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Assessment of Upper Limb Sensory Deficit in People with Type 2 Diabetes Mellitus – a Descriptive Study

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Assessment of Upper Limb Sensory Deficit in People with Type 2 Diabetes Mellitus – a Descriptive Study International Journal of Research in Engineering, Science and Management 503 Volume-2, Issue-7, July-2019 www.ijresm.com | ISSN (Online): 2581-5792 Assessment of Upper Limb Sensory Deficit in People with Type 2 Diabetes Mellitus – A Descriptive Study Amrita Ghosh1, Shreejan Regmi2, Trapthi Kamath3 1,3Assistant Professor, Department of Neurology, R. V. College of Physiotherapy, Bangalore, India 2Student, Department of Neurology, R. V. College of Physiotherapy, Bangalore, India Abstract: Background and objective of study: The term diabetes multiple etiology characterized by chronic hyperglycemia with mellitus describes a metabolic disorder of multiple etiology disturbance of carbohydrate, fat and protein metabolism characterized by chronic hyperglycemia with disturbance of resulting from deficit in insulin secretion, insulin action or both carbohydrate, fat and protein metabolism resulting from deficit in [1]. Diabetic patients often develop different chronic insulin secretion, insulin action or both. Neurologic complications occur in diabetes mellitus where small fiber damage affects complications which decrease their quality of life [2]. Diabetes sensation of temperature, light touch, pinprick, and pain. Large mellitus(DM)-related complications include neuropathy, fiber damage diminishes vibratory sensation, position sense, retinopathy, nephropathy, cardiovascular and musculoskeletal muscle strength, sharp-dull discrimination, and two-point disease [3]. discrimination. Numerous prior studies had shown that abnormal Diabetes is one of the seventh most devastating non sensory functioning of the hand from several types of diseases may communicable disease affecting half of the population in the lead to poor motor performance, but few reported the outcomes related to diabetic hands. Therefore, it was necessary to know the world. The International Diabetes Federation (IDF) and extent and the severity of sensory involvement in type 2 diabetes Diabetes Atlas reports that there are 415 million people mellitus in order to design the rehabilitation protocol of upper diagnosed with diabetes. This population represents 8.8% of extremity accordingly. adults aged between 20–79 years in India [4]. It is further Methods: A total of 60 subjects having history of type 2 diabetes predicted that the number of adults with diabetes will increase were recruited for the study. The written informed consent and to more than 640 million by 2040 [4] institutional ethical clearance were obtained from them. The subjects underwent thorough sensory evaluation of upper Diabetes is a silent disorder leading to disabling and fatal extremity, which included assessment for pain, touch, tactile complications that are related with increased costs. The long- localization, temperature, two-point discrimination, stereognosis, term complications of diabetes affect almost every system in vibration and graphesthesia. the body, especially the eyes, kidneys, heart, feet and nerves. Results: The data was described using descriptive statistics. The micro- and macrovascular complications include anatomic, Pain was the unaffected sensory component for all the subjects. structural and functional changes, which leads to multiple organ 60% of subjects had impaired two-point discrimination which was dysfunction. Causative factors include persistent the most affected component. Touch, temperature, tactile localisation, graphesthesia, vibration and stereognosis were also hyperglycemia, microvascular insufficiency, oxidative and affected in 35%, 44%, 27%, 45%, 32% and 39% subjects nitrosative stress, defective neurotrophism, and autoimmune respectively. mediated nerve destruction [5]. Conclusion: The current study concluded that two-point The true prevalence of diabetic neuropathy (DN) is not discrimination was most affected component. Pain was the known and reports vary from 10% to 90% in diabetic patients, unaffected sensory component. The most to least affected depending on the criteria and methods used to define components were graphesthesia, temperature, stereognosis, touch, vibration and tactile localisation respectively. The conclusion neuropathy [6]-[9]. In a study it was found that among diabetic indicates that there are some degree of sensory involvement in population 50% had neuropathy after a simple clinical test such upper extremity in type 2 diabetic subjects and equal importance as the ankle jerk or vibration perception test, almost 90% tested should be given to upper extremity while assessing the neuropathy positive to sophisticated evaluations of autonomic function or along with the lower extremity. peripheral sensation [10]. Diabetic neuropathy is generally subdivided into Keywords: Pain, Sensory Evaluation, Tpd, Type 2 Diabetes, Upper Exterimity. focal/multifocal neuropathies, including diabetic amyotrophy, symmetric polyneuropathies and diabetic sensorimotor 1. Introduction polyneuropathy (DSPN). The proper diagnosis requires a thorough history, clinical and neurological examinations and The term diabetes mellitus describes a metabolic disorder of exclusion of secondary causes [11]. Neurologic complications International Journal of Research in Engineering, Science and Management 504 Volume-2, Issue-7, July-2019 www.ijresm.com | ISSN (Online): 2581-5792 occur equally in type 1 and type 2 diabetes mellitus and diabetes manual behaviors [29]. Over 90 % of diabetic patients additionally in various forms of acquired diabetes [12]. In diagnosed with neuropathy reportedly present with sensory sensory nerve damage, the nerves with the longest axons symptoms, while approximately 77 % have experienced motor usually are affected first, resulting in a stocking and glove symptoms [31]. Despite the high incidence of both sensory and distribution. Small fiber damage affects sensation of motor symptoms with diabetic neuropathy, evaluation and temperature, light touch, pinprick, and pain. Large fiber damage treatment of diabetic peripheral neuropathy have been focused diminishes vibratory sensation, position sense, muscle strength, solely on the lower extremity [32], [33]. sharp-dull discrimination and two-point discrimination [13]. While many previous works focus on the pathology and Generally, “sensibility” is defined as normal touch, functional interference associated with diabetic feet, few diminished light touch, diminished protective sensation, and explore the effects of diabetic hands [34]-[36]. There are a wide loss of protective sensation [14] Various modalities of touch range of symptoms associated with diabetic hand syndrome, sensation, such as pressure, vibration, and two point such as numbness, chronic pain, stiffness, tingling, reduced discrimination (TPD), are used to test loss of sensation or strength, abnormal sensory functioning or fatigue and these can sensibility [15]- [17]. The peripheral nervous system (PNS) lies lead to deficits in the sensorimotor control and even functional between the transducers at our muscles, joints, and skin and the performance of the hand [37]-[39]. Therefore, it was necessary central nervous system (CNS). Thus, the PNS carries to know the extent and the severity of sensory involvement in information about responses to movement, pressure, patterns, type 2 diabetes mellitus in order to design the rehabilitation and temperature. The end organs, themselves, are tuned to be protocol according to the need of those. So the present study optimally sensitive to specific types of energy input, [18] which threw light on the extent of sensory impairment and the most is "exquisite, but not exclusive." [19] These members work in affected sensory component of upper extremity in type 2 concert to produce the quality of sensibility, including active diabetic population. touch [20]- [24]. A. Objectives The problem for the examiner extends beyond measurement and documentation of sensibility to that of recognizing the stage To assess the extent of sensory deficits of upper limb in type and degree of involvement so that treatment considerations can 2 diabetes mellitus. To find out the most affected sensory be made with the highest probability of positive outcomes. If component among them. the injury is detected early enough, treatment to restore PNS function can be considered. That failing, in the case of 2. Methodology irreversible nerve damage, retraining of capabilities is based on A. Source of the data residual PNS function. No treatment can ever be superior to Subjects were recruited from Jnana Sanjeevini Hospital, preventing the problem from developing in the first place. Thus, Bangalore and Outpatient Department of R V College of the earliest detection of reduced sensation is paramount to keep Physiotherapy, Bangalore. the patient from unintentional self-inflicted damage, which may occur at levels of reduced protective sensation. The B. Method of collection of data measurement of residual PNS function becomes the baseline for The investigator contacted the above mentioned authorities detecting new damage, with the hope that early detection can and obtained permission from the concerned authorities. prevent further loss of PNS function [25]. Subsequently, after obtaining the permission, the investigator Evaluation should be of greater importance in a neuropathy obtained signed informed consent from the subjects, then the which is predominantly sensory and studies have shown that investigator screened the subjects according to inclusion criteria conduction velocity is diminished, sensory amplitude potentials and exclusion criteria to meet
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