Evaluation of interoceptive accuracy in diabetic individuals with or without polyneuropathy

Yıl 2024, Cilt: 29 Sayı: 1, 62 - 68, 27.01.2024

Serkan Aksu Melik Gürsoy Esra Daloğlu Yadigar Bacakoğlu Gülnihal Kutlu

https://doi.org/10.21673/anadoluklin.1336415

Öz

Aim: Diabetic peripheral neuropathy (DPN) is a heterogeneous disease with a complex pathophysiology that can affect both autonomic and somatic components of the nervous system. Interoception is a perceptual and cognitive concept expressing the internal sensory perception that evaluates signals from the body and internal organs. Interoceptive abilities have been indicated to be reduced in various chronic pain syndromes and chronic neuropathies. That said, interoceptive skills in individuals with Type 2 Diabetes Mellitus with and without a previous DPN comorbidity have not been comparatively examined. We aimed to examine whether there is a difference in terms of interoceptive accuracy in individuals diagnosed with Type 2 Diabetes Mellitus with and without DPN for the first time.

Methods: 20 individuals with a diagnosis of Type 2 Diabetes Mellitus with a co-diagnosis of DPN and 20 individuals with a diagnosis of Type 2 Diabetes Mellitus without a co-diagnosis of DPN were recruited in the Electroneurophysiology Laboratory of Muğla Sıtkı Koçman University. The presence of DPN was evaluated with both Toronto Clinical Scoring System and electromyographic examination. General cognitive status was evaluated with the Mini-Mental State Examination, general psychiatric status with the Patient Health Questionnaire-9, and cardiac interoceptive accuracy with the Heartbeat Counting Test.

Results: No difference was found in terms of cardiac interoceptive accuracy in individuals with Type 2 Diabetes Mellitus with and without DPN.

Conclusions: The potential decrease in cardiac interoception might be related to chronic pain or autonomic neuropathy rather than the presence of DPN. Studies examining interoception in these subgroups are required.

Anahtar Kelimeler

Cognition, diabetic polyneuropathy, neurophysiology, Type 2 Diabetes Mellitus

Polinöropatisi olan ve olmayan diyabetik bireylerde interoseptif keskinliğin değerlendirilmesi

Öz

Amaç: Diyabetik periferik nöropati (DPN), kompleks bir patofizyolojisi olan ve sinir sisteminin otonom ve somatik olmak üzere her iki komponentini de etkileyebilen heterojen bir hastalıktır. Interosepsiyon ise bedenden ve iç organlardan gelen sinyallerin değerlendirildiği iç duyu algısını ifade eden algısal ve bilişsel bir kavramdır. Interoseptif becerilerin çeşitli kronik ağrı sendromlarında ve kronik nöropatilerde azalmış olabileceği gösterilmiştir. Bu bilgiyle beraber daha önce DPN eştanısı olan ve olmayan Tip 2 Diyabetes Mellitus tanılı bireylerde interoseptif beceriler karşılaştırmalı olarak incelenmemiştir. Bu çalışmada ilk kez DPN olan ve olmayan Tip 2 Diyabetes Mellitus tanılı bireylerde interoseptif keskinlik açısından fark olup olmadığının incelenmesi amaçlanmıştır.

Yöntemler: Muğla Sıtkı Koçman Üniversitesi Elektronörofizyoloji Laboratuvarında DPN eştanısı olan 20 Tip 2 Diyabetes Mellitus tanılı birey ile DPN eştanısı olmayan 20 Tip 2 Diyabetes Mellitus tanılı birey çalışmaya dahil edildi. DPN varlığı Toronto Klinik Skorlama Sistemi ve elektromyografik inceleme ile değerlendirildi. Standardize Mini Mental Test ile genel bilişsel durum, Hasta Sağlık Anketi-9 ile genel psikiyatrik durum, Kalp Hızı Sayma Testi ile kardiyak interoseptif keskinlik incelendi.

Bulgular: Bu çalışmada DPN tanısı olan ve olmayan Tip 2 Diyabetes Mellitus tanılı bireylerde kardiyak interoseptif keskinlik açısından fark saptanmamıştır.

Sonuçlar: Kardiyak interoseptif becerilerdeki potansiyel azalmanın DPN varlığından ziyade kronik ağrı ya da otonom nöropati ile ilişkili olabileceği düşünülmüştür. Bu alt gruplarda interosepsiyonu inceleyen çalışmalara gereksinim duyulmaktadır.

Anahtar Kelimeler

Biliş, diyabetik polinöropati, nörofizyoloji, Tip 2 Diyabetes Mellitus

Kaynakça

• Feldman EL, Callaghan BC, Pop-Busui R, et al. Diabetic neuropathy. Nat Rev Dis Primers. 2019;5(1):41.
• Juster-Switlyk K, Smith AG. Updates in diabetic peripheral neuropathy. F1000Res. 2016;5:F1000 Faculty Rev-738.
• Chen WG, Schloesser D, Arensdorf AM, et al. The Emerging Science of Interoception: Sensing, Integrating, Interpreting, and Regulating Signals within the Self. Trends Neurosci. 2021;44(1):3-16.
• Schandry R. Heart beat perception and emotional experience. Psychophysiology. 1981;18(4):483-8.
• Quadt L, Critchley HD, Garfinkel SN. The neurobiology of interoception in health and disease. Ann N Y Acad Sci. 2018;1428(1):112-28.
• Khoury NM, Lutz J, Schuman-Olivier Z. Interoception in Psychiatric Disorders: A Review of Randomized, Controlled Trials with Interoception-Based Interventions. Harv Rev Psychiatry. 2018;26(5):250-63.
• Grammes J, Schäfer M, Benecke A, et al. Fear of hypoglycemia in patients with type 2 diabetes: The role of interoceptive accuracy and prior episodes of hypoglycemia. J Psychosom Res. 2018;105:58-63.
• Kiken LG, Shook NJ, Robins JL, Clore JN. Association between mindfulness and interoceptive accuracy in patients with diabetes: Preliminary evidence from blood glucose estimates. Complement Ther Med. 2018;36:90-2.
• Palomo-Osuna J, De Sola H, Dueñas M, Moral-Munoz JA, Failde I. Cognitive function in diabetic persons with peripheral neuropathy: a systematic review and meta-analysis. Expert Rev Neurother. 2022;22(3):269-81.
• Ünal D, Kara A, Aksak S, Altunkaynak BZ, Yildirim S. Insulin hormone: Mechanism and effects on the body and relationship with central nervous system. Dicle Med J. 2012;39(2):310–5.
• Lim J, Tesfaye S, Selvarajah D. Central nervous system involvement in diabetic peripheral neuropathy. Diabetic Neuropathy. 2022;91–101.
• Ni W, Zhang Z, Zhang B, et al. Connecting Peripheral to Central Neuropathy: Examination of Nerve Conduction Combined with Olfactory Tests in Patients with Type 2 Diabetes. Diabetes Metab Syndr Obes. 2021;14:3097-107.
• American Diabetes Association Professional Practice Committee. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):17-38.
• 14. Fedele D, Comi G, Coscelli C, et al. A multicenter study on the prevalence of diabetic neuropathy in Italy. Italian Diabetic Neuropathy Committee. Diabetes Care. 1997;20(5):836-43.
• Tesfaye S, Boulton AJ, Dyck PJ, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33(10):2285-93.
• Kaymaz S, Aykan SA, Uyar Köylü S, İkiz Kaymaz T. The Validity and Reliability of the Turkish Version of the Toronto Clinical Scoring System. J PMR Sci. 2019;22(2):41–7.
• Bennett MI, Smith BH, Torrance N, Potter J. The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain. 2005;6(3):149-58.
• Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-13.
• Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-98.
• Wu YJ, Tseng P, Huang HW, et al. The Facilitative Effect of Transcranial Direct Current Stimulation on Visuospatial Working Memory in Patients with Diabetic Polyneuropathy: A Pre-post Sham-Controlled Study. Front Hum Neurosci. 2016;10:479.
• Di Lernia D, Lacerenza M, Ainley V, Riva G. Altered Interoceptive Perception and the Effects of Interoceptive Analgesia in Musculoskeletal, Primary, and Neuropathic Chronic Pain Conditions. J Pers Med. 2020;10(4):201.
• Di Lernia D, Serino S, Riva G. Pain in the body. Altered interoception in chronic pain conditions: A systematic review. Neurosci Biobehav Rev. 2016;71:328-41.
• Ueno D, Ohira H, Narumoto J. Editorial: Interoception and the autonomic nervous system: Investigating affect, decision-making, and mental health. Front Neurosci. 2023;16:1130324.
• Berntson GG, Gianaros PJ. Interoception and the autonomic nervous system: Bottom-up meets top-down. The Interoceptive Mind: From Homeostasis to Awareness (pp 3-23) Oxford University Press; 2019.
• Verrotti A, Prezioso G, Scattoni R, Chiarelli F. Autonomic neuropathy in diabetes mellitus. Front Endocrinol (Lausanne). 2014;5:205.