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CLINICAL AND NEUROPHYSIOLOGICAL EVALUATION OF PERIPHERAL
NEUROPATHY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
¹Gulmurodov Bahodir
²Eshmamatov Murodulla
³Zoxidjonova Shahnoza
¹'²'³1st-year Residents, Department of Neurology,
Samarkand State Medical University
Affiliation: Department of Neurology,
Samarkand State Medical University, Uzbekistan
https://doi.org/10.5281/zenodo.15511393
Research Objective
: The aim of this thesis is to investigate the clinical presentation and
neurophysiological characteristics of peripheral neuropathy in patients with type 2 diabetes
mellitus (T2DM), and to evaluate the relationship between disease duration, glycemic control, and
the severity of neuropathic manifestations. Early identification and precise classification of
diabetic neuropathy is essential for preventing progression and improving patient outcomes.
Introduction
: Diabetes mellitus is a chronic metabolic disorder characterized by sustained
hyperglycemia. Among its numerous complications, diabetic peripheral neuropathy (DPN)
remains one of the most common and challenging to manage. DPN affects approximately 50% of
individuals with long-standing T2DM and contributes significantly to morbidity, diminished
quality of life, and healthcare costs. It primarily affects the distal nerves and presents with various
sensory, motor, and autonomic symptoms.
This thesis explores the intricate pathogenesis of diabetic neuropathy, highlighting the role
of chronic hyperglycemia, oxidative stress, inflammation, microvascular insufficiency, and
mitochondrial dysfunction in the progressive degeneration of peripheral nerves. Clinical
evaluation of neuropathy often involves detailed neurological examination and symptom scoring
systems, while neurophysiological assessment offers objective insights into nerve conduction and
axonal damage.
Materials and Methods:
This prospective observational study was conducted over a 12-
month period and enrolled 90 patients aged 40-70 years with a confirmed diagnosis of T2DM.
Patients were recruited from the outpatient clinic of the Department of Neurology at Samarkand
State Medical University. Ethical approval was obtained prior to initiation.
Biochemical parameters measured included:
Fasting Blood Glucose (FBG)
Glycated hemoglobin (HbA1c)
Serum lipid profile
Body mass index (BMI)
Results
: Of the 90 patients enrolled, 78 (86.7%) exhibited signs of peripheral neuropathy.
The average age of affected patients was 58.6 ± 6.9 years, with a slight male predominance
(55%). The most common symptoms were burning pain (62%), numbness (48%), tingling (40%),
and nocturnal discomfort (35%).
Neuropathy severity correlated significantly with both duration of diabetes and poor
glycemic control.
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Group III patients showed significantly lower NCV values and higher MNSI scores
compared to Groups I and II (p<0.001). Sensory nerves were more frequently and severely affected
than motor nerves. EMG findings supported predominant axonal degeneration with features of
denervation in distal muscles.
HbA1c levels above 8% were associated with a higher likelihood of severe neuropathy (OR
2.4, CI 1.5-3.7). TCSS scores correlated positively with HbA1c and duration of disease (r=0.72).
Discussion
: The findings of this study are consistent with the global literature on diabetic
neuropathy. DPN is predominantly a length-dependent axonopathy, with earliest changes
occurring in distal sensory fibers. Our study underscores the importance of routine screening for
neuropathic symptoms, particularly in patients with diabetes duration greater than 5 years or poorly
controlled glycemia.
While clinical assessments provide an initial indication of neuropathy, electrophysiological
studies are critical for confirming diagnosis, quantifying severity, and distinguishing between
demyelinating and axonal patterns. Early intervention through stringent glycemic control,
neurotrophic agents, and lifestyle modifications has been shown to delay progression and alleviate
symptoms.
Conclusion
: Diabetic peripheral neuropathy remains a prevalent and underdiagnosed
complication in patients with T2DM. Clinical and neurophysiological evaluation offers
complementary information necessary for accurate diagnosis and management. This study
confirms the strong association between hyperglycemia, disease duration, and neuropathy severity.
Implementation of standardized screening and timely electrophysiological evaluation
should be integrated into routine diabetic care to improve outcomes and reduce disability.
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