The Prevalence of Symptomatic, Diabetic Neuropathy in an Insulin-treated Population

Boulton, Andrew J.M.; Knight, Graham; Drury, John H.; Ward, John D.

doi:10.2337/diacare.8.2.125

Cited by 150 publications

(51 citation statements)

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“…One such study reported that about 20 % of diabetic patients had symptomatic neuropathy; however, about 50 % were found to have objective evidence of diabetic polyneuropathy [17]. Our results confirm the well-established correlations between the prevalence of neuropathy and age [9,[18][19][20], duration of diabetes [9,[18][19][20][21], and metabolic control [9,20,21]. Significant associations have also been reported with height [5,22,23], cigarette smoking [9], the presence of retinopathy [9,21], both background and proliferative, and reduced levels of HDL-cholesterol [9].…”

Section: Discussionsupporting

confidence: 88%

Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study

et al. 1996

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No diabetes physician would question the fact that problems relating to nerve damage in diabetes mellitus are extremely common and result in much patient morbidity and unhappiness [1]. However, as the cause and natural history of diabetic peripheral neuropathy remain unknown, attempts at defining minimal criteria for the presence of neuropathy have proved difficult [2]. This is probably the most important reason for the widely varied estimates of the prevalence of diabetic peripheral neuropathy. Other factors include differing patient selection criteria, the small size of cohorts and the employment of different diagnostic tests. Some studies have used the presence of neuropathic symptoms [3] alone for the diagnosis of neuropathy while others have used both symptoms and signs of neuropathy as minimal criteria for diagnosis [4,5]. The San Antonio Conference on Diabetic Neuropathy [6] recommended that for full classification of diabetic neuropathy, at least one measure from each of the following categories need Diabetologia (1996) Summary The EURODIAB IDDM Complications Study involved the examination of 3250 randomly selected insulin-dependent diabetic patients, from 31 centres in 16 European countries. Part of the examination included an assessment of neurological function including neuropathic symptoms and physical signs, vibration perception threshold, tests of autonomic function and the prevalence of impotence. The prevalence of diabetic neuropathy across Europe was 28 % with no significant geographical differences. Significant correlations were observed between the presence of diabetic peripheral neuropathy with age (p < 0.05), duration of diabetes (p < 0.001), quality of metabolic control (p < 0.001), height (p < 0.01), the presence of background or proliferative diabetic retinopathy (p < 0.01), cigarette smoking (p < 0.001), high-density lipoprotein cholesterol (p < 0.001) and the presence of cardiovascular disease (p < 0.05), thus confirming previous associations. New associations have been identified from this study -namely with elevated diastolic blood pressure (p < 0.05), the presence of severe ketoacidosis (p < 0.001), an increase in the levels of fasting triglyceride (p < 0.001), and the presence of microalbuminuria (p < 0.01). All the data were adjusted for age, duration of diabetes and HbA 1c . Although alcohol intake correlated with absence of leg reflexes and autonomic dysfunction, there was no overall association of alcohol consumption and neuropathy. The reported problems of impotence were extremely variable between centres, suggesting many cultural and attitudinal differences in the collection of such information in different European countries. In conclusion, this study has identified previously known and new potential risk factors for the development of diabetic peripheral neuropathy. [Diabetologia (1996[Diabetologia ( ) 39: 1377[Diabetologia ( -1384

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Section: Discussionsupporting

confidence: 88%

Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study

et al. 1996

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“…In the absence of a precise agreed definition of diabetic neuropathy, comparison of the prevalence of the condition between different epidemiological studies is difficult, although most definitions based on clinical features are similar [22]. Our data confirms the association of diabetic polyneuropathy with age and duration of diabetes [23], and highlights a strong relation with glycaemic control independent of diabetes duration.…”

Section: Discussionsupporting

confidence: 76%

Microvascular and acute complications in IDDM patients: the EURODIAB IDDM Complications Study

Steph¹

1994

Diabetologia

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SummaryThe prevalence of microvascular and acute diabetic complications, and their relation to duration of diabetes and glycaemic control were examined in a cross-sectional study of 3250 IDDM patients in Europe (EURODIAB IDDM Complications Study). Mean (SD) duration of diabetes was 14.7 (9.3) years. HbAlo and AER were measured centrally. Retinopathy was assessed by centrally graded retinal photography. Autonomic neuropathy was measured by heart rate and blood pressure responses to standing up. Sensory neuropathy was measured by biothesiometry. Normal HbAlc was found in 16 % of patients. An AER of 20 gg/min or higher was found in 30.6 % (95 % CI 29.0 %, 32.2 %) of all patients, and 19.3 % (15.6 %, 23.0 % ) of those with diabetes for 1 to 5 years. The prevalence of retinopathy (46 % in all patients; 82 % after 20 or more years) was substantially lower than in comparable studies. Of all patients 5,9% (5.1%, 6.7%) had postural hypotension, 19.3% (17.9 %, 20.7 %) had abnormal heart rate variability, 32.2 % (30.6 %, 33.8 9/o) reported one or more severe hypoglycaemic attacks during the last 12 months and 8.6% (7.6%, 9.6%) reported hospital admission for ketosis over the same period. Microvascular and acute complications were clearly related to duration of diabetes and to glycaemic control. However, the relation of glycaemic control to raised albuminuria differed qualitatively from its relation to retinopathy. [Diabetologia (1994)

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“…The diagnostic procedures used in studies of DPN have included assessment of symptoms alone [8] or signs alone [22], quantitative sensory tests [23], and various combinations of these methods: symptoms and signs [6,9,10]; signs and electrophysiological tests [14]; symptoms, signs and electrophysiological test [11,13]; and symptoms, signs, electrophysiological tests and quantitative sensory tests [24,25]. This variety of methods has contributed to discrepancies among the results.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of clinical diabetic polyneuropathy in Spain: a study in primary care and hospital clinic groups

Cabezas-Cerrato

1998

Diabetologia

171

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In Spain, as in other industrialised nations, diabetes, with an estimated prevalence of 3.7 % [1, 2], constitutes a major cause of suffering and a major burden on the health system. In both cases, it is the specific complications of diabetes that are chiefly to blame. As an aid to managing health resources, we have therefore studied the prevalence of diabetic polyneuropathy among Spanish diabetic patients.Previous studies of the prevalence of diabetic polyneuropathy [3±14] had widely differing results. This was attributable to differences in the kind of patient sample (most samples were recruited in specialised centres); to whether or not the neurological effects of ageing were taken into account; and to study or diagnostic methods and criteria or both (studies differed as to whether they included neurophysiological tests in the diagnostic protocol; target- Diabetologia (1998)

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The Prevalence of Symptomatic, Diabetic Neuropathy in an Insulin-treated Population

Cited by 150 publications

References 0 publications

Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study

Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study

Microvascular and acute complications in IDDM patients: the EURODIAB IDDM Complications Study

The prevalence of clinical diabetic polyneuropathy in Spain: a study in primary care and hospital clinic groups

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