Diabetic Polyneuropathy
The NeuroQuick handheld screening device (Schweers; Meerbusch, Germany) may be more sensitive in detecting early diabetic symmetric polyneuropathy than elaborate thermal testing and screening tests such as the tuning fork, according to a new study from Germany published in the May issue of Diabetes Care.
To verify the device's ability to detect diabetic symmetric polyneuropathy early on, the researchers used quantitative testing of cold sensation based on the wind chill factor. They termed this the NeuroQuick threshold, or NQT.
Subjects included 60 and 128 diabetic patients with and without diabetic symmetric polyneuropathy, respectively, and 160 healthy individuals. Diabetic symmetric polyneuropathy had been diagnosed by a neurologic examination, motor and sensory nerve conduction velocity, vibration perception threshold, and warm and cold thermal perception threshold. Subjects were also screened with a C-64 Hz tuning fork and TipTherm device.
The researchers measured NQT on the foot dorsum and found that it correlated significantly with all nerve function tests in the diabetic subjects. NQT was abnormal in subjects with diabetic symmetric polyneuropathy. However, the warm thermal perception threshold was normal in 39% of subjects with diabetic symmetric polyneuropathy and abnormal in 2%, the TipTherm was normal in 47% and abnormal in 2%, and the tuning fork was normal in 29% and abnormal in 10% (all P < .05).
The researchers concluded that overall, NeuroQuick is a valid and reliable screening tool for quantitative assessment of small nerve fiber dysfunction.
Source: Ziegler D, Siekierka-Kleiser E, Meyer B, Schweers M. Validation of a novel screening device (NeuroQuick) for quantitative assessment of small nerve fiber dysfunction as an early feature of diabetic polyneuropathy. Diabetes Care 2005;28:1169-74.
Diabetic Ulcers
A recent randomized, placebo-controlled, multicenter, National Institutes of Health-sponsored Phase II clinical trial of topical talactoferrin alfa (talactoferrin; Agennix Inc, Houston, TX) in patients with diabetic neuropathic ulcers met its primary end point: incidence of greater than or equal to 75% healing at the end of the dosing (week 12) relative to baseline.
Patients receiving talactoferrin had double the incidence of 75% or greater healing compared with patients receiving a placebo gel. There were no adverse events related to the treatment or laboratory abnormalities.
The 55-patient, 2-part study was designed to determine if topical talactoferrin increases the incidence of wound healing in patients with diabetic neuropathic ulcers. In part 1, groups of 3 patients each received 1%, 2.5%, or 8.5% talactoferrin gel in a sequential design, with twice daily administration to the ulcer for 30 days. Part 2 of the study was a randomized, placebo-controlled evaluation of 2.5% and 8.5% talactoferrin gel. Patients were equally divided between the 2 talactoferrin combinations and placebo.
No drug-related adverse events were found at any dose level, and no patient had any infection of the target ulcer during the dosing period.
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