vendex and Diabetes-Mellitus--Type-1

The purpose of this study was to investigate the effect of diabetes, motor nerve impairment, and training status on neuromuscular function by concurrent assessment of the torque-velocity relationship and muscle fiber conduction velocity (MFCV).. Four groups were studied (n = 12 each): sedentary patients with diabetes in the first (lower) and fourth (higher) quartile of motor nerve conduction velocity (D1 and D4, respectively), trained diabetic (TD) patients, and nondiabetic sedentary control (C) subjects. Maximal isometric and isokinetic contractions were assessed over a wide range of angular velocities for the elbow flexors and knee extensors to evaluate the torque-velocity relationship. Simultaneously, MFCV was estimated from surface electromyography of the vastus lateralis and biceps brachii.. Isometric strength was similar among groups. The dynamic strength of elbow flexors was reduced in patients with diabetes at the higher contraction speeds. The strength of knee extensors was lower in sedentary patients with diabetes at all velocities considered, with significantly lower values in D1 than that in D4 at 60°, 90°, and 120°·s(-1), whereas it was similar between TD and C subjects, especially at low contraction velocities. At the vastus lateralis, but not the biceps brachii, MFCV was lower in D1 and D4 as compared with TD and C subjects, showing similar values.. Muscle weakness in diabetes affects also the upper limb, although to a lower extent than the lower limb, is only partly related to motor nerve impairment, and is dependent on contraction velocity. Exercise training might counteract diabetes-induced alterations in muscle fiber contractile properties and MFCV.

Topics: Aged; Biomechanical Phenomena; Case-Control Studies; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Electromyography; Exercise Therapy; Humans; Male; Middle Aged; Motor Neurons; Muscle Contraction; Muscle Strength; Muscle, Skeletal; Neural Conduction; Single-Blind Method; Torque

Transforming growth factor beta 1 (TGF-β1) and bone morphogenetic protein-2 (BMP-2) are important regulators of bone repair and regeneration. In this study, we examined whether TGF-β1 and BMP-2 expressions were delayed during bone healing in type 1 diabetes mellitus. Tibial fractures were created in 95 diabetic and 95 control adult male Wistar rats of 10 weeks of age. At 1, 2, 3, 4, and 5 weeks after fracture induction, five rats were sacrificed from each group. The expressions of TGF-β1 and BMP2 in the fractured tibias were measured by immunohistochemistry and quantitative reverse-transcription polymerase chain reaction, weekly for the first 5 weeks post-fracture. Mechanical parameters (bending rigidity, torsional rigidity, destruction torque) of the healing bones were also assessed at 3, 4, and 5 weeks post-fracture, after the rats were sacrificed. The bending rigidity, torsional rigidity and destruction torque of the two groups increased continuously during the healing process. The diabetes group had lower mean values for bending rigidity, torsional rigidity and destruction torque compared with the control group (P<0.05). TGF-β1 and BMP-2 expression were significantly lower (P<0.05) in the control group than in the diabetes group at postoperative weeks 1, 2, and 3. Peak levels of TGF-β1 and BMP-2 expression were delayed by 1 week in the diabetes group compared with the control group. Our results demonstrate that there was a delayed recovery in the biomechanical function of the fractured bones in diabetic rats. This delay may be associated with a delayed expression of the growth factors TGF-β1 and BMP-2.

Topics: Animals; Biomechanical Phenomena; Bone Morphogenetic Protein 2; Bony Callus; Diabetes Mellitus, Experimental; Diabetes Mellitus, Type 1; Fracture Healing; Fractures, Bone; Immunohistochemistry; Male; Rats, Wistar; Real-Time Polymerase Chain Reaction; Tibial Fractures; Time Factors; Torque; Transforming Growth Factor beta1

The functional performance of the JuniorSTAR(®) (Sanofi, Paris, France) half-unit insulin pen was evaluated through a series of specific objective tests to assess the dose accuracy, pen weight, injection force, and dialing torque.. Pens (n = 60) were tested under standard atmospheric conditions with 3 different types of insulins manufactured by Sanofi (insulin glargine, insulin glulisine, and biphasic insulin isophane). The dose accuracy was tested according to the ISO 11608-1:2012 standards. Injection doses of 0.010, 0.155, and 0.300 ml were evaluated. For mean weight evaluation, the pens without the cartridge were weighed on precision balances. The injection force was measured using a texture analyzer and the dialing torque was measured using a torque meter.. JuniorSTAR met the ISO 11608-1:2012 criteria for dose accuracy as all the delivered doses were within the predefined limits for all types of insulin tested. The mean weight of the JuniorSTAR pen was 33.4 g (SD = 0.075). The mean injection force was 6.0 N (SD = 0.8), 4.3 N (SD = 0.4), and 5.1 N (SD = 0.6) for insulin glargine, insulin glulisine, and biphasic insulin isophane, respectively. The mean dialing torque was 5.09 Ncm (SD = 0.29) and 5.88 Ncm (SD = 0.53) for setting and correcting a dose, respectively.. Together with results from a previously reported usability survey, these results show that the JuniorSTAR reusable, half-unit pen is a lightweight and accurate device for insulin delivery with a dialing torque and injection force suitable for young people with type 1 diabetes.

Topics: Diabetes Mellitus, Type 1; Equipment Reuse; Humans; Hypoglycemic Agents; Insulin; Reproducibility of Results; Syringes; Torque

The aim of this study was to determine whether local insulin delivery using a fibrin gel (FG) loaded with insulin/poly(lactic-co-glycolic acid) microspheres (FGIPM) improves the biomechanical retention of titanium implants in type 1 diabetic rats.. Rats were divided randomly into 8 groups: a group of healthy rats (no treatment), a group of diabetic rats (no treatment), and 6 groups of diabetic rats treated locally using carriers containing or not containing insulin. Rats received implants in the tibia and were allowed to heal for 4 or 8 weeks. Removal torque tests (RTQ) were performed to evaluate the biomechanical retention of the implants.. In the diabetic control group, the mean RTQ values were significantly decreased compared with those for the healthy group. The local application of FGIPM increased the RTQ values in diabetic rats to the values found in the healthy rats at 8 weeks. The FG-treated group presented statistically significant higher mean RTQ values than the diabetic rats receiving no treatment.. Local insulin delivery using FGIPM ameliorated the biomechanical retention of titanium implants in type 1 diabetic rats and the FG had a beneficial effect.

Topics: Administration, Topical; Animals; Biomechanical Phenomena; Delayed-Action Preparations; Dental Implants; Dental Materials; Dental Prosthesis Retention; Diabetes Mellitus, Experimental; Diabetes Mellitus, Type 1; Drug Carriers; Drug Delivery Systems; Fibrin; Hypoglycemic Agents; Insulin; Lactic Acid; Male; Microscopy, Electron, Scanning; Microspheres; Placebos; Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer; Random Allocation; Rats; Rats, Wistar; Streptozocin; Time Factors; Titanium; Torque

Type I diabetes mellitus inhibits fracture healing and leads to an increase in complications. As a pilot study, we used a closed fracture model in the diabetic rat to address the question of whether osteogenic protein-1 (OP-1) in a collagen carrier can overcome this inhibition by increasing the area of the newly mineralized callus and femoral torque to failure compared with diabetic animals with fractures treated without OP-1. Diabetes was created in 54 rats by injection of streptozotocin. After 2 weeks, a closed femur fracture was created using a drop-weight impaction device. Each fracture site was immediately opened and treated with or without 25 microg OP-1 in a collagen carrier. Animals were euthanized after 2 or 4 weeks. Fracture healing was assessed by callus area from high-resolution radiographs, callus strength from torsional failure testing, and undecalcified histologic analysis. The area of newly mineralized callus was greater in diabetic animals treated with 25 microg OP-1/carrier compared with diabetic animals with untreated fractures and with fractures treated with carrier alone. This increase in callus area did not translate into an equivalent increase in torque to failure. Osteogenic protein-1 showed some evidence of overcoming the inhibition of fracture healing in the diabetic rat.

Topics: Animals; Biomechanical Phenomena; Bone Morphogenetic Protein 7; Bony Callus; Calcification, Physiologic; Collagen Type I; Diabetes Mellitus, Experimental; Diabetes Mellitus, Type 1; Drug Carriers; Femoral Fractures; Fracture Healing; Fractures, Closed; Male; Pilot Projects; Radiography; Rats; Rats, Sprague-Dawley; Time Factors; Torque

Several clinical series, analyzing fracture healing in patients with diabetes mellitus (DM). demonstrated significant incidence of delayed union, non-union, and pseudarthrosis. In this study, analysis was performed to evaluate the effects of blood glucose (BG) control on fracture healing in the DM BB Wistar rat, a rat strain that represents a close homology to Type I DM in man. Our study showed decreased cell proliferation at the fracture site as well as decreased mechanical stiffness and bony content in the poorly controlled DM rats. To determine the effect of BG control, DM rats were treated with insulin sufficient to maintain physiologic BG levels throughout the course of the study. Values of cellular proliferation, biomechanical properties and callus bone content in tightly controlled DM animals were not significantly different from values of non-DM control values. This study suggests that insulin treatment with resultant improved BG control will ameliorate the impaired early and late parameters of DM fracture healing.

Topics: Animals; Biomechanical Phenomena; Blood Glucose; Bromodeoxyuridine; Cell Division; Diabetes Mellitus, Type 1; Disease Models, Animal; Femoral Fractures; Fracture Healing; Hypoglycemic Agents; Insulin; Male; Microscopy, Acoustic; Rats; Rats, Inbred BB; Rats, Wistar; Torque

Type I diabetes mellitus (DM) is associated with impaired fracture healing. Specifically, DM affects multiple phases of fracture healing including early cellular proliferation and late phases resulting in inferior biomechanical properties. Recent studies demonstrated the utility of pulsed low-intensity ultrasound (US) to facilitate fracture healing. The current study evaluated the effects of daily application of US on mid-diaphyseal femoral fractures in DM and non-DM BB Wistar rats. Immunohistochemical staining for PCNA was used to evaluate cellular proliferation at 2, 4, and 7 days post-fracture. In concordance with previous findings. DM fracture callus demonstrated decreased cellular proliferation. Importantly, the application of US did not significantly alter the proliferation in either DM or control groups. However, mechanical testing revealed significantly greater torque to failure and stiffness in US-treated DM versus non-US-treated DM groups at six weeks post-fracture. Despite the inability of US to affect the early proliferative phase of fracture healing, its application clearly results in improved mechanical properties during the late phases of healing. These findings suggest a potential role of US as an adjunct for DM fracture treatment.

Topics: Animals; Biomechanical Phenomena; Bony Callus; Cell Division; Diabetes Mellitus, Type 1; Elasticity; Femoral Fractures; Femur; Fracture Healing; Rats; Rats, Wistar; Torque; Ultrasonics

Case report with repeated measures.. To describe the effects of a tendo-Achilles lengthening (TAL) and total contact casting (TCC) on wound healing, motion, plantar pressure, and function in a patient with diabetes mellitus, peripheral neuropathy, neuropathic ulcer, and limited dorsiflexion range of motion (DFROM).. Limited DFROM has been associated with increased forefoot pressures and skin breakdown. A TAL was expected to increase DFROM and reduce forefoot pressures during walking, but the influence on muscle performance and function was unknown.. The patient was a 42-year-old man with a 20-year history of type 1 diabetes (NIDDM) and a recurrent neuropathic plantar ulcer. Outcome measures were DFROM, isokinetic plantar flexor muscle peak torque, in-shoe and barefoot peak plantar pressure, physical performance test (PPT) score, and peak ankle and hip moments during walking obtained from an automated gait analysis. All tests were completed pre-TAL, 8 weeks post-TAL (after immobilization in a TCC), and 7 months post-TAL.. The wound healed in 40 days. The TAL resulted in a sustained increase in DFROM (0 to 18 degrees). Plantar flexor peak torque was reduced by 21% 8 weeks after the TAL compared with the torque before surgery but recovered fully at 7 months. Seven months following TAL, in-shoe forefoot peak plantar pressure was reduced by 55%, barefoot pressure decreased by 14%, PPT score increased by 24%, peak ankle plantar flexor moment remained decreased by 30%, and the peak hip flexor moment increased by 41% during walking.. For this patient, a TAL resulted in short-term deficits in peak plantar flexor torque, but a 7-month follow-up showed improvements in ankle DFROM, walking ability, and a decrease in forefoot in-shoe peak plantar pressure.

Topics: Achilles Tendon; Adult; Casts, Surgical; Diabetes Mellitus, Type 1; Diabetic Foot; Gait; Humans; Male; Muscle, Skeletal; Orthotic Devices; Pressure; Range of Motion, Articular; Recurrence; Torque; Wound Healing

To determine the short-term muscular endurance and working capacity of leg muscles in long-term IDDM patients in relation to neuropathic complications, muscle strength, and metabolic control.. The muscular endurance of extensors and flexors at the ankle and knee was assessed in 44 IDDM patients and in 44 matched control subjects during 30 maximal isokinetic movements. The endurance index was the work performance of the last 5 movements relative to the first 5 movements. Total work was the summated work of all movements. All patients underwent a neurological evaluation, nerve conduction studies, and quantitative sensory tests.. The combined endurance index of the ankle extensors and flexors was 70% (51-88) (median [range]) in the diabetic group and 65% (55-82) in the control group (P < 0.01). For knee extensors and flexors the combined endurance index was 65% (55-103) for the diabetic patients and 63% (48-75) in the control subjects (P < 0.01). The endurance index related neither to the severity of neuropathy nor to the metabolic control (blood glucose and HbA1c) for any of the muscle groups. Diabetic patients had reduced strength of all muscle groups (14-24%, P < 0.02) and impaired total work performance (15-20%, P < 0.01) for ankle movements.. Long-term IDDM patients have increased endurance but reduced strength and work performance of leg muscles. The combined effect of the motor abnormalities is suggested to give rise to functional impairment, including an increased risk of falls and injuries.

Topics: Adult; Ankle Joint; Blood Glucose; Diabetes Mellitus, Type 1; Diabetic Neuropathies; Female; Glycated Hemoglobin; Humans; Knee Joint; Male; Middle Aged; Muscle Contraction; Muscle, Skeletal; Physical Endurance; Reference Values; Regression Analysis; Torque