Prevalence of peripheral neuropathy in patients with diabetes: A systematic review and meta-analysis

AimsWe aimed to determine pooled prevalence of diabetic peripheral neuropathy (DPN) in patients with diabetes and to explore the impacts of research variables on prevalence estimates.MethodsA systematic search was performed in PubMed, EMBASE, The Cochrane Library and Scopus from onset up to July 2018 to identify articles investigating the prevalence of DPN. Random-effects models were used to calculate the pooled prevalence of DPN. The heterogeneity of the study was estimated with the I² statistic. The publication bias was described by Egger’s test and funnel plot.ResultsA total of 29 studies with a total of 50,112 participants were included in this meta-analysis. The results showed that the pooled prevalence of DPN was 30% (95% confidence interval, CI 25–34%). The pooled prevalence of DPN among patients with type 2 diabetes mellitus was higher than patients with type 1 diabetes mellitus (31.5%, 95% CI 24.4–38.6% vs 17.5%, 95% CI 4.8–30.2%). The pooled prevalence of DPN of studies involving a mixed type of diabetes mellitus was 24.8% (95% CI 13.1–36.5%, I² = 99.1%).ConclusionsMedical staff should strengthen the evaluation and diagnosis of DPN. Moreover, they need to teach diabetic patients how to prevent this complication.     

Prevalence and risk factors for diabetic peripheral neuropathy,neuropathic pain and foot ulceration in the Arabian Gulf region

Aims/IntroductionThis study determined the prevalence and risk factors for diabetic peripheral neuropathy (DPN), painful DPN and diabetic foot ulceration (DFU) in patients with type 2 diabetes in secondary healthcare in Qatar, Kuwait and the Kingdom of Saudi Arabia.Materials and MethodsAdults aged 18–85 years with type 2 diabetes were randomly enrolled from secondary healthcare, and underwent clinical and metabolic assessment. DPN was evaluated using vibration perception threshold and neuropathic symptoms and painful Diabetic Peripheral Neuropathy was evaluated using the Douleur Neuropathique 4 questionnaire.ResultsA total of 3,021 individuals were recruited between June 2017 and May 2019. The prevalence of DPN was 33.3%, of whom 52.2% were at risk of DFU and 53.6% were undiagnosed. The prevalence of painful DPN was 43.3%, of whom 54.3% were undiagnosed. DFU was present in 2.9%. The adjusted odds ratios for DPN and painful DPN were higher with increasing diabetes duration, obesity, poor glycemic control and hyperlipidemia, and lower with greater physical activity. The adjusted odds ratio for DFU was higher with the presence of DPN, severe loss of vibration perception, hypertension and vitamin D deficiency.ConclusionsThis is the largest study to date from the Middle East showing a high prevalence of undiagnosed DPN, painful DPN and those at risk of DFU in patients with type 2 diabetes, and identifies their respective risk factors.     

Benefits of Ophdiat, a telemedical network to screen for diabetic retinopathy: A retrospective study in five reference hospital centres

AimOne objective of Ophdiat^®, a telemedical network using digital non-mydriatic cameras in Île-de-France, is to develop a comprehensive screening programme that provides access to annual fundus examinations to all diabetic patients. The aim of this study was to evaluate the benefits of this programme in a hospital setting.MethodsA retrospective analysis of 500 case reports of diabetic patients hospitalized before and after Ophdiat^® setup was performed in five reference hospital centres. At each centre, 100 case reports (50 before, 50 after) of patients aged greater than 18 years, hospitalized for their annual check-up, with no known diabetic retinopathy (DR) before hospitalization and with the last fundus examination performed greater than 11 months previously, were randomly selected. The primary endpoint was the proportion of patients whose fundus examinations were performed during hospitalization; secondary endpoints were the number of cases of DR found and the time taken by ophthalmologists to make the diagnosis.ResultsThe mean proportion of patients with fundus examinations was 50.4% and 72.4% before and after, respectively, Ophdiat^® (P < 0.01). The prevalence of DR was 11.1% before and 12.7% after (not significant). The mean time taken by an ophthalmologist per diagnosis of DR was 0.90 half-day before and 0.32 half-day after Ophdiat^®.ConclusionThis evaluation shows that Ophdiat^®, combined with the availability of modern and effective devices, has improved DR screening in diabetology departments in hospitals. Additional human resources would certainly ensure more effective use of the system.     

Urinary albumin excretion in latent autoimmune diabetes in adults (LADA) is more similar to type 2 than type 1 diabetes: Results of the Nord-Trøndelag Health Study 1995–1997

AimAs it is unclear, whether or not, urinary albumin excretion (UAE) differs between patients classified as latent autoimmune diabetes in adults (LADA) and other forms of diabetes, our study aimed to investigate the distribution of the albumin-to-creatinine ratio (ACR) in LADA compared with those in the “classical” types 1 (T1D) and 2 (T2D) diabetes.MethodsWe used data from the Nord-Trøndelag Health Study (HUNT) (n = 64,931) of 1995–1997. ACR (mg/mmol) was measured in three urine samples from all diabetic patients (n = 1525) and from 5% of the non-diabetic study population (n = 2104). We calculated the geometric means and 95% confidence intervals (CI) using a general linear model.ResultsThe unadjusted mean ACR in LADA was similar to that in T2D (1.45, CI: 1.23–1.71 vs 1.41, CI: 1.33–1.49, respectively) but was significantly higher than those in T1D (0.99, CI: 0.83–1.19; P = 0.002) and non-diabetics (0.72, CI: 0.69–0.74; P < 0.001). These results remained similar even after multiple adjustments.ConclusionIn this cross-sectional study, the ACR in LADA and in T2D were similar and higher than in T1D. This similarity between LADA and T2D makes it unlikely that the autoimmune processes that operate in LADA promote albuminuria.     

Association of diabetic foot ulcers with chronic vascular diabetic complications in patients with type 2 diabetes

ContextDiabetes mellitus is a common disease which is prevalent globally, presenting with chronic complications and constitutes a major risk to the patient. Diabetic foot ulcers are the single biggest risk factor for non-traumatic lower limb amputations in persons with diabetes. We aimed to screen for the chronic vascular diabetic complications in patients with diabetic foot ulcers (DFUs) and to assess the association of diabetic foot ulcers with these complications in the study group.Subjects and methodsThis cross-sectional study included 180 type 2 diabetic patients (aged 30–70 years) with diabetic foot ulcers who attended the Outpatient Clinic of Diabetes in Alexandria Main University Hospital. Full diabetic foot examination was done to all study subjects. DFUs were assessed using University of Texas Diabetic Wound Classification System. HbA1c, LDL-C, serum creatinine, and urinary albumin creatinine ratio (ACR) were measured for all study subjects. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Fundus examination was done for all study subjects.ResultsThe prevalence of diabetic kidney disease (DKD) and diabetic retinopathy (DR) was 86.1% and 90% respectively among the study group. 86.7% of patients had neuropathic DFUs, 11.1% of them had ischemic DFUs and 2.2% had neuro-ischemic DFUs. Regarding diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD) as risk factors for developing DFU, the prevalence of both of them respectively was 82% and 20% among the study group. There was statistically significant association between both DKD, DR and peripheral neuropathy. There was also statistically significant association between both DKD, DR and peripheral arterial disease (PAD).ConclusionChronic vascular diabetic complications are common among type 2 diabetic patients with diabetic foot ulcers. There is statistically significant association between these complications and diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD).     

Increased gait variability in diabetes mellitus patients with neuropathic pain

AimsGait dysfunction in subjects with diabetes mellitus (DM) contributes to falling and subsequent injuries. Using a portable device (GaitMeter^TM), we measured gait parameters in DM patients with and without diabetic peripheral neuropathy (DPN) during flat surface walking. We hypothesized that DM patients with DPN and neuropathic pain (NeP) would have greater gait step variability than those with DPN without NeP.MethodsSubjects with DPN and at least moderate NeP (DPN-P), DPN without NeP (DPN-NoP), DM without DPN, and control subjects without DM were assessed. Our outcome measure was gait variability for step length and velocity. DPN severity was quantified using the Toronto Clinical Scoring System and the Utah Early Neuropathy Score. Falls and their outcomes were retrospectively quantified.ResultsEach cohort contained ≥ 20 subjects. Durations of DM and HbA1C were greatest amongst DPN cohorts. DPN-P participants had greater variability of step length and step velocity, except for DM only participants. DPN-P participants also reported greater risk of hospitalizations for fall-related injuries, and greater fear of falling. Modest negative relationships emerged for step length with step velocity, reported falls and pain severity.ConclusionsNeP contributes to gait variability, potentially contributing to the risk of falling in DM patients.     

Multicentre, randomised, controlled study of the impact of continuous sub-cutaneous glucose monitoring (GlucoDay) on glycaemic control in type 1 and type 2 diabetes patients

AimThis randomised study was designed to investigate the impact of continuous glucose monitoring (CGM) for 48 h on glycaemic control with a 3-month follow-up in patients with type 1 (T1D) or type 2 (T2D) diabetes.MethodsA total of 48 patients with poor glycaemic control (HbA_1c: 8–10.5%) underwent CGM for 48 h using the GlucoDay^® system (A. Menarini Diagnostics), after which they were randomly assigned to treatment adjustments based on either their CGM profile (CGM group) or their usual self-monitoring of blood glucose (SMBG group). HbA_1c measurement and 48-h CGM were repeated 3 months later.ResultsAltogether, 34 patients with either T1D (n = 9) or T2D (n = 25) completed the study; seven patients chose to leave the study, and seven patients in the CGM group were excluded because their baseline CGM graphs were not interpretable. HbA_1c levels decreased significantly in the CGM group (n = 14, –0.63 ± 0.27%; P = 0.023), but not in the controls (n = 20, –0.28 ± 0.21%; P = 0.30). In T2D patients, the improvement associated with CGM vs SMBG was due to HbA_1c decreases (mean: –0.63 ± 0.34%; P = 0.05 vs –0.31 ± 0.29%; P = 0.18, respectively). However, HbA_1c did not change significantly with CGM in T1D patients. Comparisons of CGM data at baseline and after 3 months showed no significant changes in glucose control, glucose variability or hypoglycaemia. No major adverse events related to the GlucoDay^® system were reported.ConclusionThis is the first randomised study showing that CGM improves glycaemic control in patients with T2D.     

Glycemic profile variability: An independent risk factor for diabetic neuropathy in patients with type 2 diabetes

BackgroundImpaired glycemic control is a potential predictor for macro- and microvascular complications of diabetes, which could be recognized by glycemic variability. The aim of this 10-year prospective cohort study presented here is to gain a better understanding of the correlation between GV and diabetic peripheral neuropathy (DPN) as one of the most common complications of T2DM.MethodsSince February 2010, 1152 adult patients with T2DM have been followed-up. Baseline features, anthropometric measurements, and laboratory findings were collected and documented during ten years. The association between DPN incidence and glycemic profile variability was evaluated using cox regression analysis. The coefficient of variation of glycemic indices within subjects was calculated and compared using an independent sample t-test.ResultsIndividuals who developed neuropathy had significantly higher mean levels of glycemic indices (HbA1c, FBS, and 2hpp), urinary albumin excretion, mean creatinine levels, and a longer duration of diabetes. A significant positive correlation between incidence of DPN and glycemic profile variability (cv-FBS10 %, cv-FBS20 %, cv-2hpp20 %, cv-HbA1c5 % and cv-HbA1c10 %) was revealed. Results also showed that higher variability of FBS was associated with the higher risk of neuropathy incidence (HR: 12.29, p-value: 0.045), which indicates that glycemic profile variability is an independent risk factor for DPN in patients with T2DM.ConclusionVariability of glycemic profiles from a visit to visit, regardless of sustained hyperglycemia, was indeed a significant risk factor for DPN in diabetic type 2 patients. CV-FBS was the most critical glycemic variability indices for DPN development.     

Fit for purpose? Footwear for patients with and without diabetic peripheral neuropathy: A cross-sectional study

AimThis paper determines whether patients with and without Diabetic Peripheral Neuropathy use suitable footwear, taking into account that these persons are subject to a significant loss of sensitivity in the feet.MethodsCross-sectional observational study was conducted of 108 participants with diabetes mellitus. Inclusion criteria were at least five years’ progression of diabetes, the ability to walk unaided and no distal amputation of the foot. The presence of DPN was evaluated according to the criteria of the International Working Group on the Diabetic Foot. Foot length was measured using a Brannock® device and internal shoe length was determined using a CEGI® pedometer.ResultsIn relation to adjustment, 21.6% of the shoes examined had no type of closure. The most common form of closure was laces, which were used in 32.4% of the shoes. 92.5% of footwear had internal seams. No significant relationship was found between the presence or otherwise of DPN and the use of appropriate shoe closure (p = 0.304), recommended heel height (p = 0.18), leather material (p = 0.77) and absence of internal seams (p = 0.759).ConclusionsThe majority of our participants living with DPN do not wear fitting shoes. Therefore, it is advisable to evaluate their use of footwear, both in primary health care and in podiatry clinics, to forestall potential complications.     

Smoking habits and the risk of type 2 diabetes: A case-control study

AimThe objective of the study was to assess the relationship between smoking and the risk of type 2 diabetes.Subject and methodsThis case-control study included 234 cases with newly confirmed diagnoses of type 2 diabetes and 468 controls who were free of the disease in 2001. Cases and controls were matched by gender and age (±5 years). A questionnaire was used to collect information on the possible risk factors of type 2 diabetes. Clinical measurements were taken in accordance with the recommendations of the WHO. Fasting plasma glucose and triglycerides were also measured, and the glucose tolerance test was performed in the controls. The odds ratios (OR) and 95% confidence intervals (CI) for type 2 diabetes were calculated using conditional logistic regression.ResultsThe diabetes cases had significantly less education, more first-degree relatives with a positive family history of diabetes and higher body mass index (BMI) scores compared with the controls. Also, after adjusting for possible confounders, an increased risk of type 2 diabetes was determined for current smokers (OR = 2.41; 95% CI 1.07–5.44) vs. non-smokers. In addition, there was an association between the disease and duration of smoking (OR = 2.47; 95% CI 1.03–5.93 for 40 years or more) vs. non-smokers, and those who had been smokers for 10 or more pack-years had twice the risk of diabetes (OR = 2.17; 95% CI 1.07–4.40) vs. non-smokers. There were no significant associations found between the risk of type 2 diabetes and number of cigarettes smoked per day or stopping smoking.ConclusionOur data confirms that smoking may be an independent risk factor for type 2 diabetes.     

Nonalcoholic fatty liver disease and microvascular complications in type 2 diabetes

AIM:To evaluate the correlation between nonalcoholic fatty liver disease(NAFLD) and microvascular complications in type 2 diabetes mellitus(T2DM).METHODS:Data were obtained from 1217 inpatients with T2DM(757 females,460 males;aged 63.39 ± 12.28 years).NAFLD was diagnosed by hepatic ultrasonography.Diabetic nephropathy(DN),diabetic peripheral neuropathy(DPN),and diabetic retinopathy(DR) were diagnosed according to their respective criteria.The prevalence of NAFLD and the independent correlations of clinical characteristics with NAFLD were determined by cross-tabulation and logistic regression,respectively.RESULTS:Approximately 61% of inpatients with T2DM in Qingdao,China had NAFLD,which decreased significantly with increase in age and prolonged course of diabetes.The prevalence of NAFLD in patients presenting with DN,DPN and DR was 49.4%,57.2% and 54.9%,respectively.These rates were significantly lower than those of patients without DN,DPN and DR(65.9%,65.6% and 66.1%,respectively,P < 0.05).Participants with NAFLD had greater body weight,waist circumference(WC),body mass index(BMI),fasting blood glucose(FBG),hemoglobin A1c,alanine aminotransferase,aspartate aminotransferase,γ-glutamyltransferase,blood pressure,as well as triglyceride(TG) levels and lower high-density lipoprotein(HDL) concentration than those without NAFLD(P < 0.05).NAFLD was positively correlated with BMI,WC,TG,FBG,diastolic blood pressure,and systolic blood pressure but negatively correlated with the duration of diabetes,DR,DPN,DN,and HDL.CONCLUSION:Despite the benign nature of NAFLD,efforts should be directed toward early diagnosis,intensive blood glucose and blood pressure control,and effective dyslipidemia correction.     

住院老年2型糖尿病患者微血管病变的相关因素分析

目的探讨老年2型糖尿病患者微血管病变的构成比及相关因素。方法用回顾性分析的方法研究2003年～2010年于卫生部北京医院住院治疗的年龄≥60岁的2型糖尿病患者876例,分为糖尿病肾病(DN)组和非糖尿病肾病(非DN)组,糖尿病视网膜病变(DR)组和非糖尿病视网膜病变(非DR)组,糖尿病周围神经病变(DPN)组和非糖尿病周围神经病变(非DPN)组,计算DN、DR、DPN构成比,比较患者的临床特点,并探寻老年2型糖尿病患者DR、DN、DPN的相关因素。结果 (1)DN构成比为34.5%,DR构成比为42.4%,DPN构成比为82.3%。(2)DN与非DN两组间体质量指数(BMI)、糖尿病病程、高血压病程、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBS)、糖化血红蛋白(HbA1c)、空腹胰岛素(Fins)、高密度脂蛋白胆固醇(HDL)、甘油三酯(TG)、尿酸(UA)均有显著性差异(P<0.05或P<0.01);DR与非DR两组间仅糖尿病病程、SBP、空腹C肽(FCP)有显著性差异(均P<0.01);DPN与非DPN两组间年龄、糖尿病病程、HbA1c、TC、LDL有显著性差异(P<0.05或P<0.01)。(3)Logistic回归结果显示,DN与SBP、HbA1c、FBS、HDL、UA、糖尿病病程有关(OR值分别为1.022、1.098、1.075、0.501、1.004,1.048,P<0.05或P<0.01);DR与SBP、HbA1c、糖尿病病程有关(OR值分别为1.017、1.102、1.097,P<0.05或P<0.01);DPN与HbA1c、LDL、糖尿病病程、年龄有关(OR值分别为1.226、1.370、1.041、1.058,P<0.05或P<0.01)。结论对于老年2型糖尿病患者,DN、DR、DPN均与糖尿病病程和HbA1c有关,控制血糖对防治微血管病变意义重大,综合控制血糖、血压、血脂、尿酸可以更好的防治糖尿病微血管并发症。     

Left ventricular hypertrophy in hypertensive type 2 diabetic patients according to renal function

AimCardiovascular disease is the main cause of death in diabetic patients undergoing haemodialysis. Dialysis and hypertension increase left ventricular hypertrophy (LVH), a strong predictor of cardiovascular events. This study evaluated left ventricular structure and function in three groups of hypertensive type 2 diabetic patients with different renal function, and assessed the factors associated with LVH, in an Afro-Caribbean population.MethodsLeft ventricular structure and function were measured by ultrasonography. Group 1 consisted of 150 patients with normal renal function, group 2 included 183 patients with renal dysfunction and the third group comprised 75 dialysis patients.ResultsLeft ventricular mass/height^2.7 increased from group 1 to groups 2 and 3 (49.00 g/m^2.7, 57.12 g/m^2.7 and 59.75 g/m^2.7, respectively; P < 0.0001). The prevalences of LVH were 48.3% in group 1, 64.8% in group 2 and 70.3% in the dialysis patients (P = 0.001). LVH was more concentric than eccentric in groups 2 and 3.The factors significantly associated with LVH were obesity in groups 1 and 2, and an increase of 10 mmHg in pulse pressure in groups 2 and 3, according to multivariate logistic-regression analysis.ConclusionOur study confirmed that, in a population of Afro-Caribbean hypertensive type 2 diabetic patients, renal failure was associated to an increased left ventricular mass/height^2.7. The data show that the variables associated with LVH differ according to renal profile. This finding will be of value in the treatment and follow-up of these patients.     

Diagnostic utility of corneal confocal microscopy in type 2 diabetic peripheral neuropathy

Aims/IntroductionThe early pathological changes of diabetic peripheral neuropathy (DPN) are mainly small nerve fiber injuries. Corneal confocal microscopy (CCM) is an easy, rapid, non‐invasive and repeatable technique to detect the damage of small nerve fibers. The purpose of this study was to explore the application of CCM in DPN and other chronic complications of type 2 diabetes mellitus.Materials and MethodsA total of 220 individuals (48 normal healthy control participants and 172 patients with type 2 diabetes mellitus) were included in the study. All participants were assessed and scored for neurological symptoms and neurological deficits, quantitative sensory test, neuroelectrophysiological test, and CCM.ResultsCorneal nerve fiber density, corneal nerve fiber length and corneal nerve branch density were significantly reduced in patients with type 2 diabetes mellitus compared with normal healthy control subjects (P < 0.001, P < 0.001 and P < 0.001, respectively). In the DPN group, corneal nerve fiber density, corneal nerve branch density and corneal nerve fiber length were significantly lower than for patients without DPN (P < 0.001, P < 0.001 and P < 0.001, respectively). Receiver operating characteristic analysis showed that the optimal cut‐off values were 24.68, 39 and 15.315, respectively, in which corneal nerve fiber density and corneal nerve fiber length had moderate sensitivity and specificity.ConclusionThis study provides more support for the clinical use of CCM to diagnose type 2 diabetes mellitus‐related complications, especially DPN.     

Prevalence of peripheral neuropathy and associated risk factors in children with type 1 diabetes

AimTo detect the prevalence of diabetic polyneuropathy (DPN) in children with type 1 diabetes (T1D) and to identify associated the risk factors.MethodsThis cross-sectional study evaluated children aged between 2 and 16y with T1D for ≥2 y. Detailed neurological examination, neuropathy symptom score, and nerve conduction studies were done in all children to assess nerve dysfunction. Disease-related factors were evaluated for the prediction of neuropathy.ResultsSixty-six children (67% boys) were enrolled. The mean age at the time of diagnosis of T1D was 7.1 ± 2.6 years. The mean duration of diabetes was 4 ± 1.8 years. None of the patients had neuropathy on clinical examination or on the neuropathy symptom score. The prevalence of subclinical DPN was 18.2% (n = 12/66). The type of neuropathy was pure motor (n = 11, 91.6%) and mixed sensorimotor (n = 1, 8.3%). The common peroneal nerve was most commonly affected (n = 6, 50%), followed by the tibial (n = 4, 33.3%) nerve. The most common patterns of nerve involvement were mixed axonal and demyelination (n = 7, 58.3%), followed by axonal (n = 3, 25%) and demyelinating type (n = 2, 16.6%). Children with subclinical DPN had a significant reduction in velocity of tibial, common peroneal, median motor, and ulnar motor nerves; delayed latency in common peroneal, median motor, ulnar motor, and median sensory nerves compared to those without DPN (p value <0.05). A higher body mass index predicted the development of subclinical DPN (p value <0.05).ConclusionNearly one-fifth of children with T1D have subclinical neuropathy as early as two years of the disease. A higher body mass index is significantly associated with DPN. Electrophysiological studies should be performed regularly to screen for nerve dysfunction and its progression.     

Insulin treatment in IA-2A-positive relatives of type 1 diabetic patients

AimsWe examined whether parenteral regular insulin can prevent diabetes in IA-2 antibody-positive (IA-2A+) relatives of type 1 diabetic patients, using a trial protocol that differed substantially from that of the Diabetes Prevention Trial-1.MethodsTwenty-five IA-2A+ relatives received regular human insulin twice a day for 36 months, during which time they were followed (median [interquartile range; IQR]: 47 [19–66] months) for glucose tolerance, HbA_1c and islet autoantibodies, together with 25 IA-2A+ relatives (observation/control group) who fulfilled the same inclusion criteria, but were observed for 52 [27–67] months (P = 0.58).ResultsTwelve (48%) insulin-treated relatives and 15 (60%) relatives in the control group developed diabetes. There was no difference in diabetes-free survival between the two groups (P = 0.97). Five-year progression (95% confidence interval) was 44% (25–69) in the insulin-treated group and 49% (29–70) in the observation group. At inclusion, progressors tended to have a higher pro-insulin/C-peptide ratio than non-progressors when measured 2 hours after a standardized glucose load (median [IQR]: 2.7% [1.8–4.3] vs. 1.6% [1.1–2.1]; P = 0.01). No major hypoglycaemic episodes or significant increases in body mass index or diabetes autoantibodies were observed.ConclusionProphylactic injections of regular human insulin were well tolerated, but failed to prevent type 1 diabetes onset in IA-2A+ relatives.     

Depression Symptoms in Patients with Diabetic Peripheral Neuropathy

AIMThe study aimed to investigate the possible relationship between diabetic peripheral neuropathy (DPN) and the development of depressive symptoms in patients with type 2 diabetes mellitus (T2D).METHODSA comparative non-experimental study was conducted. Ninety-five T2D individuals aged 65 years and more were recruited. The sample was divided into two groups: 50 participants with T2D and without DPN and 45 participants with T2D and DPN. The Patient Health Questionnaire 9 (PHQ-9) was used to collect information about low mood and depression symptoms in the subjects recruited.RESULTSParticipants with DPN recorded higher scores on PHQ-9 than those with T2D only. The mean PHQ-9 score for the DPN group (6.09) was significantly higher than that for the T2D only group (2.24) (p < 0.001). Participants with DPN were more likely to have mild to moderate or moderately severe low mood and depression symptoms than T2D only participants who exhibited minimal to no low mood and depressive symptoms.CONCLUSIONSThe association between DPN and depression is confirmed by this study, with significant depressive symptoms found in patients with neuropathy when compared to diabetes patients with no neurological complications. It is therefore important that discomfort and emotional problems caused by DPN should be taken seriously and addressed closely in the management of DPN in order to prevent depression. Also, a change in screening practices to identify patients with diabetes and depressive symptoms is required.     

Usefulness of the vibration perception thresholds measurement as a diagnostic method for diabetic peripheral neuropathy: Results from the Rio de Janeiro type 2 diabetes cohort study

Aims

To investigate the associated factors with the vibration threshold perception (VPT) in patients with type 2 diabetes and to assess whether it is useful for detection of diabetic peripheral neuropathy (DPN).

血清骨钙素水平与2型糖尿病周围神经病变的关系

目的 分析2型糖尿病患者血清骨钙素水平与糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的关系.方法 选取2018年7月—2019年12月于内蒙古包钢医院内分泌科就诊的T2DM患者120例,将其分为2型糖尿病无周围神经病变组(NDPN组,n=60)、2型糖尿病合并周围神经病变组...     

Prevalence and risk factors of development of peripheral diabetic neuropathy in type 2 diabetes mellitus in a tertiary care setting

Aims/Introduction

The study was carried out to assess the prevalence of diabetic peripheral neuropathy (DPN), compare the prevalence between known diabetes mellitus (KDM) and newly detected diabetes mellitus (NDDM), identify risk factors associated, its prevalence pattern and to assess if any sex-specific differences are present.

Materials and Methods

A cross-sectional study was carried out in a tertiary care hospital. Patients with duration of diabetes ≤6 months were considered to be NDDM. DPN was diagnosed by the combination of more than one abnormal result of 10-g monofilament, pinprick sensations and ankle reflexes, and categorized according to the severity level using vibration perception threshold. The study included 1,637 KDM and 369 NDDM patients.

Results

A total of 586 participants were found to have DPN, accounting for 29.2% (95% confidence interval [CI] 27.2–31.2) prevalence. The higher prevalence was observed in KDM compared with NDDM 33.7% (95% CI 31.42–36.01) vs 9.2% (95% CI 6.3–12.2; P < 0.001). Prevalence of mild, moderate, and severe neuropathies was 8.06, 14.55 and 6.63%, respectively. Regression analysis showed age (P < 0.001), duration of diabetes (P < 0.001), dyslipidemia (P = 0.03), glycated hemoglobin (P < 0.001), the presence of other microvascular complications (P < 0.001), macrovascular complications (P = 0.003) and alcoholic status (P < 0.033) to be associated. No sex-specific differences were observed in the mean age at diagnosis of diabetes, mean age at the diagnosis of neuropathy, and duration taken for the DPN development among females and males.

Conclusions

The study showed a high prevalence (29.2%) of DPN among north Indian type 2 diabetes mellitus patients. Thus, timely screening with earlier detection and intervention would be useful in preventing the progression of neuropathy.