Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Nov 15, 2016; 7(19): 547-553
Published online Nov 15, 2016. doi: 10.4239/wjd.v7.i19.547
Effect of pioglitazone on nerve conduction velocity of the median nerve in the carpal tunnel in type 2 diabetes patients
Sudip Chatterjee, Debmalya Sanyal, Sourav Das Choudhury, Mili Bandyopadhyay, Suraj Chakraborty, Arabinda Mukherjee
Sudip Chatterjee, Mili Bandyopadhyay, Department of Medicine, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata 700026, West Bengal, India
Debmalya Sanyal, Department of Endocrinology, KPC Medical College, Ramakrishna Mission Seva Pratishthan, Kolkata 700026, West Bengal, India
Sourav Das Choudhury, Department of Medicine, Gitaram Hospital, Berhampore, Murshidabad 742187, West Bengal, India
Suraj Chakraborty, Arabinda Mukherjee, Department of Neurology, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata 700026, West Bengal, India
Author contributions: Chatterjee S, Sanyal D, Das Choudhury S and Mukherjee A contributed to study conception and design; Chatterjee S, Sanyal D, Bandyopadhyay M and Chakraborty S contributed to data acquisition; Chatterjee S, Sanyal D and Das Choudhury S contributed to data analysis and interpretation, and writing of article; all authors contributed to editing, reviewing and final approval of article.
Supported by Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata who provided a research grant and allowed us to use the hospital facilities for the study.
Institutional review board statement: None.
Informed consent statement: Written informed consent was obtained prior to the procedure and the study was cleared by the Institutional Ethics Committee.
Conflict-of-interest statement: None.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Debmalya Sanyal, MBBS, MD, DM, MRCP, Associate Professor, Consultant Endocrinologist, Department of Endocrinology, KPC Medical College, Ramakrishna Mission Seva Pratishthan, 99, Sarat Bose Road, Kolkata 700026, West Bengal, India. dr_debmalya@hotmail.com
Telephone: +91-98-30118388
Received: April 30, 2016
Peer-review started: May 3, 2016
First decision: June 17, 2016
Revised: August 8, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: November 15, 2016
Abstract
AIM

To evaluate the impact of pioglitazone pharmacotherapy in median nerve electrophysiology in the carpal tunnel among type 2 diabetes patients.

METHODS

The study was executed in patients with type 2 diabetes, treated with oral drugs, categorized under pioglitazone or non-pioglitazone group (14 in each group), and who received electrophysiological evaluation by nerve conduction velocity at baseline and 3 mo.

RESULTS

At 3 mo, pioglitazone-category had inferior amplitude in sensory median nerve [8.5 interquartile range (IQR) = 6.5 to 11.5) vs non-pioglitazone 14.5 (IQR 10.5 to 18.75)] (P = 0.002). Non-pioglitazone category displayed amelioration in amplitude in the sensory median nerve [baseline 13 (IQR = 9 to 16.25) vs 3 mo 8.5 (IQR = 6.5 to 11.5)] (P = 0.01) and amplitude in motor median nerve [baseline 9 (IQR = 4.75 to 11) vs 3 mo 6.75 (IQR = 4.75 to 10.25)] (P = 0.049); and deterioration of terminal latency of in motor ulnar nerve [baseline 2.07 (IQR = 1.92 to 2.25) vs 3 mo 2.16 (IQR = 1.97 to 2.325)] (P = 0.043). There was amelioration of terminal latency in sensory ulnar nerve [baseline 2.45 (IQR = 2.315 to 2.88) vs 3 mo 2.37 (IQR = 2.275 to 2.445) for pioglitazone group (P = 0.038).

CONCLUSION

Treatment with pioglitazone accentuates probability of compressive neuropathy. In spite of comparable glycemic control over 3 mo, patients treated with pioglitazone showed superior electrophysiological parameters for the ulnar nerve. Pioglitazone has favourable outcome in nerve electrophysiology which was repealed when the nerve was subjected to compressive neuropathy.

Keywords: Pioglitazone, Adipocytes, Diabetes mellitus, Neuropathy, Carpal tunnel

Core tip: Significant findings of the study: (1) Non-pioglitazone group showed favourable outcome in amplitude in the sensory and motor median nerve, and aggravation of terminal latency of motor ulnar nerve; and (2) Pioglitazone group showed favourable outcome of terminal latency in sensory ulnar nerve. What this study adds: (1) Pioglitazone has beneficial effect on nerve electrophysiology; and (2) The beneficial effect is nullified by the higher risk of compressive neuropathy conferred.