Fatores preditivos da velocidade de condução nervosa motora distal em doentes com neuropatia diabética: um estudo transversal
DOI:
https://doi.org/10.47197/retos.v81.119409Palavras-chave:
Diabetes mellitus tipo 2 (DM2), neuropatia periférica diabética, velocidade de condução nervosa, força muscular intrínseca do pé, estudo transversalResumo
Contexto: A diabetes mellitus tipo 2 reduz a velocidade de condução nervosa (VCN), levando à neuropatia diabética (ND) com manifestações sensoriais, motoras e autonómicas. O estudo dos preditores de VCN é necessário para melhorar a avaliação, o tratamento e o prognóstico dos doentes afetados. Objectivo: Determinar preditores de VCN motora distal (nervos tibial e fibular) em doentes com ND. Métodos: Quarenta e quatro doentes ambulatórios com ND foram incluídos no estudo. Para além dos dados demográficos, a VCN motora dos nervos tibial e fibular e a força do músculo flexor longo dos dedos foram avaliadas através de um dinamómetro. Foram realizadas correlações através do coeficiente de correlação de Pearson e regressão linear. Resultados: A análise univariada mostrou que a força e o índice de massa corporal (IMC) estão associados à VCN motora do nervo peroneal, e a idade está associada à VCN motora do nervo tibial (p ≤ 0,2). O modelo de regressão não mostrou qualquer preditor significativo de cardiopatia congénita motora peroneal ou tibial (p < 0,05). Conclusão: A força isométrica dos flexores dos dedos, a idade e o IMC não são preditores independentes de cardiopatia congénita motora distal em doentes com pé diabético. São necessários estudos mais amplos para explorar possíveis métodos alternativos de rastreio clínico.Referências
Abd Elrazik Gad Elhak, R. K., Battesha, H. H. M., & Samir, S. M. (2021). Muscle energy technique versus active release technique on motor functions in patients with carpal tunnel syndrome. Interna-tional Journal of Therapy and Rehabilitation, 28(7), 1–11. https://doi.org/10.12968/ijtr.2020.0114
Abd Elrazik, R. K., Battesha, H. H. M., & Samir, S. M. (2021). Shock wave versus iontophoresis in pa-tients with carpal tunnel syndrome. Physiotherapy Quarterly, 29(1), 1–6. https://doi.org/10.5114/pq.2020.96420
Abouzid, M. R., Ali, K., Elkhawas, I., & Elshafei, S. M. (2022). An overview of diabetes mellitus in Egypt and the significance of integrating preventive cardiology in diabetes management. Cureus, 14(7), Article e27012. https://doi.org/10.7759/cureus.27012
Almurdhi, M. M., Reeves, N. D., Bowling, F. L., Boulton, A. J. M., Jeziorska, M., & Malik, R. A. (2016). Re-duced lower-limb muscle strength and volume in patients with type 2 diabetes in relation to neuropathy, intramuscular fat, and vitamin D levels. Diabetes Care, 39(3), 441–447. https://doi.org/10.2337/dc15-0995
Almurdhi, M. M., Reeves, N. D., Bowling, F. L., Boulton, A. J., Jeziorska, M., & Malik, R. A. (2017). Distal lower limb strength is reduced in subjects with impaired glucose tolerance and is related to el-evated intramuscular fat level and vitamin D deficiency. Diabetic medicine : a journal of the British Diabetic Association, 34(3), 356–363. https://doi.org/10.1111/dme.13163
AlSawahli, H., Mpyet, C. D., Ezzelarab, G., Hassanin, I., Shalaby, M., Safa, O., & Almansour, A. (2021). Population-based cross-sectional prevalence survey of diabetes and diabetic retinopathy in So-hag—Egypt, 2019. BMJ Open, 11(6), Article e047757. https://doi.org/10.1136/bmjopen-2020-047757
Alshimy, A. M., Ibrahim, S. M., Osama, L., & Metwally, H. M. (2023). Effect of neurodynamic mobiliza-tion techniques in patients with diabetic neuropathy. Human Movement, 24(3), 115–120. https://doi.org/10.5114/hm.2023.123456
Andersen, H., Nielsen, S., Mogensen, C. E., & Jakobsen, J. (2004). Muscle strength in type 2 diabetes. Diabetes, 53(6), 1543–1548. https://doi.org/10.2337/diabetes.53.6.1543
Andersen, H., Stålberg, E., Gjerstad, M. D., & Jakobsen, J. (1998). Association of muscle strength and electrophysiological measures of reinnervation in diabetic neuropathy. Muscle & Nerve, 21(12), 1647–1654.https://doi.org/10.1002/(SICI)1097-4598(199812)21:12<1647::AID-MUS4>3.0.CO;2-D
Andersen, H., Stålberg, E., Gjerstad, M. D., & Jakobsen, J. (1998). Association of muscle strength and electrophysiological measures of reinnervation in diabetic neuropathy. Muscle & nerve, 21(12), 1647–1654. https://doi.org/10.1002/(sici)1097-4598(199812)21:12<1647::aid-mus4>3.0.co;2-d
Andersen, S. T., Witte, D. R., Dalsgaard, E. M., Andersen, H., Nawroth, P., Fleming, T., Jensen, T. M., Fin-nerup, N. B., Jensen, T. S., Lauritzen, T., Feldman, E. L., Callaghan, B. C., & Charles, M. (2018). Risk factors for incident diabetic polyneuropathy in a cohort with screen-detected type 2 dia-betes followed for 13 years: ADDITION-Denmark. Diabetes Care, 41(5), 1068–1075. https://doi.org/10.2337/dc17-2062
Andersen, S. T., Witte, D. R., Dalsgaard, E. M., Andersen, H., Nawroth, P., Fleming, T., Jensen, T. M., Fin-nerup, N. B., Jensen, T. S., Lauritzen, T., Feldman, E. L., Callaghan, B. C., & Charles, M. (2018). Risk Factors for Incident Diabetic Polyneuropathy in a Cohort With Screen-Detected Type 2 Diabetes Followed for 13 Years: ADDITION-Denmark. Diabetes care, 41(5), 1068–1075. https://doi.org/10.2337/dc17-2062
Andreassen, C. S., Jakobsen, J., Ringgaard, S., Ejskjaer, N., & Andersen, H. (2009). Accelerated atrophy of lower leg and foot muscles—A follow-up study of long-term diabetic polyneuropathy using magnetic resonance imaging (MRI). Diabetologia, 52(6), 1182–1191. https://doi.org/10.1007/s00125-009-1345-4
Awang, M. S., Abdullah, J. M., Abdullah, M. R., Tharakan, J., Prasad, A., Husin, Z. A., Hussin, A. M., Tahir, A., & Razak, S. A. (2006). Nerve conduction study among healthy malays. The influence of age, height and body mass index on median, ulnar, common peroneal and sural nerves. The Malay-sian journal of medical sciences : MJMS, 13(2), 19–23.
Bansal, D., Gudala, K., Muthyala, H., Esam, H. P., Nayakallu, R., & Bhansali, A. (2014). Prevalence and risk factors of development of peripheral diabetic neuropathy in type 2 diabetes mellitus in a tertiary care setting. Journal of Diabetes Investigation, 5(6), 714–721. https://doi.org/10.1111/jdi.12223
Battesha, H. H. M., & Elhak, R. K. A. E. G. (2020). Effect of trunk control training on plantar pressure in patients with lumbar disc herniation. International Journal of Therapy and Rehabilitation, 27(8), 1–12. https://www.ijtrjournal.com
Bodman, M. A., & Varacallo, M. (2023). Peripheral diabetic neuropathy. In StatPearls. StatPearls Pub-lishing. https://www.ncbi.nlm.nih.gov/books/NBK537350/
Callaghan, B. C., Burke, J. F., Rodgers, A., McCammon, R., Langa, K. M., Feldman, E. L., & Kerber, K. A. (2013). Expenditures in the elderly with peripheral neuropathy: Where should we focus cost-control efforts? Neurology: Clinical Practice, 3(5), 421–430. https://doi.org/10.1212/CPJ.0b013e3182a78f60
Callaghan, B. C., Gallagher, G., Fridman, V., & Feldman, E. L. (2020). Diabetic neuropathy: What does the future hold? Diabetologia, 63(5), 891–897. https://doi.org/10.1007/s00125-020-05115-6
Darwesh, A., Sharaf, M. A., & Aboeleneen, A. M. (2017). Isokinetic testing of ankle muscular strength and proprioception, balance and nerve conduction in patients with polyneuropathy. Interna-tional Journal of Physiotherapy, 4(6), 335–342. https://doi.org/10.15621/ijphy/2017/v4i6/152742
Dyck, P. J., Overland, C. J., Low, P. A., Litchy, W. J., Davies, J. L., Dyck, P. J. B., ... & (Coordinating Commit-tee) for the Cl vs. NPhys Trial Investigators. (2010). Signs and symptoms versus nerve conduc-tion studies to diagnose diabetic sensorimotor polyneuropathy: Cl vs. NPhys trial. Muscle & Nerve, 42(2), 157–164. https://doi.org/10.1002/mus.21660
Feldman, E. L., Callaghan, B. C., Pop-Busui, R., Zochodne, D. W., Wright, D. E., Bennett, D. L., Bril, V., England, J. D., Freeman, R., Greene, D., Malik, R., Pasnoor, M., Russell, J. W., & Viswanathan, V. (2019). Diabetic neuropathy. Nature Reviews Disease Primers, 5(1), Article 41. https://doi.org/10.1038/s41572-019-0092-1
Gracia-Sánchez, A., López-Pineda, A., Nouni-García, R., Zúnica-García, S., Chicharro-Luna, E., & Gil-Guillén, V. F. (2025). Impact of Exercise Training in Patients with Diabetic Peripheral Neuropa-thy: An Umbrella Review. Sports medicine - open, 11(1), 75. https://doi.org/10.1186/s40798-025-00863-4
Haji Naghi Tehrani K. (2020). A study of nerve conduction velocity in diabetic patients and its relation-ship with tendon reflexes (T-Reflex). Acta bio-medica:AteneiParmensis, 91(3),e2020066. https://doi.org/10.23750/abm.v91i3.7288
Haji Naghi Tehrani, K. (2020). A study of nerve conduction velocity in diabetic patients and its rela-tionship with tendon reflexes (T-Reflex). Acta Bio-Medica, 91(3), Article e2020066. https://doi.org/10.23750/abm.v91i3.7288
Hilton, T. N., Tuttle, L. J., Bohnert, K. L., Mueller, M. J., & Sinacore, D. R. (2008). Excessive adipose tissue infiltration in skeletal muscle in individuals with obesity, diabetes mellitus, and peripheral neu-ropathy: Association with performance and function. Physical Therapy, 88(11), 1336–1344. https://doi.org/10.2522/ptj.20080079
Hundekari, J. C., Rai, A., Wasnik, S., & Kot, L. (2022). Effect of backpack load on nerve conduction ve-locity and risk of peripheral neuropathy in upper extremities of undergraduate medical stu-dents carrying backpack. Asian Journal of Medical Sciences, 13(12), 124–130. https://doi.org/10.3126/ajms.v13i12.48891
International Diabetes Federation. IDF Diabetes Atlas. Brussels, Belgium: International Diabetes Fed-eration (2019). Available at: https://diabetesatlas.org/en/sections/worldwide-toll-of-diabetes.html.
Kim, S. E., Park, K. M., Park, J., Kim, B. J., Kim, J. W., & Seo, J. G. (2019). Vascular factors and neuropathy in lower limb of diabetic patients. Journal of Clinical Neuroscience, 59, 130–135. https://doi.org/10.1016/j.jocn.2018.10.123
Laginestra, F. G., Cavicchia, A., Vanegas-Lopez, J. E., Barbi, C., Martignon, C., Giuriato, G., Pedrinolla, A., Amann, M., Hureau, T. J., & Venturelli, M. (2022). Prior Involvement of Central Motor Drive Does Not Impact Performance and Neuromuscular Fatigue in a Subsequent Endurance Task. Medicine and science in sports and exercise, 54(10), 1751–1760. https://doi.org/10.1249/MSS.0000000000002965
Li, Z., Gao, Y., Jia, Y., & Chen, S. (2021). Correlation between hemoglobin glycosylation index and nerve conduction velocity in patients with type 2 diabetes mellitus. Diabetes, Metabolic Syndrome and Obesity, 14, 4757–4765. https://doi.org/10.2147/DMSO.S337891
Litchy, W. J., Albers, J. W., Wolfe, J., Bolton, C. F., Walsh, N., Klein, C. J., ... & CI. Nphys Trial 4 Investiga-tors. (2014). Proficiency of nerve conduction using standard methods and reference values (Cl. NPhys Trial 4). Muscle & Nerve, 50(6), 900–908. https://doi.org/10.1002/mus.24262
Liu, M., Zou, Z., Guan, Y., Li, J., Zhou, D., & Cui, L. (2015). Motor nerve conduction study and muscle strength in newly diagnosed POEMS syndrome. Muscle & Nerve, 51(1), 19–23. https://doi.org/10.1002/mus.24264
Mao, F., Zhu, X., Liu, S., Qiao, X., Zheng, H., Lu, B., & Li, Y. (2019). Age as an independent risk factor for diabetic peripheral neuropathy in Chinese patients with type 2 diabetes. Aging and Disease, 10(3), 592–600. https://doi.org/10.14336/AD.2018.0618
Mao, F., Zhu, X., Liu, S., Qiao, X., Zheng, H., Lu, B., & Li, Y. (2019). Age as an Independent Risk Factor for Diabetic Peripheral Neuropathy in Chinese Patients with Type 2 Diabetes. Aging and disease, 10(3), 592–600. https://doi.org/10.14336/AD.2018.0618
Mohamed, O. A., Yousef, A. M., El-Banna, R. A., Abd Elrazik, R. K., & Osman, D. A. (2020). Effect of biop-tron light therapy on postmenopausal osteoporosis: A randomized controlled trial. Fizjoterapia Polska, 20(5), 160–165. https://fizjoterapiapolska.pl
Moreno-Fresco, M. M., Munuera-Martínez, P. V., Regife-Fernández, L., Cuevas-Sánchez, J. M., & Távara-Vidalón, P. (2026). Effects of Strengthening the Intrinsic Muscles of the Foot in Adults with Flat-foot: A Scoping Review. Journal of the American Podiatric Medical Association, 116(1), 8. https://doi.org/10.3390/japma116010008
Olimzhonovna, K. O. (2024). Diabetic neuropathy: Etiology, pathogenesis, clinical features and treat-ment approaches. European Journal of Modern Medicine and Practice, 4(3), 159–166. https://doi.org/10.5281/zenodo.10888888
Ponirakis, G., Elhadd, T., Chinnaiyan, S., Hamza, A. H., Sheik, S., Kalathingal, M. A., ... & Malik, R. A. (2021). Prevalence and risk factors for diabetic neuropathy and painful diabetic neuropathy in primary and secondary healthcare in Qatar. Journal of Diabetes Investigation, 12(4), 592–600. https://doi.org/10.1111/jdi.13387
Reeves, N. D., Najafi, B., Crews, R. T., & Bowling, F. L. (2013). Aging and type 2 diabetes: Consequences for motor control, musculoskeletal function, and whole-body movement. Journal of Aging Re-search, 2013, Article 508756. https://doi.org/10.1155/2013/508756
Richardson, J. K., Demott, T., Allet, L., Kim, H., & Ashton-Miller, J. A. (2014). Hip strength: Ankle propri-oceptive threshold ratio predicts falls and injury in diabetic neuropathy. Muscle & Nerve, 50(3), 437–442. https://doi.org/10.1002/mus.24188
Romero Ganuza, F. J., Encinas Sotillos, A., & Fernández Azuela, M. (1991). Obesidad y neuropatía au-tonómica en la diabetes mellitus no insulín-dependiente [Obesity and autonomic neuropathy in non-insulin-dependent diabetes mellitus]. Anales de medicina interna (Madrid, Spain : 1984), 8(4), 174–178. https://pubmed.ncbi.nlm.nih.gov/1912170/
Sánchez-Pozos, K., Monroy-Escutia, J., Jaimes-Santoyo, J., Granados-Silvestre, M. D. L. Á., Menjivar, M., & Ortiz-López, M. G. (2021). Risk factors associated with diabetic neuropathy in Mexican pa-tients. Cirugía y Cirujanos, 89(2), 189–199. https://doi.org/10.24875/CIRU.20000499
Seiglie, J. A., Marcus, M. E., Ebert, C., Prodromidis, N., Geldsetzer, P., Theilmann, M., ... & Manne-Goehler, J. (2020). Diabetes prevalence and its relationship with education, wealth, and BMI in 29 low- and middle-income countries. Diabetes Care, 43(4), 767–775. https://doi.org/10.2337/dc19-2095
Streckmann, F., Balke, M., Cavaletti, G., Toscanelli, A., Bloch, W., Décard, B. F., ... & Faude, O. (2023). Specific exercise is medicine—Preventing and treating a peripheral neuropathy. Current Issues in Sport Science, 8, Article 089. https://doi.org/10.48340/ciss.v8i2.189
Tesfaye, S., Boulton, A. J. M., Dyck, P. J., Freeman, R., Horowitz, M., Kempler, P., Lauria, G., Malik, R. A., Spallone, V., Vinik, A., Bernardi, L., Valensi, P., & Toronto Diabetic Neuropathy Expert Group. (2010). Diabetic neuropathies: Update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care, 33(10), 2285–2293. https://doi.org/10.2337/dc10-1303
Tesfaye, S., Boulton, A. J., Dyck, P. J., Freeman, R., Horowitz, M., Kempler, P., Lauria, G., Malik, R. A., Spallone, V., Vinik, A., Bernardi, L., Valensi, P., & Toronto Diabetic Neuropathy Expert Group (2010). Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes care, 33(10), 2285–2293. https://doi.org/10.2337/dc10-1303
Tesfaye, S., Chaturvedi, N., Eaton, S. E. M., Ward, J. D., Manes, C., Ionescu-Tirgoviste, C., Witte, D. R., & Fuller, J. H. (2005). Vascular risk factors and diabetic neuropathy. New England Journal of Medicine, 352(4), 341–350. https://doi.org/10.1056/NEJMoa032782
Tuttle, L. J., Sinacore, D. R., Cade, W. T., & Mueller, M. J. (2011). Lower physical activity is associated with higher intermuscular adipose tissue in people with type 2 diabetes and peripheral neu-ropathy. Physical Therapy, 91(6), 923–930. https://doi.org/10.2522/ptj.20100267
Van Schie, C. H., Vermigli, C., Carrington, A. L., & Boulton, A. J. (2004). Muscle weakness and foot de-formities in diabetes: Relationship to neuropathy and foot ulceration in Caucasian diabetic men. Diabetes Care, 27(7), 1668–1673. https://doi.org/10.2337/diacare.27.7.1668
van Schie, C. H., Vermigli, C., Carrington, A. L., & Boulton, A. (2004). Muscle weakness and foot deform-ities in diabetes: relationship to neuropathy and foot ulceration in caucasian diabetic men. Dia-betes care, 27(7), 1668–1673. https://doi.org/10.2337/diacare.27.7.1668
Weisman, A., Bril, V., Ngo, M., Lovblom, L. E., Halpern, E. M., Orszag, A., & Perkins, B. A. (2013). Identi-fication and prediction of diabetic sensorimotor polyneuropathy using individual and simple combinations of nerve conduction study parameters. PLoS ONE, 8(3), Article e58783. https://doi.org/10.1371/journal.pone.0058783
Xu, J., Goss, D. D., & Saliba, S. A. (2023). A novel intrinsic foot muscle strength dynamometer demon-strates moderate-to-excellent reliability and validity. International Journal of Sports Physical Therapy, 18(4), 997–1007. https://doi.org/10.26603/001c.76738
Yang Zurong, Li Yuandong, Tan Xiankui, Mo Fuhao, Liu Tang, Zhan Junkun; Morphological and Me-chanical Properties of Lower-Limb Muscles in Type 2 Diabetes: New Potential Imaging Indica-tors for Monitoring the Progress of DPN. Diabetes 1 December 2022; 71 (12): 2751–2763. https://doi.org/10.2337/db22-0009
Yokoyama, H., Tsuji, T., Hayashi, S., Kabata, D., & Shintani, A. (2020). Factors associated with diabetic polyneuropathy-related sensory symptoms and signs in patients with polyneuropathy: A cross-sectional Japanese study (JDDM 52) using a non-linear model. Journal of Diabetes Investiga-tion, 11(2), 450–457. https://doi.org/10.1111/jdi.13123
Yoshida, K., Miura, Y., Nakanishi, S., Tanaka, S., Kuniyasu, K., Matsumoto, S., & Hanayama, K. (2023). The impact of diabetic polyneuropathy on toe grip strength in patients with type 2 diabetes mellitus: a cross-sectional study. Journal of diabetes and metabolic disorders, 22(2), 1391–1397. https://doi.org/10.1007/s40200-023-01260-y
Younesian, H., Farahpour, N., Mazde, M., Simoneau, M., & Turcot, K. (2020). Standing balance perfor-mance and knee extensors' strength in diabetic patients with neuropathy. Journal of Applied Biomechanics, 36(3), 171–177. https://doi.org/10.1123/jab.2019-0198
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Direitos de Autor (c) 2026 Adel M Ibrahim, Reda Kotb Abdelrazik, Adel Motawea Elsayed Zedan, Ahmed Magdy Alshimy, Reham M. Abdelrahim, Ezzat Moubarak, Raghda Nasr Nassar, Ashraf Helal Farag Ammaar, Khaled A. Shalash

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