Peripheral Neuropathy In People Research Articles

Socioeconomic deprivation independently predicts symptomatic painful diabetic neuropathy in type 1 diabetes

IntroductionPainful peripheral neuropathy in people with type 1 diabetes is a disabling and costly complication. A greater understanding of predisposing factors and prescribing may facilitate more effective resource allocation. MethodsThe Townsend index of deprivation (numerically higher for greater disadvantage) was examined in the pseudonymised records of 1621 (684 females) individuals with type 1 diabetes and related to prevalence of drug treated severe diabetes related neuropathic pain. ResultsTreatment for neuropathic pain was initiated in 280 patients, who were older at 57.1 vs 45.6 years and had greater BMI (29.8 vs 27.8kg/m2; p<0.0001). HbA1C was similar between groups, whilst eGFR was lower in the neuropathic pain group.Amitriptyline was the most commonly prescribed agent (46.8% of total prescriptions). Duloxetine (60mg daily) was prescribed in 9.3% of cases.There were significant differences between the groups for the Townsend index, with a greater proportion (34.3% vs 21.7%) of patients with treated neuropathic pain having a score of ≥1 (X2=19.9, p<0.001).Multivariate logistic regression analyses indicated that each unit increment in Townsend index was associated with a 11% increased odds of requiring neuropathic pain treatment [odds ratio (95% CI) 1.11 (1.05–1.17), p<0.001]. This was independent of age: 1.04 (1.02–1.05), BMI: 1.03 (1.01–1.05), HbA1C: 1.15 (1.05–1.24), male gender: 0.74 (0.55–0.98), systolic BP and eGFR. Inclusion of depression and mixed anxiety/depressive disorder did not change the risk estimates. ConclusionAmitriptyline was the most commonly used agent for treatment of diabetes related neuropathic pain with Duloxetine much less used.A higher level of socioeconomic deprivation may predispose to severe neuropathic pain in diabetes. Differential allocation of resources may benefit this group.

Cardiovascular Risk Factors Predicting the Development of Distal Symmetrical Polyneuropathy in People with Type 1 Diabetes

The aim of the article was to use prospectively collected data on people with type 1 diabetes to examine which routinely collected clinical measures predict the development of peripheral neuropathy in people with type 1 diabetes. Within the Newcastle Diabetes Services, structured data collection at an annual review has been collected since 1985. This includes metabolic measures, cardiovascular risk factors, and markers of complications. From 1990 data collection was standardized and computerized. For this study, all people with type 1 diabetes in the database in both 1992 and 2001 were ascertained. Data were extracted for a diagnosis of peripheral neuropathy (based on neuropathic symptoms, absence of pinprick sensation, and abnormal biothesiometer measurements and/or monofilament sensation) and for the other metabolic and cardiovascular risk measures, as well as markers of other microvascular complications. Associations with the development of neuropathy were sought. Eighteen of 404 people already had peripheral neuropathy in 1992, and 38 others developed neuropathy during follow-up. People who developed neuropathy were older (47 +/- 14 [SD] versus 36 +/- 11 years; P = 0.000), had longer-duration of diabetes (27 +/- 13 versus 18 +/- 10 years; P = 0.001), higher baseline serum cholesterol (5.8 +/- 1.3 versus 5.2 +/- 1.2 mmol/L, P = 0.017), and higher systolic (139 +/- 18 versus 129 +/- 20 mmHg; P = 0.003) and diastolic BP (82 +/- 12 versus 76 +/- 11 mmHg; P = 0.009) than those who remained free of neuropathy. We found no significant difference for BMI and glycated hemoglobin. The multivariate model showed that diastolic BP, duration of diabetes, serum cholesterol, and history of callus/ulcers on the feet predicted the development of peripheral neuropathy. Neuropathy developed in 11.4% of people with type 1 diabetes over a 9-year follow-up, and was predicted by factors normally associated with cardiovascular rather than microvascular disease.