Translational Neuroscience Facility, School of Medical Sciences, University of New South Wales, Sydney, Australia.
Diabetes Metab Res Rev. 2015 Feb;31(2):175-82. doi: 10.1002/dmrr.2583. Epub 2014 Sep 15.
Diabetic peripheral neuropathy is a common and debilitating complication of diabetes mellitus. Although strict glycaemic control may reduce the risk of developing diabetic peripheral neuropathy, the neurological benefits of different insulin regimens remain relatively unknown.
In the present study, 55 consecutive patients with type 1 diabetes mellitus underwent clinical neurological assessment. Subsequently, 41 non-neuropathic patients, 24 of whom were receiving multiple daily insulin injections (MDII) and 17 receiving continuous subcutaneous insulin infusion (CSII), underwent nerve excitability testing, a technique that assesses axonal ion channel function and membrane potential in human nerves. Treatment groups were matched for glycaemic control, body mass index, disease duration and gender. Neurophysiological parameters were compared between treatment groups and those taken from age and sex-matched normal controls.
Prominent differences in axonal function were noted between MDII-treated and CSII-treated patients. Specifically, MDII patients manifested prominent abnormalities when compared with normal controls in threshold electrotonus (TE) parameters including depolarizing TE(10-20ms), undershoot and hyperpolarizing TE (90-100 ms) (P < 0.05). Additionally, recovery cycle parameters superexcitability and subexcitability were also abnormal (P < 0.05). In contrast, axonal function in CSII-treated patients was within normal limits when compared with age-matched controls. The differences between the groups were noted in cross-sectional analysis and remained at longitudinal follow-up.
Axonal function in type 1 diabetes is maintained within normal limits in patients treated with continuous subcutaneous insulin infusion and not with multiple daily insulin injections. This raises the possibility that CSII therapy may have neuroprotective potential in patients with type 1 diabetes.
糖尿病周围神经病变是糖尿病常见且使人虚弱的并发症。尽管严格的血糖控制可能会降低发生糖尿病周围神经病变的风险，但不同胰岛素方案的神经获益仍相对未知。
在本研究中，55 例 1 型糖尿病患者接受了临床神经学评估。随后，41 例非神经病变患者（其中 24 例接受多次每日胰岛素注射（MDII），17 例接受持续皮下胰岛素输注（CSII））接受了神经兴奋性测试，这是一种评估人类神经轴突离子通道功能和膜电位的技术。治疗组在血糖控制、体重指数、病程和性别方面相匹配。将神经生理参数与治疗组和年龄及性别匹配的正常对照组进行比较。
MDII 治疗组和 CSII 治疗组之间的轴突功能存在明显差异。具体而言，与正常对照组相比，MDII 患者在阈电紧张（TE）参数中表现出明显异常，包括去极化 TE（10-20ms）、超射和超极化 TE（90-100ms）（P<0.05）。此外，恢复周期参数超兴奋性和亚兴奋性也异常（P<0.05）。相比之下，CSII 治疗组的轴突功能与年龄匹配的对照组相比在正常范围内。这些差异在横断面分析中可见，并在纵向随访中仍然存在。
在接受持续皮下胰岛素输注治疗的 1 型糖尿病患者中，轴突功能保持在正常范围内，而接受多次每日胰岛素注射治疗的患者则不然。这表明 CSII 治疗可能具有 1 型糖尿病患者的神经保护潜力。
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