NEUROPATHY PROFILE OF DIABETIC-PATIENTS IN A PANCREAS TRANSPLANTATIONPROGRAM

We describe the results of extensive neurologic evaluation of 290 pati ents with insulin-dependent diabetes mellitus who came to our institut ion as potential recipients of a pancreas transplant. Large nerve fibe rs were evaluated by motor and sensory nerve conduction, small sensory fibers by thermal sensation thresholds, vagal and vasomotor functions by cardiovascular reflexes, and sympathetic sudomotor fibers by silic one imprints and evaporimetry. A scored anamnesis revealed symptoms of neuropathy in 86% of patients; 94% had an abnormal neurologic examina tion. The most frequently abnormal measurements of motor conduction we re the amplitude of the extensor digitorum brevis muscle action potent ial to peroneal nerve stimulation and the conduction velocity of peron eal and tibial nerves in more than 80% of patients. Sensory nerve acti on potentials were abnormal in 76% and the distal latency of the sural nerve in 91%. Heart rate variability with deep breathing and during a Valsalva's maneuver was abnormal in 90% and 88%. Sudomotor function w as reduced in 59% on the foot. Thermal sensitivity limen was above nor mal limits in 95% in the foot and 77% in the hand. Composite indexes o f the degree of abnormality found for each type of function tested wer e correlated one with another, but were not predictive of results for any other test. The neuropathy of most patients was symmetric, involvi ng to a similar degree motor, sensory, and autonomic nerves. Thus, dia betic neuropathy is very common and severe among patients who decide t o be candidates for pancreas transplantation.