Therapeutic training in complex therapy in type 2 diabetes patients with distal diabetic neuropathy

• I.I. Dubinina
• S.V. Berstneva
• V.A. Zhadnov
• L.V. Tverdova
• V.V. Baranov

Abstract

Aim - to study the effect of complex therapy and therapeutic training with distant support upon quality of life (QoL) in type 2 diabetes patient with distal diabetic neuropathy.

Material and methods. Forty-nine type 2 diabetes patients with diabetic neuropathy (DN) have been studied who were taking the therapeutic training in the Diabetes School under a structured program with further distant support. The dynamic of HbA1c has been studied, along with the glycemia variability by using the 8-point self-monitoring of blood glucose with standard deviation (SD) and coefficient of variation (CV) calculation. Cholesterol, low density lipids (LDL), high density lipids (HDL), triglycerides (TG) and atherogenic index (AI) were determined. Neurological symptoms under TSS (Total Simptom Score) and NIS-LL (Neuropathy Impairment Score in the Lower Limbs) scales with the analysis of temperature sensitivity, visual-analog scale and the MacGill pain questionnaire were examined. Arteries of lower extremities have been examined by ultrasonic Doppler examination, electroneuromyography has been provided for n. tibialis and n. peroneus to determine the M-wave, along with nerve conduction velocity (NCV) and residual latency (RL). QoL has been assessed by using the ADDQoL questionnaire upon the arrival to the clinic and in 12 weeks thereafter.

Results. As a result of therapeutic training in the Diabetes School under a structured program with further distant support, the type 2 diabetes patients have been found with a decreased HbA1c level, reduced fasting glycaemia, in 2 hours after having breakfast and before bed, decreased glycaemia variability, TG and AI levels. The subclinical stage in 12 weeks has shown increased vibration and tactile sensitivity, M-wave, reduced RL and increased NCV levels. The clinical stage has shown decreased numbness, paresthesia, and the reduced number of points for applicable descriptors according to the McGill questionnaire, the increased NCV and decreased RL. The complicated DN stage shows decreased numbness and a trend to decreased burning, paresthesia, and lightning pains under the TSS scale. The ADDQoL questionnaire revealed an improved average QoL level in DN patients at the subclinical stage, whereas the clinical and complicated stages showed a substantially decreased number of scales reflecting positive dynamics.

Conclusion. Therapeutic training in the Diabetes School with further distant support proved to be efficient in achieving the carbohydrate metabolism compensation. Increased vibration, tactile sensitivity and M-wave, reduced RL and increased NCV levels as measured for n. tibialis and n.peroneus have been found at the subclinical and clinical stages of diabetic neuropathy. Significant improvement of quality of life parameters has been revealed at the subclinical stage of diabetic neuropathy.

Keywords:diabetes mellitus, quality of life, diabetic neuropathy, subclinical stage, electroneuromyography, therapeutic training, Diabetes School

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