Association of Muscle Strength and Electrophysiological Measures of Reinnervation in Diabetic Neuropathy

Motor function was assessed in 34 non-insulin-dependent and 19 insulin-dependent diabetic patients with macroelectromyography and isokinetic dynamometry. Fiber density (FD) and the amplitude of the macro motor unit potential (macro MUP) of the anterior tibial and lateral vastus muscles were obtained and maximal isokinetic strength of the ankle and knee extensors were determined. All patients underwent standardized clinical examination including a neurological disability score (NDS), quantitative sensory examination, and conventional motor nerve conduction studies. The amplitude of the macro MUP and FD of the anterior tibial muscle were increased in neuropathic patients without weakness (P < 0.05) and further increased in neuropathic patients with weakness (P < 0.05). The NDS was related to the FD and the amplitude of the macro MUP for the anterior tibial and lateral vastus muscle [r=0.55-0.75 (P < 0.005)]. Muscle strength of ankle and knee extensors correlated with the FD [r=-0.69 (P < 0.0001) and r=-0.58 (P< 0.001), respectively] and with the amplitude of the macro MUP of the two muscles [r=-0.63 (P < 0.0001) and r=-0.37 (P < 0.05), respectively]. Our findings support the hypothesis that loss of muscle strength in diabetic patients is due to incomplete reinnervation following axonal loss.