Early detection of peripheral neuropathy and its correlation with retinopathy and HbA1c levels in type 2 diabetes mellitus patients

Abstract

Screening of asymptomatic diabetes mellitus (DM) patients may reduce future complications. Despite having diabetic peripheral neuropathy (DPN), about 50% of type 2 diabetes mellitus (type 2 DM) patients are asymptomatic. If diabetic neuropathy is diagnosed early, the annual cost of treating diabetic neuropathy and associated complications can be decreased. The study objectives are to identify peripheral neuropathy at an early stage and to correlate peripheral neuropathy with diabetic retinopathy and HbA1c (glycated haemoglobin) in asymptomatic type 2 DM patients.: A cross-sectional analytical study was done during July and August 2022 using consecutive sampling on 105 patients who attended the General Medicine out-patient dept (OPD) at Pondicherry Institute of Medical Sciences and the Primary Health Centre (PHC) Kalapet in Puducherry, India. Patients over 18 years old with type 2 DM, who were asymptomatic for peripheral neuropathy, and had their HbA1c levels checked within the last two months were included. Patients have undergone Michigan Neuropathy Screening Instrument (MNSI) examination, biothesiometer and monofilament testing for neuropathy and Fundus examination for retinopathy. The average age of the study participants was 54.7±11.4 yrs, and they had a male-female ratio of 6:4. The retinopathy was present in 18.1% (95% CI:11.9-26.5). The prevalence of DPN by MNSI examination was 3.8% (95% CI:1.5-9.4), monofilament testing was 21.0% (95% CI:14.3-29.7) and biothesiometer was 98.1% (95% CI:93.3-99.5). A statistically significant association between DPN measured by a biothesiometer and HbA1c (p<0.05). There was no significant correlation between DR and HbA1c and between DPN measured by monofilament and HbA1c (p>0.05).The objective assessment by the biothesiometer is the best tool for detecting peripheral neuropathy at an early stage in asymptomatic type 2 DM individuals than monofilament testing.