High prevalence of diagnosed and undiagnosed polyneuropathy in subjects with and without diabetes participating in a nationwide educational initiative (PROTECT study)

Ziegler, Dan; Strom, Alexander; Lobmann, Ralf; Reiners, K.; Rett, K.; Schnell, Oliver

doi:10.1016/j.jdiacomp.2015.09.008

Cited by 42 publications

(35 citation statements)

References 23 publications

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“…Our study confirmed previous literature with >61.5% (72.5%) of our patient population (type 2 diabetes) not having documentation of DPN in referring patient information from their primary physician 15. Additionally, our study uncovers that 53.8% of our patient population did not have documentation of p-DN.…”

Section: Discussionsupporting

confidence: 90%

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Identification, prevalence, and treatment of painful diabetic neuropathy in patients from a rural area in South Carolina

Pruitt¹,

Moracho-Vilrriales²,

Threatt³

et al. 2017

JPR

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Diabetic peripheral neuropathy (DPN) represents significant burdens to many patients and the public health-care system. Patients with diabetes in rural areas have higher risk of developing complications and having less access to proper treatment. We studied a rural population of patients with diabetes who attended a pharmacist-led free clinic for a diabetic education program. Our objectives were to 1) determine the prevalence of DPN and painful diabetic neuropathy (p-DN) in patients with type 2 diabetes; 2) assess the proportion of patients with DPN and p-DN left undocumented upon physician referral to a pharmacist-led free clinic; and 3) determine the appropriateness of pain medication regimen. We performed a retrospective analysis of clinical records of patients from the Presbyterian College School of Pharmacy (PCSP) Wellness Center located in Clinton, SC. Diagnoses of DPN and/or p-DN were obtained from referral notes in the clinical records and compared with results from foot examinations performed in the free clinic and clinical features. Medication regimens were also obtained and compared using American Academy of Neurology (AAN) treatment guidelines. Within our study population (n=111), the prevalence of DPN was 62.2% (national average of 28%–45%) and that of p-DN was 23.4% (national average of 11%–24%). In p-DN patients (n=26), 53.8% (n=14) had a documented diagnosis of p-DN by the referring physician, and 46.2% (n=12) were identified by the pharmacists. A total of 95% (19 of 20) of the patients treated for p-DN received adequate pharmacological agents, though suboptimal as per clinical guidelines. More than 50% of the patients used subtherapeutic doses of their medications. Gabapentin was the most frequently used medication in our population (65.4%). Patients in rural South Carolina had a higher prevalence of DPN and p-DN with >60% undocumented cases of p-DN. More than 95% of treated patients did not receive optimum therapy according to AAN guidelines.

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Section: Discussionsupporting

confidence: 90%

“…In addition, it has been reported that up to 61.5% of patients with type 2 diabetes are not documented as having DPN 15. However, the proportion of undocumented patients with p-DN is not known.…”

Section: Introductionmentioning

confidence: 99%

Identification, prevalence, and treatment of painful diabetic neuropathy in patients from a rural area in South Carolina

Pruitt¹,

Moracho-Vilrriales²,

Threatt³

et al. 2017

JPR

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“…There is increasing evidence that peripheral neuropathy may start as early as during prediabetes [3][4][5][6]. This and the present findings suggest the importance of prompt action, not only for those diagnosed with Type 2 diabetes, but also for those in the prediabetes (IGT) stage [11,32,34].…”

Section: Discussionsupporting

confidence: 63%

“…Peripheral neuropathy is a well-known long-term complication of Type 2 diabetes, occurring in up to 50% of people with Type 2 diabetes [1,2]. Symptoms of neuropathy are often present, even at the time of diagnosis, and affect~8% of people with Type 2 diabetes [1,[3][4][5][6]. Over a third of those with Type 2 diabetes with diabetic sensory-motor polyneuropathy develop neuropathic pain, which significantly impairs their quality of life [1].…”

Section: Introductionmentioning

confidence: 99%

Association between HbA_1c and peripheral neuropathy in a 10-year follow-up study of people with normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes

Peterson¹,

Pingel²,

Lagali³

et al. 2017

Diabet. Med.

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“…Symptoms of neuropathy are often present even at the time of diagnosis. [4,6,7,8,9]. Combined with reduced blood flow, neuropathy in the feet promotes the risk of foot ulcers, infection, and at times even the need for limb amputation [10,11].…”

Section: Introductionmentioning

confidence: 99%

Vibrotactile perception in the sole of the foot in people with normal glucose tolerance and type 2 diabetes

Peterson

Pingel²,

Rolandsson

et al. 2019

Preprint

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AimTo evaluate vibrotactile perception thresholds in people with normal glucose tolerance (NGT) and type 2 diabetes (T2DM) in relation to other sensory tests.MethodsNerve function was evaluated in 36 and 42 participants with NGT and T2DM, respectively [mean age 70.0 (1.2) years; males n=40, females n=38]. The mean duration of T2DM was 12.3 (7.3) years. Vibration perception thresholds were measured at four frequencies (8, 16, 32 and 125 Hz) bilaterally on the sole of the foot at first and fifth metatarsal heads using Multifrequency vibrametry and compared to vibration perception thresholds using Biothesiometer (128 Hz) bilaterally (medial malleolus and distal dorsal bony surface of great toes), touch sensation with Semmes-Weinstein monofilament bilaterally (10 g) at three sites on the sole of foot (distal great toe and 1st and 5th metatarsal heads), electrophysiology (amplitude and conduction velocity of sural nerve; right side) and thermal sensory testing (i.e. small diameter nerve fibers; method of limits using Thermotest®).ResultsVibration perception and temperature thresholds in the foot and sural nerve function were different between the NGT and T2DM categories. Measuring vibration perception thresholds at lower frequencies with Multifrequency vibrametry, compared to Biothesiometer, both provided similar correlations to the amplitude of the sural nerve. Temperature thresholds did also correlate with vibration perception thresholds and with sural nerve function. Only 4/42 participants with T2DM showed pathology by monofilament test, none with NGT.ConclusionsVibration perception thresholds have a fair correlation to amplitude of the sural nerve, even when measured at a non-tactile surface. Thus in the present study, measuring vibration perception threshold at a tactile surface does not seem to provide any clear advantage over the traditional way of measuring vibration perception on the medial malleolus. In people with T2DM, both large and small diameter nerve fibers seem to be affected.

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High prevalence of diagnosed and undiagnosed polyneuropathy in subjects with and without diabetes participating in a nationwide educational initiative (PROTECT study)

Cited by 42 publications

References 23 publications

Identification, prevalence, and treatment of painful diabetic neuropathy in patients from a rural area in South Carolina

Identification, prevalence, and treatment of painful diabetic neuropathy in patients from a rural area in South Carolina

Association between HbA_1c and peripheral neuropathy in a 10-year follow-up study of people with normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes

Vibrotactile perception in the sole of the foot in people with normal glucose tolerance and type 2 diabetes

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High prevalence of diagnosed and undiagnosed polyneuropathy in subjects with and without diabetes participating in a nationwide educational initiative (PROTECT study)

Cited by 42 publications

References 23 publications

Identification, prevalence, and treatment of painful diabetic neuropathy in patients from a rural area in South Carolina

Identification, prevalence, and treatment of painful diabetic neuropathy in patients from a rural area in South Carolina

Association between HbA1c and peripheral neuropathy in a 10-year follow-up study of people with normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes

Vibrotactile perception in the sole of the foot in people with normal glucose tolerance and type 2 diabetes

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Association between HbA_1c and peripheral neuropathy in a 10-year follow-up study of people with normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes