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Uzun Dönem Oral Antidiyabetik ve İnsülin Kullanımında Nöropatik Ağrı Seyrinin Karşılaştırılması

Yıl 2020, Cilt: 11 Sayı: 41, 79 - 83, 01.12.2020
https://doi.org/10.17944/mkutfd.750407

Öz

Amaç: Bu çalışmada uzun dönem oral antidiyabetik ve insülin kullanan tip 2 diyabetes mellituslu hastalarda nöropatik ağrının diğer risk faktörleri ile birlikte karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Amerikan Diyabet Cemiyeti kriterlerine göre Tip 2 diyabetes mellitus olan 100 hasta çalışmaya alındı. Hastalara nörolojik muayene yapılıp, LANSS (Leeds Assesment of Neuropatic Symptoms and Signs) ve McGill Melzack Ağrı Sorgu Formu uygulandı. LANSS ≥12 olan hastalar Nöropatik Ağrılı gurup ve LANSS <12 olan hastalar Nöropatik Ağrısız gurup olarak ayrıldı. Guruplar demografik özellikler, diyabet süresi, kullanılan antidiyabetik tedavi, serum glukoz ve HbA1c değerleri, hipertansiyon ve hiperlipidemi varlığı açısından karşılaştırıldı.
Bulgular: Hastaların %51’inde nöropatik ağrı saptandı. Nöropatik Ağrılı gurupta ileri yaş, uzun diyabet süresi, yüksek serum glukoz ve HbA1c düzeyleri, hipertansiyon varlığı Nöropatik Ağrısız gurupla karşılaştırıldığında anlamlı fark bulundu. (P<0.05) Her 2 gurup arasında cinsiyet, hiperlipidemi varlığı, kullanılan antidiyabetik tedavi açısından anlamlı bir fark bulunmadı (P>0.05). Hastalarda nöropatik ağrı lokalizasyonu en sık alt ve üst ekstremite distalinde, paterni paroksismal ve spontan, tanımında en sık kullanılan ifadeler ‘sıcaklık veren’ ‘diken diken’ ve en sık tetikleyen faktör anksiyeteydi.
Sonuç: Tip 2 diyabetes mellitus hastalarında nöropatik ağrı gelişiminde; ileri yaş, uzun diyabetes mellitus süresi, kötü glisemik kontrol ve hipertansiyon varlığı önemli rol oynamaktadır. Cinsiyet, hiperlipidemi varlığı, kullanılan antidiyabetik tedavi ise nöropatik ağrı gelişiminde farklılık yaratmamaktadır.

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

-

Kaynakça

  • Ertekin C. Diyabetik noropatiler. Ertekin C,editor. Santral ve periferik EMG 1. Baskı. İzmir: 2006; s.212-213.
  • England JD, Gronseth GS, Miller RG, Asbury AK, Carter GT, Cohen JA, Fisher MA, Howard JF, Kinsella LJ, Latov N, Lewis RA, Low PA, Sumner AJ.Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2005; 64:199-207. https://doi.org/10.1212/01.WNL.0000149522.32823.EA
  • Farmer K.L., Dobrowsky R.T. Diabetic peripheral neuropathy: should a chaperone accompany our therapeutic approach?Pharmacol.Rev.2012. 880-900 https://doi.org/10.1124/pr.111.005314
  • American Diabetes Association. Position statement: standards of medical care for patients with diabetes mellitus. Diabetes Care 2002; 25:33-49. https://doi.org/10.2337/diacare.25.2007.S33
  • Yücel A, Senocak M, Kocasoy Orhan E, Cimen A, Ertas M. Results of the Leeds assessment of neuropathic symptoms and signs pain scale in Turkey: a validation study.J.Pain2004;5:427-32. https://doi.org/10.1016/j.jpain.2004.07.001
  • R Melzack. The McGill Pain Questionnaire: Major Properties and Scoring Methods. Pain.1975Sep;1(3):277-99. https://doi.org/10.1016/0304-3959(75)90044-5
  • J.W. Albers, R. Pop-Busui.Diabetic neuropathy: mechanisms, emerging treatments, and subtypes.Curr.Neurol.Neurosci.2014.pp.473-485 https://doi.org/10.1007/s11910-014-0473-5
  • Sima A.A., Sugimoto K. Experimental diabetic neuropathy: an update. Diabetologia,1999.pp.773-788. https://doi.org/10.1007/s001250051227
  • Morre D.M., Lenaz G., Morre D.J.Surface oxidase and oxidative stress propagation in aging.J.Exp.Biol,2000.pp.1513-1521.
  • Chung S.S.M., Ho E.C.M., Lam K.S.L. Contribution of polyol pathway to diabetes-induced oxidative stress.J.Am.Soc.Nephrol.,2003),pp.233-236. https://doi.org/10.1097/01.ASN.0000077408.15865.06
  • Hongping Y.,Juanyi F., Qiaowei Z., Youxia W., Shixiang W., Weiyi F. The effects of gliclazide, methylcobalamin, and gliclazide + methylcobalamin combination therapy on diabetic peripheral neuropathy in rats, Sciences 2016.Volume 161,Pages 60-68. https://doi.org/10.1016/j.lfs.2016.07.019
  • Lósa D.B., Oliveira W.H., Duarte-Silvac E., Wyllie W. .Preventive role of metformin on peripheral neuropathy induced by diabetes. International Immunopharmacology .2019. 74:105672. https://doi.org/10.1016/j.intimp.2019.05.057
  • Stecker M., Stevenson M. Effects of insulin on peripheral nerves. Journal of Diabetes and its Complications,2016,Volume 30,Issue 5, Pages 770-777. https://doi.org/10.1016/j.jdiacomp.2016.03.009
  • Kwai N., Arnold R., Poynten A., Lin C.S., Kiernan M.C.,Krishnan,A.V. Continuous subcutaneous insulin infusion (CSII) preserves axonal function in Type 1 diabetes mellitus. Diabetes/Metabolism Research and Reviews,2014. 31(2). · https://doi.org/10.1002/dmrr.2583
  • Gibbons CH, Freeman R. Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes. Brain. 2015;138(Pt 1):43-52. https://doi.org/10.1093/brain/awu307
  • Gibbons CH, Freeman R.Treatment-induced diabetic neuropathy:a reversible painful autonomic neuropathy. Ann Neurol,2010;67(4): 534-41. https://doi.org/10.1002/ana.21952
  • Gibbons CH. Treatment induced neuropathy of diabetes-long term implications in type 1 diabetes. J Diabetes Complicat. 2017;31(4):715-20. https://doi.org/10.1016/j.jdiacomp.2017.01.010
  • Feldman EL, Callaghan BC, Pop-Busui R, Zochodne DW, Wright DE, Bennett DL, Bril V, Russell JW, Viswanathan V. Diabetic Neuropathy . Nat Rev Dis Primers. 2019.13;5(1):41. https://doi.org/10.1038/s41572-019-0092-1
  • Tamer A, Yıldız S, Yıldız N, Kanat M, Gunduz H, Tahtacı M, Celebi H. The prevalence of neuropathy and relationship with risk factors in diabetic patients: a single-center experience. Med Princ Pract. 2006; 15:190-194. https://doi.org/10.1159/000092180
  • Barbosa AP, Medina JL, Ramos EP, Barros HP, The DPN in Porto Study Group. Prevalence and risk factors of clinical diabetic polyneuropathy in a Portuguese primary health care population. Diabetes Metab 2001; 27:496-502.
  • İnternational Asociation fort the Study of Pain . pain terminology . In ; Merskey H, Bogduk N, eds . Classificaton of Choronic pain IASP Press, Seatle 1994 : 209 - 214
  • Woolf CJ, Mannion RJ. Neuropathıc pain, aetiology, symptoms, mechanisms and management . Lancet,1999 .353 : 1959 - 1964. https://doi.org/10.1016/S0140-6736(99)01307-0
  • Devor M, Selzer Z, Patophysiology of damaged peripheral nerves in relationto chronic pain. In textbook of pain. Wal PD, Melzak R, Edinburg : Churcill Livingstone 2002 : 129 - 165.

Comparison of Neuropathic Pain Course in Long-Term Oral Antidiabetic and Insulin Use

Yıl 2020, Cilt: 11 Sayı: 41, 79 - 83, 01.12.2020
https://doi.org/10.17944/mkutfd.750407

Öz

Objective: It was aimed to compare neuropathic pain with other risk factors in patients with type 2 diabetes mellitus using long-term oral antidiabetic and insulin.
Materials and Methods: According to the American Diabetes Society criteria, 100 patients with Type 2 diabetes mellitus were included in the study. Patients underwent neurological examination, Leeds Assesment of Neuropatic Symptoms and Signs (LANSS) and McGill Melzack Pain Questionnaire Form were applied. Patients were divided into two groups as Neuropathic Pain group (LANSS ≥12) and Non-neuropathic Pain group (LANSS <12). Groups were compared in terms of demographic characteristics, duration of diabetes, antidiabetic therapy, serum glucose and HbA1c values, presence of hyperlipidemia and hypertension.
Results: Neuropathic pain was detected in 51% of the patients. Advanced age , long diabetes duration, high serum glucose and HbA1c levels, presence of hypertension in the Neuropathic Pain group, compared with the Non-neuropathic Pain group significant difference was found. (P<0.05) There was no significant difference between the groups in terms of gender, presence of hyperlipidemia, and antidiabetic therapy. (P> 0.05) Neuropathic pain localization was most commonly distal to the lower and upper extremities, pattern was paroxysmal and spontaneous, the most commonly used phrases in the definition was 'warmth', 'thorn bumps' and the most common trigger was anxiety.
Conclusion: In the development of neuropathic pain with type 2 diabetes mellitus; advanced age, long diabetes duration, poor glycemic control and presence of hypertension play an important role. Gender, presence of hyperlipidemia, and antidiabetic therapy don’t make difference in the development of neuropathic pain.

Proje Numarası

yok

Kaynakça

  • Ertekin C. Diyabetik noropatiler. Ertekin C,editor. Santral ve periferik EMG 1. Baskı. İzmir: 2006; s.212-213.
  • England JD, Gronseth GS, Miller RG, Asbury AK, Carter GT, Cohen JA, Fisher MA, Howard JF, Kinsella LJ, Latov N, Lewis RA, Low PA, Sumner AJ.Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2005; 64:199-207. https://doi.org/10.1212/01.WNL.0000149522.32823.EA
  • Farmer K.L., Dobrowsky R.T. Diabetic peripheral neuropathy: should a chaperone accompany our therapeutic approach?Pharmacol.Rev.2012. 880-900 https://doi.org/10.1124/pr.111.005314
  • American Diabetes Association. Position statement: standards of medical care for patients with diabetes mellitus. Diabetes Care 2002; 25:33-49. https://doi.org/10.2337/diacare.25.2007.S33
  • Yücel A, Senocak M, Kocasoy Orhan E, Cimen A, Ertas M. Results of the Leeds assessment of neuropathic symptoms and signs pain scale in Turkey: a validation study.J.Pain2004;5:427-32. https://doi.org/10.1016/j.jpain.2004.07.001
  • R Melzack. The McGill Pain Questionnaire: Major Properties and Scoring Methods. Pain.1975Sep;1(3):277-99. https://doi.org/10.1016/0304-3959(75)90044-5
  • J.W. Albers, R. Pop-Busui.Diabetic neuropathy: mechanisms, emerging treatments, and subtypes.Curr.Neurol.Neurosci.2014.pp.473-485 https://doi.org/10.1007/s11910-014-0473-5
  • Sima A.A., Sugimoto K. Experimental diabetic neuropathy: an update. Diabetologia,1999.pp.773-788. https://doi.org/10.1007/s001250051227
  • Morre D.M., Lenaz G., Morre D.J.Surface oxidase and oxidative stress propagation in aging.J.Exp.Biol,2000.pp.1513-1521.
  • Chung S.S.M., Ho E.C.M., Lam K.S.L. Contribution of polyol pathway to diabetes-induced oxidative stress.J.Am.Soc.Nephrol.,2003),pp.233-236. https://doi.org/10.1097/01.ASN.0000077408.15865.06
  • Hongping Y.,Juanyi F., Qiaowei Z., Youxia W., Shixiang W., Weiyi F. The effects of gliclazide, methylcobalamin, and gliclazide + methylcobalamin combination therapy on diabetic peripheral neuropathy in rats, Sciences 2016.Volume 161,Pages 60-68. https://doi.org/10.1016/j.lfs.2016.07.019
  • Lósa D.B., Oliveira W.H., Duarte-Silvac E., Wyllie W. .Preventive role of metformin on peripheral neuropathy induced by diabetes. International Immunopharmacology .2019. 74:105672. https://doi.org/10.1016/j.intimp.2019.05.057
  • Stecker M., Stevenson M. Effects of insulin on peripheral nerves. Journal of Diabetes and its Complications,2016,Volume 30,Issue 5, Pages 770-777. https://doi.org/10.1016/j.jdiacomp.2016.03.009
  • Kwai N., Arnold R., Poynten A., Lin C.S., Kiernan M.C.,Krishnan,A.V. Continuous subcutaneous insulin infusion (CSII) preserves axonal function in Type 1 diabetes mellitus. Diabetes/Metabolism Research and Reviews,2014. 31(2). · https://doi.org/10.1002/dmrr.2583
  • Gibbons CH, Freeman R. Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes. Brain. 2015;138(Pt 1):43-52. https://doi.org/10.1093/brain/awu307
  • Gibbons CH, Freeman R.Treatment-induced diabetic neuropathy:a reversible painful autonomic neuropathy. Ann Neurol,2010;67(4): 534-41. https://doi.org/10.1002/ana.21952
  • Gibbons CH. Treatment induced neuropathy of diabetes-long term implications in type 1 diabetes. J Diabetes Complicat. 2017;31(4):715-20. https://doi.org/10.1016/j.jdiacomp.2017.01.010
  • Feldman EL, Callaghan BC, Pop-Busui R, Zochodne DW, Wright DE, Bennett DL, Bril V, Russell JW, Viswanathan V. Diabetic Neuropathy . Nat Rev Dis Primers. 2019.13;5(1):41. https://doi.org/10.1038/s41572-019-0092-1
  • Tamer A, Yıldız S, Yıldız N, Kanat M, Gunduz H, Tahtacı M, Celebi H. The prevalence of neuropathy and relationship with risk factors in diabetic patients: a single-center experience. Med Princ Pract. 2006; 15:190-194. https://doi.org/10.1159/000092180
  • Barbosa AP, Medina JL, Ramos EP, Barros HP, The DPN in Porto Study Group. Prevalence and risk factors of clinical diabetic polyneuropathy in a Portuguese primary health care population. Diabetes Metab 2001; 27:496-502.
  • İnternational Asociation fort the Study of Pain . pain terminology . In ; Merskey H, Bogduk N, eds . Classificaton of Choronic pain IASP Press, Seatle 1994 : 209 - 214
  • Woolf CJ, Mannion RJ. Neuropathıc pain, aetiology, symptoms, mechanisms and management . Lancet,1999 .353 : 1959 - 1964. https://doi.org/10.1016/S0140-6736(99)01307-0
  • Devor M, Selzer Z, Patophysiology of damaged peripheral nerves in relationto chronic pain. In textbook of pain. Wal PD, Melzak R, Edinburg : Churcill Livingstone 2002 : 129 - 165.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Original Articles
Yazarlar

Damla Yürük 0000-0002-0799-3434

Ismet Melek 0000-0002-0599-4695

Proje Numarası yok
Yayımlanma Tarihi 1 Aralık 2020
Gönderilme Tarihi 15 Haziran 2020
Kabul Tarihi 6 Eylül 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 11 Sayı: 41

Kaynak Göster

Vancouver Yürük D, Melek I. Uzun Dönem Oral Antidiyabetik ve İnsülin Kullanımında Nöropatik Ağrı Seyrinin Karşılaştırılması. mkutfd. 2020;11(41):79-83.