Association of Diabetic Peripheral Neuropathy with.pptx

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1. Association of Diabetic Peripheral Neuropathy with Micronutrients MODERATOR- DR FATHIMATH UNAIZA PRESENTED BY – DR MOHAMMED AMEER KP

2. Journal of the Association of Physicians of India, Volume 72 Issue 5 (May 2024) Sandhya Gautam Chhaya Mittal Alok Ranjan Gajraj Singh

3. Introduction Uncontrolled blood sugar is commonly associated with many microvascular and macrovascular complications. This can be prevented or delayed by a healthy diet, physical activity, avoiding smoking and alcohol, and maintaining normal body weight. Micronutrients are essential nutrients that our body requires in a very small amount on a daily basis. The association of diabetes with trace elements like copper (Cu), magnesium (Mg), vitamin B12 (Vit B12), and zinc (Zn) has been seen in many studies.

4. Trace elements like Cu, chromium, Mg, Zn, manganese, and selenium enhances insulin action, as a cofactor or component for enzymes that are involved in glucose metabolism, activation of insulin receptor sites, increasing insulin sensitivity, they act as an antioxidant and prevent peroxidation in tissues.

5. Diabetic complications can be divided into two broad categories: Microvascular complications diabetic retinopathy diabetic nephropathy diabetic neuropathy Macrovascular complications coronary artery disease peripheral vascular disease cerebrovascular disease

6. Decrease in antioxidant defense, which increases the production of ROS. This oxidative stress is responsible for many diabetic complications. Micronutrients play a role in the genesis of oxidative stress, and some minerals and vitamins can be used to decrease oxidative stress and improve glycemic control. This study is conducted to see the association of micronutrients in patients with diabetic peripheral neuropathy (DPN).

7. Aims and Objectives To see the distribution of DPN in various age and sex groups among diabetics. To see the association between DPN and the level of micronutrients among diabetics

8. Materials and methods Cross-sectional study was conducted to assess the level of micronutrients in peripheral neuropathy patients among diabetics at Lala Lajpat Rai Memorial Medical College, Meerut Inclusion Criteria – Age 18–65 years. Patients consenting to take part in the study.

9. Exclusion Criteria Taking vitamin, mineral supplements, thyroid hormones , estrogens , progesterone, and diuretics History of myocardial infarction, hepatic disease, psychiatric disorders, and alcoholism. Pregnant and lactating female.

10. All the study participants have undergone CBC RFT LFT hemoglobin A1c, both fasting and postprandial blood sugar FLP level of Zn, Cu, Mg, and Vit B12.

11. All the diabetic patients were assessed for DPN by using the Michigan neuropathy screening instrument. A physical examination of both feet was done. The total possible score of physical examination is 8, and patients who had a score of 2.5 or more were considered to have DPN.

12. OBSERVATION AND RESULTS Total of 130 patients . Out of these, 65% were male, and 35% were female. 8.5% belonged to the 18–35 years age-group, while 40% were in the 35–50 years age-group. Around 51.5% of study subjects were >50 years old. Around 67% of study subjects were vegetarian, and 33% were nonvegetarian

13. On the basis of the Michigan neuropathy screening instrument, out of 130 study subjects, 28 (21.53%) were found to have DPN 9.1% of the 18–35 years age-group developed peripheral neuropathy. In the 35–50 years age-group, 9.6% develop DPN. While in the >50 years agegroup , 32.8% develop the DPN

14. In the present study, 21.5% of diabetics developed DPN DPN was observed to increase significantly with increasing age 50% of patients with low Cu levels develop DPN. While 23.6% of patients with high Cu values develop DPN, indicating that though Cu levels were higher among diabetics, patients with low Cu levels were found to be more prone to develop neuropathy

15. mean serum Zn level was significantly lower in the DPN group Among those with low Zn levels, 24.19% develop DPN, while 50% of patients with high Zn levels develop DPN 43.9% of diabetic patients were found to have low Mg levels, and only 8.4% had high Mg levels Proportion of patients developing DPN was high among those with high serum Mg levels (36.36%), compared to 24.56% among those with low Mg levels.

16. 31.5% had low Vit B12 levels, and 6.9% had high Vit B12 levels. A total of 17 (41.46%) among those with low Vit B12 levels develop DPN. The Association between Vit B12 and DPN was found to be highly significant (p-value of 0.0008).

17. CONCLUSION It can be concluded from the study that altered levels of trace elements have a role in the pathogenesis and progression of DM. It has a significant role in the complications of diabetes especially diabeteic neuropathy. The decreased blood levels of Zn, Mg, and Vit B12 and increased blood levels of Cu, as have been found in the present study, can be utilized for the management of DM

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