The prevalence, patterns and predictors of diabetic peripheral neuropathy in a developing country.

This abstract shows that in Asian countries neuropathy is common in diabetes.

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.

Diabetic foot Wound care / debridement

Wound care in diabetic foot :
Attention to the minor details of the foot care can avoid the major complications. Careful paring of the nails, skin care, callus excision (by professionals), moisturizing cream application are known to avoid the major complications. In one of the recent meetings conducted at NIMS ( by vascular surgery, Diabetes departments) the importance of team work and foot care has been explained to doctors who came neighboring districts and states. Practical demonstration of the Excision of the calluses using oranges and sharp blade. The orange peel is comparable to the the plantar skin of foot. Neuropathic ulcers with excessive callus around them heal much faster and safely after adequate removal of the thickened skin (Callus) around the wounds.
( Photograph: Participating team of doctors who are providing care to the diabetic foot patients in NIMS)

Pinjala R K

Diabetic Foot

The feet in Diabetic persons need special attention to avoid the trauma, infection, ulceration, gangrene and amputation. The protective sensations in the foot are diminished due to peripheral neuropathy ( Nerve damage). At the same time the circulation to the foot is also diminished due to thickening and calcification of the arterial walls in the leg. That means diminished sensations (pumbness)results in frequent trauma which is often neglected (due to lack of pain)the resulting wounds fail to heal due to the diminished blood supply. The end result is wound which gets infected by multiple organisms. These infections are initially easily controlled but later the resistant organisms start colonizing the wounds. They spread proximally and produce infective gangrene which forces us to consider an amputation. In 80% of the diabetic patients who are loosing the legs there is a history of trauma as precipitating factor and could have been avoided by simple protective and preventive measures. So, protection feet and prevention of injury is the primary responsibility of the people to avoid the complications of diabetic foot which can lead to disability even after excellent treatments.

by
Pinjala R K