Correlation of leg pain responses with ankle-brachial index and peripheral sensory responses in foot of type 2 diabetes mellitus
https://doi.org/10.4081/hls.2023.11173
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Introduction: Type 2 Diabetes Mellitus (T2DM) is associated with changes that occur in the peripheral circulation that affect foot functions. Therefore, there is a need for a risk prediction test on foot abnormalities using the leg pain response parameters in T2DM patients with ankle-brachial index (ABI) and peripheral sensory changes as a preventive effort to manage foot care.
Design and Methods: This study employed a cross-sectional design in which 63 T2DM patients in a Public Health Center (PHC) in Malang were investigated. The instruments used include visual analog scale (VAS), monofilament, and foot doppler.
Results: The Pearson correlation test showed no relationship between the responses to leg pain and the ABI of the right and left feet (p-values = 0.217 and 0.692), but there was a significant relationship between the left foot ABI and sensory status (p-value 0.002; left foot r = 0.383). Meanwhile, the Pearson's correlation and linear regression test also showed a relationship between the right foot ABI and sensory status (p-value = 0.007; r = 0.338). Furthermore, a multiple linear regression test showed a relationship between the leg pain response and sensory perception of the right and left feet (p-value = 0.035; r = 0.325).
Conclusions: The relationship between the sensory status of the right and left feet and the response to leg pain in T2DM patients were moderate with a negative direction. It, therefore, implies that a decrease in the sensory responses increased the leg pain. Meanwhile, the moderate relationship and positive direction between the ABI and sensory status of the feet of T2DM patients indicates that a higher ABI score led to an increase in the sensory status of the foot.
Salvotelli L, Stoico V, Perrone F, et al. Prevalence of neuropathy in type 2 diabetic patients and its association with other diabetes complications: The Verona Diabetic Foot Screening Program. J of Diabetes Complicat 2015;29:1066-70. DOI: https://doi.org/10.1016/j.jdiacomp.2015.06.014
Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes 2015;6:37. DOI: https://doi.org/10.4239/wjd.v6.i1.37
Zhang P, Lu J, Jing Y, et al. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med 2017;49:106-16. DOI: https://doi.org/10.1080/07853890.2016.1231932
Crawford F, Cezard G, Chappell FM. The development and validation of a multivariable prognostic model to predict foot ulceration in diabetes using a systematic review and individual patient data meta-analyses. Diabetic Med 2018;35:1480-93. DOI: https://doi.org/10.1111/dme.13797
Shrestha S, Gorhaly MP, Bajracharya MR. Diagnostic accuracy of monofilament test to detect diabetic neuropathy. J Adv Int Med 2021;10:20-5. DOI: https://doi.org/10.3126/jaim.v10i1.37086
Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent and constant osteoarthritis pain (icoap). Arthritis Care Res 2011;63:S240-S52. DOI: https://doi.org/10.1002/acr.20543
Kristianto H, Waluyo A, Gayatri D. Relationship between diabetic foot ulcers profile and ankle brachial index score: A preliminary study. Enfermería Clínica 2021;31:S424-S7. DOI: https://doi.org/10.1016/j.enfcli.2020.09.038
Dobson J, McMillan J, Li L. Benefits of exercise intervention in reducing neuropathic pain. Front Cellular Neurosci 2014;8:1-9 DOI: https://doi.org/10.3389/fncel.2014.00102
Jensen TS, Finnerup NB. Allodynia and hyperalgesia in neuropathic pain: clinical manifestations and mechanisms. Lancet Neurol 2014;13:924-35. DOI: https://doi.org/10.1016/S1474-4422(14)70102-4
Forbang NI, McDermott MM, Liao Y, et al. Associations of diabetes mellitus and other cardiovascular disease risk factors with decline in the ankle–brachial index. Vascular Medicine 2014;19:465-72. DOI: https://doi.org/10.1177/1358863X14554033
Salawu F, Shadrach L, Adenle T, et al. Diabetic peripheral neuropathy and its risk factors in a Nigerian population with type 2 diabetes mellitus. Afr J Diabetes Med 2018;26:16-20
Bouhassira D, Letanoux M, Hartemann A. Chronic Pain with Neuropathic Characteristics in Diabetic Patients: A French Cross-Sectional Study. PLoS One 2013;8:e74195. DOI: https://doi.org/10.1371/journal.pone.0074195
Hébert HL, Veluchamy A, Torrance N, et al. Risk factors for neuropathic pain in diabetes mellitus. Pain 2017;158:560-8. DOI: https://doi.org/10.1097/j.pain.0000000000000785
Baraz S, Zarea K, Shahbazian HB, et al. Comparison of the accuracy of monofilament testing at various points of feet in peripheral diabetic neuropathy screening. J Diabetes Metabolic Disord 2014;13:19. DOI: https://doi.org/10.1186/2251-6581-13-19
Wang F, Zhang J, Yu J, et al. Diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy: a systematic review and meta-analysis. J Diabetes Res 2017;2017:1-12 DOI: https://doi.org/10.1155/2017/8787261
Bakker K, Apelqvist J, Lipsky BA, et al. The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: development of an evidence-based global consensus. Diabetes/Metabolism Res Rev 2016;32:2-6. DOI: https://doi.org/10.1002/dmrr.2694
Peltier A, Goutman SA, Callaghan BC. Painful diabetic neuropathy. Br Med J 2014;348:1799. DOI: https://doi.org/10.1136/bmj.g1799
Volmer-Thole M, Lobmann R. Neuropathy and Diabetic Foot Syndrome. Int J Molecular Sci 2016;17:917. DOI: https://doi.org/10.3390/ijms17060917
Forsythe RO, Hinchliffe RJ. Assessment of foot perfusion in patients with a diabetic foot ulcer. Diabetes/Metabolism Res Rev 2016;32:232-8. DOI: https://doi.org/10.1002/dmrr.2756
Stirban A. Microvascular Dysfunction in the Context of Diabetic Neuropathy. Curr Diabetes Rep 2014;14:541. DOI: https://doi.org/10.1007/s11892-014-0541-x
Vouillarmet J, Bourron O, Gaudric J, et al. Lower-extremity arterial revascularization: Is there any evidence for diabetic foot ulcer-healing? Diabetes Metabolism 2016;42:4-15. DOI: https://doi.org/10.1016/j.diabet.2015.05.004
Huang K, Ma Y, Wang J, et al. The correlation between transcutaneous oxygen tension and microvascular complications in type 2 diabetic patients. J Diabetes Complicat 2017;31:886-90. DOI: https://doi.org/10.1016/j.jdiacomp.2017.02.006
Deng W, Dong X, Zhang Y, et al. Transcutaneous oxygen pressure (TcPO2): A novel diagnostic tool for peripheral neuropathy in type 2 diabetes patients. Diabetes Res Clinical Pract 2014;105:336-43. DOI: https://doi.org/10.1016/j.diabres.2014.05.012
Eleftheriadou I, Tentolouris A, Grigoropoulou P, et al. The association of diabetic microvascular and macrovascular disease with cutaneous circulation in patients with type 2 diabetes mellitus. J Diabetes Complicat 2019;33:165-70. DOI: https://doi.org/10.1016/j.jdiacomp.2018.10.008
Gritsch S, Lu J, Thilemann S, et al. Oligodendrocyte ablation triggers central pain independently of innate or adaptive immune responses in mice. Nature Comm 2014;5:5472. DOI: https://doi.org/10.1038/ncomms6472
Sorge RE, Mapplebeck JC, Rosen S, et al. Different immune cells mediate mechanical pain hypersensitivity in male and female mice. Nature Neurosci 2015;18:1081. DOI: https://doi.org/10.1038/nn.4053
Feldman EL, Nave K-A, Jensen TS, et al. New Horizons in Diabetic Neuropathy: Mechanisms, Bioenergetics, and Pain. Neuron 2017;93:1296-313. DOI: https://doi.org/10.1016/j.neuron.2017.02.005
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Downloads
Citations
