title: Association between visceral, cardiac and sensorimotor polyneuropathies in diabetes mellitus.
abstract: OBJECTIVE
  Gastrointestinal complaints are common in diabetes mellitus. However, its association to peripheral sensorimotor and autonomic neuropathies is not well investigated. The aim was to assess skin, muscle, bone and visceral sensitivity in diabetes patients with sensorimotor neuropathy, and correlate these with gastrointestinal symptoms and degree of cardiac autonomic neuropathy.
  
  
  METHODS
  Twenty patients with sensorimotor neuropathy (65% type 2 diabetes, aged 58.3±12.0 years, diabetes duration 15.8±10.0 years) and 16 healthy controls were recruited. Cutaneous sensitivity to von Frey filaments, mechanical allodynia, muscle/bone/rectosigmoid sensitivities, and heart rate variability were examined. Gastrointestinal symptom scores (PAGI-SYM) and health-related quality of life (SF-36) were also recorded.
  
  
  RESULTS
  Patients displayed hypesthesia to von Frey filaments (p=0.028), but no difference to muscle and bone pain sensitivities. Also, patients were hyposensitive to multimodal rectal stimulations (all p<0.05), although they suffered more gastrointestinal complaints. Heart rate variability was reduced in the patient cohort. Rectal mechanical and cutaneous sensitivities correlated (p<0.001), and both were associated with heart rate variability as well as PAGI-SYM and SF-36 scores (p<0.01).
  
  
  CONCLUSIONS
  In diabetic sensorimotor neuropathy there is substantial evidence of concomitant cutaneous, cardiac and visceral autonomic neuropathies. The neuropathy may reduce quality of life and explain the higher prevalence of gastrointestinal complaints.
authors.affiliation: Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. Electronic address: eirik.softeland.med@helse-bergen.no.
authors.forename: Eirik
authors.initials: E
authors.lastname: Søfteland
authors.affiliation: Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Christina
authors.initials: C
authors.lastname: Brock
authors.affiliation: Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Jens B
authors.initials: JB
authors.lastname: Frøkjær
authors.affiliation: Section for Clinical Neurophysiology, Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Jan
authors.initials: J
authors.lastname: Brøgger
authors.affiliation: 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Madácsy
authors.affiliation: Department of Clinical Medicine, University of Bergen, Bergen, Norway; National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: Odd H
authors.initials: OH
authors.lastname: Gilja
authors.affiliation: Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Arendt-Nielsen
authors.affiliation: Institute of Medicine, Department of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Simrén
authors.affiliation: Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Asbjørn M
authors.initials: AM
authors.lastname: Drewes
authors.affiliation: Department of Clinical Medicine, University of Bergen, Bergen, Norway; National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: Georg
authors.initials: G
authors.lastname: Dimcevski
mesh_terms: D000368:Aged; D017776:Autonomic Pathways / Q000503:physiopathology; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000503:physiopathology; D006321:Heart / Q000294:innervation*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006987:Hypesthesia / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010525:Peripheral Nerves / Q000503:physiopathology; D011115:Polyneuropathies / Q000209:etiology / Q000503:physiopathology*; D015995:Prevalence; D011788:Quality of Life; D066191:Sensorimotor Cortex / Q000503:physiopathology*; D012867:Skin / Q000294:innervation; D014781:Viscera / Q000294:innervation*
keywords: Autonomic Neuropathy; Diabetes; Experimental; Gastrointestinal; Heart Rate Variability; Pain; Peripheral Neuropathy; Visceral