Dos Santos Soares Francyelle, de Souza Pinto Milena, Kruger Alana, Coracini Camila Amaral, Bertolini Gladson Ricardo Flor
Department of Physical Therapy, Center of Biological and Health Sciences, State University of Western Paraná, Universitaria St. 2069, Cascavel, Paraná, 85819-110, Brazil.
Lasers Med Sci. 2023 Aug 14;38(1):185. doi: 10.1007/s10103-023-03853-8.
Diabetes-related muscle damage has been overlooked despite its known association with increased morbidity and mortality in DM individuals. PBMT is a recognized alternative to improve skeletal muscle health in other populations, but its effectiveness in DM is still unclear. To address this issue, we reviewed preclinical studies, available in any language and period, in ten sources of information. The methods were previously registered at PROSPERO (CRD42021271041), based on PRISMA recommendations. Studies in murine models of T1DM or T2DM that reported quantitative analyses of skeletal muscles treated with low-level light therapy could be included after a blind selection process. Most of the seven included studies focus on decompensated T1DM rats with acute muscle injury (cryoinjury or contusion). In these five studies, PBMT improved muscle regeneration, by reducing inflammation and stimulating factors pro-angiogenesis and pro-myogenesis. Some positive effects could also be observed in two studies on muscles without acute injury: control of oxidative stress (T1DM) and reduction of myosteatosis (T2DM). Although infrared laser applied locally appears to be a promising approach, optimal parameters are undefined due to the heterogeneity of outcomes and high risk of bias, which prevented a quantitative synthesis. Several aspects of this growing field have yet to be investigated, particularly regarding the DM model (e.g., aged animals, T2DM), intervention (e.g., comparison with LED), and outcomes (e.g., muscle mass, strength, and function). Future research should aim to improve the internal validity by following guidelines for animal studies and enhance the translatability to clinical trials by using animal models that closely mimic patients with DM in rehabilitation settings.
尽管糖尿病相关的肌肉损伤与糖尿病患者发病率和死亡率的增加有关，但其一直被忽视。低强度脉冲磁刺激（PBMT）是公认的改善其他人群骨骼肌健康的替代方法，但其在糖尿病患者中的有效性仍不明确。为解决这一问题，我们检索了十个信息源中任何语言和时期的临床前研究。该方法先前已根据系统评价和Meta分析的首选报告项目（PRISMA）建议在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD4202127********）进行了注册。在经过盲选过程后，可纳入报告了低强度光疗治疗骨骼肌定量分析的1型糖尿病（T1DM）或2型糖尿病（T2DM）小鼠模型研究。纳入的七项研究中，大多数聚焦于患有急性肌肉损伤（冷冻损伤或挫伤）的失代偿性T1DM大鼠。在这五项研究中，PBMT通过减轻炎症、刺激促血管生成和促肌生成因子，改善了肌肉再生。在两项关于无急性损伤肌肉的研究中也观察到了一些积极效果：控制氧化应激（T1DM）和减少肌脂肪变性（T2DM）。尽管局部应用红外激光似乎是一种有前景的方法，但由于结果的异质性和高偏倚风险，尚未确定最佳参数，这阻碍了定量综合分析。这一新兴领域的几个方面仍有待研究，特别是关于糖尿病模型（如老年动物、T2DM）、干预措施（如与发光二极管（LED）比较）和结果（如肌肉质量、力量和功能）。未来的研究应旨在遵循动物研究指南提高内部效度，并通过使用在康复环境中密切模拟糖尿病患者的动物模型，增强向临床试验的可转化性。
