Abstract
AimWe aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a low-middle income country setting.MethodsCross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (<10 vs. ≥10 years), glycaemic control (HbA1c <7% vs. ≥7%), microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios.ResultsDPN was observed in 73/129 (56.6%) patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07–1.88) in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02–1.93) in patients with ≥10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p<0.001), onychomycosis (p = 0.012), abnormal Achilles reflex (p<0.001), pain perception (p<0.001) and vibration perception (p<0.001).ConclusionDPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin
Highlights
Type-2 diabetes mellitus (T2DM) constitutes a major challenge in low-middle income countries (LMIC): only 3.6% of patients in Latin America achieve the three American Diabetes Association (ADA) recommended targets for blood pressure, LDL cholesterol, and HbA1C [1]. This demonstrates that a significant gap between recommended diabetes care and the care patients receive exists in LMIC
The primary objective of the study was to determine the prevalence of diabetic peripheral neuropathy (DPN) in ambulatory patients in a general national hospital in an LMIC setting and the secondary objective was to explore associated factors for DPN in this population
Ethics Statement Hospital Nacional Cayetano Heredia’s (HNCH) Ethics Committee approved the study protocol and written informed consent was obtained from all participants
Summary
Type-2 diabetes mellitus (T2DM) constitutes a major challenge in low-middle income countries (LMIC): only 3.6% of patients in Latin America achieve the three American Diabetes Association (ADA) recommended targets for blood pressure, LDL cholesterol, and HbA1C [1]. This demonstrates that a significant gap between recommended diabetes care and the care patients receive exists in LMIC. Prior to assessing appropriate methods to diagnose and prevent these complications, it is necessary to better understand the prevalence and characterize associated risk factors in our population. The primary objective of the study was to determine the prevalence of DPN in ambulatory patients in a general national hospital in an LMIC setting and the secondary objective was to explore associated factors for DPN in this population
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