{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T10:50:43Z","timestamp":1784631043373,"version":"3.55.0"},"reference-count":26,"publisher":"American Diabetes Association","issue":"12","license":[{"start":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T00:00:00Z","timestamp":1630108800000},"content-version":"vor","delay-in-days":2845,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,12,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>Patients with diabetic neuropathy (DN) demonstrate variable degrees of nerve regeneration and degeneration. Our aim was to identify risk factors associated with sural nerve degeneration in patients with DN.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>Demographic, anthropometric, biochemical, and anatomical data of subjects with DN from a 52-week trial of acetyl-L-carnitine were retrospectively examined. Based on the change in sural nerve myelinated fiber density (\u0394MFD%), subjects were divided into three groups: regenerator (top 16 percentiles, n = 67), degenerator (bottom 16 percentiles, n = 67), and intermediate (n = 290), with dramatically increased, decreased, and steady \u0394MFD%, respectively. ANOVA, Fisher exact test, and multifactorial logistic regression were used to evaluate statistical significance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>\u0394MFD%s were 35.6 \u00b1 17.4 (regenerator), \u22124.8 \u00b1 12.1 (intermediate), and \u221239.8 \u00b1 11.0 (degenerator). HbA1c at baseline was the only factor significantly different across the three groups (P = 0.01). In multifactorial logistic regression, HbA1c at baseline was also the only risk factor significantly different between regenerator (8.3 \u00b1 1.6%) and degenerator (9.2 \u00b1 1.8%) (odds ratio 0.68 [95% CI 0.54\u20130.85]; P &amp;lt; 0.01). Support Vector Machine classifier using HbA1c demonstrated 62.4% accuracy of classifying subjects into regenerator or degenerator. A preliminary microarray experiment revealed that upregulated genes in the regenerator group are enriched with cell cycle and myelin sheath functions, while downregulated genes are enriched in immune\/inflammatory responses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>These data, based on the largest cohort with \u0394MFD% information, suggest that HbA1c levels predict myelinated nerve fiber regeneration and degeneration in patients with DN. Therefore, maintaining optimal blood glucose control is likely essential in patients with DN to prevent continued nerve injury.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc12-2530","type":"journal-article","created":{"date-parts":[[2013,10,8]],"date-time":"2013-10-08T03:28:59Z","timestamp":1381202939000},"page":"4043-4049","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":37,"title":["Identification of Factors Associated With Sural Nerve Regeneration and Degeneration in Diabetic Neuropathy"],"prefix":"10.2337","volume":"36","author":[{"given":"Junguk","family":"Hur","sequence":"first","affiliation":[{"name":"Department of Neurology, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelli A.","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan, Ann Arbor, Michigan"},{"name":"Department of Medical Education, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian C.","family":"Callaghan","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodica","family":"Pop-Busui","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva L.","family":"Feldman","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2013,11,13]]},"reference":[{"key":"2022031222415351800_B1","unstructured":"National Diabetes Fact Sheet [internet], 2011. 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