Clinical and electrophysiological correlation of peripheral neuropathy in newly diagnosed type 2 diabetes mellitus

Authors

  • Ashok K. Bhuyan Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
  • Sonali Appaiah Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20182073

Keywords:

Nerve conduction study, Neuropathy symptoms score, Neuropathy disability score, Peripheral neuropathy, Type 2 Diabetes mellitus

Abstract

Background: The study was undertaken to evaluate the prevalence of peripheral neuropathy in newly diagnosed type2 Diabetes mellitus (DM) by clinical examination and nerve conduction study (NCS), and to correlate them with risk factors.

Methods: Eighty newly detected cases of type2DM of age ≥18 years attending Endocrinology Department of Gauhati Medical College and Hospital, Assam, India were evaluated. Grading of symptoms and signs was done using the Neuropathy Symptoms Score (NSS) and Neuropathy Disability Score (NDS) respectively followed by NCS.  Neuropathy was diagnosed based on abnormal NSS, NDS or NCS.

Results: Prevalence of peripheral neuropathy was 68.75 % based on abnormal NCS/NDS/NCS. The most common symptom was presence of paraesthesia in 70.9%, followed by weakness in lower limbs in 16.36%.  The most common sign was impairment of vibration perception in 76.3%, followed by absent ankle reflex in 56.36%. Abnormal NCS finding was seen in 55% of patients with neuropathy. Of all the patients with neuropathy, only 2.5% had subclinical neuropathy that is abnormal NCS finding in absence of sign and symptoms. Peripheral neuropathy had significant association with age at diagnosis, presence of hypertension, fasting plasma glucose(FPG), HbA1c, serum creatinine and estimated glomerular filtration rate(eGFR) (p<0.05). On multiple linear regression analysis, only age at diagnosis and FPG were independently associated with neuropathy (p<0.05).

Conclusions: Patients with type 2DM have a high prevalence of peripheral neuropathy at diagnosis and very few of them harbour subclinical neuropathy. This study has shown that clinical examination still remains the main tool for detection of neuropathy.

References

Ziegler D. Diabetic peripheral Neuropathy. In:Holt R, Cockram C, Flyvbjerg A, Goldstein B. Textbook of Diabetes. 4th ed. West Sussex, UK: Wiley Blackwell. 2010;38:615-25.

Shaw JE, Zimmet PZ, Gries FA, Ziegler D. Epidemiology of diabetic neuropathy. In: Gries FA, Cameron NE, Low PA, Ziegler D, eds. Textbook of Diabetic Neuropathy. Stuttgart/New York, 2003;64-82.

Vinik AI, Mitchell BD, Leichter SB, Wagner AL, O’Brian AT, Georges LP. Epidemiology of the complications of diabetes. In: Leslie RDG, Robbins DC, eds. Diabetes: Clinical Science in Practice. Cambridge, UK: Cambridge University Press; 1995:221-87.

Vinik A, Mehrabyan A. Diabetic neuropathies. Med Clin North Am. 2004;88:947-99

Holzer SE, Camerota A, Martens L, Cuerdon T, Crystal-Peters J, Zagari M. Costs and duration of care for lower extremity ulcers in patients with diabetes. Clin Ther. 1998;20:169-81.

Caputo GM, Cavanagh PR, Ulbrecht JS, Gibbons GW, Karchmer AW. Assessment and management of foot disease in patients with diabetes. N Engl J Med. 1994;331:854-60.

American Diabetic Association. Standards of medical care in diabetes-2018. Diabetes Care. 2018; 41:s1-2.

Dyck PJ, Sherman WR, Hallcher LM, Service FJ, O’Brien PC, Grina LA, et al. Human diabetic endoneurial sorbitol, fructose and myoinositol related to sural nerve morphometry. Ann Neurol 1980;8:590-6

Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33:2285-93.

Melmed S, Polonsky KS, Larsen PR, Kronenberg H M. Williams Textbook Of Endocrinology.13th ed:525-35.

International Diabetes Federation. IDF Diabetic Atlas. 7th Edition.

Dutta A, Naorem S, Singh TP, Wangjam K. Prevalence of peripheral neuropathy in newly diagnosed type 2 diabetes mellitus. Int J Diab Dev Countries 2005;25:30-33.

Gill HK, Yadav SB, Ramesh V, Bhatia E. A prospective study of prevalence and association of peripheral neuropathy in Indian patients with newly diagnosed type2 diabetes mellitus. J Postgrad Med. 2014;60:270-5.

Sosale A, Prasanna Kumar KM, Sadikot SM, Nigam A, Bajaj S, Zargar AH, et al. Chronic complications in newly diagnosed patients with Type 2 diabetes mellitus in India. Indian J Endocr Metab. 2014; 18:355-60.

Weerasuriya N, Siribaddana S, Dissanayake A, Subasinghe Z, Wariyapola D, Fernando DJ. Long-term complications in newly diagnosed Sri Lankan patients with type 2 diabetes mellitus. QJM. 1998; 91:439-43.

Spijkerman AM, Dekker JM, Nijpels G, Adriaanse MC, Kostense PJ, Ruwaard D, et al. Microvascular complications at time of diagnosis of type 2 diabetes are similar among diabetic patients detected by targeted screening and patients newly diagnosed in general practice: The Hoorn screening study. Diab Care. 2003;26:2604-8.

Bansal D, Gudala K, Esam HP, Nayakallu R, Vyamusani RV, Bhansali A. Microvascular Complications and Their Associated Risk Factors in Newly Diagnosed Type 2 Diabetes Mellitus Patients. Int J Chron Dis. 2014;1-7

Ratzmann KP, Raschke M, Gander I, Schimke E. Prevalence of peripheral and autonomic neuropathy in newly diagnosed type II (noninsulin-dependent) diabetes. J Diabet Complications 1991;5:1-5

Abbott CA, Garrow AP, Carrington AL, Morris J, Van Ross ER, Boulton AJ; North-West diabetes foot care study. Foot ulcer risk is lower in South-Asian and African-Caribbean compared with European diabetic patients in the U.K.: The North-West diabetes foot care study. Diab Care 2005;28:1869-75.

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Published

2018-05-22

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Original Research Articles