Diagnosing peripheral neuropathy in South‐East Asia: A focus on diabetic neuropathy

Abstract

Burning and stabbing pain in the feet and lower limbs can have a significant impact on the activities of daily living, including walking, climbing stairs and sleeping. Peripheral neuropathy in particular is often misdiagnosed or underdiagnosed because of a lack of awareness amongst both patients and physicians. Furthermore, crude screening tools, such as the 10‐g monofilament, only detect advanced neuropathy and a normal test will lead to false reassurance of those with small fiber mediated painful neuropathy. The underestimation of peripheral neuropathy is highly prevalent in the South‐East Asia region due to a lack of consensus guidance on routine screening and diagnostic pathways. Although neuropathy as a result of diabetes is the most common cause in the region, other causes due to infections (human immunodeficiency virus, hepatitis B or C virus), chronic inflammatory demyelinating polyneuropathy, drug‐induced neuropathy (cancer chemotherapy, antiretrovirals and antituberculous drugs) and vitamin deficiencies (vitamin B1, B6, B12, D) should be actively excluded.

Prevalence and risk factors for diabetic neuropathy and painful diabetic neuropathy in primary and secondary healthcare in Qatar

“…Despite the introduction of national diabetes pathways in Qatar, the present study confirms an alarmingly high prevalence of undiagnosed DPN in PHC and SHC 2,9 . It highlights the considerable need to educate both patients and physicians on DPN and pDPN 41 . This might explain why up to 25% of patients with diabetes in SHC in Qatar have foot problems 16 .…”

Diabetic Sensorimotor Polyneuropathy Severity Classification Using Adaptive Neuro Fuzzy Inference System

“…As we aim for a cost-effective and simple DSPN severity classifier, we need data from a screening method, which is simple, inexpensive, accurate, non-invasive, and does not require expensive instruments or tools. Besides increasing patient's awareness and urgency about the seriousness of DSPN, simple diagnosis tools like a 128-Hz tuning fork, monofilament test and temperature sensation test, reflexes of ankle test are required to be provided to the primary healthcare professionals [38]. So, we have selected Michigan Neuropathy Screening Instrumentation (MNSI) [28] as input to train our DSPN severity classifier using the ANFIS algorithm.…”

Current concepts in the management of diabetic polyneuropathy

“…Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form; it affects approximately 30% of individuals with diabetes and its yearly incidence amounts to approximately 2% 3 . A recent review reported prevalence rates of DSPN in different South-East Asian countries ranging between 33 and 58% among patients with diabetes 4 . A retrospective survey of 1,078 patient records and interviews in primary care clinics in Thailand reported a prevalence of DSPN of 34% among diabetes patients 5 .…”

“…This might be due to a lack of consensus on screening and diagnosis. In most countries, only experts have even simple screening tools, and so many general practitioners do not know how to use them 4 . According to a survey from Thailand, just 45% of patients with diabetes undergo annual foot examinations, which might explain the high frequency of foot ulcers 5,17 .…”

“…In practice, full blood count, creatinine, C‐reactive protein, thyroid‐stimulating hormone, vitamin B 12 , folic acid, liver enzymes and immunoelectrophoresis are vital for differential diagnosis 25 . Finally, causes of polyneuropathy might vary between countries, as well as between urban and rural areas 4 .…”