Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2020; 11(7): 309-321
Published online Jul 15, 2020. doi: 10.4239/wjd.v11.i7.309
Relationship between diabetic polyneuropathy, serum visfatin, and oxidative stress biomarkers
Banu Buyukaydin, Eray Metin Guler, Tahsin Karaaslan, Atilla Olgac, Mehmet Zorlu, Muharrem Kiskac, Abdurrahim Kocyigit
Banu Buyukaydin, Atilla Olgac, Mehmet Zorlu, Muharrem Kiskac, Department of Internal Medicine, Bezmialem Vakif University Medical Faculty, İstanbul 34093, Turkey
Eray Metin Guler, Abdurrahim Kocyigit, Department of Medical Biochemistry, Bezmialem Vakif University Medical Faculty, İstanbul 34093, Turkey
Tahsin Karaaslan, Department of Nephrology, Istanbul Medeniyet University Medical Faculty, İstanbul 34093, Turkey
Author contributions: Buyukaydin B designed the study and wrote the paper; Guler EM performed research; Karaaslan T, Olgac A, Zorlu M, and Kiskac M participated in data collection and analysis; Kocyigit A interpreted the data and drafted the initial manuscript.
Institutional review board statement: The study was reviewed and approved by the Bezmiâlem Vakıf University Clinical Research Ethics Committee Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Banu Buyukaydin, MD, Academic Research, Doctor, Department of Internal Medicine, Bezmialem Vakif University Medical Faculty, Adnan Menderes Street, İstanbul 34093, Turkey. bbuyukaydin@hotmail.com
Received: December 30, 2019
Peer-review started: December 30, 2019
First decision: March 24, 2020
Revised: May 8, 2020
Accepted: May 12, 2020
Article in press: May 12, 2020
Published online: July 15, 2020
Processing time: 196 Days and 10.4 Hours
ARTICLE HIGHLIGHTS
Research background

Diabetic polyneuropathy is the most common complication of type 2 diabetes. However, there is no standard method for clinical follow-up and early diagnosis.

Research motivation

Diagnosis of neuropathy is possible only with special examination methods before clinical signs and symptoms. Studies on pathogenesis continue to be conducted on the basis of evidence. However, there is a need for practical methods for early diagnosis.

Research objectives

With this study, we aimed to investigate the frequency of neuropathy in our patients, to test the sensitivity of the interrogation methods used, and to investigate the location of visfatin and thiol balance, which have not yet been studied in pathogenesis.

Research methods

Neuropathy examinations were completed with two defined questionnaires and examination methods: Subjective Peripheral Neuropathy Screen and Michigan Neuropathy Screening Instrument (MNSI). At the same time, venous samples were taken and stored under appropriate conditions until analysis. The analysis included biochemistry panels, oxidative stress parameters, visfatin, and thiol disulfide balance. The last two parameters were evaluated for the first time specifically for this patient group.

Research results

A total of 392 patients were evaluated (271 female, 121 male). The mean age of the patients was 57.5 ± 9.0 years. The mean diabetes period was 12.00 ± 7.29 years. The mean Subjective Peripheral Neuropathy Screen Questionnaire score was 5.6 ± 3.6, the mean MNSI questionnaire score was 4.5 ± 2.3, and the mean MNSI exam score was 2.4 ± 2.0 points. Subjective Peripheral Neuropathy Screen Questionnaire, MNSI questionnaire, and MNSI exam scores were correlated with each other (P < 0.005). There was a positive linear relationship between MNSI examination scores and glycated hemoglobin, visfatin, total oxidant status, and oxidative stress index. Visfatin was positively correlated with higher glucose, glycated hemoglobin, total oxidant status and oxidative stress index (P < 0.005, r = 0.537, r = 0.753, r = 0.407, r = 0.587), and it was negatively correlated with total antioxidant status (r = -0.499). Total and native thiol was negatively correlated with glucose, glycated hemoglobin, total oxidant status, and oxidative stress index, but it was positively correlated with total antioxidant status. A statistically significant negative correlation was detected between visfatin and total with native thiol (P < 0.005, r = -0.338), (P < 0.005, r = -0.448).

Research conclusions

The sensitivity of the survey methods is low in the diagnosis of neuropathy. The place of oxidative stress in pathogenesis is indisputable. Neuropathy complaints must be included in the clinical examination of the patient, but its reliability is low. The sensitivity of the neuropathy examination is partially higher. However, its applicability is time consuming and difficult in the internal medicine clinic. Increased oxidative stress starts nerve damage in these patients without any clinical symptoms. Visfatin and thiol disulfide balance are being investigated in the pathogenesis of many diseases. It has been shown with this study that they may have a role in the development of polyneuropathy in pathogenesis. Routine monitoring of these parameters in patients with diabetes may be a practical approach for early diagnosis. However, the sensitivity levels of these techniques should be tested together with standard methods. In addition, comparisons for these parameters between patients with different levels of neuropathy, comorbidities, glycemic regulation, and using drugs are promising studies.

Research perspectives

With this study, we observed how often neuropathy was in patients admitted to internal medicine clinics. We found that there is a need for a practical method for early diagnosis within the clinic. The pathogenesis of neuropathy is one of the issues illuminated in many aspects. These markers, which are thought to be involved in the pathogenesis, should continue to be studied, and their practical use should be evaluated.