Profile of Neurological Problems in Diabetes Mellitus: Retrospective Analysis of Data from 1294 Patients

Abstract

Data from 1294 patients with diabetes mellitus admitted to the Endocrinology Department of the Institute of Medical Sciences, Srinagar, Kashmir, from 1986 to 1994, were analyzed for frequency of various neurological problems. Of 1294 patients, 46.29% had clinical evidence of one or more neurological problems. The frequency of neurological problems was significantly more in patients with type II diabetes mellitus (P<0.001). Predominant neurological problems included peripheral neuropathy (96.66%), stroke (5.51%), Parkinsonism (1.50%), seizure disorder (1.17%) and dementia (1% Diabetes mellitus (DM) constitutes a growing concern to the population of the world, predominantly because of the devastating effects of its chronic complications. So common and so definite are the chances of developing certain complications during the course of this "lifelong" disease that some of them have been regarded as "consequences" rather than complications.1 Major long-term complications of diabetes are neuropathy, retinopathy, nephropathy and angiopathy. Peripheral neuropathy (PNP) is the most common chronic complication of diabetes mellitus and can involve almost any peripheral nerve. It is a major cause of morbidity among these patients. 1,2Estimates of prevalence of diabetic PNP vary widely, between 10% to 100%. [2][3][4][5][6] Compared to complications in the peripheral nervous system, long-term diabetic complications in the central nervous system are relatively subtle and occur more frequently than is believed. Diabetes literature is replete with information on the vascular complications of neuropathy, nephropathy, retinopathy, coronary artery disease and peripheral vascular disease, but little information is available on the cerebrovascular disease in diabetic patients. This is surprising because diabetic patients have a two-to sixfold increased risk of thromboembolic strokes than the nondiabetic population, and strokerelated mortality and morbidity are increasing in the diabetic population. [6][7][8][9][10] In this study, we retrospectively analyzed the data from 1294 patients with DM, for various neurological problems (NP), with particular reference to PNP and strokes. This study was conducted with the particular purpose of finding the pattern of NP in the diabetic population in a developing part of the world, where health care systems are nowhere near optimal. Subjects and MethodsThe medical records of 1294 patients with DM admitted to the endocrine division of the Institute of Medical Science (IMS), Srinagar, Kashmir (India), were screened for NP. Out of these, 167 patients had type I DM, 1087 patients had type II DM, and 40 were documented to have fibrocalculous pancreatic diabetes (FCPD). Patients with gestational diabetes, secondary causes of hyperglycemia (i.e., Cushing's syndrome, acromegaly, drugs, etc.) and those whose records were inadequate or diagnosis was not satisfactorily made, were excluded from the study. The definitions and terms used during the analysis of the patient records are as follows: 1) Admission:...

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