Prevalence and Risk Factors for Diabetic Peripheral Neuropathy among Patients with Type 2 Diabetes in Saudi Arabia: A Cross-sectional Study.

BACKGROUND AND AIMS: Neuropathy is the most prevalent among diabetes-related microvascular complications, of which distal symmetric polyneuropathy is very extensive. This study aimed to evaluate the frequency and risk factors for Diabetic Peripheral Neuropathy (DPN) among Type 2 Diabetes (T2D) in Saudi Arabia. METHODS: This study included 238 patients with T2D, between 18 and 80 years of age. Using a structured questionnaire, data on the sociodemographic characters of the study group and laboratory tests were collected. Distal symmetrical peripheral neuropathy in patients with diabetes was identified using the Michigan Neuropathy Screening Instrument (MNSI). RESULTS: In this cohort, 66 patients (27.7%) had positive MNSI questionnaire scores (≥ 7) and 90 (37.8%) patients had positive examination scores (≥ 2.5). From the patient's perception, patients on oral plus insulin treatment exhibited a higher risk for DPN (OR 2.95; p = 0.018) than those who received only oral treatment and an ulcer in an earlier period exhibited a higher risk for DPN (OR: 3.25; p = 0.005). From the health professionals' perception, more females than males showed a high risk for DPN (OR: 3.92; p = 0004). Likewise, compared to the patients in the age group of <50 years, those in the age group of ≥50 years revealed a high risk for DPN (OR 6.30; p = 0.009). Further, patients on oral and insulin treatments were at greater risk for DPN (OR: 3.71; p = 0.024); patients experiencing complications like prior ulcers, and high-density lipoprotein also exhibited higher risk than the patients who lacked them. CONCLUSION: Diabetes neuropathy is one of the most common complications of microangiopathy experienced by patients with T2D in Saudi Arabia. The risks for DPN among patients with T2D can be reduced with the implementation of focused and evidence-based interventions.

Evaluation of Risk Factors Associated with Diabetic Foot Ulcers in Saudi Arabia.

BACKGROUND AND AIMS: Considering that diabetic foot ulceration is one of the major health issues globally, we aimed to evaluate the risk factors associated with foot ulcers in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 81 T2DM patients (age range: 40-80 years) registered at the Diabetes Treatment Center, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia between April and September 2015 were included in this cross-sectional study after purposive selection and assigning of patient numbers. The selected participants were interviewed and examined, and their medical records were reviewed for sensory, vibratory, and painful neuropathies; vascular insufficiency; retinopathy; and dermatological variations. The Wagner's classification system was employed to evaluate the stage of patients' foot ulcers. RESULTS: Among the study participants [mean age range: 56.4 ± 6.72 years; 53 males (65.4%)], cases of loss of protective sensation, foot deformity, amputation history, and dermatological abnormalities were notable. The Wagner gradation value of ulcers were grade 0 for 16% study population, grade 1 for 35.8%, grade 2 for 45.7%, grade 3 for 2.5%, and grades 4 and 5 for 0%. Approximately 19% of the patients had a previous case of amputation and 29.6% had nail disease. The most common footwear reported to be used by the patients was sandals shoes (46%). CONCLUSION: The issues of loss of protective sensation, vascular insufficiency, deformity, previous amputations, and dermatological abnormalities of the lower limbs were found to be most common among the foot ulceration patients. The study findings thus recommend regular foot examination, following basic hygiene habits, encouragement of the use of appropriate footwear, patient education about foot ulcers, and prompt treatment for minor injuries to prevent further ulceration in DM patients.

Common Pathogens and Antibiotic Sensitivity Profiles of Infected Diabetic Foot Ulcers in Saudi Arabia.

We sought to define the type and antibiotic sensitivity response of pathogens isolated from diabetic foot ulcers based on ulcer location and Wagner classification. This retrospective analysis was done among 126 patients between 40 and 70 years of age at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia, using the swab culture method for microbiological assessment. Data on demographic variables, ulcer sites (location), and depth of ulcer (Wagner classification) were also collected. A total of 134 pathogens were isolated from 126 patients. The most common gram-negative pathogen identified was Pseudomonas aeruginosa (15.6%), followed by Klebsiella spp (6.7%). The most common gram-positive pathogen was Staphylococcus aureus (35%), followed by Streptococcus (8.9%). The most widely accepted antibiotic to which the gram-negative bacteria were sensitive was gentamycin (20.1%), followed by ciprofloxacin (19%). The most routinely used antibiotic in the treatment of the gram-positive bacteria was erythromycin (16%), with trimethoprim-sulfamethoxazole (14.1%) being the next most effective. In conclusion, Pseudomonas aeruginosa, Klebsiella spp, Staphylococcus aureus, and Streptococcus were the most common causes of diabetic foot infections. However, the frequency of encountered pathogens and respective sensitivity to antibiotic therapy may be influenced by the location site and severity of the ulceration.