Abstract
Diabetes alters numerous physiological functions and can lead to disastrous consequences in the long term. Neuromuscular function is particularly affected and is impacted early, offering an opportunity to detect the onset of diabetes-related dysfunctions and follow the advancement of the disease. The role of physical training for counteracting the deleterious effects of diabetes is well accepted but at the same time, it appears difficult to reliably assess the effects of exercise on functional capacity in patients with diabetic peripheral neuropathy (DPN). In this paper, we will review the specific characteristics of various neuromuscular dysfunctions associated with diabetes according to the DPN presence or not, and their changes over time. We present several propositions regarding the onset of neuromuscular alterations in people with diabetes compared to people with DPN. It appears that motor unit loss and neuromuscular transmission impairment are among the main mechanisms explaining the considerable degradation of neuromuscular function in the transition from a diabetic to neuropathic state. Rate of force development and contractile properties could start to decrease with the onset of preferential type II fiber atrophy, commonly reported in people with DPN. Finally, Mmax amplitude could decrease with neuromuscular fatigue only in people with DPN, reflecting the fatigue-related neuromuscular transmission impairment reported in people with DPN. In this review, we show that the different neuromuscular parameters are altered at different stages of diabetes, according to the presence of DPN or not. The precise evaluation of these parameters might participate in adapting the physical training prescription.
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Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
Abbreviations
- T2D & T1D:
-
Type 1 & Type 2 diabetes
- DPN:
-
Diabetic peripheral neuropathy
- MVC:
-
Maximal voluntary contraction
- HbA1c:
-
Glycated hemoglobin
- RFD:
-
Rate of force development
- PT:
-
Peak twitch
- TPT:
-
Time to peak twitch
- HRT:
-
Half relaxation time
- TTF:
-
Time to task failure
- VA:
-
Voluntary activation
- M max :
-
Maximal muscle wave
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The authors thank Benjie BARTOS for the English corrections. We also thank Lalang NAPWINLEZO for her rereading on the manuscript. This work was supported by the European Regional Development Fund (FEDER), in the framework of the DALON research project.
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Le Corre, A., Caron, N., Turpin, N.A. et al. Mechanisms underlying altered neuromuscular function in people with DPN. Eur J Appl Physiol 123, 1433–1446 (2023). https://doi.org/10.1007/s00421-023-05150-2
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DOI: https://doi.org/10.1007/s00421-023-05150-2