within the subgroups. The subgroups were motor and sensory axonopathy, sensory axonopathy and those with normal NCS parameters.

In present study, a significant difference was found between the NCS parameters of study group. A longer latency with smaller amplitude and smaller conduction velocity was found in all the nerves in both motor and sensory NCS of diabetic patients.

AGE The Mean age of the study group with motor and sensory axonopathy (N=12) is 59.08±6.05 years. The Mean age of the study group with sensory axonopathy (N=14) is 56.57±13.69 years. The Mean age of the normal group with diabetes (N=4) is 49.5±9.88 years. So, the neuropathic involvement increases with age of the subjects. Sensory axonopathy occurs earlier by motor and sensory axonopathy.

SEX In the present study group of motor and sensory axonopathy (N=12) 50% (6) were males and 50% (6) were females. In the present study group of sensory axonopathy (N=14) 57% (8) were males and 42.9% (6) were females In the present study group of diabetic patients with normal conduction (N=4) 50% (2) were males and 50% (2) were females. There is no significant sex predilection for pattern of neuropathy.

In our study, there is significant difference in peroneal motor amplitude (P= 0.014) on both sides compared to normal NCS parameter diabetic subjects. This indicates significant peroneal nerve involvement compared to the tibial nerve.

In our study, there is significant difference in amplitude, latency and NCV of both sural and superficial peroneal amplitude on both sides compared with normal subjects. This indicates significant involvement of both sensory nerves.

In our study, involving comparsion of pure sensory axonopathy with normal NCS parameter subjects, there is significant difference in peroneal motor amplitude. This indicates early involvement of peroneal nerves with sensory neuropathy.

So in our study, there is obvious involvement of sensory neuropathy in the form of axonopathy with decreased amplitude and NC.