Role of Synchronized Lifestyle Modification Program in Insulin Dependent Diabetic Peripheral Neuropathy Patients
Primary Purpose
Diabetic Neuropathies
Status
Unknown status
Phase
Not Applicable
Locations
Pakistan
Study Type
Interventional
Intervention
Synchronized Lifestyle Modification Program
Synchronized Lifestyle Modification Program and Physiotherapy
Physiotherapy
Sponsored by
About this trial
This is an interventional treatment trial for Diabetic Neuropathies focused on measuring Synchronized Lifestyle Modification Program, Diabetic Neuropathy, Insulin
Eligibility Criteria
Inclusion Criteria:
- Both males and females
- Five years duration of clinically diagnosed type 2 Diabetes were included in the study
- On insulin therapy
- Diagnosed to have peripheral neuropathy according to Michigan Neuropathy Screening Instrument with a physical examination score > 2.5
Exclusion Criteria:
- Type 1 Diabetics
- Type 2 Diabetics
- On oral hypoglycemic and Glucagon-like Peptide-1 analogues, patients having neuropathies due to other causes (Vitamin B₁₂ deficiency, Drug and Alcohol abuse), patients with other co-morbidities (Renal insufficiency, Heart, Liver and Eye diseases)
- Patients with foot ulcers and orthopedic or surgical problems of lower limb
- Patients with peripheral vascular diseases, inability to walk independently
- Patients receiving any structured supervised physiotherapy intervention
- Pregnant females were excluded from the study
Sites / Locations
- Pakistan Railway Hospital, IslamabadRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm Type
Experimental
Experimental
Experimental
No Intervention
Arm Label
Synchronized Lifestyle Modification Program
Synchronized Lifestyle Modification Program and Physiotherapy
Physiotherapy
Control Group
Arm Description
Synchronized Lifestyle Modification Program
Synchronized Lifestyle Modification Program and Physiotherapy
Physiotherapy included Aerobics, Resistance exercise, Flexibility exercise, and Balance exercise.
No intervention will be given to this Group
Outcomes
Primary Outcome Measures
Lifestyle pattern assessment
Changes from baseline assessed through a self structured questionnaire consisted of open ended questions to assess the timing and type of food taken in meals, daily water intake and sleeping habits. Total 10 questions are included.
Calculation of Body Mass Index
Changes from baseline calculated by measuring height through metal measuring tape in meters and weight in kilograms through potable manual weighing scale. BMI with minimum value of 18.5 and maximum value of 24.5 Kilogram/ square meter. Below 18.5 is considered as underweight and above 24.9 is considered as obese
Measurement of Systolic Blood Pressure
Changes from baseline are assessed by using Mercury Sphygmomanometer with minimum value of 110 millimeter of Mercury and maximum value of 130 millimeter of Mercury. Below 110 millimeter of Mercury is considered as low systolic pressure and above 130 millimeter of Mercury is considered as high systolic pressure
Measurement of Diastolic Blood Pressure
Changes from baseline are assessed by using Mercury Sphygmomanometer with minimum value of 60 millimeter of Mercury and maximum value of 90 millimeter of Mercury. Below 60 millimeter of Mercury is considered as low diastolic pressure and above 90 millimeter of Mercury is considered as high diastolic pressure
Assessment of Presence and Severity of Neuropathy by Michigan Neuropathy Screening Instrument (MNSI)
Changes from baseline are assessed by Michigan Neuropathy Screening Instrument (MNSI) that consists of a history questionnaire comprising of 15 questions related to symptoms of diabetic neuropathy with a score of >7 is considered as abnormal and Physical examination that consists of inspection of foot for deformities, ulcers and callus formation, Ankle reflex and vibration sensation with a score of >2.5 is considered abnormal
Measurement of Peak Latency of Sensory Nerves of lower extremities (Sural and Peroneal)
Changes from baseline are assessed by Nerve Conduction Studies with a maximum value of 4.2 millisecond for sural nerve and 6.1 milliseconds for peroneal nerve are considered normal. Values below 4.2 and 6.1 milliseconds are considered abnormal.
Measurement of Amplitude of Sensory Nerves of lower extremities (Sural and Peroneal)
Changes from baseline are assessed by Nerve Conduction Studies with a value of 2 microvolts for peroneal nerve and 6 microvolts for sural nerve are considered normal. Values below 2 and 6 microvolts were considered abnormal.
Velocity of Sensory Nerves of lower extremities (Sural and Peroneal)
Changes from baseline are assessed by Nerve Conduction Studies with minimum limit of 44 meters /second and maximum limit of 64 meters/second. Value below 44m/sec and above 64m/sec are considered abnormal.
Onset Latency of Motor Nerves (Peroneal and Tibial)
Changes from baseline are assessed by Nerve Conduction Studies with a value of 6.1 milliseconds for both nerves is considered normal. Value below 6.1 milliseconds is considered abnormal.
Amplitude of Motor Nerves (Peroneal and Tibial)
Changes from baseline are assessed by Nerve Conduction Studies with a value of 2 millivolts for peroneal nerve and 3 millivolts for tibial nerve is considered normal. Value below 2 and 3 microvolts is considered abnormal.
Velocity of Motor Nerves (Peroneal and Tibial)
Changes from baseline are assessed by Nerve Conduction Studies with a value of 41 m/sec is considered normal. Value below 41 m/sec is considered abnormal
Assessment of Balance by Berg Balance Scale (BBS)
Changes from baseline are assessed by Berg Balance Scale (BBS) with Low Fall Risk score of 41-56, Medium Fall Risk 21-40, High Fall Risk 0-20
Fasting Blood Glucose
Changes from baseline are measured by glucose oxidase strip method in milligram/deciliter using glucometer with a minimum value of 72 mg/dL and a maximum value of 99mg/dL is considered normal. Value below 72mg/dL is considered as hypoglycemia and value above 99 mg/dL is considered hyperglycemia.
Serum HbA1c concentration
Changes from baseline are measured by Ion Exchange Chromatography with a minimum value of 4% and maximum value of 5.9% is considered normal.
Serum Triglycerides
Changes from baseline are measured by Glycerol Phosphate Enzyme Based Method with a minimum value of 150 milligram /deciliter and a maximum value of 199 milligram/deciliter is considered normal. Value above 200 milligram/deciliter is considered as increased serum triglycerides
Serum Total Cholesterol
Changes from baseline are measured by Cholesterol Oxidase Enzyme Based Method with a minimum value of 125 and a maximum value of 200 milligram /deciliters considered as normal. Value above 200 milligram/deciliter is considered as hypercholesterolemia.
Serum Low Density Lipoproteins (LDL)
Changes from baseline are measured by Friedewald calculation with a minimum value of 100 and a maximum value of 120 milligram /deciliter is considered as normal.
Serum High Density Lipoproteins (HDL)
Changes from baseline are measured by Direct Enzymatic Immuno-inhibition with a maximum value of 40milligram/deciliter and higher is considered as normal. Value below 40 milligram/deciliter is considered as abnormal.
Secondary Outcome Measures
Full Information
NCT ID
NCT04813133
First Posted
February 2, 2021
Last Updated
March 21, 2021
Sponsor
Riphah International University
1. Study Identification
Unique Protocol Identification Number
NCT04813133
Brief Title
Role of Synchronized Lifestyle Modification Program in Insulin Dependent Diabetic Peripheral Neuropathy Patients
Official Title
Role of Synchronized Lifestyle Modification Program in Peripheral Neuropathy in Insulin Dependent Type 2 Diabetics
Study Type
Interventional
2. Study Status
Record Verification Date
March 2021
Overall Recruitment Status
Unknown status
Study Start Date
February 5, 2021 (Actual)
Primary Completion Date
January 30, 2022 (Anticipated)
Study Completion Date
January 30, 2022 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Riphah International University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
This study aims to determine the role of Synchronized Lifestyle modification program along with Physiotherapy on the symptoms of DPN in patients on insulin therapy.
Detailed Description
Diabetes mellitus (DM) is a metabolic disorder which influence about 8.3% of adult population and is the fifth major cause of death globally. In Pakistan, prevalence of type 2 diabetes is 16.98% according to recent survey held in 2019. DM is classified into type 1 and type 2 diabetes. In type 1 diabetes, there is an absolute deficiency of insulin secretion due to an autoimmune pathologic process occurring in beta islets of pancreas. While Type 2 diabetes is characterized by a combination of insulin resistance and inadequate insulin secretion with resultant hyperglycemia leading to micro and macrovascular complications. Macrovascular complications include cardiovascular disease, stroke and peripheral artery disease. Amongst microvascular complications, Diabetic peripheral neuropathy (DPN) is one of the most common complication in both developed and developing countries. DPN is a symmetrical, length-dependent sensorimotor polyneuropathy which is attributed to metabolic and micro vessel alterations due to hyperglycemia and concomitant cardiovascular risk covariates. Major risk factors for development of DPN include duration of diabetes, hyperglycemia, and age, followed by prediabetes, hypertension, dyslipidemia, and obesity. DPN can engender disablement in touch sensation, vibration sense, lower limb proprioception, and kinesthesia thus contributing to impaired balance, altered gait with increased risk of falling. DPN occurs in more than 50% of people with type 2 diabetes. It is a salient risk factor for skin breakdown, amputation, and reduced physical mobility consequently lowering the quality of life Management of DPN is multifaceted and includes efforts to alter the natural history (lifestyle changes) and symptomatic treatments through pharmacological interventions. Daily habits and actions exert an enormous influence on short-term and long-term health and quality of life. Importance of dietary modification is enhanced if it is synchronized with the circadian rhythm of the body. Therefore, Synchronized Lifestyle modification program is a personalized, homeostasis restoring, liver centric lifestyle modification program that works through the correction of body clock rhythm. Lifestyle medicine comprises of cluster of positive lifestyle practices including maintenance of a healthy body weight, regular physical activity, cessation of cigarette smoking, stress reduction as well following a few nutritional practices such as increasing whole grains and consuming more fruits and vegetables. Lifestyle modification, including diet and exercise, slow the progression of neuropathy by promoting small nerve fiber regeneration. Dietary modifications include intake of nutrient, such as whole grains, vegetables, fruits, legumes, low-fat dairy, lean meats, nuts, and seeds. These foods help to maintain body weight, attain individualized glycemic, blood pressure, and lipid goals and prevent complications of diabetes. Exercise improves three of the biggest risk factors for diabetic neuropathy including insulin sensitivity and glucose control, obesity, and dyslipidemia. These exercises include aerobic exercise that improves glycemic control and insulin sensitivity in diabetics. Strength training exercise improves postural sway during standing, and gait characteristics during level-ground walking. While the flexibility exercise are suggested for refining distal joint mobility and plantar pressure distribution during gait. Thus, Exercise is known to enhance multiple metabolic factors that may affect nerve health and microvascular function, which may indirectly protect against peripheral nerve damage.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetic Neuropathies
Keywords
Synchronized Lifestyle Modification Program, Diabetic Neuropathy, Insulin
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
216 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Synchronized Lifestyle Modification Program
Arm Type
Experimental
Arm Description
Synchronized Lifestyle Modification Program
Arm Title
Synchronized Lifestyle Modification Program and Physiotherapy
Arm Type
Experimental
Arm Description
Synchronized Lifestyle Modification Program and Physiotherapy
Arm Title
Physiotherapy
Arm Type
Experimental
Arm Description
Physiotherapy included Aerobics, Resistance exercise, Flexibility exercise, and Balance exercise.
Arm Title
Control Group
Arm Type
No Intervention
Arm Description
No intervention will be given to this Group
Intervention Type
Other
Intervention Name(s)
Synchronized Lifestyle Modification Program
Intervention Description
Synchronization of dietary intake with circadian rhythm of the body.
Intervention Type
Other
Intervention Name(s)
Synchronized Lifestyle Modification Program and Physiotherapy
Intervention Description
Synchronization of dietary intake with circadian rhythm of the body along with Physiotherapy ( Aerobics, flexibility, resistance and balance exercises.)
Intervention Type
Other
Intervention Name(s)
Physiotherapy
Intervention Description
Only Physiotherapy training which includes ( Aerobics, flexibility, resistance and balance exercises.)
Primary Outcome Measure Information:
Title
Lifestyle pattern assessment
Description
Changes from baseline assessed through a self structured questionnaire consisted of open ended questions to assess the timing and type of food taken in meals, daily water intake and sleeping habits. Total 10 questions are included.
Time Frame
12 weeks
Title
Calculation of Body Mass Index
Description
Changes from baseline calculated by measuring height through metal measuring tape in meters and weight in kilograms through potable manual weighing scale. BMI with minimum value of 18.5 and maximum value of 24.5 Kilogram/ square meter. Below 18.5 is considered as underweight and above 24.9 is considered as obese
Time Frame
12 weeks
Title
Measurement of Systolic Blood Pressure
Description
Changes from baseline are assessed by using Mercury Sphygmomanometer with minimum value of 110 millimeter of Mercury and maximum value of 130 millimeter of Mercury. Below 110 millimeter of Mercury is considered as low systolic pressure and above 130 millimeter of Mercury is considered as high systolic pressure
Time Frame
12 weeks
Title
Measurement of Diastolic Blood Pressure
Description
Changes from baseline are assessed by using Mercury Sphygmomanometer with minimum value of 60 millimeter of Mercury and maximum value of 90 millimeter of Mercury. Below 60 millimeter of Mercury is considered as low diastolic pressure and above 90 millimeter of Mercury is considered as high diastolic pressure
Time Frame
12 weeks
Title
Assessment of Presence and Severity of Neuropathy by Michigan Neuropathy Screening Instrument (MNSI)
Description
Changes from baseline are assessed by Michigan Neuropathy Screening Instrument (MNSI) that consists of a history questionnaire comprising of 15 questions related to symptoms of diabetic neuropathy with a score of >7 is considered as abnormal and Physical examination that consists of inspection of foot for deformities, ulcers and callus formation, Ankle reflex and vibration sensation with a score of >2.5 is considered abnormal
Time Frame
12 weeks
Title
Measurement of Peak Latency of Sensory Nerves of lower extremities (Sural and Peroneal)
Description
Changes from baseline are assessed by Nerve Conduction Studies with a maximum value of 4.2 millisecond for sural nerve and 6.1 milliseconds for peroneal nerve are considered normal. Values below 4.2 and 6.1 milliseconds are considered abnormal.
Time Frame
12 weeks
Title
Measurement of Amplitude of Sensory Nerves of lower extremities (Sural and Peroneal)
Description
Changes from baseline are assessed by Nerve Conduction Studies with a value of 2 microvolts for peroneal nerve and 6 microvolts for sural nerve are considered normal. Values below 2 and 6 microvolts were considered abnormal.
Time Frame
12 weeks
Title
Velocity of Sensory Nerves of lower extremities (Sural and Peroneal)
Description
Changes from baseline are assessed by Nerve Conduction Studies with minimum limit of 44 meters /second and maximum limit of 64 meters/second. Value below 44m/sec and above 64m/sec are considered abnormal.
Time Frame
12 weeks
Title
Onset Latency of Motor Nerves (Peroneal and Tibial)
Description
Changes from baseline are assessed by Nerve Conduction Studies with a value of 6.1 milliseconds for both nerves is considered normal. Value below 6.1 milliseconds is considered abnormal.
Time Frame
12 weeks
Title
Amplitude of Motor Nerves (Peroneal and Tibial)
Description
Changes from baseline are assessed by Nerve Conduction Studies with a value of 2 millivolts for peroneal nerve and 3 millivolts for tibial nerve is considered normal. Value below 2 and 3 microvolts is considered abnormal.
Time Frame
12 weeks
Title
Velocity of Motor Nerves (Peroneal and Tibial)
Description
Changes from baseline are assessed by Nerve Conduction Studies with a value of 41 m/sec is considered normal. Value below 41 m/sec is considered abnormal
Time Frame
12 weeks
Title
Assessment of Balance by Berg Balance Scale (BBS)
Description
Changes from baseline are assessed by Berg Balance Scale (BBS) with Low Fall Risk score of 41-56, Medium Fall Risk 21-40, High Fall Risk 0-20
Time Frame
12 weeks
Title
Fasting Blood Glucose
Description
Changes from baseline are measured by glucose oxidase strip method in milligram/deciliter using glucometer with a minimum value of 72 mg/dL and a maximum value of 99mg/dL is considered normal. Value below 72mg/dL is considered as hypoglycemia and value above 99 mg/dL is considered hyperglycemia.
Time Frame
12 weeks
Title
Serum HbA1c concentration
Description
Changes from baseline are measured by Ion Exchange Chromatography with a minimum value of 4% and maximum value of 5.9% is considered normal.
Time Frame
12 weeks
Title
Serum Triglycerides
Description
Changes from baseline are measured by Glycerol Phosphate Enzyme Based Method with a minimum value of 150 milligram /deciliter and a maximum value of 199 milligram/deciliter is considered normal. Value above 200 milligram/deciliter is considered as increased serum triglycerides
Time Frame
12 week
Title
Serum Total Cholesterol
Description
Changes from baseline are measured by Cholesterol Oxidase Enzyme Based Method with a minimum value of 125 and a maximum value of 200 milligram /deciliters considered as normal. Value above 200 milligram/deciliter is considered as hypercholesterolemia.
Time Frame
12 weeks
Title
Serum Low Density Lipoproteins (LDL)
Description
Changes from baseline are measured by Friedewald calculation with a minimum value of 100 and a maximum value of 120 milligram /deciliter is considered as normal.
Time Frame
12 weeks
Title
Serum High Density Lipoproteins (HDL)
Description
Changes from baseline are measured by Direct Enzymatic Immuno-inhibition with a maximum value of 40milligram/deciliter and higher is considered as normal. Value below 40 milligram/deciliter is considered as abnormal.
Time Frame
2 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Both males and females
Five years duration of clinically diagnosed type 2 Diabetes were included in the study
On insulin therapy
Diagnosed to have peripheral neuropathy according to Michigan Neuropathy Screening Instrument with a physical examination score > 2.5
Exclusion Criteria:
Type 1 Diabetics
Type 2 Diabetics
On oral hypoglycemic and Glucagon-like Peptide-1 analogues, patients having neuropathies due to other causes (Vitamin B₁₂ deficiency, Drug and Alcohol abuse), patients with other co-morbidities (Renal insufficiency, Heart, Liver and Eye diseases)
Patients with foot ulcers and orthopedic or surgical problems of lower limb
Patients with peripheral vascular diseases, inability to walk independently
Patients receiving any structured supervised physiotherapy intervention
Pregnant females were excluded from the study
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Imran Amjad, PhD
Phone
03324390125
Email
imran.amjad@riphah.edu.pk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Shazia Ali, PhD
Organizational Affiliation
Riphah International University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Pakistan Railway Hospital, Islamabad
City
Islamabad
State/Province
Federal
ZIP/Postal Code
44000
Country
Pakistan
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Shazia Ali, PhD
Phone
03005001789
Email
shazia.ali@riphah.edu.pk
First Name & Middle Initial & Last Name & Degree
Shazia Ali, PhD
First Name & Middle Initial & Last Name & Degree
Tayyaba Anis, M. Phil
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
26781070
Citation
Domingueti CP, Dusse LM, Carvalho Md, de Sousa LP, Gomes KB, Fernandes AP. Diabetes mellitus: The linkage between oxidative stress, inflammation, hypercoagulability and vascular complications. J Diabetes Complications. 2016 May-Jun;30(4):738-45. doi: 10.1016/j.jdiacomp.2015.12.018. Epub 2015 Dec 18.
Results Reference
background
PubMed Identifier
30796126
Citation
Aamir AH, Ul-Haq Z, Mahar SA, Qureshi FM, Ahmad I, Jawa A, Sheikh A, Raza A, Fazid S, Jadoon Z, Ishtiaq O, Safdar N, Afridi H, Heald AH. Diabetes Prevalence Survey of Pakistan (DPS-PAK): prevalence of type 2 diabetes mellitus and prediabetes using HbA1c: a population-based survey from Pakistan. BMJ Open. 2019 Feb 21;9(2):e025300. doi: 10.1136/bmjopen-2018-025300.
Results Reference
background
Citation
Diabetes DOF. DEFINITION AND DESCRIPTION OF DIABETES OTHER CATEGORIES OF GLUCOSE. 2010;33.
Results Reference
background
Citation
Lilly E, Homburg B. P R O G R E S S I O N , Initiating Insulin Therapy in Type 2. 2009;32:0-5.
Results Reference
background
Citation
Majeedkutty NA, Jabbar MA. Physical Therapy for Diabetic Peripheral Neuropathy : A Narrative Review. 30(1):112-25.
Results Reference
background
PubMed Identifier
28864841
Citation
Alam U, Riley DR, Jugdey RS, Azmi S, Rajbhandari S, D'Aout K, Malik RA. Diabetic Neuropathy and Gait: A Review. Diabetes Ther. 2017 Dec;8(6):1253-1264. doi: 10.1007/s13300-017-0295-y. Epub 2017 Sep 1.
Results Reference
background
PubMed Identifier
26676661
Citation
Papanas N, Ziegler D. Risk Factors and Comorbidities in Diabetic Neuropathy: An Update 2015. Rev Diabet Stud. 2015 Spring-Summer;12(1-2):48-62. doi: 10.1900/RDS.2015.12.48. Epub 2015 Aug 10.
Results Reference
background
PubMed Identifier
27445060
Citation
Kluding PM, Bareiss SK, Hastings M, Marcus RL, Sinacore DR, Mueller MJ. Physical Training and Activity in People With Diabetic Peripheral Neuropathy: Paradigm Shift. Phys Ther. 2017 Jan 1;97(1):31-43. doi: 10.2522/ptj.20160124.
Results Reference
background
Citation
Education DS. 4 . Lifestyle Management. 2017;40(January):33-43.
Results Reference
background
PubMed Identifier
28553628
Citation
Nadi M, Marandi SM, Esfarjani F, Saleki M, Mohammadi M. The Comparison between Effects of 12 weeks Combined Training and Vitamin D Supplement on Improvement of Sensory-motor Neuropathy in type 2 Diabetic Women. Adv Biomed Res. 2017 May 2;6:55. doi: 10.4103/2277-9175.205528. eCollection 2017.
Results Reference
background
PubMed Identifier
26108438
Citation
Handsaker JC, Brown SJ, Bowling FL, Maganaris CN, Boulton AJ, Reeves ND. Resistance exercise training increases lower limb speed of strength generation during stair ascent and descent in people with diabetic peripheral neuropathy. Diabet Med. 2016 Jan;33(1):97-104. doi: 10.1111/dme.12841. Epub 2015 Jul 17.
Results Reference
background
Citation
Andayani TM, Izham M, Ibrahim M, Asdie AH. Comparison of the glycemic control of insulin and triple oral therapy in type 2 diabetes mellitus. 2010;1(April):13-8.
Results Reference
background
PubMed Identifier
28900535
Citation
Rahimi N, Samavati Sharif MA, Goharian AR, Pour AH. The Effects of Aerobic Exercises and 25(OH) D Supplementation on GLP1 and DPP4 Level in Type II Diabetic Patients. Int J Prev Med. 2017 Aug 8;8:56. doi: 10.4103/ijpvm.IJPVM_161_17. eCollection 2017.
Results Reference
background
PubMed Identifier
13814676
Citation
DE BODO RC, ALTSZULER N, DUNN A, STEELE R, ARMSTRONG DT, BISHOP JS. Effects of exogenous and endogenous insulin on glucose utilization and production. Ann N Y Acad Sci. 1959 Sep 25;82:431-51. doi: 10.1111/j.1749-6632.1959.tb44924.x. No abstract available.
Results Reference
background
PubMed Identifier
25905175
Citation
Donnor T, Sarkar S. Insulin- Pharmacology, Therapeutic Regimens and Principles of Intensive Insulin Therapy. 2023 Feb 15. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrere B, Levy M, McGee EA, McLachlan R, New M, Purnell J, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from http://www.ncbi.nlm.nih.gov/books/NBK278938/
Results Reference
background
Learn more about this trial
Role of Synchronized Lifestyle Modification Program in Insulin Dependent Diabetic Peripheral Neuropathy Patients
We'll reach out to this number within 24 hrs