NEUROPHYSIOLOGICAL CHANGES IN CONTEXT TO DURATION OF EXPOSURE IN INSULIN DEPENDENT AND NON INSULIN DEPENDENT DIABETES MELLITUS

Background: Diabetes mellitus is characterized by inability of the body to metabolize glucose properly. The prevalence of diabetes is rapidly rising all over the globe at an alarming rate. IDDM and NIDDM shows effect on central nervous system, peripheral nervous system, autonomic nervous system, cardiovascular system and other physiological system. A common complication due to the IDDM and NIDDM includes peripheral neuropathy, retinopathy, nephropathy and vascular complication. Insulin and non-insulin dependent diabetes mellitus both affect the peripheral nervous system depending on the duration of exposure and blood glucose level.

Diabetes mellitus is characterized by chronic hyperglycemia with disturbance of carbohydrate, fat, and protein metabolism resulting from defects in insulin secretion, insulin action or both.The two broad categories of diabetes are designated -Insulin dependent and non insulin dependent.IDDM is the result of complete or near-total insulin deficiency.NIDDM is a heterogeneous group of disorders characterized by varying degrees of insulin resistance, impaired insulin secretion, and increased glucose production tion, the number of people with diabetes in India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken [2].Insulin dependent and non insulin dependent diabetes shows their effect on various physiological system like Central nervous system, peripheral nervous system, musculoskeletal system, autonomic nervous system and cardiovascular system [3,4].11,12], which shows a close correlation between clinical findings and the degree of conduction changes [13,14].The prevalence of diabetic neuropathy appears parallel with duration of exposure of diabetes in both type 1 and type 2 diabetes.People with diabetes can develop neurological problems at any time, but the risk of developing diabetic neuropathy increases with duration of diabetes.
[15] Few studies suggest that duration of diabetes is also a factor for neuropathy.
Therefore the aim of the study was to find Neurophysiological changes in context to duration of exposure in insulin dependent and non insulin dependent diabetes mellitus.
Review of literatures: Arindam [16] had observed that there is significant correlation between peripheral neuropathy and duration of diabetes, age of patients and postprandial blood glucose level.Screen with basic assessment form and NCV examination was performed on sural, tibial and peroneal nerves with RMS Aleron-2012 machine.

Major Sharmeen Sultan
Distal latency, CMAP, SNAP and NCV were taken as outcome measures.
Bio-Statistical analysis was performed by using Mann-Whitney test in SPSS 21.
Surface recording for common peroneal nerve was obtained from extensor digitorum brevis and stimulation was given at the ankle and at the neck of the fibula.For Sural nerve examination, the surface electrode between lateral malleolus and tendoachilles, records nerve conduction of sural nerve.The nerve was stimulated antidromically 10-16 cm proximal to the recording electrode, distal to the lower border of gastrocnemius.The active surface recording electrode for tibial nerve was placed on abductor hallusis or abductor digiti quiniti, slightly below and anterior to navicular tuberosity.Surface stimulation was used behind and proximal to the medial malleolus and in the popliteal fossa.Data Analysis: Bio-Statistical analysis was done using SPSS (version 21).Mann-Whitney test was used for data analysis.Level of significance was 0.05.Graph 2: Amplitude changes in context to Duration in Sural, Tibial and peroneal nerves.
Graph 3: NCV changes in context to Duration in Sural, Tibial and peroneal nerves.

RESULT DISCUSSION
Table 1 and 2 suggest that Duration has significant effect on neurophysiological changes in IDDM and NIDDM groups.Long duration of exposure shows major impact on neurophysiological changes in sural, tibial and peroneal nerve compared to short duration.Graph 1 to 3 suggest that long duration of exposure has more increase in latency, more reduction in amplitude and more reduction in NCV compared to short duration of exposure.
Duration of exposure has a significant effect on the peripheral nervous system.Our finding is consistent with the previous findings of Vinik,Gregersen,.Knuiman et al [21] reported that sensory neuropathy is more common in long standing diabetic subjects especially in those who develop the disease late in life.No significant sensory nerve dysfunction was found in the diabetic group with relatively short duration of diabetes.In hyperglycemias, glucose shunted through the Sorbitol pathway, causes the accumulation of sorbitol in Schwann cells, which undergoes osmotic damage leading to segmental demyelination.Future Study Scope: The study can be repeated to find the therapeutic effect of exercise on neurophysiological changes in context duration of exposure, The study can be repeated to find proximal nerve involvement in and NIDDM with different duration of exposure.

REFERENCES
In context to this study and neurophysiological findings, individuals with long duration of exposure must be taken into consideration for promotion, prevention, and care as compared to short duration in IDDM and NIDDM for secondary complications.
[1].According to the Diabetes Atlas 2006 published by the International Diabetes Federa-Maitrey Pandya, Miral Damani.NEUROPHYSIOLOGICAL CHANGES IN CONTEXT TO DURATION OF EXPOSURE IN INSULIN DEPENDENT AND NON INSULIN DEPENDENT DIABETES MELLITUS.
[17]  had observed that neuronal dysfunction of sensory nerves appears after prolonged exposure to hyperglycemia.Method: This was an observational cross sectional study which included 120 subjects.Subjects between 25 to 60 years of age and individuals with IDDM and NIDDM screened with SF-36 (general health good and above) were included in the study.Subjects having present history of lower limb radiculopathy, history of hospitalization in last 1 year, open wound and acute fever were excluded from the study.The room temperature was maintained between 21 0 c to 23 0 c.The skin resistance was reduced by cleaning with spirit.Supra maximal stimulation was given for the nerve conduction examination.Flow Chart 1: Procedure and Data Collection.120 diabetic individuals were selected based on inclusion criteria and informed consent was taken.
These changes indicate duration of hyper glycemia plays a detrimental role on neurophysiological changes.Increase in latency and decreases in NCV are suggestive of demyelinating changes.While reduced amplitude is suggestive of axonal loss.[17] Here longer duration of exposure has more demyelinating and axonal changes compared to Maitrey Pandya, Miral Damani.NEUROPHYSIOLOGICAL CHANGES IN CONTEXT TO DURATION OF EXPOSURE IN INSULIN DEPENDENT AND NON INSULIN DEPENDENT DIABETES MELLITUS.How to cite this article: Maitrey Pandya, Miral Damani.NEUROPHYSIOLOGICAL CHANGES IN CON-TEXT TO DURATION OF EXPOSURE IN INSULIN DEPENDENT AND NON IN-SULIN DEPENDENT DIABETES MELLITUS.Int J Physiother Res 2017;5(2):1902-1905.DOI: 10.16965/ijpr.2016.178CONCLUSION shorter duration of exposure in IDDM and NIDDM.

Table 1 :
Neurophysiological changes in context to Duration of Exposure in Sural nerve.
Maitrey Pandya, Miral Damani.NEUROPHYSIOLOGICAL CHANGES IN CONTEXT TO DURATION OF EXPOSURE IN INSULIN DEPENDENT AND NON INSULIN DEPENDENT DIABETES MELLITUS.

Table 2 :
Neurophysiological changes in context to Duration of Exposure in Tibial and Peroneal nerves.
*= suggests significant differenceGraph 1: Latency changes in context to Duration in Sural, Tibial and peroneal nerves.