Solomon Tesfaye, MD


October 01, 2014

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Hello. My name is Solomon Tesfaye. I am a consulting physician and honorary professor of diabetic medicine at the University of Sheffield, United Kingdom. Today [September 17, 2014] I was chairman of the Neuropathy Oral Session at the European Association for the Study of Diabetes (EASD). I am going to tell you about some of the interesting findings in the six papers that were presented today.

The first two abstracts were presented on a topic familiar to most of us: urogenital and erectile dysfunction complications in our patients with diabetes. This was from the DCCT/EDIC group; the first was presented by Rodica Pop-Busui[1] and the second by Dr. Jacobson.[2] Essentially, what they showed was that erectile dysfunction is very common in our patients with type 1 diabetes, and that the prevalence increases with increasing duration of diabetes and increasing age. It was very interesting that there is a massive reduction in quality of life in these patients with this problem. There was a very clear relationship with diabetic peripheral neuropathy, but unfortunately, data on the vascular status of these patients were not provided today. A couple of questions were raised as to why they didn't have these data, but the speakers duly say that they will provide these data in the future. This appears to be an interim analysis.

These were followed by two papers from Manchester, United Kingdom.[3,4] They were looking at balance and gait in diabetes with and without neuropathy. They showed by elegant techniques that the ability of patients with neuropathy to walk properly is altered. Walking up and down stairs poses major problems for these patients. The way they stand is also altered, in that they tend to have a wide-based gait. However, questions were raised as to whether they measured muscle strength and muscle mass. They did measure muscle strength but they didn't measure it perhaps with better techniques—using MRI, for instance. A question was also raised as to whether they looked at strengthening exercises or physiotherapy, to determine the impact of physiotherapy in making our patients walk better. Anecdotally, we find—particularly with elderly patients with neuropathy—that if you give them a period of rehabilitation and strengthening exercises, they tend to walk better and they tend to have fewer falls. These were very interesting studies.

Finally, two papers came from our unit in Sheffield. The first paper[5] looked at functional connectivity at rest, or what we call "resting-state functional MR imaging (fMRI)" or "default mode network." When we close our eyes and are relaxed, and fMRI is recorded at rest when we are not thinking of anything in particular, the brain still is active and there are key areas in the brain that are connected. We found with these resting-state fMRI scans that patients with painful diabetic neuropathy show increased connectivity in certain areas of the brain and reduced connectivity in other areas of the brain compared with healthy volunteers. In other words, we can tell if somebody has painful diabetic neuropathy by doing 5-minute resting state fMRI scans. What was very interesting about this study was that it also correlated not only with pain intensity (showing increased connectivity in relation to increased pain), but it is also related to hospital anxiety, depression scores, and pain behavior. With this simple 5-minute MRI study, we can tell not only about pain severity in the patients but also about the extent of emotional distress these patients have. This has a huge potential for diagnosing this condition more objectively and also to see the impact of treatments.

Finally, with Dinesh Selvarajah, we presented a second paper[6] in which we showed tested response to a painful stimulus (heat pain in the foot and thigh) in patients who have "painful painless neuropathy." These are patients who have intense pain and yet when you stick a needle in their feet, they can't feel it. This is called a paradox: the painful painless foot. In these patients we found that the heat pain is processed not in the normal area of the somatosensory entry cortex that causes foot and leg problems, but in a different area that represents the hand and the face, showing the cortical reorganization using fMRI. It's a very elegant study (even though it's our study), with huge potential. These MRI studies are giving us a new noninvasive window to interrogate what is taking place in our patients with diabetic neuropathy.

You can see the full presentations at the EASD website. Thank you very much indeed for your very kind attention.


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