Does the blood glucose control have an effect on the success of the painful diabetic neuropathy treatment?

Jovanikić, Olivera; Anđelić, Gordana; Lepić, Milan; Mirković, Dušica; Jovanović, Bojan; Lepić, Toplica; Dragović, Tamara

doi:10.2298/VSP160613367J

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Vojnosanitetski pregled

2018, vol. 75, br. 6, str. 552-557

Da li kontrola glukoze u krvi ima efekta na uspeh terapije bolne dijabetesne neuropatije?

Jovanikić Olivera^a, Anđelić Gordana^b, Lepić Milan^a, Mirković Dušica^c, Jovanović Bojan^d, Lepić Toplica^e, Dragović Tamara^f

^aVojnomedicinska akademija, Klinika za neurohirurgiju, Beograd
^bVojnomedicinska akademija, Institut za medicinska istraživanja, Beograd
^cVojnomedicinska akademija, Centar za kliničku farmakologiju, Beograd + Vojnomedicinska akademija, Klinika za endokrinologiju, Beograd
^dVojnomedicinska akademija, Klinika za neurologiju, Beograd
^eUniverzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd + Vojnomedicinska akademija, Klinika za neurologiju, Beograd
^fUniverzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd + Vojnomedicinska akademija, Klinika za endokrinologiju, Beograd

e-adresa: olijovan@mail.ru

Ključne reči: dijabetesne neuropatije; glikemija; krv; hemijskeanalize; upitnici; anestetici; lokalni; blokada živca; bol; merenje; lečenje; ishod

Sažetak

Uvod/Cilj. Dijabetesna neuropatija (DN) je osnovna komplikacija dijabetesa, udružena sa poremećajem glikoregulacije i metabolizma, oštećenjem malih krvnih sudova i povišenim kardiovaskularnim rizikom. U istraživanju je praćen uticaj glikoregulacije na efikasnost lečenja bolne dijabetesne neuropatije (BMDN) rezistentne na medikamentno minimalno invazivnom terapijom. Metode. Kod bolesnika (n = 53, oba pola, starosti 68,3 ± 12,6) sa BMDN primenjena je minimalno invazivna terapija - lokalnim anesteticima (0.5% prokain hidrohlorid, 1% lidokain, 0.25% levobupivakain) ultrazvučno vođenim blokovima. Neuropatija je potvrđena u skladu sa važećim kriterijumima Evropske federacije neurološkog udruženja (EFNU). Glikoregulacija je preko vrednosti glikemije i glikozilirani hemoglobina (HbA1c), pre lečenja, nakon ciklusa terapije i posle jednog meseca od završetka terapije. Neuropatski bol potvrđen je skalama Leeds assessment of neuropathic symptoms and signs (LANSS) ili Dopleur neuropathique (DN4) ili pain DETECT skale za utvrđivanje bola. Intenzitet bola je ocenjeni su vizuelnom analognom skalom, neuropatskom skalom simptoma bola i listom simptoma neuropatskog bola. Primenjena je perineuralna blokada lokalnim anesteticima, pod kontrolom ultrazvuka. Efikasnost terapije određivana je procentom smanjenja bola: > 50% - odličan rezultat, 30%-49% - dobar rezultat i < 30% - terapija ne deluje. Ispitana je korelacija glikoregulacije (glikemije i nivoa HbA1c) i ishoda lečenja. Rezultati. Svi bolesnici su imali povišenu vrednost glikemije i HbA1C na početku lečenja (8,23 ± 2,77 mmol/L i 8,53% ± 2,48%, redom), na kraju terapije (8,43 ± 2,46 mmol/L i 8,85% ± 2,87%, redom) i posle meseca praćenja (8,49 ± 2,22 mmol/L i 8,51% ± 2,09%, redom). Prestanak bola nije bio u vezi sa smanjenjem glikemije [skale za procenu bola redom pre terapije: 81,53 ± 11,62 mm; 62 ± 13,04; 53,40 ± 17,63; jedan mesec posle terapije: 29 ± 9,23 mm; 13,79 ± 6,65; 11,83 ± 7,93; i jedan mesec kasnije; 26,15 ± 8,41 mm; 12,68 ± 6,03; 9,81 ± 7,64]. Nije bilo korelacije između poremećaja glikoregulacije i odličnog terapijskog odgovora.

Abstract

Background/Aim. Diabetic neuropathy (DN) is the basic complication of diabetes, associated with impared glucoregulation, metabolic distrurbances, microvascular vessel damage and increased cardiovascular risk. We monitored the impact of glucoregulation on the efficacy of painful diabetic neuropathy (PDN) treatment, when all pharmaceutical treatment options were exhausted. Methods. Patients (n = 53, both gender, average age 68.3 ± 12.6) with PDN resistant to the pharmacotherapy were treated with the ultrasound-guided local anesthetic (0.5% procaine hydrochloride, 1% lidocaine, 0.25% levobupivacaine) blocks. Neuropathy was confirmed in accordance with the applicable European Federation of Neurological Societies (EFNS) criteria. Glycosylated hemoglobin (HbA1C) and blood glucose levels were monitored before and after therapy and one month after the treatment. Neuropathic pain was confirmed by Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) or Douleur neuropathique (DN4) or pain DETECT scales. The pain intensity was assessed by Visual analog scale, Neuropathic pain symptom and Neuropathic pain symptom inventory (VAS, NPS and NPSI, respectively) scales before and after therapy and one month after the treatment. The efficacy of the therapy was assessed as: excellent result (> 50% of pain loss), good result (30%-49% of pain loss and the therapy does not work (< 30% of pain loss). The correlation between glucoregulation and the outcome was examined. Results. Because the values of glycenia and HbA1c were not different among patients treated with different local anesthetics, they were presented together. All patients had elevated blood glucose and HbA1C levels before (8.23 ± 2.77 mmol/L and 8.53% ± 2.48% respectively), after (8.43 ± 2.461 mmol/L and 8.85% ± 2.87%, respectively) and one month after the treatment (8.49 ± 2.22 mmol/L and 8.51% ± 2.09%, respectively). The loss of the pain was not result of the decrease in blood glucose and HbA1C blood levels. VAS, NPS, NPSI values were the following before the therapy: 81.53 ± 11.62 mm; 62.00 ± 13.04; 53.40 ± 17.63, respectively; after the therapy: 29.00 ± 9.23 mm; 13.79 ± 6.65; 11.83 ± 7.93, respectively; and one month later: 26.15 ± 8.41 mm; 12.68 ± 6.03; 9.81 ± 7.64, respectively]. There was no correlation between glucoregulation and excellent outcome. Conclusion. Even though the disturbance of glucose control is the key factor for the progression of PDN, it is not significant for the outcome of the pain treatment. New investigations are required.

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O članku

jezik rada: engleski
vrsta rada: izvorni naučni članak
DOI: 10.2298/VSP160613367J
objavljen u SCIndeksu: 09.08.2018.
metod recenzije: dvostruko anoniman

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