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.
ABSTRACT
Peripheral neuropathy is highly associated with foot complications among diabetics. This study aimed to identify risk factors associated with the development of peripheral neuropathy in diabetic patients and their association with degree of severity of peripheral neuropathy. A cross-sectional study was conducted in follow-up clinics at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia involving 72 diabetic patients and 19 controls. Exclusion criteria were those with amputated limbs, gross foot deformity and existing peripheral neuropathy. Controls were non diabetics who walked normally, had no history of foot problem and attended the clinic as subjects’ companion. Quantitative assessment of neuropathy was done using Semmes-Weinstein monofilament. Neuropathy Disability Score (NDS) were used to quantify severity of diabetic neuropathy. Spearman’s Rank test and Mann-Whitney test were used to determine correlation between variables and their differences. Logistic regression analysis was used to determine risk factors associated with peripheral neuropathy. The mean HbA1c among diabetics was 8.6% + 4.1, and mean NDS was 7.0 + 6.0. A total of 79.1% demonstrated various level of neuropathy with presence of callus was associated with higher NDS scores. Older age (P=0.02), body weight (P=0.03), HbA1c (P=0.005) and duration of diabetes (P <0.005) showed positive correlation with NDS. Proper foot care program for diabetics should include recognition of the callus, with special emphasis given to those with heavier weight and increasing age.
ABSTRACT
BACKGROUND: The neuropathy disability score (NDS) is a type of clinical grading method for diabetic polyneuropathy. In clinical practice, a nerve conduction study (NCS) is routinely employed as a non-invasive test for the evaluation of polyneuropathy. However, the consensus regarding the degree of abnormalities in NCS as a parameter for the severity of the disease is lacking. The objective of our study is to assess the relation between NDS and NCS parameters and thus verifying the reliability of our new NCS grading method in the representation of objective neurological defects. METHODS: Seventy three patients (man 31, women 42) with diabetes mellitus were included in the study. The NDS was scored in each patient by a single examiner and a NCS was performed on one side of extremities by an experiencedtechnician. Also, the gastrocnemius-soleus H-reflex was performed and analysed for the representation of a deep tendon reflex. The observed values of CMAP and CNAP were transformed into square root and log values. The transformed individual amplitudes and nerve conduction velocities were graded in relation to the mean normal values and standard deviations of our control group study. Then, the sum of the graded score was calculated in each individual and was correlated to the NDS using correlational analysis. RESULTS: There has been a significant linear relationship between NDS and our new NCS scoring system (Pearson's correlation coefficient r=0.703, p<0.01) CONCLUSIONS: The study showed significant correlations between NDS and our new grading system for NCS. Thus, NCS appears to reliably represent theobjective neurologic findings. In asddition, the quantititive grading of NCS would be useful in determining the grade of peripheral polyneuropathy in diabetic patients.