DM was diagnosed according to the American Diabetes Association criteria based on one of four abnormalities: hemoglobin A1c (HbA1c), fasting plasma glucose, random elevated glucose with symptoms, or abnormal oral glucose tolerance test (American Diabetes Association 2013). DSP was diagnosed according to the following criteria: at least one abnormal sural NCS result, one abnormal peroneal NCS result, and at least one neuropathic sign or symptom (England et al. 2005; Dyck et al. 2011). Criteria for mild D-DSP Inhibitors,research,lifescience,medical were defined previously (Dunnigan et al. 2013). In brief, we defined patients as having demyelination out of proportion to axonal loss (D-DSP)

if amplitudes were preserved and at least two NCS see more parameters showed slowed conduction as suggested by the European Federation of Neurological Societies (EFNS) criteria for CIDP (Van den Bergh et al. 2010). CIDP was diagnosed in those patients Inhibitors,research,lifescience,medical having a clinical and electrodiagnostic presentation consistent with CIDP as judged by a neuromuscular expert (VB) (Magda et al. 2003). Criteria for the D-DSP and CIDP + DM study groups are shown in Figure ​Figure11. Figure 1 Schematic of two groups used to categorize patients as having demyelinating DSP (D-DSP) or diabetes and CIDP (CIDP + DM), based Inhibitors,research,lifescience,medical on a combination of amplitude, and latency and conduction velocity parameters. Demyelinating features are as follows: peroneal … As part of the initial cohort study, each

participant underwent comprehensive medical and neurologic evaluation for the assessment of neuropathy-related symptoms and comorbidities, physical examination, and biochemical testing (HbA1c). Our current study involved the extraction of demographic data, clinical history, physical examination, laboratory results, and electrophysiologic Inhibitors,research,lifescience,medical data from the research Inhibitors,research,lifescience,medical database for DSP patients and previously coded charts for CIDP patients. None of the D-DSP subjects had a diagnosis of immune-mediated polyneuropathy or CIDP. The CIDP + DM group lacked specific tests or biomarkers to confirm the diagnosis of CIDP other than NCS and expert opinion. The Research

Ethics Board of the University Health Network approved the current study protocol. Subjects were evaluated for neuropathy by neurological examination, Resminostat the 19-point Toronto Clinical Neuropathy Score (TCNS), vibration perception thresholds (VPT), and sural and peroneal NCS (Bril and Perkins 2002). We restricted this comparison to lower limb NCS parameters as the battery of NCS testing differed between D-DSP and CIDP + DM in our patient population. NCS were performed using the Sierra Wave instrument (Cadwell Laboratories Inc., Kennewick, WA). Age- and height-adjusted NCS reference values were used, according to the standards of the TGH (UHN) electrophysiology laboratory. Limb temperature was measured prior to NCS, and if required, warming was performed to ensure a surface temperature of ≥32.0°C in the hands and ≥31.0°C in the feet.