Mechanisms underlying altered neuromuscular function in people with DPN

Area of Science:

• Neurology
• Endocrinology
• Sports Medicine

Background:

• Diabetes mellitus is a systemic disease with significant long-term complications.
• Neuromuscular function is affected early in diabetes, offering a window for intervention.
• Diabetic peripheral neuropathy (DPN) complicates the assessment of exercise effects on functional capacity.

Purpose of the Study:

• To review neuromuscular dysfunctions in diabetes with and without DPN.
• To analyze the progression of neuromuscular alterations over time.
• To propose mechanisms underlying neuromuscular degradation in the transition to DPN.

Main Methods:

• Literature review of neuromuscular characteristics in diabetes and DPN.
• Analysis of proposed mechanisms for neuromuscular dysfunction onset.
• Examination of changes in specific neuromuscular parameters (e.g., Mmax amplitude, rate of force development).

Main Results:

• Motor unit loss and impaired neuromuscular transmission are key in diabetes to DPN transition.
• Type II fiber atrophy may precede decreases in force development and contractile properties.
• Mmax amplitude reduction during fatigue is specific to DPN, indicating transmission impairment.

Conclusions:

• Neuromuscular parameters change at different stages of diabetes, with or without DPN.
• Distinct neuromuscular alterations characterize diabetes progression and DPN.
• Precise evaluation of neuromuscular parameters can inform personalized physical training programs.