Prevalence of painful peripheral neuropathy in a screening program looking at risk for developing diabetic foot in a public Peruvian hospital
Abstract
Objective: To determine prevalence of painful asymptomatic peripheral neuropathy (PN) in persons with type 2 diabetes mellitus (DM2) and its associated characteristics. Materials and Methods: This is a cross-sectional descriptive study performed in patients belonging to the program ‘Feet at risk’ at the Endocrinology Service in Maria Auxiliadora National Hospital. Patients with DM2 who were seen between 2015 and 2020 were included. The definition of PN is according to Toronto Consensus, considering the evaluation of three components: symptoms, signs and Achilles reflex, determining certainty as possible and probable, according to the combinations found. For assessing symptoms, the total symptom score (TTS) was used; for signs, monofilament test was used, and vibration sensitivity was assessed using a 128-Hz tuning fork. Prevalence of PN was calculated according to symptoms and certainty of the diagnosis. Also, the clinical characteristics of patient groups were described. Results: One-thousand and six persons were included, their mean age was 60,5 years, and 69,3% were female. In those who had at least one item from Toronto criteria, 60,5% had painful PN, and 21,8% had asymptomatic PN. When using more diagnostic certainty, i.e., two from three criteria being positive, the prevalence of painful PN was 42,2% and for asymptomatic PN, it was 6,5%. Four groups with different distributions with respect to sex, time with diabetes, ulcer history, peripheral arterial disease and glycemic control were established. Conclusion: In patients from the Endocrinology Service at Maria Auxiliadora Hospital 42,2% and 6,5% had more certainty for presenting with probable painful PN and asymptomatic PN, respectively. Further studies are needed for confirming the usefulness of the aforementioned criteria for properly estimating the burden of disease.
Downloads
References
Vinik AI, Nevoret M-L, Casellini C, Parson H. Diabetic neuropathy. Endocrinol Metab Clin North Am. 2013, 42(4):747-87. doi: 10.1016/j.ecl.2013.06.001.
Pai Y, Lin CH, Lee I, Chang MH. Prevalence and biochemical risk factors of diabetic peripheral neuropathy with or without neuropathic pain in Taiwanese adults with type 2 diabetes mellitus. Diabetes Metab Syndr. 2018;12(2):111-116. doi: 10.1016/j. dsx.2017.09.013.
Yovera-Aldana M, Velásquez-Rimachi V, Huerta-Rosario A, More- Yupanqui MD, Osores-Flores M, Espinoza R, et al. Prevalence and incidence of diabetic peripheral neuropathy in Latin America and the Caribbean: A systematic review and meta-analysis. PLoS One. 2021;16(5):e0251642. doi: 10.1371/journal.pone.0251642.
Solís-Villanueva J, Michahelles-Barreno C, Rodríguez-Lay G, Farfán- García E, Anticona-Sayán J, Curo-Carrión M. Prevalence and risk factors of diabetic peripheral neuropathy in newly diagnosed patients of diabetes mellitus attending at national hospital. Rev Soc Peru Med Interna. 2019,32(1):6-10.
Ibarra T, Rocha J De C, Hernández J. Prevalencia de neuropatía periférica en diabéticos tipo 2 en el primer nivel de atención. Rev Med Chile. 2012;140(9):1126-31. doi: 10.4067/S0034- 98872012000900004.
Nascimento OJM do, Pupe CCB, Cavalcanti EBU. Diabetic neuropathy. Rev Dor. 2016;17:46-51. doi: 10.5935/1806-0013.20160047.
Themistocleous AC, Ramirez JD, Shillo PR, Lees JG, Selvarajah D, Orengo C, et al. The Pain in Neuropathy Study (PiNS): a cross- sectional observational study determining the somatosensory phenotype of painful and painless diabetic neuropathy. Pain. 2016,157(5):1132-45. doi: 10.1097/j.pain.0000000000000491.
Shillo P, Sloan G, Greig M, Hunt L, Selvarajah D, Elliott J, et al. Painful and painless diabetic neuropathies: What is the difference? Curr Diab Rep. 2019,19(6):32. doi: 10.1007/s11892-019-1150-5.
Gylfadottir SS, Weeracharoenkul D, Andersen ST, Niruthisard S, Suwanwalaikorn S, Jensen TS. Painful and non-painful diabetic polyneuropathy: Clinical characteristics and diagnostic issues. J Diabetes Investig. 2019,10(5):1148-57. doi: 10.1111/jdi.13105.
TesfayeS,BoultonAJ,DyckPJ,FreemanR,HorowitzM,Kempler P, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33(10):2285-93. doi: 10.2337/dc10-1303.
Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Hinchliff RJ, Lipsky BA. Guías del IWGDF para la prevención y el manejo de la enfermedad de pie diabético [Internet]. Madrid: IWGDF; 2019 [citado el 2 de enero de 2024]. Disponible en: https://iwgdfguidelines.org/wp- content/uploads/2020/03/IWGDF-Guidelines-2019_Spanish.pdf
Escaño-PolancoM,OdriozolaF,DavidsonA,PedrosaJ,FuenteH, Márquez G. Consenso de expertos para el manejo de la neuropatía diabética. Revista ALAD. 2016;6:121-50.
ZieglerD,HanefeldM,RuhnauKJ,MeissnerHP,LobischM,SchütteK, Gries FA. Treatment of symptomatic diabetic peripheral neuropathy with the anti-oxidant alpha-lipoic acid. A 3-week multicentre randomized controlled trial (ALADIN Study). Diabetologia.
;38(12):1425-33. doi: 10.1007/BF00400603.
Jensen TS, Karlsson P, Gylfadottir SS, Andersen ST, Bennett DL, Tankisi H, et al. Painful and non-painful diabetic neuropathy, diagnostic challenges and implications for future management. Brain. 2021;144(6):1632-1645. doi: 10.1093/brain/awab079.
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(5):435-44. Disponible en: doi: 10.1016/j.pcd.2019.12.005.
Garoushi S, Johnson MI, Tashani O. Point prevalence of painful diabetic neuropathy in the Middle East and North Africa region: A systematic review with meta-analysis. Libyan J Med Sci. 2018;2(3):85-94. doi: 10.4103/LJMS.LJMS_36_18.
Van Hecke O, Austin SK, Khan RA, Smith BH, Torrance N. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014,155(4):654-62. doi: 10.1016/j. pain.2013.11.013.
Kirthi V, Perumbalath A, Brown E, Nevitt S, Petropoulos IN, Burgess J, et al. Prevalence of peripheral neuropathy in pre- diabetes: a systematic review. BMJ Open Diabetes Res Care. 2021,9(1):e002040. doi: 10.1136/bmjdrc-2020-002040.
FabryV,GerdelatA,AcketB,CintasP,RousseauV,Uro-CosteE,et al. Which method for diagnosing small fiber neuropathy? Front Neurol. 2020;11:342. doi: 10.3389/fneur.2020.00342.
Baraz S, Zarea K, Shahbazian HB, Latifi SM. Comparison of the accuracy of monofilament testing at various points of feet in peripheral diabetic neuropathy screening. J Diabetes Metab Disord. 2014;13(1):19. doi: 10.1186/2251-6581-13-19.
Dutra LMA, Moura MC, do Prado FA, De Oliveira Lima G, Melo MC, Fernandez RNM, et al. Is it possible to substitute the monofilament test for the Ipswich Touch Test in screening for peripheral diabetic neuropathy? Diabetol Metab Syndr. 2020;12(1):27. doi: 10.1186/ s13098-020-00534-2.
BishopK,PooleR.Commontestsfordiabeticperipheralneuropathy. Diabetes Practice. 2022;39(6):35-8. doi: 10.1002/pdi.2428.
Shehab DK, Al-Jarallah KF, Abraham M, Mojiminiyi OA, Al- Mohamedy H, Abdella NA. Back to basics: ankle reflex in the evaluation of peripheral neuropathy in type 2 diabetes mellitus. QJM. 2012;105(4):315-20. doi: 10.1093/qjmed/hcr212.
Selvarajah D, Kar D, Khunti K, Davies MJ, Scott AR, Walker J, et al. Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention. Lancet Diabetes Endocrinol. 2019,7(12):938-48. doi: 10.1016/S2213- 8587(19)30081-6.
CarmichaelJ,FadaviH,IshibashiF,ShoreAC,TavakoliM.Advances in screening, early diagnosis, and accurate staging of diabetic neuropathy. Front Endocrinol (Lausanne). 2021;12:671257. doi: 10.3389/fendo.2021.6712.
Themistocleous AC, Ramirez JD, Serra J, Bennett DL. The clinical approach to small fibre neuropathy and painful channelopathy. Pract Neurol. 2014;14(6):368-79. doi: 10.1136/practneurol-2013-000758.
Ziegler D, Nowak H, Kempler P, Vargha P, Low PA. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha- lipoic acid: a meta-analysis. Diabet Med. 2004;21(2):114-21. doi: 10.1111/j.1464-5491.2004.01109.x.
Prevalencia de neuropatía periférica dolorosa y asintomática en diabéticos
Kisozi T, Mutebi E, Kisekka M, Lhatoo S, Sajatovic M, Kaddumukasa M, et al. Prevalence, severity and factors associated with peripheral neuropathy among newly diagnosed diabetic patients attending Mulago hospital: a cross-sectional study. Afr Health Sci. 2017,17(2):463-73. doi: 10.4314/ahs.v17i2.21.
Yovera-Aldana M, Pérez-Cavero S, Pinedo-Torres I, Zubiate-López C. Prevalence of foot at-risk and its associated characteristics among outpatients with diabetes mellitus in a Peruvian public hospital. Rev Diabet Stud. 2022;18(1):1-9. doi: 10.1900/RDS.2022.18.1.
Iacopi E, Pieruzzi L, Riitano N, Abbruzzese L, Goretti C, Piaggesi A. The Weakness of the Strong Sex: Differences Between Men and Women Affected by Diabetic Foot Disease. Int J Low Extrem Wounds. 2023;22(1):19-26. doi: 10.1177/1534734620984604.
ZoungasS,WoodwardM,LiQ,CooperME,HametP,HarrapS,et al. Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes. Diabetologia. 2014;57(12):2465-74. doi: 10.1007/ s00125-014-3369-7.
KitilaKM,HajureM.Whytoosoon?Predictorsoftimetodiabetic peripheral neuropathy among newly diagnosed diabetes mellitus patients: a multicenter follow-up study at health-care setting of Ethiopia. Arch Public Health. 2023;81(1):186. doi: 10.1186/s13690- 023-01202-3.
Jasso-Huamán LE, Villena-Pacheco A, Guevara-Linares X. Control metabólico en pacientes diabéticos ambulatorios de un hospital general. Rev Med Hered. 2015;26(3):167-172.
Hwang YT, Davies G. “Insulin neuritis” to “treatment-induced neuropathy of diabetes”: new name, same mystery. Pract Neurol. 2016;16(1):53-5. doi: 10.1136/practneurol-2015-001215.
Dirección General de Medicamentos, Insumos y Drogas, Ministerio de Salud del Perú. Petitorio nacional único de medicamentos esenciales: Perú 2010 [Internet]. Lima: Minsa; 2010. Disponible en: https://www.gob.pe/institucion/minsa/informes- publicaciones/321918-petitorio-nacional-unico-de-medicamentos- esenciales-peru-2010
Morriss WW, Roques CJ. Pain management in low- and middle- income countries. BJA Educ. 2018;18(9):265-270. doi: 10.1016/j. bjae.2018.05.006.
KaramSL,DendyJ,PoluS,BlondeL.OverviewofTherapeuticInertia in Diabetes: Prevalence, Causes, and Consequences. Diabetes Spectr. 2020;33(1):8-15. doi: 10.2337/ds19-0029.
BommerC,SagalovaV,HeesemannE,Manne-GoehlerJ,AtunR, Bärnighausen T, et al. Global economic burden of diabetes in adults: Projections from 2015 to 2030. Diabetes Care. 2018,41(5):963-70. doi: 10.2337/dc17-1962.
BommerC,SagalovaV,HeesemannE,Manne-GoehlerJ,AtunR, Bärnighausen T, et al. Global Economic Burden of Diabetes in Adults: Projections From 2015 to 2030. Diabetes Care. 2018;41(5):963-970. doi: 10.2337/dc17-1962.
Maldonado-Valer T, Pareja-Mujica LF, Corcuera-Ciudad R, Terry- Escalante FA, Chevarría-Arriaga MJ, Vasquez-Hassinger T, et al. Prevalence of diabetic foot at risk of ulcer development and its components stratification according to the international working group on the diabetic foot (IWGDF): A systematic review with metanalysis. PLoS One. 2023,18(11):e0284054. doi: 10.1371/ journal.pone.0284054.
1.png)
.png){kind=logo}
