Prevalence and management of diabetic neuropathy in secondary care in Qatar

Ponirakis, Georgios; Elhadd, Tarik; Chinnaiyan, Subitha; Dabbous, Zeinab; Siddiqui, Mashhood; Almuhannadi, Hamad; Petropoulos, Ioannis N.; Khan, Adnan; Ashawesh, Khaled; Dukhan, Khaled; Mahfoud, Ziyad; Murgatroyd, Chris; Slevin, Mark; Malik, Rayaz A.

doi:10.1002/dmrr.3286

Cited by 28 publications

(24 citation statements)

References 49 publications

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“…However, screening annually for symptoms and signs of DPN starting at diagnosis of type 2 diabetes is advocated on the basis that early management of risk factors for DPN might reduce the rate of disease progression, and treatment to relieve neuropathic symptoms might improve the patient's quality of life 1 . We have recently assessed the prevalence of DPN and pDPN in SHC in Qatar 2,9 . This is the first study to compare the prevalence of DPN and pDPN in PHC and SHC using the same criteria and in the same population.…”

Section: Discussionmentioning

confidence: 99%

“…Early diagnosis and management of DPN might limit or reduce disease progression 1 . However, screening for DPN and pDPN is inadequate [7][8][9] . The prevalence of DPN and pDPN have been shown to range from 2.4 to 24.1% 10,11 and 16 to 19% 12,13 in primary care, and 32.1 14 and 21.0% 15 in secondary care in patients with type 2 diabetes, respectively.…”

Section: Introductionmentioning

confidence: 99%

“…This wide range has been attributed to differing populations and methods used to identify DPN and pDPN. We have recently reported that approximately 80% of patients with DPN 9 and pDPN 2 have not previously been diagnosed in hospital clinics in secondary health care (SHC) in Qatar, which might lead to late presentation with DFU. Indeed, in Qatar it has been reported that 25% of patients with diabetes in SHC have foot problems 16 .…”

Section: Introductionmentioning

confidence: 99%

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

Ponirakis

Elhadd

Chinnaiyan

et al. 2020

J of Diabetes Invest

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Aims/Introduction: This study determined the prevalence and risk factors for diabetic peripheral neuropathy (DPN) and painful DPN (pDPN) in patients with type 2 diabetes in primary healthcare (PHC) and secondary healthcare (SHC) in Qatar. Materials and Methods: This was a cross-sectional multicenter study. Adults with type 2 diabetes were randomly enrolled from four PHC centers and two diabetes centers in SHC in Qatar. Participants underwent assessment of clinical and metabolic parameters, DPN and pDPN. Results: A total of 1,386 individuals with type 2 diabetes (297 from PHC and 1,089 from SHC) were recruited. The prevalence of DPN (14.8% vs 23.9%, P = 0.001) and pDPN (18.1% vs 37.5%, P < 0.0001) was significantly lower in PHC compared with SHC, whereas those with DPN at high risk for diabetic foot ulceration (31.8% vs 40.0%, P = 0.3) was comparable. The prevalence of undiagnosed DPN (79.5% vs 82.3%, P = 0.66) was comparably high, but undiagnosed pDPN (24.1% vs 71.5%, P < 0.0001) was lower in PHC compared with SHC. The odds of DPN and pDPN increased with age and diabetes duration, and DPN increased with poor glycemic control, hyperlipidemia and hypertension, whereas pDPN increased with obesity and reduced physical activity. Conclusions: The prevalence of DPN and pDPN in type 2 diabetes is lower in PHC compared with SHC, and is attributed to overall better control of risk factors and referral bias due to patients with poorly managed complications being referred to SHC. However, approximately 80% of patients had not been previously diagnosed with DPN in PHC and SHC. Furthermore, we identified a number of modifiable risk factors for PDN and pDPN.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ponirakis

Elhadd

Chinnaiyan

et al. 2020

J of Diabetes Invest

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“…In the KORA F4 survey, 77% of participants with diabetes and DSPN were unaware of having the disorder, and approximately one-quarter of the participants with known diabetes had never undergone a foot examination 8 . In a survey including 1,082 participants with type 2 diabetes attending two national diabetes centers in Qatar, 82% of patients with PDPN had not previously been diagnosed or treated for this condition 25 . In a study from Japan, physicians were aware of PDPN in just 36% of patients with the disorder 11 .…”

Section: Discussionmentioning

confidence: 99%

Polyneuropathy is inadequately treated despite increasing symptom intensity in individuals with and without diabetes (PROTECT follow‐up study)

Ziegler

Landgraf

Lobmann

et al. 2020

J of Diabetes Invest

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Aims/Introduction Despite its major clinical impact, distal symmetric polyneuropathy remains frequently undiagnosed and undertreated in clinical practice. We previously reported in the PROTECT Study that 70% of type 2 diabetes patients with distal symmetric polyneuropathy were unaware of having the latter condition. Materials and Methods In the present follow up after 2.5 ± 0.7 years, 122 and 85 participants with and without type 2 diabetes, respectively, completed questionnaires to obtain information about the further course of disease and its management. Results At follow up, 49 and 48% of the respondents with type 2 diabetes and without diabetes, respectively, reported that the intensity of paresthesia or numbness in the feet increased, whereas for burning and pain in the feet the corresponding percentages were 56 and 61%. However, 33 and 40% of the respondents with type 2 diabetes and without diabetes, respectively, reporting neuropathic symptoms at follow up did not receive any pharmacotherapy. Pharmacotherapy of neuropathic symptoms at follow up among participants with type 2 diabetes and without diabetes included mainly World Health Organization Step 1 analgesics (17% each; excluding acetylsalicylic acid), pregabalin/gabapentin (20 and 12%), vitamin B complex (13 and 22%), benfotiamine (13 and 2%), opioids (7 and 12%), antidepressants (4 and 5%) and α‐lipoic acid (4 and 2%). Conclusions These findings point to insufficient care, inadequate treatment adherence or limited efficacy of treatments in patients with polyneuropathy, suggesting that effective measures should be implemented to correct these healthcare deficits.

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“…This indicates that hyperglycemia is less important to the development of DPN in T2D patients and that other mechanisms may be involved in disease progression. Studies have shown that the prevalence of DPN increases with obesity, dyslipidemia, hypertension, and hyperglycemia [ 5 – 7 ]. However, it is still unclear which of these components contribute to the onset and progression of DPN.…”

Section: Introductionmentioning

confidence: 99%

Insulin Treatment Attenuates Small Nerve Fiber Damage in Rat Model of Type 2 Diabetes

ANDREASEN

Kirk

Fledelius

et al. 2020

Journal of Diabetes Research

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Introduction. Current clinical guidelines for management of diabetic peripheral neuropathy (DPN) emphasize good glycemic control. However, this has limited effect on prevention of DPN in type 2 diabetic (T2D) patients. This study investigates the effect of insulin treatment on development of DPN in a rat model of T2D to assess the underlying causes leading to DPN. Methods. Twelve-week-old male Sprague-Dawley rats were allocated to a normal chow diet or a 45% kcal high-fat diet. After eight weeks, the high-fat fed animals received a mild dose of streptozotocin to induce hyperglycemia. Four weeks after diabetes induction, the diabetic animals were allocated into three treatment groups receiving either no insulin or insulin-releasing implants in a high or low dose. During the 12-week treatment period, blood glucose and body weight were monitored weekly, whereas Hargreaves’ test was performed four, eight, and 12 weeks after treatment initiation. At study termination, several blood parameters, body composition, and neuropathy endpoints were assessed. Results. Insulin treatment lowered blood glucose in a dose-dependent manner. In addition, both doses of insulin lowered lipids and increased body fat percentage. High-dose insulin treatment attenuated small nerve fiber damage assessed by Hargreaves’ test and intraepidermal nerve fiber density compared to untreated diabetes and low-dose insulin; however, neuropathy was not completely prevented by tight glycemic control. Linear regression analysis revealed that glycemic status, circulating lipids, and sciatic nerve sorbitol level were all negatively associated with the small nerve fiber damage observed. Conclusion. In summary, our data suggest that high-dose insulin treatment attenuates small nerve fiber damage. Furthermore, data also indicate that both poor glycemic control and dyslipidemia are associated with disease progression. Consequently, this rat model of T2D seems to fit well with progression of DPN in humans and could be a relevant preclinical model to use in relation to research investigating treatment opportunities for DPN.

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Prevalence and management of diabetic neuropathy in secondary care in Qatar

Cited by 28 publications

References 49 publications

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

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

Polyneuropathy is inadequately treated despite increasing symptom intensity in individuals with and without diabetes (PROTECT follow‐up study)

Insulin Treatment Attenuates Small Nerve Fiber Damage in Rat Model of Type 2 Diabetes

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