Skip to content
2000
Volume 21, Issue 3
  • ISSN: 1573-3998
  • E-ISSN: 1875-6417

Abstract

Aim

The present study aimed to determine the prevalence and predictors of DPN in newly diagnosed T2DM patients.

Background

Diabetic Peripheral Neuropathy (DPN) is the most common and debilitating complication of Type 2 Diabetes Mellitus (T2DM).

Methods

Newly diagnosed T2DM patients visiting the outpatient department were recruited. Detailed demographic parameters, histories, physical examinations, and biochemical investigations were carried out. Patients were screened for DPN using the Diabetic Neuropathy Symptom (DNS) score, the revised Disability Neuropathy Score (NDS), Vibration Perception Threshold (VPT) using a biosthesiometer, and the 10 g SW Monofilament Test (MFT).

Results

A total of 350 newly diagnosed T2DM patients (mean age 46.4±13.6 years) were included. The prevalence of DPN was found to be 34% using the combined DNS and NDS scores. VPT was moderately impaired in 18.3% and severely impaired in 12% patients, while MFT revealed a loss of protective sensation in 35.4% patients. After logistic regression analysis, DPN was significantly associated with increasing age (OR 1.08, 95%CI 1.06-1.11), increasing HbA1C levels (OR 1.23, 95%CI 1.05-1.42), increasing TSH levels (OR 1.23, 95%CI 1.05-1.44), presence of hypertension (OR 2.78, 95%CI 1.51-5.11), and reduced BMI (OR 0.9, 95%CI 0.84-0.99). The sensitivity and specificity of detecting DPN by combining VPT and MFT were 91.6% and 84.2%, respectively.

Conclusion

The prevalence of DPN was high even in newly diagnosed T2DM and associated significantly with increasing age, HbA1C levels, TSH levels, hypertension, and reduced BMI. Earlier screening for DPN, along with aggressive control of glycemia, blood pressure, and hypothyroidism, may be beneficial.

Loading

Article metrics loading...

/content/journals/cdr/10.2174/0115733998282818240125110248
2024-02-12
2024-11-22
Loading full text...

Full text loading...

References

  1. International Diabetes Federation.IDF Diabetes Atlas.2021Available from: https://www.diabetesatlas.org
    [Google Scholar]
  2. PradeepaR. MohanV. Prevalence of type 2 diabetes and its complications in India and economic costs to the nation.Eur. J. Clin. Nutr.201771781682410.1038/ejcn.2017.40 28422124
    [Google Scholar]
  3. MathurP. LeburuS. KulothunganV. Prevalence, awareness, treatment and control of diabetes in India from the countrywide national ncd monitoring survey.Front. Public Health20221074815710.3389/fpubh.2022.748157 35359772
    [Google Scholar]
  4. Pop-BusuiR. BoultonA.J.M. FeldmanE.L. Diabetic neuropathy: A position statement by the American Diabetes Association.Diabetes Care201740113615410.2337/dc16‑2042 27999003
    [Google Scholar]
  5. TesfayeS. BoultonA.J.M. DyckP.J. Diabetic neuropathies: Update on definitions, diagnostic criteria, estimation of severity, and treatments.Diabetes Care201033102285229310.2337/dc10‑1303 20876709
    [Google Scholar]
  6. AngL. JaiswalM. MartinC. Pop-BusuiR. Glucose control and diabetic neuropathy: Lessons from recent large clinical trials.Curr. Diab. Rep.201414952810.1007/s11892‑014‑0528‑7 25139473
    [Google Scholar]
  7. MartinC.L. AlbersJ.W. Pop-BusuiR. Neuropathy and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study.Diabetes Care2014371313810.2337/dc13‑2114 24356595
    [Google Scholar]
  8. Volmer-TholeM. LobmannR. Neuropathy and diabetic foot syndrome.Int. J. Mol. Sci.201617691710.3390/ijms17060917 27294922
    [Google Scholar]
  9. HicksC.W. SelvinE. Epidemiology of peripheral neuropathy and lower extremity disease in diabetes.Curr. Diab. Rep.201919108610.1007/s11892‑019‑1212‑8 31456118
    [Google Scholar]
  10. TesfayeS. Recent advances in the management of diabetic distal symmetrical polyneuropathy.J. Diabetes Investig.201121334210.1111/j.2040‑1124.2010.00083.x 24843458
    [Google Scholar]
  11. BoultonA.J.M. ArmstrongD.G. AlbertS.F. Comprehensive foot examination and risk assessment: A report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists.Diabetes Care20083181679168510.2337/dc08‑9021 18663232
    [Google Scholar]
  12. KanjiJ.N. AnglinR.E. HuntD.L. PanjuA. Does this patient with diabetes have large-fiber peripheral neuropathy?JAMA2010303151526153210.1001/jama.2010.428 20407062
    [Google Scholar]
  13. RamseyS.D. NewtonK. BloughD. Incidence, outcomes, and cost of foot ulcers in patients with diabetes.Diabetes Care199922338238710.2337/diacare.22.3.382 10097914
    [Google Scholar]
  14. CarmichaelJ. FadaviH. IshibashiF. ShoreA.C. TavakoliM. Advances in screening, early diagnosis and accurate staging of diabetic neuropathy.Front. Endocrinol.20211267125710.3389/fendo.2021.671257 34122344
    [Google Scholar]
  15. AgrawalR.P. OlaV. BishnoiP. GothwalS. SirohiP. AgrawalR. Prevalence of micro and macrovascular complications and their risk factors in type-2 diabetes mellitus.J. Assoc. Physicians India2014626504508 25856915
    [Google Scholar]
  16. GeorgeH. RakeshP. KrishnaM. Foot care knowledge and practices and the prevalence of peripheral neuropathy among people with diabetes attending a secondary care rural hospital in southern India.J. Family Med. Prim. Care201321273210.4103/2249‑4863.109938 24479039
    [Google Scholar]
  17. IunesD.H. RochaC.B.J. BorgesN.C.S. MarconC.O. PereiraV.M. CarvalhoL.C. Self-care associated with home exercises in patients with type 2 diabetes mellitus.PLoS One2014912e11415110.1371/journal.pone.0114151 25479542
    [Google Scholar]
  18. BansalD. GudalaK. MuthyalaH. EsamH.P. NayakalluR. BhansaliA. Prevalence and risk factors of development of peripheral diabetic neuropathy in type 2 diabetes mellitus in a tertiary care setting.J. Diabetes Investig.20145671472110.1111/jdi.12223 25422773
    [Google Scholar]
  19. DuttaA. NaoremS. SinghT. WangjamK. Prevalence of peripheral neuropathy in newly diagnosed type 2 diabetics.Int. J. Diabetes Dev. Ctries.20052513010.4103/0973‑3930.26756
    [Google Scholar]
  20. GillH.K. YadavS.B. RameshV. BhatiaE. A prospective study of prevalence and association of peripheral neuropathy in Indian patients with newly diagnosed type 2 diabetes mellitus.J. Postgrad. Med.201460327027510.4103/0022‑3859.138750 25121366
    [Google Scholar]
  21. American Diabetes Association. Classification and diagnosis of diabetes: Standards of medical care in diabetes-2021.Diabetes Care202144Suppl. 1S15S3310.2337/dc21‑S002 33298413
    [Google Scholar]
  22. KrauseS.J. BackonjaM.M. Development of a neuropathic pain questionnaire.Clin. J. Pain200319530631410.1097/00002508‑200309000‑00004 12966256
    [Google Scholar]
  23. MeijerJ.W.G. SmitA.J. SonderenE.V. GroothoffJ.W. EismaW.H. LinksT.P. Symptom scoring systems to diagnose distal polyneuropathy in diabetes: The Diabetic Neuropathy Symptom score.Diabet. Med.2002191196296510.1046/j.1464‑5491.2002.00819.x 12421436
    [Google Scholar]
  24. PetropoulosI.N. PonirakisG. KhanA. AlmuhannadiH. GadH. MalikR.A. Diagnosing diabetic neuropathy: Something old, something new.Diabetes Metab. J.201842425526910.4093/dmj.2018.0056 30136449
    [Google Scholar]
  25. DyckP.J. Detection, characterization, and staging of polyneuropathy: Assessed in diabetics.Muscle Nerve1988111213210.1002/mus.880110106 3277049
    [Google Scholar]
  26. AbbottC.A. CarringtonA.L. AsheH. The north-west diabetes foot care study: Incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort.Diabet. Med.200219537738410.1046/j.1464‑5491.2002.00698.x 12027925
    [Google Scholar]
  27. WeintrobN. AmitayI. LilosP. ShalitinS. LazarL. JosefsbergZ. Bedside neuropathy disability score compared to quantitative sensory testing for measurement of diabetic neuropathy in children, adolescents, and young adults with type 1 diabetes.J. Diabetes Complications2007211131910.1016/j.jdiacomp.2005.11.002 17189869
    [Google Scholar]
  28. YoungM.J. BoultonA.J.M. MacLeodA.F. WilliamsD.R.R. SonksenP.H. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population.Diabetologia199336215015410.1007/BF00400697 8458529
    [Google Scholar]
  29. ChawlaA. BhasinG.K. ChawlaR. Validation of neuropathy symptoms score (NSS) and neuropathy disability score (NDS). In: The Clinical Diagnosis of Peripheral Neuropathy In Middle Aged People With Diabetes. The Internet Journal of Family Practice201312
    [Google Scholar]
  30. SinghN. ArmstrongD.G. LipskyB.A. Preventing foot ulcers in patients with diabetes.JAMA2005293221722810.1001/jama.293.2.217 15644549
    [Google Scholar]
  31. ShehabD.K. Al-JarallahK.F. AbrahamM. MojiminiyiO.A. Al-MohamedyH. AbdellaN.A. Back to basics: Ankle reflex in the evaluation of peripheral neuropathy in type 2 diabetes mellitus.QJM2012105431532010.1093/qjmed/hcr212 22071964
    [Google Scholar]
  32. SahaD. SahaK. DasguptaP.K. Vibration sense impairment in diabetes mellitus.Indian J. Physiol. Pharmacol.2011554381383 23362733
    [Google Scholar]
  33. GhosalS. StephensJ. MukherjeeA. Quantitative vibration perception threshold in assessing diabetic neuropathy: Is the cut-off value lower for Indian subjects? [Q-VADIS Study].Diabetes Metab. Syndr.2012628589[Q-VADIS Study].10.1016/j.dsx.2012.08.002 23153975
    [Google Scholar]
  34. YoungM.J. BreddyJ.L. VevesA. BoultonA.J.M. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. A prospective study.Diabetes Care199417655756010.2337/diacare.17.6.557 8082524
    [Google Scholar]
  35. McIllhattonA. LantingS. LambkinD. LeighL. CaseyS. ChuterV. Reliability of recommended non-invasive chairside screening tests for diabetes-related peripheral neuropathy: a systematic review with meta-analyses.BMJ Open Diabetes Res. Care202192e00252810.1136/bmjdrc‑2021‑002528 34952841
    [Google Scholar]
  36. BoothJ. YoungM.J. Differences in the performance of commercially available 10 g monofilaments.Diabetes Care200023798498810.2337/diacare.23.7.984 10895851
    [Google Scholar]
  37. ZhangQ. YiN. LiuS. Easier operation and similar power of 10 g monofilament test for screening diabetic peripheral neuropathy.J. Int. Med. Res.20184683278328410.1177/0300060518775244 29808737
    [Google Scholar]
  38. SchaperN.C. Van NettenJ.J. ApelqvistJ. LipskyB.A. BakkerK. Prevention and management of foot problems in diabetes: A summary guidance for daily practice 2015, based on the IWGDF Guidance Documents.Diabetes Metab. Res. Rev.201632S1Suppl. 171510.1002/dmrr.2695 26335366
    [Google Scholar]
  39. PhamH. ArmstrongD.G. HarveyC. HarklessL.B. GiuriniJ.M. VevesA. Screening techniques to identify people at high risk for diabetic foot ulceration: A prospective multicenter trial.Diabetes Care200023560661110.2337/diacare.23.5.606 10834417
    [Google Scholar]
  40. LehtinenJ.M. UusitupaM. SiitonenO. PyöräläK. Prevalence of neuropathy in newly diagnosed NIDDM and nondiabetic control subjects.Diabetes198938101307131310.2337/diab.38.10.1307 2551761
    [Google Scholar]
  41. DyckP.J. OverlandC.J. LowP.A. Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: Cl vs. NPhys trial.Muscle Nerve201042215716410.1002/mus.21661 20658599
    [Google Scholar]
  42. PartanenJ. NiskanenL. LehtinenJ. MervaalaE. SiitonenO. UusitupaM. Natural history of peripheral neuropathy in patients with non-insulin-dependent diabetes mellitus.N. Engl. J. Med.19953332899410.1056/NEJM199507133330203 7777034
    [Google Scholar]
  43. ChanderK. Prevalence of peripheral neuropathy in newly diagnosed type 2 diabetics in sub-district hospital Bishnah.International Journal of Advances in Med20218674710.18203/2349‑3933.ijam20211916
    [Google Scholar]
  44. KebedeS.A. TusaB.S. WeldesenbetA.B. TessemaZ.T. AyeleT.A. Time to diabetic neuropathy and its predictors among newly diagnosed type 2 diabetes mellitus patients in Northwest Ethiopia.Egypt. J. Neurol. Psychiat. Neurosurg.202157114710.1186/s41983‑021‑00402‑4
    [Google Scholar]
  45. SosaleA. Prasanna KumarK.M. SadikotS.M. Chronic complications in newly diagnosed patients with type 2 diabetes mellitus in India.Indian J. Endocrinol. Metab.201418335536010.4103/2230‑8210.131184 24944931
    [Google Scholar]
  46. UddinF. AliB. JunaidN. Prevalence of diabetic complications in newly diagnosed type 2 diabetes patients in pakistan: Findings from national registry.J. Ayub Med. Coll. Abbottabad2018301652658
    [Google Scholar]
  47. AbbottC.A. ChaturvediN. MalikR.A. Explanations for the lower rates of diabetic neuropathy in Indian asians versus europeans.Diabetes Care20103361325133010.2337/dc09‑2067 20215455
    [Google Scholar]
  48. ChengY. CaoW. ZhangJ. Determinants of diabetic peripheral neuropathy and their clinical significance: A retrospective cohort study.Front. Endocrinol.20221393402010.3389/fendo.2022.934020 35957831
    [Google Scholar]
  49. KostevK. JockwigA. HallwachsA. RathmannW. Prevalence and risk factors of neuropathy in newly diagnosed type 2 diabetes in primary care practices: A retrospective database analysis in Germany and U.K.Prim. Care Diabetes20148325025510.1016/j.pcd.2014.01.011 24530101
    [Google Scholar]
  50. WinM.M.T.M. FukaiK. NyuntH.H. HyodoY. LinnK.Z. Prevalence of peripheral neuropathy and its impact on activities of daily living in people with type 2 diabetes mellitus.Nurs. Health Sci.201921444545310.1111/nhs.12618 31215149
    [Google Scholar]
  51. BraffettB.H. Gubitosi-KlugR.A. AlbersJ.W. Risk factors for diabetic peripheral neuropathy and cardiovascular autonomic neuropathy in the diabetes control and complications trial/epidemiology of diabetes interventions and complications (DCCT/EDIC) study.Diabetes20206951000101010.2337/db19‑1046 32051148
    [Google Scholar]
  52. KisoziT. MutebiE. KisekkaM. Prevalence, severity and factors associated with peripheral neuropathy among newly diagnosed diabetic patients attending Mulago hospital: A cross-sectional study.Afr. Health Sci.201717246347310.4314/ahs.v17i2.21 29062342
    [Google Scholar]
  53. SendiR.A. MahrusA.M. SaeedR.M. MohammedM.A. Al-DubaiS.A.R. Diabetic peripheral neuropathy among Saudi diabetic patients: A multicenter cross-sectional study at primary health care setting.J. Family Med. Prim. Care20209119720110.4103/jfmpc.jfmpc_927_19 32110590
    [Google Scholar]
  54. TantigegnS. EwunetieA.A. AgazheM. Time to diabetic neuropathy and its predictors among adult type 2 diabetes mellitus patients in Amhara regional state Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022: A retrospective follow up study.PLoS One2023184e028456810.1371/journal.pone.0284568 37115732
    [Google Scholar]
  55. Román-PintosL.M. Villegas-RiveraG. Rodríguez-CarrizalezA.D. Miranda-DíazA.G. Cardona-MuñozE.G. Diabetic polyneuropathy in type 2 diabetes mellitus: Inflammation, oxidative stress, and mitochondrial function.J. Diabetes Res.20162016342561710.1155/2016/3425617 28058263
    [Google Scholar]
  56. DarivemulaS. NagoorK. PatanS.K. ReddyN.B. DeepthiC.S. ChittooruC.S. Prevalence and its associated determinants of diabetic peripheral neuropathy (DPN) in individuals having type-2 diabetes mellitus in rural south india.Indian J. Community Med.2019442889110.4103/ijcm.IJCM_207_18 31333282
    [Google Scholar]
  57. KosiborodM. GomesM.B. NicolucciA. Vascular complications in patients with type 2 diabetes: Prevalence and associated factors in 38 countries (the DISCOVER study program).Cardiovasc. Diabetol.201817115010.1186/s12933‑018‑0787‑8 30486889
    [Google Scholar]
  58. ZhangC. TangM. LuX. Relationship of ankle-brachial index, vibration perception threshold, and current perception threshold to glycemic variability in type 2 diabetes.Medicine20209912e1937410.1097/MD.0000000000019374 32195933
    [Google Scholar]
  59. NisarM.U. AsadA. WaqasA. Association of diabetic neuropathy with duration of type 2 diabetes and glycemic control.Cureus201578e30210.7759/cureus.302 26430576
    [Google Scholar]
  60. BodmanM.A.V.M. Peripheral diabetic neuropathy. In: StatPearls. Treasure Island, FL: StatPearls Publishing 2023. Internet
    [Google Scholar]
  61. ŠkrhaJ. ŠoupalJ. ŠkrhaJ.Jr PráznýM. Glucose variability, HbA1c and microvascular complications.Rev. Endocr. Metab. Disord.201617110311010.1007/s11154‑016‑9347‑2 26975588
    [Google Scholar]
  62. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38.BMJ1998317716070371310.1136/bmj.317.7160.703 9732337
    [Google Scholar]
  63. ForrestK.Y.Z. MaserR.E. PambiancoG. BeckerD.J. OrchardT.J. Hypertension as a risk factor for diabetic neuropathy: A prospective study.Diabetes199746466567010.2337/diab.46.4.665 9075809
    [Google Scholar]
  64. BelloA. BiliaminuS. WahabK. SanyaE. Distal symmetrical polyneuropathy and cardiovascular autonomic neuropathy among diabetic patients in Ilorin: Prevalence and predictors.Niger. Postgrad. Med. J.201926212312810.4103/npmj.npmj_30_19 31187753
    [Google Scholar]
  65. ShiL. XueJ. ZhaoW. Trends in metabolic indicators and microvascular complications in Chinese adults with newly diagnosed type 2 diabetes: A retrospective, single-centre study of twenty-years.Diab. Vasc. Dis. Res.20232031479164123117986710.1177/14791641231179867 37300432
    [Google Scholar]
  66. ZhaoW. ZengH. ZhangX. A high thyroid stimulating hormone level is associated with diabetic peripheral neuropathy in type 2 diabetes patients.Diabetes Res. Clin. Pract.201611512212910.1016/j.diabres.2016.01.018 26822260
    [Google Scholar]
  67. TorunA.N. KulaksizogluS. KulaksizogluM. PamukB.O. IsbilenE. TutuncuN.B. Serum total antioxidant status and lipid peroxidation marker malondialdehyde levels in overt and subclinical hypothyroidism.Clin. Endocrinol.200970346947410.1111/j.1365‑2265.2008.03348.x 18727709
    [Google Scholar]
  68. CebeciE. Alibaz-OnerF. UstaM. YurdakulS. ErguneyM. Evaluation of oxidative stress, the activities of paraoxonase and arylesterase in patients with subclinical hypothyroidism.J. Investig. Med.2012601232810.2310/JIM.0b013e31823581dd 21997314
    [Google Scholar]
  69. CaiJ. MaA. WangQ. Association between body mass index and diabetes mellitus in tuberculosis patients in China: A community based cross-sectional study.BMC Public Health201717122810.1186/s12889‑017‑4101‑6 28245792
    [Google Scholar]
  70. KatulandaP. RanasingheP. JayawardenaR. ConstantineG.R. SheriffM.H.R. MatthewsD.R. The prevalence, patterns and predictors of diabetic peripheral neuropathy in a developing country.Diabetol. Metab. Syndr.2012412110.1186/1758‑5996‑4‑21 22642973
    [Google Scholar]
  71. PolydefkisM. HauerP. ShethS. SirdofskyM. GriffinJ.W. McArthurJ.C. The time course of epidermal nerve fibre regeneration: studies in normal controls and in people with diabetes, with and without neuropathy.Brain2004127Pt 71606161510.1093/brain/awh175 15128618
    [Google Scholar]
  72. MathiyalagenP. KanagasabapathyS. KadarZ. RajagopalA. VasudevanK. Prevalence and determinants of peripheral neuropathy among adult type II diabetes mellitus patients attending a non-communicable disease clinic in rural south india.Cureus2021136e1549310.7759/cureus.15493 34268025
    [Google Scholar]
  73. ChangM.C. YangS. Diabetic peripheral neuropathy essentials: A narrative review.Ann. Palliat. Med.202312239039810.21037/apm‑22‑693 36786097
    [Google Scholar]
  74. SaherG. QuintesS. NaveK.A. Cholesterol: A novel regulatory role in myelin formation.Neuroscientist2011171799310.1177/1073858410373835 21343408
    [Google Scholar]
  75. JendeJ.M.E. GroenerJ.B. RotherC. Association of serum cholesterol levels with peripheral nerve damage in patients with type 2 diabetes.JAMA Netw. Open201925e19479810.1001/jamanetworkopen.2019.4798 31150078
    [Google Scholar]
  76. TahirMM KhanAZ HaiderM ShamimA AsifM AliS Frequency of peripheral neuropathy in newly diagnosed type 2 diabetes presenting in a tertiary care hospital of Lahore. Pakistan Journal of Medical and Health Sciences20211574
    [Google Scholar]
  77. McNeelyM.J. BoykoE.J. AhroniJ.H. The independent contributions of diabetic neuropathy and vasculopathy in foot ulceration. How great are the risks?Diabetes Care199518221621910.2337/diacare.18.2.216 7729300
    [Google Scholar]
  78. PerkinsB.A. OlaleyeD. ZinmanB. BrilV. Simple screening tests for peripheral neuropathy in the diabetes clinic.Diabetes Care200124225025610.2337/diacare.24.2.250 11213874
    [Google Scholar]
  79. JavedN. ShahidA. QaisraS. An experience with the use of biothesiometer in diabetics at a tertiary care centre.Pak. J. Med. Health Sci.20159423426
    [Google Scholar]
  80. BloomS. TillS. SönksenP. SmithS. Use of a biothesiometer to measure individual vibration thresholds and their variation in 519 non-diabetic subjects.Br. Med. J.198428864331793179510.1136/bmj.288.6433.1793 6428547
    [Google Scholar]
  81. DavisE.A. JonesT.W. WalshP. ByrneG.C. The use of biothesiometry to detect neuropathy in children and adolescents with IDDM.Diabetes Care19972091448145310.2337/diacare.20.9.1448 9283795
    [Google Scholar]
/content/journals/cdr/10.2174/0115733998282818240125110248
Loading
/content/journals/cdr/10.2174/0115733998282818240125110248
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test