The Effect of Piracetam on Diabetic Peripheral Neuropathy Patients

Primary outcomes

1. Evaluation of efficacy:1. Measurment of McGill Pain Scale:

   Time frame: 3 Months

   Neuropathic pain severity will be assessed at baseline and every 4 weeks during the whole study duration using The Short-Form McGill Pain Questionnaire (SF-MPQ).The SF-MPQ is a concise assessment tool consisting of 15 items that evaluate both the sensory and affective dimensions of pain experience, Participants rate the intensity of each item on a four-point scale ranging from 0 (none) to 3 (severe). By summing the intensity values for the corresponding descriptors, sensory (11 items), affective (4 items), and total (15 items) pain scores can be obtained.

2. Evaluation of efficacy: 2. Assessment of the vibratory sensation using Michigan neuropathy screening instrument

   Time frame: 3 Months

   Assessment of patients' vibratory sensation will be performed using Michigan Neuropathy screening Instrument , The MNSI consists of two parts, one of them a questionnaire for the patient, a higher score (with a maximum of 13 points) indicates a greater presence of neuropathic symptoms, and the second part is done by the examiner and contains physical examination tests, A high score on the questionnaire, reduced or absent vibration sense, reduced or absent ankle reflexes, and reduced or absent sensation on the monofilament test are all indicative of neuropathic symptoms, suggesting the presence of diabetic neuropathy. Patients who score above 2 points on a 10-point scale in the clinical section of the MNSI are considered to have neuropathic symptoms.

3. Evaluation of efficacy:3. Assessment of EQ-5D-5L Score:

   Time frame: 3 Months

   Assessment of patients' Quality of life will be performed using EQ-5D-5L questionnaire, The EQ-5D-5L consists of a concise descriptive system questionnaire and a visual analog scale (EQ VAS),The questionnaire captures a straightforward profile of an individual's health state, while the EQ VAS offers an alternative approach to gauge an individual's self-rated overall current health, The updated version of the EQ-5D, known as the EQ-5D-5L, introduces five levels of severity for each of the existing five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Within the EQ-5D-5L descriptive system, there are five dimensions, and each dimension encompasses five response levels, ranging from 1 which indicates absence of problems to 5 which indicates Inability to perform/extreme problems.

4. Evaluation of efficacy: 4. Assessment of Pittsburgh sleep quality index Score:

   Time frame: 3 Months

   Sleep disturbance will be assessed, The Pittsburgh sleep quality index questionnaire about usual sleeping habits for the past month only. These questions are consolidated to create seven distinct "component" scores, each with a scoring range of 0-3 points. It is important to note that a score of "0" indicates the absence of any difficulties, while a score of "3" signifies the presence of severe difficulties. Subsequently, the seven component scores are combined to generate a single "global" score, spanning from 0 to 21 points. Within this framework, a score of "0" indicates the absence of any difficulties across all domains, while a score of "21" signifies the presence of severe difficulties in all areas.

5. Evaluation of efficacy: 5. Measurment of Montreal Cognitive Assessment Scale

   Time frame: 3 Months

   Cognitive function will be assessed. The Montreal Cognitive Assessment (MoCA), which is a quick screening assessment used to detect elderly people who have mild cognitive impairment (MCI). It is a single-page examination that may be performed in 10 minutes. This test has a maximum score of 30, with a result of 26 or higher deemed normal. A score of less than 26 without associated functional impairment indicates a diagnosis of mild cognitive impairment. Furthermore, a score of less than 26 combined with functional impairment implies that dementia is in its early stages. It is worth mentioning that an additional point is given whether the individual has completed 12 years of formal education or less.

6. Evaluation of efficacy: 6. Evaluation of serum Brain-derived neurotrophic factor:

   Time frame: 3 Months

   Blood sample will be withdrawn from each patient at baseline and after 3 months and separated sera will be stored at -80 C till analysis. Serum Brain-derived neurotrophic factor will be assessed for each patient using ELISA kits.

7. 7.Incidence of Adverse Events

   Time frame: 3 months

   Patients will be educated about any expected side effects and will be required to report any of them.