Examination of diabetic brains: Role of thioredoxin system in pathophysiology of diabetic encephalopathy
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Date
2018-08-23
Authors
Lopez, Alennie
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Abstract
Diabetes mellitus (DM) is a chronic condition involving abnormal carbohydrate metabolism that is characterized by hyperglycemia.1,2 According to a report by the World Health Organization (WHO), the global prevalence of diabetes has increased significantly from 1980 to 2014, rising from 4.7% to 8.5% in the adult population.3 In 2016, the WHO reported that 7.2% of the Canadian population lived with diabetes,4 which contributed to 3% of total deaths spanning all ages.4 There are two main forms of diabetes: Type 1 diabetes mellitus is caused by the destruction of pancreatic beta cells that produce insulin, while type 2 diabetes mellitus (T2DM) accounts for more than 90% of cases and is characterized by varying degrees of insulin deficiency and resistance.1,5 T1DM accounts for 5-10% of diabetes cases in the US, Canada, and Europe. Poorly controlled diabetes can initiate microvascular and macrovascular changes and can lead to complications including heart attack, stroke, kidney failure, leg amputation, vision loss, and nerve damage.2,3,6,7 Fetal death risk is also increased in poorly controlled diabetes in pregnant women, known as gestational diabetes.3
It is estimated that around 50% of patients with diabetes will eventually develop peripheral neuropathy.8 Progressive neuronal damage is seen in people with diabetes and has diverse clinical manifestations. Distal symmetrical polyneuropathy can manifest as numbness, pain, or weakness that typically starts in the feet or hands and proceeds proximally in a “stocking and glove” distribution.9,10 Autonomic neuropathy, which is also common in diabetic patients, can manifest as one or more of the following symptoms: gastroparesis, constipation, urinary retention, erectile dysfunction, and cardiac arrythmia.9 Diabetic neuropathy is caused by a complex interaction of metabolic, vascular, and maybe hormonal factors that affect the balance between nerve damage and nerve fiber repair, usually in favor of the former.11 Nerve damage due to chronic hyperglycemia is also seen in diabetic retinopathy which is caused by blood-retinal barrier disturbances due to inflammation.12 The potential effect of diabetes on the central nervous system (CNS) has not been adequately examined.
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Keywords
Diabetes mellitus (DM), encephalopathy, Dementia
Citation
AMA