<p>Prevalence and Risk Factors for Diabetic Peripheral Neuropathy Among Saudi Hospitalized Diabetic Patients: A Nested Case-Control Study</p>

Abstract

Objective: To determine the prevalence and the risk factors of diabetic peripheral neuropathy (DPN) in hospitalized adult Saudi diabetics. Methods: This is a retrospective, nested case-control study conducted at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. All diabetic patients admitted to the hospital between the January 1, and December 31, 2018 were considered for inclusion in the study. Patients with DPN were identified and three controls per case were randomly selected from the remaining diabetic patients without peripheral neuropathy (PN). Results: A total of 2,096 adult diabetic patients were identified during the study period. Of these, 73 patients (3.5%) were confirmed to be suffering from DPN and 219 were included as controls. When comparing diabetic with the control cases, DPN cases were significantly older (p=0.002), had a significantly higher proportion of type 2 diabetes (p=0.023), chronic kidney disease (p<0.0001), cerebral vascular stroke (p=0.027), hypertension (p=0.005), dyslipidemia (p=0.002), peripheral vascular disease (p<0.0001), osteoarthritis (p=0.034), diabetic ketoacidosis (p=0.003), foot ulcers (p=0.006), gangrene (p=0.001), lower limb ischemia (p=0.001), increased duration with diabetic disease (p=0.031), increased BMI (p=0.003), higher serum creatinine (p<0.001) and lower serum albumin levels (p=0.035). In the multivariate logistic regression, only older age {odds ratio (OR) 1.02, 95% CI 1.01-1.04, p=0.031}, chronic kidney disease (OR 2.39, 95% CI 1.23-4.64, p=0.010) and peripheral vascular disease (OR 3.14, 95% CI 1.39-7.13, p=0.006) were independently associated with DPN. Conclusion: This study identified several risk factors that contributed to the development of DPN in Saudis. These must be considered in strategies and campaigns aimed at risk reduction of cardiovascular and chronic diseases, and consequently progression of DPN.

The Confusing Tale of Restless Leg Syndrome and Diabetic Neuropathy: A Case-control Study among Patients with Diabetes Mellitus in Tabuk City, Saudi Arabia

“…A recent study was performed among Hospitalized Diabetic Patients in Riyadh, Saudi Arabia and they found that only 3.5% of them had DPN. It is noticed that the reported prevalence of DPN is decreasing throughout the years; this might be due to the increase in the awareness of patients about glycemic control, which is a crucial factor in delaying the rate of development of DPN [21]. However, this disparity in prevalence could be due to the difference in populations and the methods of data collection since some studies have used clinically based methods for the diagnosis, while others like this one have used questionnaire-based methods.…”

“…This might be because the doctors were not aware of the DPN or they have considered it as part of the regular progression and the natural history of diabetes and not as a complication, this might indicate a lack of awareness among doctors about DPN, which will require serious intervention to raise their awareness about this issue. One of the limitations of this study is that it did not investigate the presence of risk factors for DPN among the participants, risk factors such as BMI, poor glycemic control, and other comorbidities (dyslipidemia, peripheral vascular disease, hypertension, and chronic kidney disease), have been significantly associated with DPN [21]. Another limitation is that only a questionnaire-based assessment for DPN was made and was not combined with clinical assessment.…”

Serum Albumin Was Negatively Associated With Diabetic Peripheral Neuropathy in Chinese Population: A Cross-sectional Study

“…Changes of plasma concentration and structural modi cation of albumin induced by high glucose or free radicals impair its antioxidant properties and aggravate oxidative stress [19]. Several previous studies have explored the association of serum albumin with the development of DPN, and provided inconsistent results [12][13][14][15]. Iwasaki et al reported that serum albumin was independently related to the median motor nerve conduction velocity and minimum F-wave latency in 130 Japanese patients with T2DM, and was signi cantly inversely associated with the presence of DPN [12].…”

“…Data from a cross-sectional study of 409 Chinese patients with T2DM underwent measurement of nerve conduction (NC) showed that serum albumin was independently associated with peripheral nerve function as re ected by composite Z scores of all NC parametersin T2DM patients, especially in those with albuminuria [13]. Recently reported data from the Saudi study, which included 2,906 hospitalized adult diabetics, demonstrated that DPN cases had a signi cantly lower serum albumin levels compared with those without DPN [14]. However, no statistically signi cant association between serum albumin and DPN in US patients undergoing foot and ankle surgery with a history of Type 1 and 2 diabetes mellitus over a 13 month period [15].…”

“…There is considerable evidence indicated that serum albumin has a wide range of physiological functions, including antioxidant, anti-in ammatory, anticoagulant, antiplatelet aggregation activity, regulating immune response, preventing endothelial cell, Schwann cells and neuronal apoptosis, dilating blood vessel, protecting against neuronal injury from ischemia and reperfusion, and improving neuronal functional recovery [4][5][6][7][8][9][10][11], suggesting that albumin may confer robust neuroprotection, and lower levels of serum albumin may be involved in the development of DPN. Although few observations have suggested presence of such a link [12][13][14], others have reported the lack of an independent association [15]. Such discrepancy in the literature may be due to differences in study population, diabetic duration, a limitation in the diversity of selected participants, diagnostic methods for DPN, variation in design, limitations in sample size, and a limited range in which serum albumin has been studied.…”