Abstract
Prevalence of diabetes mellitus (DM) has reached epidemic proportions in Sri Lanka. Presently there are studies on the community prevalence of distal peripheral neuropathy (DPN) in Sri Lanka. We describe prevalence, patterns and predictors of DPN in patients with DM in Sri Lanka. Data were collected as part of a national study on DM. In new cases DPN was assessed using the Diabetic-Neuropathy-Symptom (DNS) score, while in those with established diabetes both DNS and Toronto-Clinical-Scoring-System (TCSS) were used. A binary logistic-regression analysis was performed with ‘presence of DPN’ as the dichomatous dependent variable and other independent co-variants. The study included 528 diabetic patients (191-new cases), with a mean age of 55.0 ± 12.4 years and 37.3% were males, while 18% were from urban areas. Prevalence of DPN according to DNS score among all patients, patients with already established diabetes and newly diagnosed patients were 48.1%, 59.1% and 28.8% respectively. Prevalence of DPN in those with established DM as assessed by TCSS was 24% and the majority had mild DPN (16.6%). The remainder of the abstract is based on subjects with established DM. The prevalence of DPN in males and female was 20.0% and 26.4% respectively. The mean age of those with and without DPN was 62.1 ± 10.8 and 55.1 ± 10.8 years respectively (p < 0.001). The majority of those with DPN were from rural-areas (75.3%) and earned a monthly income < Sri Lankan Rupees 12,000 (87.6%). In the binary logistic-regression presence of foot ulcers (OR:10.4; 95%CI 1.8–16.7), female gender (OR:6.7; 95%CI 2.0–9.8) and smoking (OR:5.9; 95%CI 1.4–9.7) were the strongest predictors followed by insulin treatment (OR:4.3; 95%CI 1.3–6.9), diabetic retinopathy (OR:2.7; 95%CI 1.3–5.4), treatment with sulphonylureas (OR:1.8; 95%CI 1.1–3.2), increasing height (OR:1.8; 95%CI 1.2–2.4), rural residence (OR:1.8; 95%CI 1.1–2.5), higher levels of triglycerides (OR:1.6; 95%CI 1.2–2.0) and longer duration of DM (OR:1.2; 95%CI 1.1–1.3). There is a high prevalence of DPN among Sri Lankan adults with diabetes. The study defines the impact of previously known risk factors for development of DPN and identifies several new potential risk factors in an ethnically different large subpopulation with DM.
Highlights
Diabetes mellitus (DM) has reached epidemic proportions worldwide
The present study aims to describe the community prevalence, patterns and predictors of distal peripheral neuropathy among patients with diabetes mellitus in Sri Lanka with a view of identifying differential risk factors, which may lead to improved preventive measures and care for diabetic patients in the South Asia region
Glitazones were used in 4.2%, while insulin was administered in 3.9% of the patients
Summary
Diabetes mellitus (DM) has reached epidemic proportions worldwide. Historically, diabetes was considered a disease confined to developed countries and affluent people. Neuropathy is considered the most common micro-vascular complications of both types 1 and 2 diabetes mellitus [2,3]. Neuropathic disorders in diabetes can impair functioning of the central, peripheral and/or autonomic nervous systems [4]. Distal peripheral neuropathy (DPN), known as diabetic polyneuropathy affects the peripheral nervous system and is by far the most common type of neuropathy seen in DM [5]. A common and important complication of diabetes, neuropathy has not been studied as often or as extensively as macro-vascular complications or retinopathy and nephropathy [7]. The reported prevalence estimates vary widely between countries, in part due to the difference in sampling methods and lack of consensus on diagnostic criteria [8]. The observed variations in prevalence could partly result from ethnic differences in predisposition and differential exposure to risk factors
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