Peripheral neuropathy and impaired sensation of feet among patients with type 2 diabetes mellitus: a descriptive cross-sectional study
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20221734Keywords:
Type 2 diabetes mellitus, Glycemic control, Diabetic peripheral neuropathy, Michigan neuropathy screening instrumentAbstract
Background: Diabetic peripheral neuropathy (DPN) is the most prevalent consequence of type 2 diabetes mellitus (T2DM). Impaired sensation of feet due to DPN increases the risk of foot injury. Therefore, the objectives of this study were to assess the level of glycemic control, the prevalence of DPN and the impaired sensation of feet among the T2DM patients attending community clinics.
Methods: A descriptive cross-sectional study was conducted on 386 T2DM patients attending community clinics in Sri Lanka. The baseline data were collected by an interviewer-administered questionnaire. DPN was diagnosed by Michigan neuropathy screening instrument (MNSI) and monofilament test. Glycemic control was assessed by serum glycated hemoglobin (HbA1c) and fasting blood glucose (FBS).
Results: Among 386 T2DM patients, 265 (68.7%) were females, 179 (46.4%) had 1-5 years duration of disease. Poor long-term glycemic control (HbA1c) was observed in 292 (75.6%), while poor short-term glycemic control (FBS) was observed in 202 (52.4%). DPN was diagnosed in 68 (17.6%). Monofilament test assessed the touch sensation in 10 points of each foot. The ninth point (plantar central heel) of each foot was the commonest point with absent sensation. It was observed in 99 (25.6%) right feet and 94 (24.4%) left feet respectively.
Conclusions: High prevalence of DPN and impaired sensation in specific sites of foot indicate high risk for foot disease. Most patients with DPN had poor glycemic control. Urgent interventions to attain glycemic control and testing for impaired sensation regularly are essential to decrease progression of DPN and foot disease.
Metrics
References
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N et al. 2019. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019157: 107843.
International Diabetes Federation. IDF Diabetes Atlas, 10th edition. Brussels, Belgium. 2021 Available at: https://www.diabetesatlas.org. Accessed on 15 December 2021.
World Health Organization. Global report on diabetes. 2016. Available at: https://apps.who. int/iris/handle/10665/204871. Accessed on 15 December 2021.
American Diabetes Association. Glycemic Targets: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020;43:66-76. Available at https://doi.org/10.2337/dc20-S006. Accessed on 15 December 2021.
Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-54.
Young MJ, Boulton AJM, Macleod AF, Williams DRR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993;36:150-4.
Zhang Y, Lazzarini PA, McPhail SM, van Netten JJ, Armstrong DG, Pacella RE. Global disability burdens of diabetes-related lower-extremity complications in 1990 and 2016. Diabetes Care. 2020;43(5):964-74.
Katulanda P, Ranasinghe P, Jayawardena R, Constantine GR, Sheriff MHR Matthews DR. The prevalence, patterns and predictors of diabetic peripheral neuropathy in a developing country. Diabetol Metab Synd. 2012;4:21.
Arambewela MH, Somasundaram NP, Jayasekara HBPR, Kumbukage MP, Jayasena PMS, Chandrasekara CMPH, et al. Prevalence of Chronic Complications, Their Risk Factors, and the Cardiovascular Risk Factors among Patients with Type 2 Diabetes Attending the Diabetic Clinic at a Tertiary Care Hospital in Sri Lanka. J Diabetes Res. 2018;4504287.
Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care. 1994;17(11):1281-9.
Moghtaderi A, Bakhshipour A, Rashidi H. Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy. Clin Neurol Neurosurg. 2006;108(5):477-81.
American Diabetes Association. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2021. Diabetes Care. 2021;44:151-67.
Herman WH, Pop-Busui R, Braffett BH, Martin CL, Cleary PA, Albers JW, Feldman EL; DCCT/EDIC Research Group. Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications. Diabetic Med. 2012;29(7):937-44.
Won JC, Park TS. Recent advances in diagnostic strategies for diabetic peripheral neuropathy. Endocrinol Metab. 2016;31(2):230-8.
Assessing Protective Sensation with a Monofilament. Adv Skin Wound Care. 2004;17(7):346.
TODAY Study Group; Risk Factors for Diabetic Peripheral Neuropathy in Adolescents and Young Adults with Type 2 Diabetes: Results from the TODAY Study. Diabetes Care. 2022;45(5):1065-72.
Haghighatpanah M, Nejad ASM, Haghighatpanah M, Thunga G, Mallayasamy S. Factors that correlate with poor glycemic control in type 2 diabetes mellitus patients with complications. Osong Public Health Res Perspect. 2018;9(4):167-74.
Amarasekara AATD, Fongkaew W, Turale S, Wimalasekara SW, Chanprasit C. An ethnographic study of diabetes health beliefs and practices in Sri Lankan adults. Int Nurs Rev. 2014;61(4):507-14.
Saumika MAR, Amarasekara TD, Jayasekara R. Diabetes Self-Care Activities and Glycaemic Control among Adults with Type 2 Diabetes in Sri Lanka: A Cross-Sectional Study. J Biosci Med. 2019;7:99-111.
Amarasekara AATD, Fongkaew W, Wimalasekera SW, Turale S, Chanprasit C. Cross-sectional study of glycemic control among adults with type 2 diabetes. Nurs Health Sci. 2015;17(2):223-8.
McIllhatton A, Lanting S, Lambkin D, Leigh L, Casey S, Vivienne C. Reliability of recommended non-invasive chairside screening tests for diabetes-related peripheral neuropathy: a systematic review with meta-analyses. BMJ Open Diabetes Res Care. 2021;9:e002528.
Fedele D, Comi G, Coscelli C, Cucinotta D, Feldman EL, Ghirlanda G. A multicenter study on the prevalence of diabetic neuropathy in Italy. Diabetes Care. 1997;20(5):836-43.
Tahrani AA, Altaf QA, Piya MK, Barnett AH. Peripheral and Autonomic Neuropathy in South Asians and White Caucasians with Type 2 Diabetes Mellitus: Possible Explanations for Epidemiological Differences. J Diabetes Res. 2017;1273789.
Khramilin VN, Strokov IA, Davydov OS, Churyukanov MV. Diagnosis of diabetic polyneuropathy in primary care. Russian J Pain. 2021;19(2):47-59.
Bandyk DF. The diabetic foot: Pathophysiology, evaluation, and treatment. Semin Vasc Surg. 2018;31(2-4):43-8.
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.
Lu Y, Xing P, Cai X, Luo D, Li R, Lloyd C, et al. Prevalence and Risk Factors for Diabetic Peripheral Neuropathy in Type 2 Diabetic Patients From 14 Countries: Estimates of the INTERPRET-DD Study. Front Public Health. 2020;8:534372.
Mathiyalagen P, Kanagasabapathy S, Kadar Z, Rajagopal A, Vasudevan K. Prevalence and Determinants of Peripheral Neuropathy Among Adult Type II Diabetes Mellitus Patients Attending a Non-communicable Disease Clinic in Rural South India. Cureus. 2021;13(6):e15493.
Yovera-Aldana M, Velasquez-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.
Pfannkuche A, Alhajjar A, Ming A, Walter I, Piehler C, Mertens PR. Prevalence and risk factors of diabetic peripheral neuropathy in a diabetics cohort: Register initiative “diabetes and nerves”. Endocrine Metab Sci. 2020;1(1-2):100053.
Pruitt J, Moracho-Vilrriales C, Threatt T, Wagner S, Wu J. Romero-Sandoval EA. Identification, prevalence, and treatment of painful diabetic neuropathy in patients from a rural area in South Carolina. J Pain Res. 2017;10:833-43.
Saurabh S, Sarkar S, Selvaraj K, Kar S, Kumar S, Roy G. Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry, India. Indian J Endocrinol Metab. 2014;18(1):106-10.
Basu S, Hadley J, Tan RM, Williams J, Shearman CP. Is There Enough Information About Foot Care Among Patients With Diabetes? Int J Lower Extremity Wounds. 2004;3(2):64-8.
Surendra BV, Muthiah NS, Sailaja MV, Sreenivasulu K. Risk Factors Associated with Peripheral Neuropathy in Type 2 Diabetic Patients at Tertiary Care Hospital-A Cross Sectional Study. Ann Romanian Soc Cell Biol. 2021;25(4):142-9.
Feng Y, Schlösser FJ, Sumpio BE. The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy. J Vasc Surg. 2009;50(3):675-82.
Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Davignon DR, Smith DG. A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study. Diabetes Care. 1999;22(7):1036-42.
Armstrong DG, Lavery LA, Vela SA, Quebedeaux TL, Fleischli JG. Choosing a Practical Screening Instrument to Identify Patients at Risk for Diabetic Foot Ulceration. Arch Intern Med. 1998;158(3):289-92.
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.
Zhang Q, Yi N, Liu S, Zheng H, Qiao X, Xiong Q, et al. Easier operation and similar power of 10 g monofilament test for screening diabetic peripheral neuropathy. J Int Med Res. 2018;46(8):3278-84.
Armstrong DG, Okunade LA. Diabetic foot ulcers: Prevention, diagnosis and classification. Am Fam Physician. 1998;57(6):1325-32.