Prevalence and grade of diabetic peripheral neuropathy among known diabetic patients in rural Uganda

Background

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus (DM). Approximately 50% of diabetic patients are estimated to develop DPN, depending on disease duration and diabetic control. Early diagnosis of DPN will avoid complications, including non-traumatic lower limb amputation, which is considered the most debilitating complication, as well as significant psychological, social, and economical problems. There is a paucity of literature on DPN from rural Uganda. This study aimed to deliver the prevalence and grade of DPN among DM patients in rural Uganda.

Methods

A cross-sectional study that recruited 319 known DM patients was conducted in an outpatient clinic and a diabetic clinic at Kampala International University-Teaching Hospital (KIU-TH), Bushenyi, Uganda, between December 2019 and March 2020. Questionnaires were used to obtain clinical and sociodemographic data, a neurological examination was carried out to assess the DPN, and a blood sample was collected from each participant (for random/fasting blood glucose and glycosylated hemoglobin analyses). Data were analyzed using Stata version 15.0.

Results

The sample size was 319 participants. The mean age of study participants was 59.4 ± 14.6 years and there were 197 (61.8%) females. The prevalence of DPN was 65.8% (210/319) (95% CI 60.4% to 70.9%), and 44.8% of participants had mild DPN, 42.4% had moderate DPN, and 12.8% had severe DPN.

Conclusion

The prevalence of DPN at KIU-TH was higher among DM patients and its stage might have a negative impact on the progression of Diabetes Mellitus. Therefore, clinicians should consider neurological examination as a routine during assessment of all DM patients especially in rural areas where resources and facilities are often limited so that complications related to Diabetic mellitus will be prevented.

Effect of weight loss on insulin sensitivity and cardiovascular risk factors in glucose tolerant and intolerant obese subjects

We observed 170 obese patients during 55 weeks in order to study the influence of insulin resistance and insulin sensitivity on cardiovascular risk factors in such patients as well as the changes occurring on these subjects as a result of weight loss. At the beginning of the study, the patients were divided into two groups, according to the results of an oral glucose tolerance test (OGTT) performed with 75 g of glucose: Group A, glucose tolerant subjects (n = 81), Group B, glucose intolerant subjects (n = 89). Initially Group B patients showed higher values for fasting blood glucose, 2 h after OGTT, systolic and diastolic blood pressure, cholesterol, triglycerides and cholesterol/HDL-cholesterol ratio when compared to Group A patients (p less than 0.05). Fasting and 1 h-post glucose load serum insulin levels in both Group A and Group B patients were higher than those found out in non over-weight tolerant subjects, but there were no differences between both groups. The serum glucose descent slope after an insulin tolerance test (ITT) was lower for group B than for group A (p less than 0.05), whereas both groups demonstrated lower descent slopes than non overweight tolerant subjects (p less than 0.05). After a 55 weeks follow-up period, the patients in Group A had lost 4.6 +/- 0.7 kg and those in Group B 6.2 +/- 1.1 kg. In both groups, the values for SBP, DBP, FBG, triglycerides and cholesterol/HDL-cholesterol ratio had dropped significantly, with a rise in the HDL-cholesterol level.(ABSTRACT TRUNCATED AT 250 WORDS)