Physical Therapy for Diabetic Peripheral Neuropathy: A Narrative Review

Nizar Abdul Majeed Kutty, Mohammed Abdul Razzaq Jabbar, Sura Sreenivasulu

Abstract


Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus in both developed and developing countries. It is found in about 10% of diabetic clients at diagnosis, and in the majority of clients 25 years down the line. Clients with pre-diabetes may also develop neuropathies that are similar to diabetic neuropathies. Long-term hyperglycemia can cause peripheral nerve damage, resulting in distal-predominant nerve fibre degeneration. Loss of feeling in the lower limbs is a high risk for limb amputation. Despite efforts to make an early diagnosis and to halt the progression of diabetic neuropathy, currently there is no effective treatment available at a global level, except for strict control of blood glucose.

Physical therapy can improve the overall quality of life of diabetes mellitus clients with peripheral neuropathy and can alleviate the symptoms of neuropathy. This paper assesses the effectiveness of interventions used by physical therapists to minimise dysfunctions in people with DPN. It reviews the different treatment strategies and presents evidence and conditions for its applications.

Keywords


Diabetic Neuropathy; Physical therapy; Pain; Aerobic exercise; Balance

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References


Ahn S, Song R (2012). Effects of Tai Chi exercise on glucose control, neuropathy scores, balance, and quality of life in patients with Type 2 diabetes and neuropathy. The Journal of Alternative and Complementary Medicine; 18(12): 1172-8. https://doi.org/10.1089/acm.2011.0690. PMid:22985218. PMCid:PMC3513979

Akashi PM, Sacco IC, Watari R, Hennig E (2008). The effect of diabetic neuropathy and previous foot ulceration in EMG and ground reaction forces during gait. Clinical Biomechanics; 23(5): 584-92. https://doi.org/10.1016/j.clinbiomech.2007.11.015. PMid:18178296

Allet L, Armand S, Golay A, Monnin D, de Bie RA, de Bruin ED (2008). Gait characteristics of diabetic patients: A systematic review. Diabetes/Metabolism Research and Reviews; 24(3): 173-91. https://doi.org/10.1002/dmrr.809. PMid:18232063

Allet L, Armand S, de-Bie RA, Golay A, Monnin D, Aminian K, de-Bruin ED (2010). The gait and balance of patients with diabetes can be improved: A randomized controlled trial. Diabetologia; 53(3): 458-66. https://doi.org/10.1007/s00125-009-1592-4. PMid:19921145. PMCid: PMC2815802

Andersen H, Nielsen S, Mogensen CE, Jakobsen J (2004). Muscle strength in type 2 diabetes. Diabetes; 53(6): 1543-8. https://doi.org/10.2337/diabetes.53.6.1543. PMid:15161759

Andreassen CS, Jakobsen J, Andersen H (2006). Muscle weakness: A progressive late complication in diabetic distal symmetric polyneuropathy. Diabetes; 55(3): 806-12. https://doi.org/10.2337/diabetes.55.03.06.db05-1237. PMid:16505247

Asif M (2014). The prevention and control of the type-2 diabetes by changing lifestyle and dietary pattern. Journal of Education and Health Promotion; 3: 1. https://doi.org/10.4103/2277-9531.127541. PMid:24741641. PMCid:PMC3977406

Boulton AJ (2004). The diabetic foot: from art to science. The 18th Camillo Golgi lecture. Diabetologia; 47(8): 1343-53. https://doi.org/10.1007/s00125-004-1463-y

Boulton AJ, Malik RA, Arezzo JC, Sosenko JM (2004). Diabetic somatic neuropathies. Diabetes Care; 27(6): 1458-86. https://doi.org/10.2337/diacare.27.6.1458. PMid:15161806

Boulton AJ, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, Malik RA, Maser RE, Sosenko JM, Ziegler D (2005). Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care; 28(4): 956-62. https://doi.org/10.2337/diacare.28.4.956. PMid:15793206

Breiner A, Lovblom LE, Perkins BA, Bril V (2014). Does the prevailing hypothesis that small-fiber dysfunction precedes large-fiber dysfunction apply to type 1 diabetic patients? Diabetes Care; 37(5): 1418-1424. https://doi.org/10.2337/dc13-2005. PMid:24574353

Bril V, England J, Franklin GM, Backonja M, Cohen J, Del-Toro D, Feldman E, Iverson DJ, Perkins B, Russell JW, Zochodne D (2011). Evidence-based guideline: treatment of painful diabetic neuropathy: report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology; 76(20): 1758-65. https://doi.org/10.1212/WNL.0b013e3182166ebe PMid:21482920. PMCid:PMC3100130

Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, Malanda B (2018). IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Research Clinical Practice; 138: 271-281. https://doi.org/10.1016/j.diabres.2018.02.023. PMid:29496507

Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Barun B (2010). Exercise and type 2 diabetes: The American College of Sports Medicine and the American Diabetes Association-joint position statement. Diabetes Care; 33(12): e147-e167. https://doi.org/10.2337/dc10-9990. PMid:21115758. PMCid:PMC2992225

Dixit S, Maiya AG, Shastry BA (2014). Effect of aerobic exercise on peripheral nerve functions of population with diabetic peripheral neuropathy in type 2 diabetes: A single blind, parallel group randomised controlled trial. Journal of Diabetes and its Complications; 28(3): 332-9. https://doi.org/10.1016/j.jdiacomp.2013.12.006. PMid:24507164

Dobretsov M, Romanovsky D, Stimers JR (2007). Early diabetic neuropathy: Triggers and mechanisms. World Journal of Gastroenterology; 13(2): 175-91. https://doi.org/10.3748/wjg.v13.i2.175. PMid:17226897. PMCid:PMC1829411

Finnerup NB, Sindrup SH, Jensen TS (2010). The evidence for pharmacological treatment of neuropathic pain. Pain; 150(3): 573-81. https://doi.org/10.1016/j.pain.2010.06.019. PMid:20705215

Flynn BP, Bhole AP, Saeidi N, Liles M, DiMarzio CA, Ruberti JW (2010). Mechanical strain stabilises reconstituted collagen fibrils against enzymatic degradation by mammalian collagenase matrix metalloproteinase 8 (MMP-8). PLoS One; 5(8): e12337. https://doi.org/10.1371/journal.pone.0012337. PMid:20808784. PMCid:PMC2925882

Gefen A (2003). Plantar soft tissue loading under the medial metatarsals in the standing diabetic foot. Medical Engineering & Physics; 25(6): 491-9. https://doi.org/10.1016/S1350-4533(03)00029-8

Giacomozzi C, Martelli F (2006). Peak pressure curve: an effective parameter for early detection of foot functional impairments in diabetic patients. Gait Posture; 23(4): 464-70. https://doi.org/10.1016/j.gaitpost.2005.06.006. PMid:16043353

Goldsmith JR, Lidtke RH, Shott S (2002). The effects of range-of-motion therapy on the plantar pressures of patients with diabetes mellitus. Journal of the American Podiatric Medical Association; 92(9): 483-90. https://doi.org/10.7547/87507315-92-9-483. PMid:12381797

Greenman RL, Khaodhiar L, Lima C, Dinh T, Giurini JM, Veves A (2005). Foot small muscle atrophy is present before the detection of clinical neuropathy. Diabetes Care; 28(6): 1425-30. https://doi.org/10.2337/diacare.28.6.1425. PMid:15920063 PMCid:PMC1224714

Hung JW, Liou CW, Wang PW, Yeh SH, Lin LW, Lo SK, Tsai FM (2009). Effect of 12-week tai chi chuan exercise on peripheral nerve modulation in patients with type 2 diabetes mellitus. Journal of Rehabilitation Medicine; 41(11): 924-9. https://doi.org/10.2340/16501977-0445. PMid:19841845

Ites KI, Anderson EJ, Cahill ML, Kearney JA, Post EC, Gilchrist LS (2011). Balance interventions for diabetic peripheral neuropathy: A systematic review. Journal of Geriatric and Physical Therapy; 34(3): 109-16. https://doi.org/10.1519/JPT.0b013e318212659a. PMid:21937901

Jaiswal M, Lauer A, Martin C L, Bell RA, Divers J, Dabelea D, Pettitt D, Saydah S, Pihoker C, Standiford D, Rodriguez B, Pop-Busui R, Feldman E (2013). SEARCH for Diabetes in Youth Study Group. Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for Diabetes in Youth follow-up cohort. Diabetes Care; 36(12): 3903-8. https://doi.org/10.2337/dc13-1213. PMid:24144652 PMCid:PMC3836139

Javed S, Petropoulos IN, Tavakoli M, Malik RA (2014) Clinical and diagnostic features of small fiber damage in diabetic polyneuropathy. Handbook of Clinical Neurology; 126: 275-90. https://doi.org/10.1016/B978-0-444-53480-4.00019-9. PMid:25410229

Juster-Switlyk K, Smith AG (2016). Updates in diabetic peripheral neuropathy [version 1; referees: 3 approved]. F1000Research, 5(F1000 Faculty Rev): 738. https://doi.org/10.12688/f1000research.7898.1. PMid:27158461. PMCid:PMC4847561

Lee K, Lee S, Song C (2013). Whole-body vibration training improves balance, muscle strength and glycosylated hemoglobin in elderly patients with diabetic neuropathy. The Tohoku Journal of Experimental Medicine; 231(4): 305-14. https://doi.org/10.1620/tjem.231.305. PMid:24334483

LeMaster JW, Reiber GE, Smith DG, Heagerty PJ, Wallace C (2003). Daily weight-bearing activity does not increase the risk of diabetic foot ulcers. Medicine and Science in Sports and Exercise; 35(7): 1093-9. https://doi.org/10.1249/01.MSS.0000074459.41029.75. PMid:12840628

Majeedkutty N, Majida N (2013). Effects of multisensory training on balance and gait in persons with Type 2 diabetes: A randomised controlled trial. Disability, CBR & Inclusive Development; 24(2): 79-91. https://doi.org/10.5463/dcid.v24i2.206

Malik RA, Veves A, Tesfaye S, Smith G, Cameron N, Zochodne D, Lauria G (2011). Toronto Consensus Panel on diabetic neuropathy. Small fibre neuropathy: Role in the diagnosis of diabetic sensorimotor polyneuropathy. Diabetes Metabolism Research and Reviews; 27: 678-84. https://doi.org/10.1002/dmrr.1222. PMid:21695760

Menz HB, Lord SR, St George R, Fitzpatrick RC (2004). Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy. Arch Physical Medicine and Rehabilitation; 85(2): 245-52. https://doi.org/10.1016/j.apmr.2003.06.015. PMid:14966709

Nimmo MA, Leggate M, Viana JL, King JA (2013). The effect of physical activity on mediators of inflammation. Diabetes, Obesity and Metabolism; 15(3): 51-60. https://doi.org/10.1111/dom.12156. PMid:24003921

Owings TM, Apelqvist J, Stenstrom A, Becker M, Bus SA, Kalpen A, Ulbrecht JS, Cavanagh PR (2009). Plantar pressures in diabetic patients with foot ulcers which have remained healed. Diabetic Medicine; 26(11): 1141-6. https://doi.org/10.1111/j.1464-5491.2009.02835.x. PMid:19929993

Payne C, Turner D, Miller K (2002). Determinants of plantar pressures in the diabetic foot. J Diabetes Complications; 16(4): 277-83. https://doi.org/10.1016/S1056-8727(01)00187-8

Pham H, Armstrong DG, Harvey C, Harkless LB, Giurini JM, Veves A (2000). Screening techniques to identify people at high risk for diabetic foot ulceration: A prospective multicenter trial. Diabetes Care; 23(5): 606-611. https://doi.org/10.2337/diacare.23.5.606. PMid:10834417

Raghav D, Sharma M, Rathore P, Panjee K (2013). Efficacy of schematic exercises over strengthening exercises on walking abilities, stride length and cadence in diabetic neuropathy. Indian Journal of Physical Therapy; 1(2): 24-8.

Rao S, Saltzman CL, Yack HJ (2010). Relationships between segmental foot mobility and plantar loading in individuals with and without diabetes and neuropathy. Gait Posture; 31(2): 251-5. https://doi.org/10.1016/j.gaitpost.2009.10.016. PMid:19926283 PMCid:PMC2818384

Richardson JK, Sandman D, Vela S (2001). A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy. Archives of Physical Medicine and Rehabilitation; 82(2): 205-9. https://doi.org/10.1053/apmr.2001.19742. PMid:11239311

Sacco IC, Hamamoto AN, Gomes AA, Onodera AN, Hirata RP, Hennig EM (2009). Role of ankle mobility in foot rollover during gait in individuals with diabetic neuropathy. Clinical Biomechanics; 24(8): 687-92. https://doi.org/10.1016/j.clinbiomech.2009.05.003. PMid:19497649

Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD (2006). Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care; 29(6): 1433-8. https://doi.org/10.2337/dc06-9910. PMid:16732040

Singleton JR, Bixby B, Russell JW, Feldman EL, Peltier A, Goldstein J, Howard J, Smith AG (2008). The Utah Early Neuropathy Scale: A sensitive clinical scale for early sensory predominant neuropathy. Journal of the Peripheral Nervous System; 13(3): 218-27. https://doi.org/10.1111/j.1529-8027.2008.00180.x. PMid:18844788

Singleton JR, Smith AG, Marcus RL (2015). Exercise as therapy for diabetic and prediabetic neuropathy. Current Diabetes Reports; 15(12): 120. https://doi.org/10.1007/s11892-015-0682-6. PMid:26538074

Smith AG, Singleton JR (2013). Obesity and hyperlipidemia are risk factors for early diabetic neuropathy. Journal of Diabetes and Its Complications; 27(5): 436-42. https://doi.org/10.1016/j.jdiacomp.2013.04.003. PMid:23731827 PMCid:PMC3766404

Song CH, Petrofsky JS, Lee SW, Lee KJ, Yim JE (2011). Effects of an exercise program on balance and trunk proprioception in older adults with diabetic neuropathies. Diabetes Technology and Therapeutics; 13(8): 803-11. https://doi.org/10.1089/dia.2011.0036. PMid:21561371

van Deursen R (2004). Mechanical loading and off-loading of the plantar surface of the diabetic foot. Clinical Infectious Diseases; 39(2): 87-91. https://doi.org/10.1086/383268. PMid:15306985

Williams DS, Brunt D, Tanenberg RJ (2007). Diabetic neuropathy is related to joint stiffness during late stance phase. Journal of Applied Biomechanics; 23(4): 251-60. https://doi.org/10.1123/jab.23.4.251. PMid:18089923

Yoo M, D'Silva LJ, Martin K, Sharma NK, Pasnoor M, LeMaster JW, Kludding PM (2015). Pilot study of exercise therapy on painful diabetic peripheral neuropathy. Pain Medicine; 16(8): 1482-9. https://doi.org/10.1111/pme.12743. PMid:25800666 PMCid:PMC4673891

Ziegler D, Rathmann W, Dickhaus T, Meisinger C, Mielck A (2009). Neuropathic pain in diabetes, prediabetes and normal glucose tolerance: the MONICA/KORA Augsburg Surveys S2 and S3. Pain Medicine; 10: 393-400. https://doi.org/10.1111/j.1526-4637.2008.00555.x. PMid:19207236




DOI: https://doi.org/10.5463/dcid.v30i1.760



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