Vibration threshold, ULNT1, Diabetes mellitus
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Background: Patients withType II diabetes mellitus are showed to affect the sensory, reflex and motor systems in distal extremities. Studies have examined the mechanosensitivity and vibration threshold (VT) in type II diabetes mellitus patients in the lower limb and compared it with normal individuals. There is scanty literature available in comparison of the VTin the upper limb in type II diabetes mellitus patients with non-diabetic individuals.
Methods: Thirty type II diabetic individuals (age - 55.60 ± 9.79 years)and 30 asymptomatic individuals (age - 53.43±9.96) without diabetes mellitus participated in the study. Tester at the baseline for both the groups using a bioesthesiometer measured VT. Bioesthesiometer is capable of deriving a vibration of 100 Hz. Following VTevaluation at the baseline, the tester performed the ULNT1 for all the subjects. During the sequence of the ULNT1, VTwas measured at initial onset of pain (termed as P1) and short of maximum pain (P2) as experienced by the patient.
Results:There was a statistical significant difference inVTbetween diabetic and non-diabetic group subjects. VTwas raised in the diabetic group at all the three levelsof evaluation (baseline, P1 and P2) compared to the non-diabetic group with a p value < 0.001.
Conclusion: VT of the upper limb is higher in individuals with type II diabetes mellitus as compared to non-diabetic individuals.
Diabetes mellitus is a group of metabolic syndrome which is characterized by increased levels of glucose in the blood resulting from impaired insulin secretion, insulin action, or both . Type II diabetes mellitus is most common form which is a disease of insulin resistance that usually has relative (rather than absolute) insulin deficiency . Earliest functional change in diabetic nerve is change in axonal excitability due to alterations in ion conductance of axon membrane due to metabolic processes directly affecting the nerves, microvascular abnormalities of the endoneurium and autoimmune inflammation . Four main mechanisms have been postulated to underlie the pathogenesis of nerve pathology in diabetes mellitus, which are metabolic processes directly affecting nerve fibres, endoneurial microvascular disease, autoimmune inflammation and deranged neurotrophic support [2,3]. These changes are due to these effects of elevated levels of glucose which involves the peripheral nerve in type II diabetes mellitus subjects. It has been documented that most of type II diabetic patients have peripheral neuropathy . Among the nerves, there is a tendency of the large diameter nerve fibers that mediate sense of vibration to get involved first in diabetes mellitus .
Neurodynamic tests involve sequential limb movements that are employed to elicit the connection between physiological and mechanical types of different mechanisms [6, 7]. The main ambition of using these different tests in assessment of a nerve function is to mechanically stimulate and mobilize neural tissues in order to get an expression of their mobility and sensitivity to mechanical stresses so as to arouse the physiological responses [7, 8]. In order to assess the upper limb nerve function, the standard upper limb neurodynamic test 1 (ULNT1) is usually used as it evokes symptoms of distribution of the median nerve because the forces generated by this test are biased towards this structure . There are various techniques of assessing the conductivity of nerve such as nerve conduction velocity that basically assesses the motor and sensory aspects of the nerve. Whereas, vibration threshold (VT) reflects particular function of the peripheral nervous system especially the somatosensory pathway [8,9].
Type II diabetes mellitus patients are showed to affect the different multimodal systems (sensory, reflex and motor) in distal extremities [10, 11]. Mechanosensitivity in diabetes mellitus patients should be considered as an essential inclusion in the assessment to predict the extent of involvement of the nerve . Studies have also been done to determine the VTin lower limb in normal individuals but there is scanty literature available in comparison of the VTin the upper limb in type II diabetes mellitus patients when compared with non diabetic subjects.
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We conclude that VTin subjects with type 2 diabetes mellitus is increased when compared to asymptomatic individuals. Physical therapists should consider this finding during evaluation and management of patients with type ll diabetes mellitus.
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