"UNCOVERING THE BURDEN OF DIABETIC PERIPHERAL NEUROPATHY: A HOSPITAL-BASED STUDY ON PREVALENCE AND RISK FACTORS
Main Article Content
Keywords
autonomic function tests, type 2 diabetes mellitus, diabetic peripheral neuropathy, autonomic dysfunction, diabetic symptom score, diabetic neuropathy examination score
Abstract
Introduction: Diabetes Mellitus (DM) is becoming a significant health concern due to its severe complications. In India, the prevalence of type 2 diabetes mellitus (T2DM) is likely to vary across regions due to differences in lifestyles and demographic factors. DM is also well known for its chronic complications, collectively referred to as "tripathy," which includes neuropathy, retinopathy, and nephropathy. Among these, diabetic neuropathy, particularly Diabetic Peripheral Neuropathy (DPN), is the most common clinical complication. The presence of DPN is linked to a worsened prognosis and a reduced quality of life. The likelihood of developing peripheral neuropathy in DM depends on various factors. It is crucial to evaluate the prevalence and risk factors in order to develop strategies that can slow or halt the disease’s progression. Since there is no definitive data on the prevalence and risk factors for diabetic peripheral neuropathy, this study aims to assess them within a hospital setting.
Material and Methods: A cross sectional study was conducted to find out the prevalence and risk factors for diabetic peripheral neuropathy in T2DM individuals of age above 30 years visiting Index Medical College and Hospital, Indore, Madhya Pradesh. 400 participants having type 2 diabetes participants were enrolled in the study. Participants identified as T2DM were screened and assessed by using diabetic Neuropathy Examination Score (DNE) to identify the presence of diabetic peripheral neuropathy.
Results: - Overall prevalence of DPN was found to be 49.35%. Prevalence was increase with advancement of age, more than 60 years of age (90.32%). Male’s had higher prevalence (79.98%) as compare to female participants (60.53%). Age, diet, BMI, truncal obesity, smoking, alcohol consumption and family history of diabetes appear to increase the risk for developing DPN. Furthermore, advance age and duration of diabetes appear to be risk factors for developing DPN in the T2DM participants.
Conclusion: - The high prevalence of DPN in the study area indicates the influence of socioeconomic changes on the occurrence of the disease. The Diabetic Neuropathy Examination score can serve as effective screening tools for assessing DPN in community settings. It is essential to implement screening and awareness programs for the early detection of diabetic complications to prevent long-term consequences. The study's findings highlight the importance of promoting preventive measures to avoid or delay the onset of chronic diabetes complications. This can be achieved through proper glycemic control, regular monitoring, lifestyle changes, and the practice of exercise and yoga to maintain a healthy balance between sympathetic and parasympathetic tone.
Material and Methods: A cross sectional study was conducted to find out the prevalence and risk factors for diabetic peripheral neuropathy in T2DM individuals of age above 30 years visiting Index Medical College and Hospital, Indore, Madhya Pradesh. 400 participants having type 2 diabetes participants were enrolled in the study. Participants identified as T2DM were screened and assessed by using diabetic Neuropathy Examination Score (DNE) to identify the presence of diabetic peripheral neuropathy.
Results: - Overall prevalence of DPN was found to be 49.35%. Prevalence was increase with advancement of age, more than 60 years of age (90.32%). Male’s had higher prevalence (79.98%) as compare to female participants (60.53%). Age, diet, BMI, truncal obesity, smoking, alcohol consumption and family history of diabetes appear to increase the risk for developing DPN. Furthermore, advance age and duration of diabetes appear to be risk factors for developing DPN in the T2DM participants.
Conclusion: - The high prevalence of DPN in the study area indicates the influence of socioeconomic changes on the occurrence of the disease. The Diabetic Neuropathy Examination score can serve as effective screening tools for assessing DPN in community settings. It is essential to implement screening and awareness programs for the early detection of diabetic complications to prevent long-term consequences. The study's findings highlight the importance of promoting preventive measures to avoid or delay the onset of chronic diabetes complications. This can be achieved through proper glycemic control, regular monitoring, lifestyle changes, and the practice of exercise and yoga to maintain a healthy balance between sympathetic and parasympathetic tone.
References
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35. Snehalatha C, Viswanathan V, Ramachandran A. Cutoff values for normal anthropometric variables in Asian Indian Adults. Diabetes Care; 2006; 26:1380-1384.
36. World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Geneva: Department of Non-communicable Disease Surveillance, Available from: Http://whqlibdoc.who.int/hq/1999/ who_ncd_ncs_99.2.pdf, Cited on 9 January 2013
37. Kamat A, G. Shivprakash, G, Adhikari P. Body mass Index and Waist circumference in type 2 diabetes mellitus patient attending diabetic clinic. Int J Biol Med Res. 2011; 2(3):636-638.
38. Khan S, Hull R, Utzschneider K. Review Article Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006; 444: 840-846.
39. Skeie S, Thue G, Nerhus K, Sandberg S. Instruments for self-monitoring of blood glucose: Comparisons of Testing Quality Achieved by Patient and a Technician. Clinical chemistry. 2002; 48(7): 994-1003.
40. Maurice JOK, Bunting B, Margaret C, Vivien EC. Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomized controlled trial BMJ. 2008; online first; Available from: bmj.com doi:10.1136/bmj.39534.571644.BE.
41. Chobani AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The seventh report on joint national commission on prevention, detection, evaluation and treatment of high blood pressure, the JNC 7 report. JAMA. 2003; 289: 2560-72.
42. Jan-William GM, Bosma E, Lefrandt JD, Links TP, Smit AJ, Stewart RE, et al. Clinical Diagnosis of Diabetic Polyneuropathy with the Diabetic Neuropathy Symptom and Diabetic Neuropathy Examination Scores. DIABETES CARE. Mar. 2003; 26; 3: 697.
43. Hamman RF, Franklin GA, Mayer EJ, Marshall SM, Marshall JA, Baxter J, et al. Microvascular complications of NIDDM in Hispanics and Non-Hispanic whites: San Luis Valley Diabetes Study. Diabetes Care. 1991; 14: 655-64
44. Ashok S, Ramu M, Deepa R, Mohan V. Prevalence of neuropathy in type 2 diabetic patients attending a diabetes centre in South India. JAPI. 2002; 50: 546-50.
45. Booya F, Bandarian F, Larijani B, Pajouhi M, Nooraei M, Lotfi J et al. Potential risk factors for diabetic neuropathy: a case control study. BMC Neurology 2005, 5:24.
46. Pradeepa R, Rema M, Vignesh J. Prevalence and risk factors for diabetic neuropathy in an urban south Indian population; the Chennai Urban Rural Epidemiology Study (CURES-55). Diabet Med; 2008: 25 (4); 407–412.
47. Young MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993 Feb; 36(2):150-4.
2. Permutt MA, Wasson J, Cox N. Genetic Epidemiology of Diabetes. Journal of clinical Investigation. 2005; 115:1431–1439.
3. IDF report 2012. International diabetes federation. Available from: http:// www. idf. org/ sites/default/files/5E_IDFAtlasPoster_2012_EN.pdf.
4. Sadikot SM, Nigam A, Das S, Bajaj S, Zargar AH, Prasannakumar K, et al. The burden of diabetes and impaired fasting glucose in India using the ADA 1997 criteria: prevalence of diabetes in India study (PODIS). Diabetes Research and Clinical Practice. 2004; 66:293-300.
5. Majagi SM, Soudarssanne BM, Roy G, Das AK. Risk factors of diabetes mellitus in rural Pondicherry. Online J Health Scs. 2012;11(1):4
6. Ramachandran A. Epidemiology of diabetes in India: three decades of research. J Assoc Physicians India. 2005; 53:34-8.
7. Mohan V. Urban rural differences in prevalence of self-reported diabetes in India – WHO-ICMR Indian NCD risk factor surveillance. Diabetes Research and Clinical Practice.2008; 80:159-168.
8. Bennett P H, Hadden D R. WHO Expert Committee on Diabetes Mellitus: second report.World Health Organization. Tech. Rep. Ser. 1980; 646: 1-13.
9. Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes- related complications. Physical Therapy. 2008; 88: 1254-1264.
10. Tale S, Sontakke TR, Heart rate variability analysis a Non-invasive clinical screening tool to detect functional ability of diabetic cardiac autonomic neuropathy. International J of Computer Application. 2011 July; 25:10:47-51.
11. Ziegler D, Gries FA, Spuler M, Lessmann F. Diabetic Cardiovascular Autonomic Neuropathy Multicenter Study Group: The epidemiology of diabetic neuropathy. J Diabetes Complications. 1992; 6:49 –57.
12. Kennedy WR, Navarro X, Sutherland. DER: Neuropathy profile of diabetic patients in a pancreas transplantation program. Neurology. 1995; 45:773–780.
13. Wheeler S, Singh N, Boyko EJ. The epidemiology of diabetic neuropathy. In. Veves A, Malik R. Eds. Diabetic Neuropathy: Clinical Management. Second edition. 2007, Springer.
14. Majagi SM, Soudarssanne BM, Roy G, Das AK. Risk factors of diabetes mellitus in rural Pondicherry. Online J Health Scs. 2012; 11(1): 4
15. Mc Cance DR, Hanson RL. Which test for diagnosing diabetes? Diabetes Care.1995; 18: 1042-4.
16. Mc Cance DR, Hanson RL, Pettit DJ. Diagnosing diabetes mellitus: do we need new criteria? Diabetologia.1997; 40: 247-55.
17. James MF, David EJ. Standards of medical care in diabetes. Diabetes Care. 2005; 28(1): 4-36.
18. Mehta S, Mathur D, Chaturvedi M. Incidence of cardiac autonomic neuropathy and its correlation with retinopathy, microalbuminuria and glycated haemoglobin in non- insulin dependent diabetes mellitus. J. Ind. Med. Assoc. 2002; 100: 141–3.
19. Solomon Tesfaye et al, Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments Diabetes Care 2010 Oct;33(10):2285-93.doi: 10.2337/dc10-1303
20. Andrew J M Boulton et al, The global burden of diabetic foot disease, Lancet 2005 Nov 12;366(9498):1719-24. doi: 10.1016/S0140-6736(05)67698-2.
21. Brian C Callaghan et al, Diabetic neuropathy: clinical manifestations and current treatments Lancet Neurol 2012 Jun;11(6):521-34. doi: 10.1016/S1474-4422(12)70065-0.
22. Rodica Pop-Busui et al, Diabetic Neuropathy: A Position Statement by the American Diabetes Association Diabetes Care. 2017 Jan; 40(1): 136–154.
23. Vinik et al., Capsaicin 8% patch repeat treatment plus standard of care (SOC) versus SOC alone in painful diabetic peripheral neuropathy: a randomised, 52-week, open-label, safety study BMC Neurol 2016 Dec 6;16(1):251 doi: 10.1186/s12883-016-0752-7
24. Nikolaos Papanas et al Emerging Biomarkers, Tools, and Treatments for Diabetic Polyneuropathy Endocr Rev 2019 Feb 1;40(1):153-192. doi: 10.1210/er.2018-00107
25. Surendra Darivemula et al Prevalence and Its Associated Determinants of Diabetic Peripheral Neuropathy (DPN) in Individuals Having Type-2 Diabetes Mellitus in Rural South India Indian Journal of Community Medicine ¦ Volume 44 ¦ Issue 2 ¦ April-June 2019.
26. Kastenbauer T, Irsigler P, Sausen S, Grimm A, Prager Rl. The prevalence of symptoms of sensorimotor and autonomic neuropathy in type 1 and type 2 diabetic subjects. J Diabetes Complications. 2004; 18: 27-31.
27. Training for middle level manager. Expanded program on immunization world health organization. (1991). Available from: Http //whqlibdoc.who.int /hq/1991/ WHO_EPI_ MLM_ 91.1.Pdf. Cited on 8 January 2013.
28. UNUNESCO. International Standard Classification of Education ISCED, 1997. Available from: Http:// tuikapp.tuik.gov.tr/ DIESS/ FileUpload/ yayinlar/ ISCDE_2011_ draft.pdf, Cited on 9 January 2013.
29. Govt. of India. Directorate General of Employment & Training. National Classification of Occupations - 2004. Ministry of Labour, Government of India; 2004 Available from : dget.nic.in/nco/preface.pdf, Cited on 8 January 2013.
30. Chaturvedi N, Stephenson J, Fuller J. The relationship between socioeconomic status and diabetes control and complications in the EURODIAB IDDM Complications Study. Diabetes Care.1996, Vol.19:423-430.
31. Sakai Y, Yamaji T, Tabata S, Ogawa S, Yamaguchi K, Mineshita M, et al. Relation of alcohol use and smoking to glucose tolerance status in Japanese men. Diabetes Research Clinical Practice. 2006; 73:83-88.
32. Viswanathan M, McCarthy M, Snehalatha C, Hitman GA, Ramchandrean A. Familial aggregation of Type 2 (non-insulin-dependent) diabetes mellitus in south India: absence of excess maternal transmission. Diabetic Medicine.1996; Vol; 13: 232-237.
33. Report of World Health Organization consultation. Obesity: Preventing and managing the global epidemic. Geneva, Swizarland: World Health Organization; WHO Tech RespSer No.894, Available from: Http://whqlibdoc.who.int/trs/who_trs_916.pdf (cited 9 January 2013).
34. WHO, BMI Classification. Global Database on Body Mass Index. World Health Organization. 2006: Retrieved on July 27, 2012.
35. Snehalatha C, Viswanathan V, Ramachandran A. Cutoff values for normal anthropometric variables in Asian Indian Adults. Diabetes Care; 2006; 26:1380-1384.
36. World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Geneva: Department of Non-communicable Disease Surveillance, Available from: Http://whqlibdoc.who.int/hq/1999/ who_ncd_ncs_99.2.pdf, Cited on 9 January 2013
37. Kamat A, G. Shivprakash, G, Adhikari P. Body mass Index and Waist circumference in type 2 diabetes mellitus patient attending diabetic clinic. Int J Biol Med Res. 2011; 2(3):636-638.
38. Khan S, Hull R, Utzschneider K. Review Article Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006; 444: 840-846.
39. Skeie S, Thue G, Nerhus K, Sandberg S. Instruments for self-monitoring of blood glucose: Comparisons of Testing Quality Achieved by Patient and a Technician. Clinical chemistry. 2002; 48(7): 994-1003.
40. Maurice JOK, Bunting B, Margaret C, Vivien EC. Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomized controlled trial BMJ. 2008; online first; Available from: bmj.com doi:10.1136/bmj.39534.571644.BE.
41. Chobani AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The seventh report on joint national commission on prevention, detection, evaluation and treatment of high blood pressure, the JNC 7 report. JAMA. 2003; 289: 2560-72.
42. Jan-William GM, Bosma E, Lefrandt JD, Links TP, Smit AJ, Stewart RE, et al. Clinical Diagnosis of Diabetic Polyneuropathy with the Diabetic Neuropathy Symptom and Diabetic Neuropathy Examination Scores. DIABETES CARE. Mar. 2003; 26; 3: 697.
43. Hamman RF, Franklin GA, Mayer EJ, Marshall SM, Marshall JA, Baxter J, et al. Microvascular complications of NIDDM in Hispanics and Non-Hispanic whites: San Luis Valley Diabetes Study. Diabetes Care. 1991; 14: 655-64
44. Ashok S, Ramu M, Deepa R, Mohan V. Prevalence of neuropathy in type 2 diabetic patients attending a diabetes centre in South India. JAPI. 2002; 50: 546-50.
45. Booya F, Bandarian F, Larijani B, Pajouhi M, Nooraei M, Lotfi J et al. Potential risk factors for diabetic neuropathy: a case control study. BMC Neurology 2005, 5:24.
46. Pradeepa R, Rema M, Vignesh J. Prevalence and risk factors for diabetic neuropathy in an urban south Indian population; the Chennai Urban Rural Epidemiology Study (CURES-55). Diabet Med; 2008: 25 (4); 407–412.
47. Young MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993 Feb; 36(2):150-4.
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Dec 16, 2024
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Sanjay Dattatraya Bhalerao, Manila Jain, & Avinash Prabhakar Kulkarni. (2024). "UNCOVERING THE BURDEN OF DIABETIC PERIPHERAL NEUROPATHY: A HOSPITAL-BASED STUDY ON PREVALENCE AND RISK FACTORS. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 1383-1395. https://doi.org/10.53555/qwyecp97
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Author Biographies
Sanjay Dattatraya Bhalerao
Department of Physiology, Index Medical College & Hospital, Indore, MP
Manila Jain
Prof & HOD, Department of Physiology, Index Medical College & Hospital, Indore, MP
Avinash Prabhakar Kulkarni
Department of Physiology, BGS Medical College & Hospital, Bangalore
How to Cite
Sanjay Dattatraya Bhalerao, Manila Jain, & Avinash Prabhakar Kulkarni. (2024). "UNCOVERING THE BURDEN OF DIABETIC PERIPHERAL NEUROPATHY: A HOSPITAL-BASED STUDY ON PREVALENCE AND RISK FACTORS. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 1383-1395. https://doi.org/10.53555/qwyecp97