The prevalence of and risk factors for diabetic peripheral neuropathy among type 2 diabetic outpatients in Bangladesh
Author: Kjersti Mørkrid
Supervisors: Akhtar Hussain, Liaquat Ali
Aims/hypothesis: The purpose of the study was to estimate the prevalence and risk factors for diabetic peripheral neuropathy (DPN), and additionally, evaluate the sensory and musculoskeletal lower-leg function, in type 2 diabetic outpatients, attending the BIRDEM hospital in Bangladesh.
Materials and methods: Type 2 diabetic outpatients, diagnosed 5-11 years prior the investigation was randomly drawn. The Neuropathy Symptom Score (NSS) and the Neuropathy Disability Score (NDS) was employed to assess DPN. Data about socio-demographic characters, blood pressure, height, weight, waist and hip circumference, and random blood and urine samples were collected. For the lower-leg function evaluation, the plantar cutaneous sensation (Semmer-Weinstein 5.07 g monofilament), 1st MTP and ankle joint rang of motion (ROM) (goniometry) and muscle function (Kendall’s muscle test) in addition to balance (one and two leg static balance, tandem walk) was examined.
Results: Two hundred and ninety four (139 men, 155 women) type 2 diabetic outpatients were studied. The overall DPN prevalence was 19.7 %, male (20.9%) and female (18.7 %). The prevalence rate increased with increasing age (from 11.1% in the 23-40 year-old group to 32.3% in the 60-80 year-old group) and duration of diabetes (from 14.1% in patients with 5 years to 29.2% in patients with 9-11 years duration). Age > 60 years (OR 4.2, 95% CI 1.4 – 12.3), low/normal WHR (OR 3.8, 95%CI 1.6-9.3), treatment with insulin (OR 2.0, 95% CI 1.0-4.0) and income < 800 TK (OR 3.1, 95% CI 1.1-9.3) were independent, statistically significant risk factors for the occurrence of DPN, longer duration of diabetes (OR 1.2, 95% CI 1.0-1.4) and higher HbA1c (OR 1.1, 95% CI 1.0-1.3) were independent, borderline statistically significant risk factors for DPN. The 1st MTP dorsal (p=0.03) and plantar flexion (p=0.003) joint ROM, the Tibialis anterior (p=0.03) and Flexor hallucis (p=0.02) strength, balance (<0.001) and protective sensation (p<0.001) was statistically significant diminished in the DPN group compared to the non-DPN-group. After controlling for age, protective sensation, balance, 1st MTP plantar and dorsal flexion ROM, and Tibialis anterior and Flexor hallucis strength in a multivariate logistic regression model, the DPN-group still had reduced balance (OR 1.4, 95% CI 1.1-1.6), diminished protective sensation (OR2.0, 95% CI 1.5-2.6) and Flexor hallucis weakness (OR 3.2, 95% CI 1.1-9.4).
Conclusions/interpretations: We observed a DPN prevalence of 19.7%. Higher age, low socioeconomic status and treatment with insulin were statistically significant risk factors, while longer duration of diabetes and poor glycemic control were borderline statistically significant risk factors for DPN. The DPN subjects preformed worse on all the lower-leg function tests, especially for the protective sensation and balance test. They may therefore be at high risk for developing foot complications. In societies like Bangladesh, where the resources are scare, the awareness among patients and professionals should be raised. Necessary measures ought to be taken to prevent diabetes complication and secure the quality of care to reduce the burden and costs for both the individual family and the society at large.
Key words: Type 2 diabetes, peripheral neuropathy, risk factors, balance, strength, physical therapy techniques, plantar cutaneous sensation
Financed by: The Institute of General Practice and Community Medicine, University of Oslo||nor