Plasma adrenomedullin and peripheral neuropathy in type i diabetic patients

الملخص EN

Objective : to assess the clinical utility of adrenomedullin in juvenile diabetic patients and its correlation with neuropathy and other micro vascular complications.

Methodology : Thirty patients with type 1 DM were included in this study; another fifteen healthy age and sex matched volunteers were enrolled as controls.

Subjects with hereditary neuropathy, malignancy, peripheral neuropathies caused by other neurological diseases were excluded from the study.

All subjects underwent motor and sensory nerve conduction studies of posterior tibia, personal and sural nerves.

Accordingly, the patients were divided into 2 groups, group I: 12 patients with neuropathy and other complications and group II: 18 patients without micro vascular complications.

All patients and controls were subjected to full history taking, thorough clinical examination including goniometric assessment of range of motion of ankle, subtler and first metatarsophalangeal (MTP) joints on both sides.

Fundus examination with slit lamp microscopy and indirect ophthalmoscopy.

Laboratory assessment included random blood sugar, glycated hemoglobin (HbAIC), and determination of micro albuminuria with immunoturbidemetric method and plasma adrenomedullin level estimation with Enzyme linked Immunosorbent Assay (ELISA technique).

Results : Neuropathy and other micro vascular complications as retinopathy and nephropathy were found in 40% of juvenile diabetic patients (12 out of 30 patients).

There was a highly statistical significant difference between complicated and non-complicated diabetic patients regarding the age, disease duration, random blood sugar and adrenomedullin level (p < 0.001).

There was a statistical significant difference between them as regards the gyrated HbA1C (p < 0.05) while there was a non-statistical significant difference between controls and non-complicated patients regarding the adrenomedullin level (p > 0.05).

Also, there was a highly statistical significant difference between the 2 groups regarding all parameters of motor and sensory NCS (p < 0.001).

Among the complicated patients, there was a significant positive correlation between adrenomedullin and distal motor latencies of posterior tibial and personal nerves (r = +0.50566, r = +0.64248) (p < 0.05) and a significant negative correlation was found between adrenomedullin level and motor nerve conduction velocities of both nerves (r = -0.62897 ; r = -0.69577) (p < 0.05).

Those patients with PN had diminished range of motion of ankle plantar flexion, subtler inversion, plantar and dorsiflexion of 1st MTP compared to those patients without neuropathy (p < 0.001) while there was a non-statistical significant difference regarding the mean ankle dorsiflexion (p > 0.05).

There was significant negative correlation between adrenomedullin level, ankle plantar flexion (r = -0.52085) (p < 0.05) and first MTP dorsiflexion (r = -0.53981) (p < 0.05).

By Receiver operating characteristic (ROC) curve analysis, the diagnostic specificity, sensitivity and efficacy of adrenomedullin were 83.3% respectively to discriminate between complicated and non-complicated patients with type 1 DM.

Conclusion : the presence of peripheral neuropathy in juvenile diabetic patients was associated with risk for co-occurrence of all remaining micro vascular complications as retinopathy and nephropathy.

Patients with PN often had joint stiffness that might contribute to some functional impairment especially in the lower limbs.

The elevated levels of plasma adrenomedullin in complicated cases suggest its close relation to micro vascular complications.

This is important for early prediction of such cases to put them under strict observation and frequent follow-up by the physiatrist.