Background
Type 2 diabetic mellitus (T2DM) is an emerging global pandemic which is associated with lots of co-morbidities and reported vascular dysfunctions. T2DM associated vascular dysfunctions leads to vasculopathy in the form of altered peripheral vascular dynamics. Cold stress test (CST) is a reliable sympathetic reactivity test used for assessing vascular dysfunctions. In this study we are trying to quantify vascular dysfunctions in T2DM patients non invasively by various parameters of photoplethysmography (PPG) of cold stress test.
Methods
Case control study had done in referral health center AIIMS, Raipur. Parameters are recorded by finger-PPG before, during and after CST (1 min) in 2 groups, control (n = 20 healthy volunteers) and case (n = 20 diagnosed T2DM patients).
Results
Due to cold stress, PPG parameter peak amplitude was significantly decreased in both healthy and T2DM groups (p <0.001 and p <0.001, respectively). However, recovery trend of amplitude was significantly slow in T2DM compared to healthy subjects. Another PPG parameter peak to peak interval was significantly higher in healthy group compared to T2DM patients.
Conclusions
This study showed that T2DM patients has significant deranged pulse volume parameters like amplitude and peak to peak interval can be used to objectively quantify the vasculopathy in T2DM patients by using sympathetic reactivity to cold stress.

Background: Early detection of neuropathy may prevent further progression of this complication in the diabetic patients. The purpose of this study was to evaluate the prevalence of early neuropathic complication in patients with newly diagnosed type 1 and type 2 diabetes. Methods: Nerve conduction studies (median, ulnar, posterior tibial, peroneal, and sural nerves) were performed for 49 type 1 (27 males, mean 14.1±7.5 years) and 40 type 2 (27 males, 42.0±14.1 years) diabetic patients at onset of diabetes. Children with age at onset under 4 years and adults over 55 years were excluded to eliminate the aging effect and the influence of obstructive arteriosclerosis. Neuropathy was defined as abnormal nerve conduction findings in two or more nerves including the sural nerve. Results: Mean HbA1c level was 12.6±3.3% for type 1 and 10.5±2.9% for type 2 diabetes. The prevalence of neuropathy was 12.2% for type 1, and 35.0% for type 2 diabetes, respectively. There were significant trends in the prevalence of neuropathy with increasing age (p<0.05). The effect of the mean level of glycosylated hemoglobin on the prevalence of polyneuropathy at onset of diabetes was borderline (p=0.0532). Neither sex of the patients nor the type of diabetes affected the neurophysiologic abnormalities at the diagnosis. Conclusions: Even in a population with diabetes at the diagnosis, the prevalence of subclinical neuropathy was not low. Neuropathy has been significantly associated with increasing age indicating the possibility of longer duration of undetected diabetes among them, especially in type 2 diabetes.

B a c k g r o u n d: Somatosensory evoked potential (SSEP) is valuable for the evaluation of the central pathway.However, peripheral neuropathy sometimes renders the test useless by preventing the conduction from reaching theCNS. We postulated that the peripheral conduction problems could be overcome by proximal stimulation in SSEP andwanted to verify this in the study.Methods: Twenty patients with diabetic sensorimotor polyneuropathy were included. SSEP was elicited by stimulatingthe median and posterior tibial nerves. We compared the effect of distal and proximal stimulations in each SSEP inthe aspect of presence/absence and various latencies of resultant waves.Results: Among the 40 cases, proximal stimulation caused reappearance of subsided waves in 10 cases (25%). In themedian nerve SSEP, proximal stimulation made EN1 and CN2 visible which were not evident when distally stimulated.In the posterior tibial nerve SSEP, there was also improvement of forming waves when proximally stimulated.Conclusions: In the diabetic polyneuropathy, proximal stimulation of SSEP is more effective than the conventionaldistal stimulation in evaluating central pathway.

Background
The medial plantar nerve (MPN) is a distal branch of the posterior tibial nerve, and various methods of nerveconduction study for MPN have been introduced so far. Hemmi et al described a new method (Hemmi's method) forrecording medial plantar sensory nerve action potentials (SNAPs), which is considered as a simple and reliable method formeasuring medial plantar SNAPs. This study was aimed to establish the normal values for the MPN conduction study amongKoreans and to compare the sensitivities of three different methods for MPN conduction study (Hemmi, Oh, and Saeed'smethod) in detecting evidence of peripheral neuropathy among diabetic patients. Methods: In 27 healthy subjects, MPN conductionstudy using Hemmi