A higher incidence of diabetic peripheral neuropathy may be associated with decreased sleep and increased depression in older adults

Abstract

Aim: Diabetes mellitus (DM) tends to increase with aging. Nearly half of the patients with DM develop neuropathy (DPN). Despite its high burden and morbidity, the conditions that DPN may be associated with have not been adequately studied in older adults. We aimed to identify sleep duration and comprehensive geriatric assessment components that may be associated with DPN. Material and Method: This is a cross-sectional retrospective study. DPN diagnosed with a medical history, neurologic examination, and electromyography (EMG). 125 diabetic older patients were included. All comprehensive geriatric assessment tests and questions about sleep quality and time were performed. We divided the patients into two groups those without neuropathy and with neuropathy and compared them. Results: The median age of 125 patients was 72 (min-max; 64-94). 58.8% of them were women. The percentage of married people and living with their spouse and slept for 6 hours or more had a lower percentage in the DPN group. Polypharmacy and the percentage of heart failure were significantly higher in the DPN group. Lawton-Brody score, which shows instrumental daily living activities (IADL) and geriatric depression score (GDS) was higher in the DPN group. In logistic regression, we found that depression scores were higher and sleep duration was shorter in the DPN group (respectively, odd ratio:265 p:.012; odd ratio:.1.917 p:.045) Conclusions: DPN in older adults may affect the functionality and be associated with fewer sleep hours and depression. Not only blood glucose regulation but also other factors such as sleep duration and depressed mood may be associated with DPN in older adults.

Keywords

• Diabetic neuropathy
• comprehensive geriatric assessment
• older adults
• sleep duration
• depression

References

1. Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Research and Clinical Practice 2019; 157: 107843.
2. Ziegler D, Tesfaye S, Spallone V, et al. Screening, diagnosis and management of diabetic sensorimotor polyneuropathy in clinical practice: International expert consensus recommendations. Diab Res Clin Pract 2022; 186:109063.
3. Feldman EL, Callaghan BC, Pop-Busui R, et al. Diabetic neuropathy. Nat Rev Dis Primers 2019; 5: 41.
4. Zhang Q, Lin Y, Liu X, et al. Diabetic peripheral neuropathy affects pinch strength and hand dexterity in elderly patients. Neural Plasticity 2021; 2021: 9959103.
5. Iqbal Z, Azmi S, Yadav R, et al. Diabetic peripheral neuropathy: epidemiology, diagnosis, and pharmacotherapy. Clinical Therapeutics 2018; 40: 828-49.
6. Khdour MR. Treatment of diabetic peripheral neuropathy: a review. J Pharmacy Pharmacol 2020; 72: 863-72.
7. Kalra S, Sharma SK. Diabetes in the elderly. Diabetes Therapy: Research, Treatment and Education of Diabetes and Related Disorders 2018; 9: 493-500.
8. Çakmak G, Ganidağlı S, Efendioğlu EM, Öztürk E, Öztürk ZA. Do long-term complications of type 2 diabetes increase susceptibility to geriatric syndromes in older adults? Medicina (Kaunas, Lithuania) 2021; 57: 968.

9. Boyle J, Eriksson ME, Gribble L, et al. Randomized, placebo-controlled comparison of amitriptyline, duloxetine, and pregabalin in patients with chronic diabetic peripheral neuropathic pain: impact on pain, polysomnographic sleep, daytime functioning, and quality of life. Diabetes Care 2012; 35: 2451-8.
10. Le Floch JP, Doucet J, Bauduceau B, Verny C. Retinopathy, nephropathy, peripheral neuropathy and geriatric scale scores in elderly people with Type 2 diabetes. Diabetic Medicine: J British Diab Assoc 2014; 31: 107-11.
11. Sable-Morita S, Tanikawa T, Satake S, Okura M, Tokuda H, Arai H. Microvascular complications and frailty can predict adverse outcomes in older patients with diabetes. Geriatr Gerontol Int 2021; 21: 359-63.
12. Arik G, Varan HD, Yavuz BB, et al. Validation of Katz index of independence in activities of daily living in Turkish older adults. Archives of Gerontology and Geriatrics 2015; 61: 344-50.
13. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9: 179-86.
14. Thal LJ, Grundman M, Golden R. Alzheimer's disease: a correlational analysis of the Blessed Information-Memory-Concentration Test and the Mini-Mental State Exam. Neurology 1986; 36: 262-4.
15. Guigoz Y, Vellas B. The Mini Nutritional Assessment (MNA) for grading the nutritional state of elderly patients: presentation of the MNA, history, and validation. Nestle Nutrition Workshop Series Clinical & Performance Programme 1999;1:3-11; discussion -2.
16. Kalmbach DA, Arnedt JT, Song PX, Guille C, Sen S. Sleep disturbance and short sleep as risk factors for depression and perceived medical errors in first-year residents.Sleep 2017; 40:3.
17. Li Y, Wu Y, Zhai L, Wang T, Sun Y, Zhang D. Longitudinal association of sleep duration with depressive symptoms among middle-aged and older chinese. Scientific Reports 2017; 7: 11794.
18. Ahmed MU, Tannous WK, Agho KE, Henshaw F, Turner D, Simmons D. Social determinants of diabetes-related foot disease among older adults in New South Wales, Australia: evidence from a population-based study. J Foot Ankle Research 2021; 14: 65.
19. Abelleira R, Zamarrón C, Ruano A, et al. Impact of sleep apnoea-hypopnoea syndrome on diabetic neuropathy. A systematic review. Medicina Clinica 2021; 157: 106-13.
20. Garg A, Chilakamarri P, Koo BB. Diagnostic and treatment considerations in restless legs syndrome complicated by diabetic neuropathy. Current Diabetes Reports 2021; 21: 66.
21. Shokri M, Sajedi F, Mohammadi Y, Mehrpooya M. Adjuvant use of melatonin for relieving symptoms of painful diabetic neuropathy: results of a randomized, double-blinded, controlled trial. Eur J Clin Pharmacol 2021; 77: 1649-63.
22. Tayanloo-Beik A, Roudsari PP, Rezaei-Tavirani M, et al. Diabetes and heart failure: multi-omics approaches. Frontiers In Physiology 2021; 12: 705424.
23. Ejaz A, LoGerfo FW, Pradhan L. Diabetic neuropathy and heart failure: role of neuropeptides. Expert Reviews In Molecular Medicine 2011; 13: e26.
24. Kaze AD, Santhanam P, Erqou S, Ahima RS, Bertoni A, Echouffo-Tcheugui JB. Microvascular disease and incident heart failure among individuals with type 2 diabetes mellitus. J Am Heart Assoc 2021; 10: e018998.
25. Kurczewska-Michalak M, Lewek P, Jankowska-Polańska B, et al. Polypharmacy management in the older adults: a scoping review of available interventions. Frontiers In Pharmacology 2021; 12: 734045.
26. Imre E, Imre E. Polypharmacy is associated with diabetic foot ulcers in type 2 diabetes mellitus. Int J Lower Extremity Wounds 2022: 15347346221090756.
27. Vinik AI, Camacho P, Reddy S, et al. Aging, diabetes, and falls. Endocrine Practice 2017; 23: 1117-39.
28. Venkataraman K, Tai BC, Khoo EYH, et al. Short-term strength and balance training does not improve quality of life but improves functional status in individuals with diabetic peripheral neuropathy: a randomised controlled trial. Diabetologia 2019; 62: 2200-10.
29. Omura T, Araki A. Skeletal muscle as a treatment target for older adults with diabetes mellitus: The importance of a multimodal intervention based on functional category. Geriatrics & Gerontology International 2022; 22: 110-20.
30. Kec D, Rajdova A, Raputova J, et al. Risk factors for depression and anxiety in painful and painless diabetic polyneuropathy: A multicentre observational cross-sectional study. European Journal of Pain 2022; 26: 370-89.
31. D'Amato C, Morganti R, Greco C, et al. Diabetic peripheral neuropathic pain is a stronger predictor of depression than other diabetic complications and comorbidities. Diabetes & Vascular Disease Research 2016; 13: 418-28.
32. De Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosomatic Medicine 2001; 63: 619-30.
33. Vas PRJ, Papanas N. Depression and diabetic peripheral neuropathy: birds of a feather, but when do they flock together? Experimental And Clinical Endocrinology & Diabetes : Official Journal, German Society Of Endocrinology [And] German Diabetes Association 2020; 128: 347-9.
34. Yakaryılmaz FD, Öztürk ZA. Treatment of type 2 diabetes mellitus in the elderly. World J Diab 2017; 8: 278-85.
35. Zhang Y, Zhang S, Pan L, et al. Painful diabetic peripheral neuropathy study of chinese outpatients (pdnscope): a multicentre cross-sectional registry study of clinical characteristics and treatment in mainland China. Pain and Therapy 2021; 10: 1355-73.
36. Yang W, Cai X, Wu H, Ji L. Associations between metformin use and vitamin B(12) levels, anemia, and neuropathy in patients with diabetes: a meta-analysis. J Diabetes 2019; 11: 729-43.
37. Gwathmey KG, Grogan J. Nutritional neuropathies. Muscle & Nerve 2020; 62: 13-29.
38. Selvarajah D, Kar D, Khunti K, et al. Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention. Lancet Diab Endocrinol 2019; 7: 938-48.
39. Ziegler D, Keller J, Maier C, Pannek J. Diabetic neuropathy. Experiment Clin Endocrin Diab: 2021; 129: 70-81.