Diabetic neuropathy, foot ulceration, peripheral vascular disease and potential risk factors among patients with diabetes in Bahrain : A nationwide primary care diabetes clinic-based study

Abstract

BACKGROUNDAlthough epidemiological studies have persistently shown a high prevalence of diabetes in Arabs, the control of diabetes is still poor and complications of diabetes are common. We examined the prevalence of diabetic peripheral neuropathy (DN), neuropathic foot ulceration (FU) and peripheral vascular disease (PVD), and potential risk factors for these complications among patients attending primary care diabetes clinics in Bahrain.PATIENTS AND METHODSWe studied 1477 diabetic patients (Type 2 diabetes 93%); to, including 635 men and 842 women, with ages ranging from 18–75 years in a cross-sectional study. The main predictor variables were demographic and clinical data, including assessment of foot and blood parameters.RESULTSMean age of the patients and duration of diabetes were 57.3±6.32 and 9.5±8.4 years, respectively. DN was present in 36.6% of the population, FU in 5.9%, and PVD in 11.8%. Diabetic patients with neuropathy were older than patients without neuropathy (P=0.001) and had had diabetes longer (P=0.002). Diabetic patients with foot ulcers had more severe neuropathy and higher vibration perception thresholds values than patients without foot ulcers (P<0.05). Older age, poor glycemic control, longer duration of diabetes, elevated cholesterol levels, current smoking, obesity defined by body mass index, large waist circumference, elevated triglycerides levels and hypertension but not gender, were significant risk factors for DN in both the univariate and the multivariate analyses (P< 0.05). DN and PVD also remained significant risk factors for foot ulceration in the multiple logistic regression analysis.CONCLUSIONRates of DN and PVD are high among diabetic patients in Bahrain. Implementation of strategies for prevention, early detection, and appropriate treatment at the primary health care level are urgently needed.

Risk Factors for Early Development of Polyneuropathy Among Type Ii Diabetic Patients.

“…The result of the study showed that, there were significant correlation between poor glycemic control (high HbA1c level) and development of DPN, that agree with several studies as 32,43,44 they reported that, among adults with diabetes, the progression of PN can be slowed when glycemic state is controlled. In the European Diabetes Perspective Complications Study, the rate of deterioration of glycemic control contributed markedly to the risk of neuropathy, independently of the glycosylated hemoglobin value at baseline 37,45 suggested that modest levels of moderate-to-vigorous intensity physical activity, coupled with glycemic control (via physical activity, diet, and/or medication), may help prevent or slow the progression of diabetic end-organ damage, particularly diabetic neuropathy.…”

“…Proposed mechanisms for this nerve damage include fat deposition, extracellular protein glycation, mitochondrial dysfunction, oxidative stress and activation of counter-regulatory signaling pathways leading to chronic metabolic inflammation 13,42 . As regard to serum cholesterol, the result of the study showed that, there were significant correlation between serum cholesterol and development of DPN and insignificant with serum triglyceride that agree with several studies as [30][31][32][33][34] .…”

“…Regarding to hypertension, the result of the study showed that there was significant correlation between hypertension and early development of DPN that supported by several studies [31][32][33][34][35][36][37] . In rodents, the additive effect of hypertension on diabetic neuropathy was attributed to damages in Schwann cells and myelin sheaths around exons.…”

“…Height may act in concert with poor glycemic control, which is postulated to contribute to capillary basement membrane thickening, possibly due to greater pressure and decreased capillary blood flow in the lower extremities 40,41 . As regard to BMI, the result of the study showed that, there were significant correlation between BMI and development of DPN that supported by several studies [30][31][32][33][34] . The metabolic syndrome and obesity are risk factor of neuropathy.…”

“…Our study showed that he development of DPN was early among smoker patients than non-smokers without significant difference. 30 reported that smoking isn't risk factor for DPN while [31][32][33][34] reported that smoking is risk factor for DPN.…”