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Diabetic neuropathy is one of the commonest diabetic complications. It affects 30-50% of people with diabetes mellitus (DM) and may cause severe pain and foot ulcers. Distal symmetric polyneuropathy and diabetic autonomic neuropathy are the main manifestations of diabetic neuropathy. The American Diabetes Association's (ADA) 82nd Scientific Sessions took place in June 2022 in New Orleans, Louisiana, and the 58th European Association for the Study of Diabetes (EASD) Annual Meeting was held in September 2022 in Stockholm, Sweden. Herein, we describe interesting studies in the field of diabetic neuropathy presented in these two meetings.

Low vitamin D levels have been associated with several diseases as its receptors are expressed in almost all tissues of the human body. Literature data have shown delayed diabetic foot ulcer (DFU) healing in patients with low vitamin D; however, data on the association between vitamin D levels and DFU in Mediterranean countries are scarce. In this cross-sectional study we examined for differences in serum vitamin D levels between patients with DFU, people with diabetes mellitus (DM) without DFU and healthy individuals in a Southern European country. A total of 96 subjects (33 patients with DFU, 35 patients without DFU and 28 healthy controls) were recruited. Medical and dietary history was obtained and total serum 25-hydroxyvitamin D [25(OH)D] levels were determined. Serum vitamin D levels differed significantly among the three groups of participants; sub-analysis showed that healthy individuals had higher vitamin D levels when compared with patients with and without DFU, while vitamin D levels did not differ between patients with and without DFU (17.9 ± 6.7 vs. 19.8 ± 8.7 ng/mL, P = 0.329, respectively). More than half of patients with DM with or without DFU had vitamin D levels <20 ng/ml. A positive correlation was found between vitamin D and sun exposure duration in participants without DFU. In conclusion, although serum vitamin D levels did not differ between people with and without DFU, the prevalence of deficiency and insufficiency was high in both groups in a Mediterranean country. This finding highlights the need for screening and supplementation with vitamin D in individuals with DM.

This study examined the performance of VibraTip for the diagnosis of loss of protective sensation (LOPS) and the interrater agreement of different neurological modalities performed by 3 health care professionals, a consultant diabetologist, a diabetes specialist nurse, and a podiatrist. Diagnosis of LOPS was based on 10-g Semmes Weinstein monofilament testing performed by a consultant diabetologist (reference method), while examination with a 128-Hz tuning form was also performed. The performance of VibraTip for the diagnosis of LOPS was examined using the receiver operating characteristic curves analysis. Interrater agreement was determined by weighted kappa (κ) statistics. Diagnosis of LOPS (%) was 37.5%. Receiver operating characteristic curve analysis showed that VibraTip examination versus 10-g monofilament, both performed by a consultant, could diagnose LOPS ( P < .001). Sensitivity, specificity, positive predictive value, and negative predictive value of VibraTip versus 10-g monofilament, both performed by a consultant (value, 95% confidence interval), was 0.705 (0.591-0.803), 0.836 (0.758-0.897), 0.733 (0.642-0.808), and 0.816 (0.757-0.863), respectively. The interrater agreement among the health care professionals for 10-g monofilament, VibraTip, and 128-Hz tuning fork in neurological assessment was good with κ > 0.61. VibraTip can be used as a screening tool for the detection of LOPS. There was good overall agreement in the results of neurological examination using 10-g monofilament, 128-Hz tuning fork, and VibraTip among health care professionals.

Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes mellitus that is associated with increased morbidity and mortality, as well as substantial economic burden for the health care system. The standard of care for DFUs includes pressure off-loading, sharp debridement, and wound moisture balance, along with infection control and management of peripheral arterial disease. A variety of advanced modalities that target distinct pathophysiological aspects of impaired wound healing in diabetes are being studied as possible adjunct therapies for difficult to heal ulcers. These modalities include growth factors, stem cells, cultured fibroblasts and keratinocytes, bioengineered skin substitutes, acellular bioproducts, human amniotic membranes, oxygen therapy, negative pressure wound therapy, and energy therapies. Additionally, the use of advanced biomaterials and gene delivery systems is being investigated as a method of effective delivery of substances to the wound bed. In the present narrative review, we outline the latest advances in the nonpharmacological management of DFUs and summarize the efficacy of various standard and advanced treatment modalities.

Cardiovascular disease is the leading cause of morbidity and mortality in subjects with type 2 diabetes mellitus. Increased aortic stiffness, assessed with the carotid-femoral pulse wave velocity, is an independent risk factor for cardiovascular disease. Statins reduce effectively cardiovascular disease and mortality in high-risk patients. The aim of this prospective non-randomized, observational study was to examine the impact of treatment with either 10 mg atorvastatin plus diet or diet alone on carotid-femoral pulse wave velocity in subjects with type 2 diabetes mellitus and dyslipidaemia. A total of 79 subjects with type 2 diabetes mellitus and dyslipidaemia were included; 46 subjects were treated with atorvastatin 10 mg daily plus diet and 33 were managed by diet alone for 12 months. Carotid-femoral pulse wave velocity and carotid-radial pulse wave velocity were measured using applanation tonometry. In the atorvastatin-treated group, carotid-femoral pulse wave velocity reduced significantly during the study and there was a trend for reduction in the carotid-radial pulse wave velocity. Total cholesterol, low-density lipoprotein cholesterol, triglycerides and C-reactive protein were reduced only in the atorvastatin-treated participants. No significant changes were found in body mass index, blood pressure, heart rate, diabetes control and high-density lipoprotein cholesterol in either study group. Treatment with low-dose atorvastatin for 12 months improves carotid-femoral pulse wave velocity in subjects with type 2 diabetes mellitus and dyslipidaemia.

In this prospective study, we examined the effect of atorvastatin treatment on baroreflex sensitivity (BRS) in subjects with type 2 diabetes. A total of 79 patients with type 2 diabetes with dyslipidaemia were recruited. A total of 46 subjects were enrolled to atorvastatin 10 mg daily and low-fat diet and 33 patients to low-fat diet only. BRS was assessed non-invasively using the sequence method at baseline, 3, 6 and 12 months. Treatment with atorvastatin increased BRS after 12 months (from 6.46 ± 2.79 ms/mmHg to 8.05 ± 4.28 ms/mmHg, p = 0.03), while no effect was seen with low-fat diet. Further sub-analysis according to obesity status showed that BRS increased significantly only in the non-obese group (p = 0.036). A low dose of atorvastatin increased BRS in non-obese subjects with type 2 diabetes and dyslipidaemia after 1-year treatment. This finding emphasizes the beneficial effect of atorvastatin on cardiovascular system, beyond the lipid-lowering effects.