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Çelik Kavaklılar B, Aybı Özdemir Ö, Yıldırım T, Dikmetaş Ö, Toprak H, Hekimsoy V, İşler AO, Yılmaz R, Kadayıfçılar S, Erdem Y, Erbas T, Ünlütürk U. Evaluation of Microvascular Complications in Kidney Recipients With Posttransplant Diabetes Mellitus. J Clin Endocrinol Metab 2024; 109:e1623-e1633. [PMID: 38101939 PMCID: PMC11244200 DOI: 10.1210/clinem/dgad738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 12/17/2023]
Abstract
CONTEXT The paucity of data on microvascular complications in patients with posttransplant diabetes (PTDM) is an obstacle to developing follow-up algorithms. OBJECTIVE To evaluate diabetic microvascular complications in patients with long-standing PTDM. METHODS In patients with ≥5-year history of PTDM and age-matched renal transplant recipients without PTDM (NDM), diabetic peripheral neuropathy was evaluated using the Michigan Neuropathy Screening Instrument, the CASE IV device, and in vivo corneal confocal microscopy (CCM). Cardiac autonomic neuropathy tests were performed using heart rate variability. Nephropathy screening was assessed using spot urine albumin/creatinine ratio and eGFR calculation. Diabetic retinopathy was evaluated by fundus examination and photography, and optical coherence tomography. RESULTS This study included 41 patients with PTDM and 45 NDM patients. The median follow-up was 107.5 months in the PTDM group. Peripheral neuropathy was significantly higher in the PTDM group than in the NDM group (P = .02). In the PTDM patients with peripheral neuropathy, corneal nerve fiber density examined by CCM was significantly lower than in PTDM patients without neuropathy (P = .001). Parasympathetic involvement was observed in 58.5% of the PTDM group and 22% of the NDM group (P = .001). Sympathetic involvement was present in 65.9% of the PTDM group and 29.3% of the NDM group (P = .001). Retinopathy was observed in 19.5% of patients in the PTDM group and in none of the NDM patients (P < .001). Renal functions were similar between the study groups. CONCLUSION Cardiac autonomic neuropathy and diabetic retinopathy can affect patients with PTDM at a high rate. Diabetic retinopathy is a threat to the vision of PTDM patients. Diabetic peripheral neuropathy can be detected early in PTDM patients by CCM.
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Affiliation(s)
- Başak Çelik Kavaklılar
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Özge Aybı Özdemir
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Tolga Yıldırım
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara 06100, Turkey
- Department of Nephrology, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Özlem Dikmetaş
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Hilal Toprak
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Vedat Hekimsoy
- Department of Cardiology, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Alperen Onur İşler
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara 06100, Turkey
- Department of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Rahmi Yılmaz
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara 06100, Turkey
- Department of Nephrology, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Sibel Kadayıfçılar
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Yunus Erdem
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara 06100, Turkey
- Department of Nephrology, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Tomris Erbas
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara 06100, Turkey
- Department of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Uğur Ünlütürk
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara 06100, Turkey
- Department of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara 06100, Turkey
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Atmaca A, Ketenci A, Sahin I, Sengun IS, Oner RI, Erdem Tilki H, Adas M, Soyleli H, Demir T. Expert opinion on screening, diagnosis and management of diabetic peripheral neuropathy: a multidisciplinary approach. Front Endocrinol (Lausanne) 2024; 15:1380929. [PMID: 38952393 PMCID: PMC11215140 DOI: 10.3389/fendo.2024.1380929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/15/2024] [Indexed: 07/03/2024] Open
Abstract
The proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of the disease by clinicians as a key factor in early recognition and diagnosis, emphasizing an improved awareness of the disease by the first-admission or referring physicians. The proposed "screening and diagnostic" algorithm involves the consideration of DPN in a patient with prediabetes or diabetes who presents with neuropathic symptoms and/or signs of neuropathy in the presence of DPN risk factors, with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction in atypical cases. Although, the first-line interventions for DPN are currently represented by optimized glycemic control (mainly for type 1 diabetes) and multifactorial intervention (mainly for type 2 diabetes), there is a need for individualized pathogenesis-directed treatment approaches for DPN. Alpha-lipoic acid (ALA) seems to be an important first-line pathogenesis-directed agent, given that it is a direct and indirect antioxidant that works with a strategy targeted directly against reactive oxygen species and indirectly in favor of endogenous antioxidant capacity for improving DPN conditions. There is still a gap in existing research in the field, necessitating well-designed, robust, multicenter clinical trials with sensitive endpoints and standardized protocols to facilitate the diagnosis of DPN via a simple and effective algorithm and to track progression of disease and treatment response. Identification of biomarkers/predictors that would allow an individualized approach from a potentially disease-modifying perspective may provide opportunities for novel treatments that would be efficacious in early stages of DPN, and may modify the natural course of the disease. This expert opinion document is expected to increase awareness among physicians about conceptual, clinical, and therapeutic aspects of DPN and to assist them in timely recognition of DPN and translating this information into their clinical practice for best practice in the management of patients with DPN.
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Affiliation(s)
- Aysegul Atmaca
- Department of Endocrinology and Metabolism, Ondokuz Mayis University Faculty of Medicine, Samsun, Türkiye
| | - Aysegul Ketenci
- Department of Physical Medicine and Rehabilitation, Koc University Faculty of Medicine, Istanbul, Türkiye
| | - Ibrahim Sahin
- Department of Endocrinology and Metabolism, Inonu University Faculty of Medicine, Malatya, Türkiye
| | - Ihsan Sukru Sengun
- Department of Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Türkiye
| | - Ramazan Ilyas Oner
- Department of Internal Medicine, Adiyaman University Faculty of Medicine, Adiyaman, Türkiye
| | - Hacer Erdem Tilki
- Department of Neurology, Ondokuz Mayis University Faculty of Medicine, Samsun, Türkiye
| | - Mine Adas
- Department of Endocrinology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
| | - Hatice Soyleli
- Department of Medical Affairs, Abdi Ibrahim Pharmaceuticals, Istanbul, Türkiye
| | - Tevfik Demir
- Department of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, Izmir, Türkiye
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Alharajin RS, Al Moaibed HS, Al Khalifah FK. Prevalence of Painful Diabetic Peripheral Neuropathy Among Saudi Patients With Diabetes in Al Ahsa: A Cross-Sectional Study. Cureus 2023; 15:e49317. [PMID: 38143603 PMCID: PMC10748796 DOI: 10.7759/cureus.49317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
Background and aim Diabetic neuropathy is one of the most common long-term complications of diabetes. A frequent presentation of neuropathy is painful diabetic peripheral neuropathy (PDPN), which is associated with morbidity and disability among patients with diabetes. This study aims to estimate the prevalence of PDPN and its associated factors among patients with type 2 diabetes mellitus (T2DM) attending primary healthcare (PHC) in Al Ahsa. Methodology A cross-sectional study was conducted on patients with diabetes at National Guard PHC clinics in Al Ahsa, Saudi Arabia. An interview-administered questionnaire was used to collect information about clinicodemographic characteristics, and the Douleur Neuropathique-4 (DN4) questionnaire was used to identify the presence of PDPN. Results A total of 342 patients with T2DM were included. The prevalence of PDPN was 29.8%. Patients' ages ranged from 25-70 years, with a mean age of 48.5 ± 12.3 years. The majority were female (118, 52.6%), with obesity detected among 115 (33.6%) individuals. Significant predictors of PDPN included noncompliance to treatment (odds ratio [OR] = 5.9, P = 0.001), female gender (OR = 3.5, P = 0.001), presence of other comorbidities (OR = 1.7, P = 0.001), and diabetes duration exceeding 15 years (OR = 1.5, P = 0.001). Conclusions This study revealed that PDPN was frequent among patients with diabetes in Al Ahsa, which was at an intermediate frequency relative to reported national and global literature levels. Identifying patients who are at high risk and implementing timely interventions are crucial.
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Affiliation(s)
- Rasmah S Alharajin
- Department of University Health Clinic, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, SAU
- Department of Family Medicine, King Abdulaziz Hospital, Ministry of the National Guard, Al Ahsa, SAU
| | - Hessa S Al Moaibed
- Department of Family Medicine, King Abdulaziz Hospital, Ministry of the National Guard, Al Ahsa, SAU
| | - Fatimah K Al Khalifah
- Department of Family Medicine, King Abdulaziz Hospital, Ministry of the National Guard, Al Ahsa, SAU
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Sabaghan M, Ataee S, Ataee M, Tebyanian M, Afrashteh S, Daneshi N. Diabetic peripheral neuropathy screening and the related risk factors to its prevalence in people with type 2 diabetes. Int J Diabetes Dev Ctries 2023. [DOI: 10.1007/s13410-022-01165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Effect of diabetes on patient-reported outcome measures at one year after laminoplasty for cervical spondylotic myelopathy. Sci Rep 2022; 12:9684. [PMID: 35690639 PMCID: PMC9188556 DOI: 10.1038/s41598-022-13838-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
Although patients with diabetes reportedly have more peripheral neuropathy, the impacts of diabetes on postoperative recovery in pain and patient-reported outcome measures (PROMs) after laminoplasty for cervical spondylotic myelopathy (CSM) is not well characterized. The authors aimed to elucidate the effects of diabetes on neck/arm/hand/leg/foot pain and PROMs after laminoplasty CSM. The authors retrospectively reviewed 339 patients (82 with diabetes and 257 without) who underwent laminoplasty between C3 and C7 in 11 hospitals during April 2017 –October 2019. Preoperative Numerical Rating Scale (NRS) scores in all five areas, the Short Form-12 Mental Component Summary, Euro quality of life 5-dimension, Neck Disability Index, and the Core Outcome Measures Index-Neck) were comparable between the groups. The between-group differences were also not significant in NRS scores and PROMs one year after surgery. The change score of NRS hand pain was larger in the diabetic group than the nondiabetic group. The diabetic group showed worse preoperative score but greater improvement in the Short Form-12 Physical Component Summary than the nondiabetic group, following comparable score one year after surgery. These data indicated that the preoperative presence of diabetes, at least, did not adversely affect pain or PROMs one year after laminoplasty for CSM.
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Cevik AB, Olgun N. The Predictors of Painful Diabetic Neuropathy and Its Effect on Quality of Life. Pain Manag Nurs 2021; 23:345-352. [PMID: 34030993 DOI: 10.1016/j.pmn.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/22/2021] [Accepted: 04/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowing the prevalence and predictors of neuropathic pain and its impacts on the quality of life (QoL) using measurement tools is important for good diabetes management. In Turkish society, neuropathic pain, its predictors and its impact on the quality of life of diabetics are not considered enough. OBJECTIVES This study examined the prevalence and predictors of neuropathic pain and its impacts on the quality of life in diabetics in Rize Province, Turkey. DESIGN This study was designed as a cross-sectional, correlational study. SETTING Data collected through face-to-face interviews. The sample size was determined using the formula [n= N t2pq / d2 (N-1) + t2pq]. PARTICIPANT The sample of the study consisted of 122 people with diabetes who visited the diabetes outpatient clinic of the hospital. METHODS A Personal Information Form, Douleur Neuropathique en 4 questions (DN4), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used to collect data. Pain intensity was measured using Visual Analogue Scale (VAS) RESULTS: The prevalence of the diagnosed painful diabetic polyneuropathy (PDPN) was found to be 22.9%. On the other hand, the prevalence of the undiagnosed PDPN was found to be 44.3% according to DN4 and 27.9% according to LANSS. The VAS pain score was determined as 1.99±1.20 (range: 1-5). In the people with PDPN, nephropathy was seen 4.514 times more frequently according to DN4 and 7.217 times more frequently according to LANSS. Painful diabetic peripheral neuropathy had negative effects on all dimensions of QoL except for social function and mental health (p <0.05). CONCLUSIONS It is important for nurses to determine the prevalence and predictive factors of PDPN in their region and to evaluate the effect of pain on the quality of life of diabetics. Nurses should attempt to increase the quality of life of people with diabetes by reducing the predictors affecting pain.
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Affiliation(s)
- Ayfer Bayindir Cevik
- Bartın University, Faculty of Health Sciences, Ağdacı Mahallesi, Ağdacı Köyü Yolu, Bartın, Turkey.
| | - Nermin Olgun
- Hasan Kalyoncu University, Yeşilkent, Gaziantep, Turkey
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Diabetes is associated with greater leg pain and worse patient-reported outcomes at 1 year after lumbar spine surgery. Sci Rep 2021; 11:8142. [PMID: 33854161 PMCID: PMC8046758 DOI: 10.1038/s41598-021-87615-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 03/31/2021] [Indexed: 01/08/2023] Open
Abstract
Although patients with diabetes reportedly have more back pain and worse patient-reported outcomes than those without diabetes after lumbar spine surgery, the impact of diabetes on postoperative recovery in pain or numbness in other regions is not well characterized. In this study, the authors aimed to elucidate the impact of diabetes on postoperative recovery in pain/numbness in four areas (back, buttock, leg, and sole) after lumbar spine surgery. The authors retrospectively reviewed 993 patients (152 with diabetes and 841 without) who underwent decompression and/or fixation within three levels of the lumbar spine at eight hospitals during April 2017–June 2018. Preoperative Numerical Rating Scale (NRS) scores in all four areas, Oswestry Disability Index (ODI), and Euro quality of life 5-dimension (EQ-5D) were comparable between the groups. The diabetic group showed worse ODI/EQ-5D and greater NRS scores for leg pain 1 year after surgery than the non-diabetic group. Although other postoperative NRS scores tended to be higher in the diabetic group, the between-group differences were not significant. Diabetic neuropathy caused by microvascular changes may induce irreversible nerve damage especially in leg area. Providers can use this information when counseling patients with diabetes about the expected outcomes of spine surgery.
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Mirghani HO, Alanazi KK, Albalawi AM, Almalki NS, Alshehri WK, Alonizei AHK. The Confusing Tale of Restless Leg Syndrome and Diabetic Neuropathy: A Case-control Study among Patients with Diabetes Mellitus in Tabuk City, Saudi Arabia. PHARMACOPHORE 2021; 12:12-17. [DOI: 10.51847/kxu8sriht6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/01/2024]
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Prevalence and associated factors of painful diabetic peripheral neuropathy among diabetic patients on follow up at Jimma University Medical Center. J Diabetes Metab Disord 2020; 19:1407-1413. [PMID: 33520843 DOI: 10.1007/s40200-020-00661-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite having significant impact on the patient's quality of life, painful diabetic peripheral neuropathy (PDPN) is usually underdiagnosed. Screening for PDPN in patients with diabetes is needed in order to get timely identification and management. Hence, the purpose of this study was to assess the prevalence and determinants of PDPN among diabetes patients attending outpatient at Jimma University Medical Center from September 1 November 10, 2019. METHODS Hospital based cross-sectional study was conducted and douleur neuropathique-4 was used to identify the presence of PDPN. Data were collected using pretested structured questionnaire and entered into EPI data 3.1 and exported to SPSS version 20 for analysis. Both bivariate and multivariate binary logistic regression was employed to identify factors associated with PDPN. Variable having a p value of <0.25 in the bivariate model were considered as candidates for multivariable regression. Adjusted odds ratios were calculated at 95%CI and considered significant with a p value of <0.05. RESULTS A total of 366 diabetic patients were enrolled into the study and their mean duration of diabetes was 6.8 ± 5.3 years. The study finding showed that the prevalence of PDPN was 14.5%. According to the multivariate logistic regression analysis smoking [current smoker(AOR = 6.17; 95%CI:2.25,16.86),former smoker(AOR = 3.22;95%CI:1.29,8.03)],diabetes duration[5 to 10 years (AOR = 3.32;95%CI:1.29,8.53), ≥ 10 years (AOR = 8.86;95% CI: 3.49,22.5)] and comorbid hypertension [AOR = 2.54; 95%CI:1.17,5.49] were independent predictors of PDPN among study participants. CONCLUSION The overall prevalence of PDPN in this study was 14.5% and it was significantly associated with smoking, comorbid hypertension and diabetes duration of above 5 years. Early detection and appropriate interventions are important for high risk patients identified in the current study.
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AlSufyani MH, Alzahrani AM, Allah AA, Abdullah RI, Alzhrani SH, Alsaab AA. Prevalence of painful diabetic peripheral neuropathy and its impact on quality of life among diabetic patients in Western region, Saudi Arabia. J Family Med Prim Care 2020; 9:4897-4903. [PMID: 33209819 PMCID: PMC7652107 DOI: 10.4103/jfmpc.jfmpc_488_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/08/2020] [Accepted: 07/10/2020] [Indexed: 12/26/2022] Open
Abstract
Background Diabetic neuropathy is the most common long-term complications of diabetes, frequently presenting as painful diabetic peripheral neuropathy (PDPN), which can significantly impair patients' quality of life (QOL). This study set to estimate the prevalence of PNPD and health-related quality of life (HRQoL) in the setting of primary health care in Saudi Arabia. Methods This study was conducted in primary health-care centers affiliated with the National Guard Health Affairs in Western Saudi Arabia. Arabic version of the Douleur Neuropathique 4 questionnaire was administered on diabetic patients to screen for neuropathic pain and short-form 12 questionnaire to assess HRQoL. Results The study screened (n = 349) Type 2 diabetic patients. The prevalence of PDPN was 33.2%. PDRN was more likely to affect females (adjusted odds ratio ["AOR"] =1.96, P = 0.024), and those living with diabetes for over 15 years (AOR = 2.26, P = 0.039), and those on insulin treatment (AOR: 2.33, P = 0.010) alone or in combination (AOR = 1.78, P = 0.034). Both physical and mental components (MCs) of QOL scores were significantly higher in diabetic patients without PDPN compared to those with it; 49.57 ± 9.31 versus 40.77 ± 8.14 for physical component QOL and 51.72 ± 9.36 versus 44.35 ± 8.12 for MC QOL, P < 0.001. Discussion and Conclusion Painful peripheral neuropathy is relatively common among type 2 diabetic patients in Western Saudi Arabia and impacts both physical and MCs of the QOL of affected patients.
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Affiliation(s)
- Maram Hassan AlSufyani
- Department of Primary Health Care, Ministry of the National Guard - Health Affairs, Taif, Saudi Arabia
| | - Abdullah M Alzahrani
- Primary Health Care Department, Ministry of the National Guard - Health Affairs, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed Aman Allah
- Primary Health Care Department, Ministry of the National Guard - Health Affairs, Taif, Saudi Arabia
| | | | - Sara Hasan Alzhrani
- Department of Family Medicine, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Adel Ali Alsaab
- Medical Intern, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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ERTUR E, VURAL KESKİNLER M, ÇAKIR İB, ERBAKAN A, OĞUZ A. Tip 2 Diyabetli Hastalarda Diyabetik Periferik Nöropati Sıklığı, İlişkili Faktörler ve Farkındalık Durumunun Değerlendirilmesi. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.669099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sun J, Wang Y, Zhang X, Zhu S, He H. Prevalence of peripheral neuropathy in patients with diabetes: A systematic review and meta-analysis. Prim Care Diabetes 2020; 14:435-444. [PMID: 31917119 DOI: 10.1016/j.pcd.2019.12.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/10/2019] [Accepted: 12/25/2019] [Indexed: 01/10/2023]
Abstract
AIMS We 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. METHODS A 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. RESULTS A 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%). CONCLUSIONS Medical staff should strengthen the evaluation and diagnosis of DPN. Moreover, they need to teach diabetic patients how to prevent this complication.
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Affiliation(s)
- Juan Sun
- School of Medicine, Nantong University, No.19 Qixiu Road, Chongchuan District, Nantong, Jiangsu Province, China
| | - Ya Wang
- Affiliated Hospital of Nantong University, No. 20, Xisi Road, Chongchuan District, Nantong, Jiangsu Province, China
| | - Xiaoyi Zhang
- Department of Endocrinology, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Chongchuan District, Nantong, Jiangsu Province, China
| | - Shengze Zhu
- School of Medicine, Nantong University, No.19 Qixiu Road, Chongchuan District, Nantong, Jiangsu Province, China
| | - Hong He
- Department of Nursing, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Chongchuan District, Nantong, Jiangsu Province, 226001, China.
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Gylfadottir SS, Itani M, Krøigård T, Kristensen AG, Christensen DH, Nicolaisen SK, Karlsson P, Callaghan BC, Bennett DL, Andersen H, Tankisi H, Nielsen JS, Andersen NT, Jensen TS, Thomsen RW, Sindrup SH, Finnerup NB. Diagnosis and prevalence of diabetic polyneuropathy: a cross-sectional study of Danish patients with type 2 diabetes. Eur J Neurol 2020; 27:2575-2585. [PMID: 32909392 DOI: 10.1111/ene.14469] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/29/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Diabetic polyneuropathy (DPN) is a common complication of diabetes. Using the Toronto criteria for diabetic polyneuropathy and the grading system for neuropathic pain, the performance of neuropathy scales and questionnaires were assessed by comparing them to a clinical gold standard diagnosis of DPN and painful DPN in a cohort of patients with recently diagnosed type 2 diabetes. METHODS A questionnaire on neuropathy and pain was sent to a cohort of 5514 Danish type 2 diabetes patients. A sample of 389 patients underwent a detailed clinical examination and completed neuropathy questionnaires and scales. RESULTS Of the 389 patients with a median diabetes duration of 5.9 years, 126 had definite DPN (including 53 with painful DPN), 88 had probable DPN and 53 had possible DPN. There were 49 patients with other causes of polyneuropathy, neuropathy symptoms or pain, 10 with subclinical DPN and 63 without DPN. The sensitivity of the Michigan Neuropathy Screening Instrument questionnaire to detect DPN was 25.7% and the specificity 84.6%. The sensitivity of the Toronto Clinical Neuropathy Scoring System, including questionnaire and clinical examination, was 62.9% and the specificity was 74.6%. CONCLUSIONS Diabetic polyneuropathy affects approximately one in five Danish patients with recently diagnosed type 2 diabetes but neuropathic pain is not as common as previously reported. Neuropathy scales with clinical examination perform better compared with questionnaires alone, but better scales are needed for future epidemiological studies.
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Affiliation(s)
- S S Gylfadottir
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - M Itani
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - T Krøigård
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - A G Kristensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - D H Christensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S K Nicolaisen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - P Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
| | - B C Callaghan
- Department of Neurology, University of Michigan, Ann Arbor,, MI, USA
| | - D L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - J S Nielsen
- Danish Centre for Strategic Research in Type 2 Diabetes, Steno Diabetes Center, Odense, Denmark
| | - N T Andersen
- Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - T S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - R W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S H Sindrup
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - N B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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UZUNER B, KETENCİ S, SALBAŞ E. Diyabetik Nöropatiye Genel Yaklaşım. ACTA MEDICA ALANYA 2020. [DOI: 10.30565/medalanya.788960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Yokoyama H, Tsuji T, Hayashi S, Kabata D, Shintani A. Factors associated with diabetic polyneuropathy-related sensory symptoms and signs in patients with polyneuropathy: A cross-sectional Japanese study (JDDM 52) using a non-linear model. J Diabetes Investig 2020; 11:450-457. [PMID: 31314173 PMCID: PMC7078109 DOI: 10.1111/jdi.13117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 02/06/2023] Open
Abstract
AIMS/INTRODUCTION To assess the prevalence of diabetic polyneuropathy (DPN)-related sensory symptoms/signs and associated factors in patients with polyneuropathy, considering non-linear effects for numerical variables. MATERIALS AND METHODS A cross-sectional survey of patients with type 2 diabetes mellitus from 17 primary care clinics across Japan was carried out. DPN and DPN-related sensory symptoms/signs were diagnosed according to the Diabetic Neuropathy Study Group in Japan criteria. RESULTS Of the 9,914 patients with type 2 diabetes mellitus in this study, 2,745 had DPN and 1,689 had DPN-related sensory symptoms/signs (61.5% of patients with DPN). There were significant correlations between DPN-related sensory symptoms/signs and smoking status (odds ratio 2.04 for current and 1.64 for former; P < 0.001 and P = 0.002, respectively), sex (odds ratio 0.56 for male/female; P < 0.001) and alcohol consumption (odds ratio 2.02 for former/never; P = 0.004). Based on the non-linear logistic regression model, significant correlations were observed between the presence of DPN-related sensory symptoms/signs and higher systolic blood pressure (SBP), longer diabetes duration, and decreasing age. The logarithm of odds for SBP increased until reaching approximately 130 mmHg, then it plateaued. CONCLUSIONS Some modifiable factors assessed in the large survey database might be associated with DPN-related sensory symptoms/signs, namely smoking, alcohol consumption and SBP. Maintaining SBP <130 mmHg was associated with lower odds of DPN-related sensory symptoms/signs in patients with DPN.
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Affiliation(s)
- Hiroki Yokoyama
- Department of Internal MedicineJiyugaoka Medical ClinicObihiroJapan
| | | | | | - Daijiro Kabata
- Department of Medical StatisticsOsaka City University Graduate School of MedicineOsakaJapan
| | - Ayumi Shintani
- Department of Medical StatisticsOsaka City University Graduate School of MedicineOsakaJapan
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Neuropathic pain in individuals with sickle cell disease. Neurosci Lett 2020; 714:134445. [DOI: 10.1016/j.neulet.2019.134445] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/06/2019] [Accepted: 08/20/2019] [Indexed: 12/18/2022]
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Zhang Y, Li N, Zhao Y, Fan D. Painful Diabetic Peripheral Neuropathy Study of Chinese OutPatiEnts (PDN-SCOPE): protocol for a multicentre cross-sectional registry study of clinical characteristics and treatment in China. BMJ Open 2019; 9:e025722. [PMID: 30962233 PMCID: PMC6500332 DOI: 10.1136/bmjopen-2018-025722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Painful diabetic peripheral neuropathy (PDN) is a growing public health problem in China. Despite recent progress in treatment, there has been no nationwide study evaluating current medical practices and compliance with treatment guidelines. The primary aims of this study are to investigate the clinical characteristics and treatment practices for PDN and associated anxiety and depression in China. METHODS AND ANALYSIS Painful Diabetic Peripheral Neuropathy Study of Chinese OutPatiEnts is a cross-sectional, multicentre registry study with a target sample size of approximately 1500 people experiencing PDN. People with PDN will be treated according to current guidelines and local practices. The demographics, medical histories, Visual Analogue Scale pain scores, Patient Health Questionnaire-9 results, Generalised Anxiety Disorder-7 scores and therapies will be recorded to evaluate clinical characteristics of PDN and current treatment practices for pain, anxiety and depression. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Peking University Third Hospital Medical Science Research Ethics Committee (2018-182).The results of this study will be disseminated through peer-reviewed publications and scientific presentations. TRIAL REGISTRATION NUMBER NCT03520608.
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Affiliation(s)
- Yuanjin Zhang
- Neurology, Peking University Third Hospital, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yiming Zhao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Neurology, Peking University Third Hospital, Beijing, China
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A cross-sectional study investigating frequency and features of definitely diagnosed diabetic painful polyneuropathy. Pain 2019; 159:2658-2666. [PMID: 30161042 DOI: 10.1097/j.pain.0000000000001378] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This cross-sectional multicentre study aimed at investigating frequency and features of painful diabetic polyneuropathy. We consecutively enrolled 816 patients attending hospital diabetic outpatient clinics. We first definitely diagnosed diabetic polyneuropathy and pure small-fibre polyneuropathy using clinical examination, nerve conduction study, and skin biopsy or quantitative sensory testing. Adhering to widely agreed criteria, we then identified neuropathic pain and diagnosed painful polyneuropathy using a combined approach of clinical examination and diagnostic tests. Of the 816 patients, 36% had a diabetic polyneuropathy associated with male sex, age, and diabetes severity; 2.5% of patients had a pure small-fibre polyneuropathy, unrelated to demographic variables and diabetes severity. Of the 816 patients, 115 (13%) suffered from a painful polyneuropathy, with female sex as the only risk factor for suffering from painful polyneuropathy. In this large study, providing a definite diagnosis of diabetic polyneuropathy and pure small-fibre polyneuropathy, we show the frequency of painful polyneuropathy and demonstrate that this difficult-to-treat complication is more common in women than in men.
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Garoushi S, Johnson MI, Tashani OA. A cross-sectional study to estimate the point prevalence of painful diabetic neuropathy in Eastern Libya. BMC Public Health 2019; 19:78. [PMID: 30654784 PMCID: PMC6335782 DOI: 10.1186/s12889-018-6374-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/27/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Painful Diabetic Neuropathy (PDN) is a complication that affects up to one third of people living with diabetes. There is limited data on the prevalence of PDN from countries in the Middle East and North Africa. The aim of this study was to estimate the point prevalence of PDN in adults in Eastern Libya using the self-report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale. METHODS We invited patients attending the Benghazi Diabetes Centre who had diabetes for ≥ 5 years to take part in the study. Patients provided consent and completed the Arabic S-LANSS. Anthropometrics, marital status, socioeconomic and education information was recoded and fasting plasma glucose concentration determined. RESULTS Four hundred and fifty participants completed the study (age = 19 to 87 years, BMI = 17.6 to 44.2 kg/m2, 224 women). One hundred and ninety five participants (43.3%) reported pain in their lower limbs in the previous 6 months and 190/195 participants (97.4%) reported a S-LANSS score of ≥ 12 suggesting they had neuropathic pain characteristics. Thus, 42.2% (190/450) of participants with diabetes were categorised as experiencing pain with neuropathic characteristics. Mean ± SD duration of diabetes for participants with PDN (20.4 ± 6.5 years) was significantly higher compared with those without PDN (11.1 ± 4.6 years). Participants with PDN smoked tobacco for more years than those without pain (7.9 ± 12.3 years versus 1.1 ± 3.9 years respectively); had significantly higher fasting plasma glucose concentration (143.6 ± 29.3 mg/dl versus 120.0 ± 17.3 mg/dl) and had a significantly higher levels of education and employment status. The most significant predictors of PDN were duration of diabetes (OR = 25.85, 95% CI = 13.56-49.31), followed by smoking for men (OR = 8.28, 95% CI = 3.53-9.42), obesity (OR = 3.96, 95% CI = 2.25-6.96) and high fasting plasma glucose concentration (OR = 3.51, 95% CI = 1.99-6.21). CONCLUSION The prevalence of PDN in people with diabetes in Eastern Libya was 42.2%. Risk factors for developing PDN were high fasting plasma glucose concentration, long duration of diabetes, and higher level of educational and employment status.
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Affiliation(s)
- Sabri Garoushi
- Centre for Pain Research, School of Clinical and Applied Sciences, Portland Way, Leeds Beckett University, Leeds, LS1 3HE UK
- MENA Research Group, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
- Faculty of Medicine, University of Benghazi, Benghazi, Libya
| | - Mark I. Johnson
- Centre for Pain Research, School of Clinical and Applied Sciences, Portland Way, Leeds Beckett University, Leeds, LS1 3HE UK
- MENA Research Group, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
| | - Osama A. Tashani
- Centre for Pain Research, School of Clinical and Applied Sciences, Portland Way, Leeds Beckett University, Leeds, LS1 3HE UK
- MENA Research Group, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
- Faculty of Medicine, University of Benghazi, Benghazi, Libya
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Sensory phenotype and risk factors for painful diabetic neuropathy: a cross-sectional observational study. Pain 2018; 158:2340-2353. [PMID: 28858986 PMCID: PMC5690294 DOI: 10.1097/j.pain.0000000000001034] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Supplemental Digital Content is Available in the Text. Cross-sectional observational study in a cohort of 232 diabetic polyneuropathy patients confirmed higher severity of neuropathy and predominant loss-of-function sensory profile in painful cases. Different sensory profiles in diabetic distal symmetrical sensory-motor polyneuropathy (DSPN) may be associated with pain and the responsiveness to analgesia. We aimed to characterize sensory phenotypes of patients with painful and painless diabetic neuropathy and to assess demographic, clinical, metabolic, and electrophysiological parameters related to the presence of neuropathic pain in a large cohort of well-defined DSPN subjects. This observational cross-sectional multi-center cohort study (performed as part of the ncRNAPain EU consortium) of 232 subjects with nonpainful (n = 74) and painful (n = 158) DSPN associated with diabetes mellitus of type 1 and 2 (median age 63 years, range 21-87 years; 92 women) comprised detailed history taking, laboratory tests, neurological examination, quantitative sensory testing, nerve conduction studies, and neuropathy severity scores. All parameters were analyzed with regard to the presence and severity of neuropathic pain. Neuropathic pain was positively correlated with the severity of neuropathy and thermal hyposensitivity (P < 0.001). A minority of patients with painful DSPN (14.6%) had a sensory profile, indicating thermal hypersensitivity that was associated with less severe neuropathy. Neuropathic pain was further linked to female sex and higher cognitive appraisal of pain as assessed by the pain catastrophizing scale (P < 0.001), while parameters related to diabetes showed no influence on neuropathic pain with the exception of laboratory signs of nephropathy. This study confirms the value of comprehensive DSPN phenotyping and underlines the importance of the severity of neuropathy for the presence of pain. Different sensory phenotypes might be useful for stratification of patients with painful DSPN for analgesic treatment and drug trials.
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Unmar Y, Zafar MI, Gao F. Factors associated with peripheral neuropathy in type 2 diabetes: Subclinical versus confirmed neuropathy. ACTA ACUST UNITED AC 2017; 37:337-342. [DOI: 10.1007/s11596-017-1737-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/29/2016] [Indexed: 12/26/2022]
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Ren F, Cao P, Li W, Zhao D, Zaiane O. Ensemble based adaptive over-sampling method for imbalanced data learning in computer aided detection of microaneurysm. Comput Med Imaging Graph 2017; 55:54-67. [DOI: 10.1016/j.compmedimag.2016.07.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/17/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
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Petropoulos IN, Javed S, Azmi S, Khan A, Ponirakis G, Malik RA. Diabetic neuropathy and painful diabetic neuropathy in the Middle East and North Africa (MENA) region: Much work needs to be done. J Taibah Univ Med Sci 2016. [DOI: 10.1016/j.jtumed.2016.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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25
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Celik S, Yenidunya G, Temel E, Purisa S, Uzum AK, Gul N, Cinkil G, Dinccag N, Satman I. Utility of DN4 questionnaire in assessment of neuropathic pain and its clinical correlations in Turkish patients with diabetes mellitus. Prim Care Diabetes 2016; 10:259-264. [PMID: 26749091 DOI: 10.1016/j.pcd.2015.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/20/2015] [Accepted: 11/16/2015] [Indexed: 12/21/2022]
Abstract
AIM We aimed to assess the utility of DN4 questionnaire (Douleur Neuropathique en 4 questions) to define the frequency and severity of neuropathic pain (NP) and also its clinical correlation to daily clinical practice. METHODS We included 1357 patients with diabetes (56.5% women, 90.4% type 2 diabetes) who were followed up in our diabetes outpatient clinic. Presence of NP was evaluated by performing simultaneous DN4 questionnaires and physical examination. Those who had a DN4 score ≥4 were considered to have NP. RESULTS The mean age was 58.2±12.1 years, mean duration was 12.5±7.5; (min-max: 1-45) years, mean HbA1c level was 7.8±1.6% (min-max: 5-16.2%), (61.7±6.0mmol/mol; min-max: 31.1-153.6mmol/mol). Three hundred thirteen patients (23%) were diagnosed with NP using the DN4 tool. Male gender (p=0.01), receiving antihypertensive treatment (p=0.01), presence of retinopathy (p<0.001), cardiovascular disease (CVD) (p=0.01) and previously diagnosed neuropathy (p<0.001) were significantly associated with higher NP scores. Those who had increased DN4 scores were more likely to be on oral hypoglycemic agents (OHA)+insulin combinations (p<0.001), had longer diabetes duration (p<0.001) and higher HbA1c levels (p=0.001). Logistic regression model revealed that diabetes duration (OR: 1.02, 95% CI: 1.00-1.04, p=0.007), elevated HbA1c levels (1.11, 1.02-1.21, 0.015), presence of retinopathy (1.41, 1.20-1.64, <0.001), management with at least one OHA (1.47; 1.12-1.92; 0.004) or any insulin regimen (1.62; 1.16-2.27; 0.005) (compared with diet only-regimens) were significantly associated with NP. CONCLUSION Utilization of DN4 questionnaire in daily clinical practice is an effective tool in the identification of pain related with peripheral diabetic polyneuropathy.
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Affiliation(s)
- S Celik
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - G Yenidunya
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - E Temel
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - S Purisa
- Istanbul University, Istanbul Faculty of Medicine, Department of Biostatistics, Istanbul, Turkey.
| | - A Kubat Uzum
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - N Gul
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - G Cinkil
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - N Dinccag
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
| | - I Satman
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.
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Aslam A, Singh J, Rajbhandari S. Prevalence of Painful Diabetic Neuropathy Using the Self-Completed Leeds Assessment of Neuropathic Symptoms and Signs Questionnaire in a Population with Diabetes. Can J Diabetes 2015; 39:285-95. [PMID: 25935401 DOI: 10.1016/j.jcjd.2014.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 11/17/2014] [Accepted: 12/09/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study assessed the feasibility of diagnosing painful diabetic neuropathy (PDN) using a postal self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire, and it compared the prevalence of PDN in patients with diabetes attending primary and secondary care. METHODS This was an observational study in northwest England, United Kingdom (n=204). S-LANSS were used by post to diagnose PDN. Consent for participation and access of blood results were obtained from the subjects with diabetes. Ethical approval was granted to do the work. RESULTS In this study the prevalence of PDN was 30.3%, comprising 33.1% of patients with type 2 diabetes compared to 14.1% patients with type 1 diabetes. The overall prevalence of PDN was 33% (n=43) in the secondary care group and 25.6% (n=19) in the primary care group; the rates were not statistically significant. There were no gender differences between the primary and secondary care populations. There was a significant association of obesity, smoking and height in males with PDN compared to the non-PDN group (p<0.05). There was a significant trend toward increasing prevalence of PDN with duration of diabetes, increasing glycated hemoglobin and increasing body mass index (p<0.05). CONCLUSION The overall prevalence of PDN in this study was 30.3%. The results demonstrated the use of self-administered S-LANSS was easy and can be used for epidemiologic surveys of PDN. The results are comparable to and similar to other published series, in both primary and secondary care settings.
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Affiliation(s)
- Amir Aslam
- Eaton Centre Medical Clinic, Calgary, Alberta, Canada.
| | - Jaipaul Singh
- School of Pharmacy and Biomedical Sciences and School of Forensic and Investigative Sciences, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Satyan Rajbhandari
- School of Pharmacy and Biomedical Sciences and School of Forensic and Investigative Sciences, University of Central Lancashire, Preston, Lancashire, United Kingdom; Department of Diabetology and Endocrinology, Lancashire Teaching Hospital NHS Trust, Chorley and South Ribble District General Hospital, Preston Road, Chorley, United Kingdom
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Shivashankar R, Kirk K, Kim WC, Rouse C, Tandon N, Narayan KMV, Ali MK. Quality of diabetes care in low- and middle-income Asian and Middle Eastern countries (1993-2012): 20-year systematic review. Diabetes Res Clin Pract 2015; 107:203-23. [PMID: 25529849 DOI: 10.1016/j.diabres.2014.11.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 10/07/2014] [Accepted: 11/23/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess the extent to which people with diabetes in low- and middle-income countries (LMIC) of Asia and the Middle East met evidence-based care recommendations through a systematic review of published literature. METHODS Electronic searches of Medline and Embase were carried out for studies assessing quality of care among people with diabetes in Asia and the Middle East between 1993 and 2012. Benchmarking against American Diabetes Association guidelines, we reported level and proportions meeting recommended risk factor control (glycated hemoglobin [HbA1c], blood pressure, and low density lipoprotein-cholesterol [LDL]) and preventive care processes across different settings. RESULTS One hundred and fifteen publications met eligibility for inclusion (91 reported risk factor control, 7 reported preventive processes, and 17 reported both). Only China, Thailand, Malaysia and Philippines had nationally representative data. Mean HbA1c (6.5-11% or 48-97 mmol/mol), SBP (120-152 mm Hg), and LDL (2.4-3.8 mmol/l) varied greatly. Despite variation in availability of data, studies consistently showed that recommended care goals were not being achieved. CONCLUSIONS The practice of auditing and benchmarking against evidence-based guidelines appears to be uncommon in Asia and the Middle East and there was heterogeneity of reporting across studies, populations, and methods used. The available data showed inadequate care.
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Affiliation(s)
- Roopa Shivashankar
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India.
| | - Katy Kirk
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Woon Cho Kim
- Emory University School of Medicine, Atlanta, GA, USA
| | - Chaturia Rouse
- Center for Disease Control and Prevention, Atlanta, GA, USA
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Mahammed K Ali
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Ballas SK. Pathophysiology and principles of management of the many faces of the acute vaso-occlusive crisis in patients with sickle cell disease. Eur J Haematol 2014; 95:113-23. [PMID: 25288149 DOI: 10.1111/ejh.12460] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 12/11/2022]
Abstract
Effective management of sickle cell pain entails a thorough understanding of its pathophysiology and the pharmacogenomics of the opioids used to manage it. In recent years, there has been significant progress along these two lines. At the pathophysiologic level, there is evidence that the severity and frequency of painful stimuli modulate their transmission at the level of the dorsal horn of the spinal cord. This modulation is achieved via two channels: the α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) and NMDA receptors. Initially, the AMPA channel controls the transmission of stimuli of mild-moderate severity. Once the AMPA channel reaches its limit of membrane depolarization, the NMDA channel is activated and facilitates the transmission of painful stimuli in a progressive fashion leading to central sensitization and glial activation. At the level of pharmacogenomics, the metabolism of each opioid is patient-specific. Glucuronidation is unique for the metabolism of morphine, hydromorphone, and oxymorphone. The metabolism of all other opioids requires specific Cytochrome P450 (CYP) isoenzymes. The activity of each isoenzyme and the activity of the metabolites of each opioid vary among patients depending on their genetic makeup and coexistent environmental factors such as the use of other medications that may enhance or inhibit the CYP isoenzyme activity.
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Affiliation(s)
- Samir K Ballas
- Cardeza Foundation for Hematologic Research, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Saeed T, Nasrullah M, Ghafoor A, Shahid R, Islam N, Khattak MU, Maheshwary N, Siddiqi A, Khan MA. Efficacy and tolerability of carbamazepine for the treatment of painful diabetic neuropathy in adults: a 12-week, open-label, multicenter study. Int J Gen Med 2014; 7:339-43. [PMID: 25061334 PMCID: PMC4085303 DOI: 10.2147/ijgm.s64419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective Anticonvulsants are increasingly being used in the symptomatic management of several neuropathic pain disorders. The present observational study was designed to evaluate the efficacy, tolerability, and quality of life (QoL) of carbamazepine use for 12 weeks in patients with painful diabetic neuropathy, in Pakistan. Methods This was a 12-week, multicenter, open-label, uncontrolled trial in adult type 2 diabetic patients (aged 18–65 years) suffering from clinically confirmed neuropathic pain (Douleur Neuropathique en 4 [DN4] score ≥4). Change in neuropathic pain at week 12 compared with baseline was assessed using the Brief Pain Inventory Scale–Short Form (pain severity score and pain interference score). QoL was determined by the American Chronic Pain Association QoL scale. Safety was assessed based on patient reported adverse events (AEs) and serious AEs. Results Of the total 500 screened patients, 452 enrolled and completed the study. The mean (± standard deviation [SD]) pain interference score decreased from 4.5±2.0 at baseline to 3.1±1.9 at week 12 (P<0.001). The mean (± SD) pain severity score decreased from 5.8±2.0 at baseline to 3.6±2.2 at week 12 (P<0.001). There was a decrease of ≥30% in the pain severity score between visits. The mean (± SD) QoL scale score improved from 5.9±1.6 at baseline to 8.0±1.7 at week 12. A total of ten (2.2%) patients reported AEs during the study period. No patient discontinued the study due to AEs. Conclusion In this real-life experience study, carbamazepine, when prescribed for 12 weeks to adult diabetic patients suffering from neuropathic pain, showed pain-relief effect, with reduced mean pain severity and mean pain interference scores and with improved QoL and good tolerability profile.
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Affiliation(s)
- Tariq Saeed
- Pakistan Telecommunication Company Ltd, Karachi, Pakistan
| | | | | | - Riaz Shahid
- Dr Riaz Shahid Clinic, Peshawar Cantt, Peshawar, Pakistan
| | - Nadeem Islam
- Punjab Employs Social Security Institution, Islamabad, Pakistan
| | | | | | | | - Muhammad Athar Khan
- Department of Medical Education, King Saud bin Abdulaziz University, Riyadh, Kingdom of Saudi Arabia
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Liberman O, Peleg R, Shvartzman P. Chronic pain in type 2 diabetic patients: a cross-sectional study in primary care setting. Eur J Gen Pract 2014; 20:260-7. [PMID: 24645789 DOI: 10.3109/13814788.2014.887674] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Although diabetes mellitus (DM) is often associated with painful neuropathic syndromes, a significant number of DM patients suffer from non-neuropathic (nociceptive) pain. Unfortunately, there is insufficient data on the epidemiology of nociceptive pain in DM patients and its effect on their quality of life. OBJECTIVE To characterize pain in type 2 DM patients, and assess its effect on their quality of life. METHODS The study population included 342 type 2 DM patients, 18 years of age and above (mean age 70.7 ± 9.7), who reported having pain. The study questionnaires included the Brief Pain Inventory (BPI), the S-LANSS scale to assess pain with neuropathic features, life impact, and socio-demographic data. RESULTS One hundred and fifty-five DM patients (46.5%) reported having pain of predominantly neuropathic origin. Almost 75% of patients with neuropathic pain were females, compared to 57.8% of patients with nociceptive pain (P = 0.002). More patients with neuropathic pain reported constant daily pain (57.6% vs. 42.4%, P < 0.0001), and worse pain during the night (53.3% vs. 46.7%, P = 0.045). The pain affected daily activities, walking capacity, and mood. Patients with neuropathic pain reported a greater negative effect of pain on their quality of life than those with nociceptive pain (41.0% vs. 15.3%, P < 0.0001). CONCLUSION The impact of neuropathic pain in DM patients is much more significant than nociceptive pain and affects their quality of life and daily function to a greater degree.
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Affiliation(s)
- Orly Liberman
- Nursing Department, Rekanati School for Community Health Professions, Ben-Gurion University of the Negev , Beer-Sheva , Israel
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Kim SS, Won JC, Kwon HS, Kim CH, Lee JH, Park TS, Ko KS, Cha BY. Prevalence and clinical implications of painful diabetic peripheral neuropathy in type 2 diabetes: results from a nationwide hospital-based study of diabetic neuropathy in Korea. Diabetes Res Clin Pract 2014; 103:522-9. [PMID: 24438877 DOI: 10.1016/j.diabres.2013.12.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 09/10/2013] [Accepted: 12/18/2013] [Indexed: 01/08/2023]
Abstract
AIMS To determine the prevalence and risk factors for painful diabetic peripheral neuropathy (PDPN) and evaluate sleep impairment and quality of life in patients with PDPN. METHODS Data from the Korean Diabetes Association Neuropathy Study Group were used to evaluate 3999 patients with type 2 diabetes. PDPN was diagnosed using visual analogue scales (VAS) and medical history. The patients were asked to answer the Brief Pain Inventory-Short Form (BPI-SF), Medical Outcomes Study Sleep (MOS-Sleep) Scale, EuroQol (EQ-5D), and VAS. RESULTS Among the patients with diabetic peripheral neuropathy (n=1338), 577 (43.1%) were diagnosed with PDPN (14.4% of all patients with type 2 diabetes). PDPN was independently associated with age, female gender, fasting plasma glucose, hypertension, and previous cerebrovascular events. All pain severity and interference measures were higher in patients with PDPN than in non-PDPN patients, and patients with PDPN reported more impaired sleep and lower EQ-5D and VAS scores. CONCLUSIONS The prevalence of PDPN in Koreans was comparable to that in Western populations. PDPN may impair sleep and quality of life compared with non-PDPN, and physicians should carefully consider pain symptoms in patients with diabetic peripheral neuropathy.
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Affiliation(s)
- Sang Soo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
| | - Jong Chul Won
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Centre, College of Medicine, Inje University, Seoul, South Korea
| | - Hyuk Sang Kwon
- Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, South Korea
| | - Chong Hwa Kim
- Department of Internal Medicine, Sejong General Hospital, Bucheon, South Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, School of Medicine, Catholic University of Daegu, Daegu, South Korea
| | - Tae Sun Park
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, South Korea
| | - Kyung Soo Ko
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Centre, College of Medicine, Inje University, Seoul, South Korea.
| | - Bong Yun Cha
- Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, South Korea
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Rajguru P, Kolber MJ, Garcia AN, Smith MT, Patel CK, Hanney WJ. Use of Mindfulness Meditation in the Management of Chronic Pain. Am J Lifestyle Med 2014. [DOI: 10.1177/1559827614522580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Chronic pain is a major health condition that has significant financial and lifestyle implications. Due to the complex etiologies of pain, it is difficult to find treatment modalities that would be universally applicable to the general population presenting for care. Mindfulness meditation is a complimentary treatment modality that has some preliminary, inconclusive evidence in support of its benefit on patients with chronic pain. Objectives. The purpose of this article is to systematically review the current literature for randomized controlled trials that assess the outcomes of mindfulness as an intervention for individuals with chronic pain. Methods. An electronic database search was performed for studies investigating the efficacy of mindfulness in treatment for chronic pain. The studies included were randomized controlled trials, published in English, from a peer-reviewed journal that identified mindfulness as the primary treatment focus for chronic pain in at least one group, and included participants with at least a 12-week history of symptoms. Results. The database search revealed 283 articles, of which 6 met the inclusion criteria. Conclusion. Mindfulness meditation appears to have minimal or statistically insignificant effects on chronic pain according to the current data. However, the effects of mindfulness on mental health scores are significant and may be an area for future trials to target. Well-conducted research is necessary before the effects of mindfulness on chronic pain can be definitively determined.
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Affiliation(s)
- Parth Rajguru
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - Morey J. Kolber
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - Ashley N. Garcia
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - Matthew T. Smith
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - Chetan K. Patel
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
| | - William J. Hanney
- Program in Physical Therapy, University of Central Florida, Orlando, Florida (PR, WJH)
- Department of Physical Therapy, Nova Southeastern University, Orlando, Florida (MJK)
- Centura Health, Littleton, Colorado (ANG)
- Physical Medicine and Rehabilitation, Florida Hospital Spine Health Institute, Altamonte Springs, Florida (MTS, CKP)
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Painful diabetic neuropathy in Japanese diabetic patients is common but underrecognized. PAIN RESEARCH AND TREATMENT 2013; 2013:318352. [PMID: 24377045 PMCID: PMC3860156 DOI: 10.1155/2013/318352] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 12/30/2022]
Abstract
Although chronic pain due to diabetic neuropathy, defined as painful diabetic neuropathy (PDN), is a debilitating and distressing complication of diabetes, epidemiological data on PDN has been scarce, especially in Asia. We evaluated the prevalence of Japanese PDN and its impact on their quality of life (QOL) and metnal state. In addition, we examined to which extent physicians are aware of patients' PDN. A total of 298 patients with diabetes were found to be eligible for the study. We revealed that substantial percentage (22.1%) of Japanese diabetic patients had PDN and that PDN had negative effect on patients' QOL and mental state. However, physicians were aware of PDN in only 36.4% of patients with the condition. To the best of our knowledge, this is the first report showing the extent of physicians' awareness of patients' PDN. In conclusion, physicians treating diabetes need to be more aware of patients' PDN in everyday clinical practice to prevent the progression of PDN and improve the patients' QOL and mental state.
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Ballas SK, Darbari DS. Neuropathy, neuropathic pain, and sickle cell disease. Am J Hematol 2013; 88:927-9. [PMID: 23963922 DOI: 10.1002/ajh.23575] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 08/14/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Samir K. Ballas
- Cardeza Foundation, Department of Medicine, Jefferson Medical College; Thomas Jefferson University; Philadelphia Pennsylvannia
| | - Deepika S. Darbari
- Division of Hematology, Center for Cancer and Blood Disorders; Children's National Medical Center; Washington District of Columbia
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Bouhassira D, Letanoux M, Hartemann A. Chronic pain with neuropathic characteristics in diabetic patients: a French cross-sectional study. PLoS One 2013; 8:e74195. [PMID: 24058527 PMCID: PMC3772849 DOI: 10.1371/journal.pone.0074195] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/29/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Our aim was to estimate the prevalence of distal chronic pain with neuropathic characteristics in patients with type 1 and type 2 diabetes mellitus and its impact on quality of life, mood, anxiety, sleep and healthcare utilization. METHODS In total, 885 patients were screened and 766 diabetic patients (38.7% with type 1 diabetes mellitus, 44.8% women, mean age: 57.2 ± 14.9 years) were enrolled consecutively over a three-month period in this observational study by 85 diabetes specialists working in a hospital department or in private practice. All the patients completed a series of questionnaires for the detection of chronic pain (i.e. daily pain for more than three months) in the lower limbs and assessment of health-related quality of life (Medical Outcomes Short Form 12 scale), sleep disturbances (MOS sleep scale), depression and anxiety (Hospital Anxiety and Depression scale). Patients with chronic pain were also assessed with the 7-item DN4-interview questionnaire, the monofilament test and the Michigan Neuropathy Screening Instrument (MNSI). RESULTS The overall prevalence of chronic pain with neuropathic characteristics was 20.3% [95% CI 17.4-23.1]. The MNSI examination score suggested that pain was related to polyneuropathy, in 80.1% of these patients (89.5% of those with bilateral pain). Patients with chronic pain had a poorer quality of life and more sleep disturbances, anxiety and depression than patients without pain and the presence of neuropathic characteristics was predictive of such impairments. Only 38.6% of the patients had received appropriate treatment for neuropathic pain. CONCLUSIONS Chronic pain with neuropathic characteristics concerns one in five diabetic patients, has a significant impact on quality of life and is not adequately managed. The close correlation between the DN4 questionnaire and MNSI results suggests that screening tools for neuropathic pain could be used in daily practice for the identification of painful diabetic polyneuropathy.
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Affiliation(s)
- Didier Bouhassira
- INSERM U-987, Centre d’Evaluation et Traitement de la Douleur, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
- Université Versailles-Saint-Quentin, Versailles, France
- * E-mail:
| | | | - Agnès Hartemann
- Service de Diabétologie, CHU Pitié-Salpétrière, Paris, France
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Abstract
Painful diabetic polyneuropathy (PDPN) is generally considered a variant of diabetic polyneuropathy (DPN) but the identification of distinctive aspects that characterize painful compared with painless DPN has however been addressed in many studies, mainly with the purpose of better understanding the mechanisms of neuropathic pain in the scenario of peripheral nerve damage of DPN, of determining risk markers for pain development, and also of recognizing who might respond to treatments. This review is aimed at examining available literature dealing with the issue of similarities and differences between painful and painless DPN in an attempt to respond to the question of whether painful and painless DPN are the same disease or not and to address the conundrum of why some people develop the insensate variety of DPN whilst others experience distressing pain. Thus, from the perspective of comparing painful with painless forms of DPN, this review considers the clinical correlates of PDPN, its distinctive framework of symptoms, signs, and nerve functional and structural abnormalities, the question of large and small fiber involvement, the peripheral pain mechanisms, the central processing of pain and some new insights into the pathogenesis of pain in peripheral polyneuropathies and PDPN.
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Affiliation(s)
- Vincenza Spallone
- Endocrinology, Department of Systems Medicine, University of Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
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Mete T, Aydin Y, Saka M, Cinar Yavuz H, Bilen S, Yalcin Y, Arli B, Berker D, Guler S. Comparison of efficiencies of michigan neuropathy screening instrument, neurothesiometer, and electromyography for diagnosis of diabetic neuropathy. Int J Endocrinol 2013; 2013:821745. [PMID: 23818897 PMCID: PMC3684087 DOI: 10.1155/2013/821745] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/21/2013] [Accepted: 04/22/2013] [Indexed: 11/18/2022] Open
Abstract
Aim. This study compares the effectiveness of Michigan Neuropathy Screening Instrument (MNSI), neurothesiometer, and electromyography (EMG) in detecting diabetic peripheral neuropathy in patients with diabetes type 2. Materials and Methods. 106 patients with diabetes type 2 treated at the outpatient clinic of Ankara Numune Education and Research Hospital Department of Endocrinology between September 2008 and May 2009 were included in this study. Patients were evaluated by glycemic regulation tests, MNSI (questionnaire and physical examination), EMG (for detecting sensorial and motor defects in right median, ulnar, posterior tibial, and bilateral sural nerves), and neurothesiometer (for detecting alterations in cold and warm sensations as well as vibratory sensations). Results. According to the MNSI score, there was diabetic peripheral neuropathy in 34 (32.1%) patients (score ≥2.5). However, when the patients were evaluated by EMG and neurothesiometer, neurological impairments were detected in 49 (46.2%) and 79 (74.5%) patients, respectively. Conclusion. According to our findings, questionnaires and physical examination often present lower diabetic peripheral neuropathy prevalence. Hence, we recommend that in the evaluation of diabetic patients neurological tests should be used for more accurate results and thus early treatment options to prevent neuropathic complications.
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Affiliation(s)
- Turkan Mete
- Ankara Numune Education and Research Hospital, Department of Endocrinology, Sıhhiye, 06622 Ankara, Turkey
- *Turkan Mete:
| | - Yusuf Aydin
- Duzce University, Faculty of Medicine, Endocrinology and Metabolism Department, Turkey
| | - Mustafa Saka
- Ankara Numune Research and Education Hospital, Department of Neurology, Turkey
| | - Halise Cinar Yavuz
- Ankara Numune Education and Research Hospital, Department of Endocrinology, Sıhhiye, 06622 Ankara, Turkey
| | - Sule Bilen
- Ankara Numune Research and Education Hospital, Department of Neurology, Turkey
| | - Yavuz Yalcin
- Ankara Numune Education and Research Hospital, Department of Endocrinology, Sıhhiye, 06622 Ankara, Turkey
| | - Berna Arli
- Ankara Numune Research and Education Hospital, Department of Neurology, Turkey
| | - Dilek Berker
- Ankara Numune Education and Research Hospital, Department of Endocrinology, Sıhhiye, 06622 Ankara, Turkey
| | - Serdar Guler
- Ankara Numune Education and Research Hospital, Department of Endocrinology, Sıhhiye, 06622 Ankara, Turkey
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Abbott CA, Malik RA, van Ross ERE, Kulkarni J, Boulton AJM. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care 2011; 34:2220-4. [PMID: 21852677 PMCID: PMC3177727 DOI: 10.2337/dc11-1108] [Citation(s) in RCA: 534] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess, in the general diabetic population, 1) the prevalence of painful neuropathic symptoms; 2) the relationship between symptoms and clinical severity of neuropathy; and 3) the role of diabetes type, sex, and ethnicity in painful neuropathy. RESEARCH DESIGN AND METHODS Observational study of a large cohort of diabetic patients receiving community-based health care in northwest England (n = 15,692). Painful diabetic neuropathy (PDN) was assessed using neuropathy symptom score (NSS) and neuropathy disability score (NDS). RESULTS Prevalence of painful symptoms (NSS ≥5) and PDN (NSS ≥5 and NDS ≥3) was 34 and 21%, respectively. Painful symptoms occurred in 26% of patients without neuropathy (NDS ≤2) and 60% of patients with severe neuropathy (NDS >8). Adjusted risk of painful neuropathic symptoms in type 2 diabetes was double that of type 1 diabetes (odds ratio [OR] = 2.1 [95% CI 1.7-2.4], P < 0.001) and not affected by severity of neuropathy, insulin use, foot deformities, smoking, or alcohol. Women had 50% increased adjusted risk of painful symptoms compared with men (OR = 1.5 [1.4-1.6], P < 0.0001). Despite less neuropathy in South Asians (14%) than Europeans (22%) and African Caribbeans (21%) (P < 0.0001), painful symptoms were greater in South Asians (38 vs. 34 vs. 32%, P < 0.0001). South Asians without neuropathy maintained a 50% increased risk of painful neuropathy symptoms compared with other ethnic groups (P < 0.0001). CONCLUSIONS One-third of all community-based diabetic patients have painful neuropathy symptoms, regardless of their neuropathic deficit. PDN was more prevalent in patients with type 2 diabetes, women, and people of South Asian origin. This highlights a significant morbidity due to painful neuropathy and identifies key groups who warrant screening for PDN.
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Affiliation(s)
- Caroline A Abbott
- Division of Cardiovascular Medicine, Core Technology Facility, University of Manchester, Manchester, UK.
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