Diyabetes mellitusta iyi glisemik kontrol ile nöropati geliþimi önlenebilir mi?

Amaç: Çalýþmamýzda tedavilerinde oral antidiyabetiklerden insüline geçilen diyabetes mellitus (DM) tanýlý hastalarda insülinin periferik sinirler üzerindeki etkisini araþtýrmayý amaçladýk. Ayrýca daha önceki çalýþmalarda vurgulandýðý gibi F yanýtýnýn polinöropatinin saptanmasýndan ziyade glisemik kontrol ile polinöropati seyrinin takibinde bir parametre olarak kullanýlabilirmi sorusuna yanýt aradýk.
Gereç ve Yöntem: Çalýþmamýza Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Diyabet Polikliniðinde Amerikan Diyabet Cemiyeti (American Diabetes Association, ADA) kriterlerine göre DM tanýsý alan, oral antidiyabetik tedavi ile izlenmekte iken, insülin tedavi endikasyonu belirlenen 10 gönüllü diyabetik hasta alýndý. Tüm hastalarýn tedavi öncesi, tedavinin 1.ve 4. haftasýnda nörolojik muayene ile Total Nöropati Skorlamasý (TNS), serum glukoz ile HbA1c düzeyleri ve elektrofizyolojik deðerlendirmeleri yapýldý.
Bulgular: Çalýþmaya alýnan toplam 10 olgunun 7’si kadýn, 3’ü erkek idi. Yaþ ortalamasý 55±9.01 (40-69) idi. Olgularýn DM süreleri 1 ile 15 yýl arasýnda deðiþmekteydi (ort: 6.2±4.83). Olgularýn dördünde baþlangýç elektrofizyolojik deðerler normal sýnýrlar içindeydi. Beþ olguda alt ekstremitelerde duyusal lifleri, bir olguda üst ekstremitelerde duysal alt ekstremitelerde duyusal ve motor lifleri tutan polinöropati sendromu
tespit edildi. Polinöropatisi olmayan veya ýlýmlý nöropatisi olan olgularýn kontrol elektrofizyolojik incelemelerinde özellikle duyusal ileti amplitüdlerinin iyileþtiði ancak baþlangýçta belirgin polinöropatisi olan olgularýn kontrol elektrofizyolojik incelemelerinde anlamlý bir fark olmadýðý görülmüþtür.
Sonuç: Erken evre polinöropatinin aksine þiddetli polinöropati ortaya çýktýktan sonra iyi glisemik kontrol ile bir düzelme tespit edilmemektedir.

Can development of neuropathy be prevented with good glycemic control in diabetes mellitus?

Objective: In our study, we aimed to investigate the effect of insulin treatment on peripheral nerves in patients with diabetes mellitus (DM) who under the oral antidiabetic therapy changed to insulin treatment. Additionally, we have searched for answer to the question that could F response used for as a parameter on monitoring the course of polyneuropathy with glycemic control. F response which use in the detection of polyneuropathy has been emphasized in previous studies.
Material and Method: Ten voluntary diabetic patients who received indication insulin treatment while being monitored with oral antidiabetic treatment and diagnosed according to the American Diabetes Association (ADA) criteria were included in our study. All our patients were outpatients of Þiþli Etfal Training and Research Hospital Diabetes Mellitus Clinic. All patients were evaluated for neurological examination, serum glucose and HbA1c levels, total neuropathy score (TNS) and electrophysiological evaluations before insulin treatment and in the first and fourth week of the treatment.
Results: Seven of patients were women and three of them were men. Age of patients were ranged from 40 to 69 and the mean age was 55±9.01. DM duration of patients ranged from 1 to 15 years (mean: 6.2±4.83). On the first Electrophysiologic evaluations of four patients were assessed within normal limits. We detected sensory polyneuropathy in lower extremities in five patients and a polyneuropathy
syndrome which affecting sensory fibers in the upper extremity and both sensory and motor fibers in the lower extremities in the remaining patient. We observed particularly improvement the sensory conduction amplitude in the control electrophysiological evaluation of the patients with moderate neuropathy or without polyneuropathy but there was not a significant difference in control electrophysiological evaluation of the patients with severe polyneuropathy in the initial evaluation.
Conclusion: After occurring severe polineuropathy syndrome there is not any improvement with good glicemic control whereas early stage of polyneuropathy.