Prevalence and Determinants of Peripheral Neuropathy Among Diabetes Mellitus Patients in a Rural Area of Salem District, Tamil Nadu

Shini Preetha  Nirmalson; Vijayakarthikeyan M; MD Thenmozhi

doi:10.55489/njcm.160520254962

Authors

Shini Preetha Nirmalson Department of Community Medicine, Vinayaka Mission’s Kirupananda Variyar Medical College and Hospitals, Salem, Affiliated to Vinayaka Missions Research Foundation (VMRF) deemed to be University, Salem, India
Vijayakarthikeyan M Department of Community Medicine, Vinayaka Mission’s Kirupananda Variyar Medical College and Hospitals, Salem, Affiliated to Vinayaka Missions Research Foundation (VMRF) deemed to be University, Salem, India
MD Thenmozhi Department of Plastic Surgery, Government Mohan Kumaramangalam Medical College and Hospital, Salem, Affiliated to The Tamil Nadu Dr. M.G.R. Medical University, Salem, India

DOI:

https://doi.org/10.55489/njcm.160520254962

Keywords:

Deformity, Pain, DPN, Hyperglycemia

Abstract

Background: One of the most prevalent side effects of diabetes mellitus is diabetic peripheral neuropathy (DPN), affecting half of them. Early detection and treatment of DPN are essential in rural areas with limited access to healthcare. The objectives of the study are twofold: first, to estimate the prevalence of peripheral neuropathy among diabetes mellitus patients, and second, to identify the variables that influence the development of peripheral neuropathy.

Materials and Methods: It is a community based cross-sectional analytical study with 350 samples chosen by simple random sampling method. Michigan Neuropathy Screening Instrument (MNSI) history and physical examination version was used to evaluate DPN, and Biothesiometer findings were used to score the severity of DPN. Data analysis was done with SPSS Version 22.

Results: DPN was present in 22.1% (MNSI history) and 38.6% (MNSI physical exam) of samples. Biothesiometer testing showed mild, moderate, and severe DPN in 16.5%, 9.5%, and 12.6%, respectively. Male gender, diabetes duration >5 years, uncontrolled blood sugar, and hypertension were significant risk factors.

Conclusion: Regular screening of DPN at the time of diagnosis and follow up must be undertaken as a routine practice to be integrated in the health system. Diabetic individuals must be urged to inculcate foot care and other self-care practices as a routine habit.

References

Kamalarathnam SR, Varadarajan S. Diabetic peripheral neuropathy in diabetic patients attending an urban health and training centre. Journal of Family Medicine and Primary Care. 2022 Jan;11(1):113-117. DOI: https://doi.org/10.4103/jfmpc.jfmpc_470_21 PMid:35309653 PMCid:PMC8930172

Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-154. DOI: https://doi.org/10.2337/dc16-2042 PMid:27999003 PMCid:PMC6977405

Albers JW, Pop-Busui R. Diabetic neuropathy: mechanisms, emerging treatments, and subtypes. Curr Neurol Neurosci Rep. 2014;14(8):473. DOI: https://doi.org/10.1007/s11910-014-0473-5 PMid:24954624 PMCid:PMC5084622

Dyck PJ, Albers JW, Andersen H, Arezzo JC, Biessels GJ, Bril V, et al. Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity. Diabetes Metab Res Rev. 2011;27(7):620-8. DOI: https://doi.org/10.1002/dmrr.1226 PMid:21695763

Sun J, Wang Y, Zhang X, Zhu S, He H. Prevalence of peripheral neuropathy in patients with diabetes: A systematic review and meta-analysis. Primary care diabetes. 2020 Oct 1;14(5):435-44. DOI: https://doi.org/10.1016/j.pcd.2019.12.005 PMid:31917119

Hicks CW, Selvin E. Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Current diabetes reports. 2019 Oct;19(10):1-8. DOI: https://doi.org/10.1007/s11892-019-1212-8 PMid:31456118 PMCid:PMC6755905

Tesfaye S, Vileikyte L, Rayman G, Sindrup SH, Perkins BA, Baconja M, Vinik AI, Boulton AJ, Toronto Expert Panel on Diabetic Neuropathy. Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management. Diabetes/metabolism research and reviews. 2011 Oct;27(7):629-38. DOI: https://doi.org/10.1002/dmrr.1225 PMid:21695762

American Diabetes Association. 11. Microvascular complications and foot care: standards of medical care in diabetes− 2020. Diabetes care. 2020 Jan 1;43(Supplement_1):S135-51. DOI: https://doi.org/10.2337/dc20-S011 PMid:31862754

Treede R-D, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008; 70: 1630- 1635. DOI: https://doi.org/10.1212/01.wnl.0000282763.29778.59 PMid:18003941

Vileikyte L, Leventhal H, Gonzalez JS, Peyrot M, Rubin RR, Ulbrecht JS, et al. Diabetic peripheral neuropathy and depressive symptoms: the association revisited. Diabetes Care. 2005;28(10): 2378-83. DOI: https://doi.org/10.2337/diacare.28.10.2378 PMid:16186266

Solan YM, Kheir HM, Mahfouz MS, et al. Diabetic Foot Care: Knowledge and Practice. J Endocrinol Metab. 2017;6(6):172-7. DOI: https://doi.org/10.14740/jem388e

Pourkazemi A, Ghanbari A, Khojamli M, Balo H, Hemmati H, Jafaryparvar Z, Motamed B. Diabetic foot care: knowledge and practice. BMC endocrine disorders. 2020 Dec;20(1):1-8.Mohanty M, Patle RA, Narlawar UW. Modified BG Prasad and modified Kuppuswami socio-economic status scales: revision and updates for January 2024. Preventive Medicine: Research & Reviews. 2024 May 1;1(3):166-7. DOI: https://doi.org/10.4103/PMRR.PMRR_28_24

Baxi H, Habib A, Hussain MS, Hussain S, Dubey K. Prevalence of peripheral neuropathy and associated pain in patients with diabetes mellitus: evidence from a cross-sectional study. Journal of Diabetes & Metabolic Disorders. 2020 Dec;19(2):1011-7. DOI: https://doi.org/10.1007/s40200-020-00597-y PMid:33520819 PMCid:PMC7843660

D'Souza M, Kulkarni V, Bhaskaran U, Ahmed H, Naimish H, Prakash A, S T, Dahiya B, Thapar R, Mithra P, Kumar N, Holla R, Bb D, Kumar A. Diabetic Peripheral Neuropathy and its Determinants among Patients Attending a Tertiary Health Care Centre in Mangalore, India. J Public Health Res. 2015 Jul 30;4(2):450. DOI: https://doi.org/10.4081/jphr.2015.450 PMid:26425491 PMCid:PMC4568420

Bansal D, Gudala K, Muthyala H, Esam HP, Nayakallu R, Bhansali A. Prevalence and risk factors of development of peripheral diabetic neuropathy in type 2 diabetes mellitus in a tertiary care setting. Journal of diabetes investigation. 2014 Nov;5(6):714-21. DOI: https://doi.org/10.1111/jdi.12223 PMid:25422773 PMCid:PMC4234236

Darivemula S, Nagoor K, Patan SK, Reddy NB, Deepthi CS, Chittooru CS. Prevalence and its associated determinants of Diabetic Peripheral Neuropathy (DPN) in individuals having type-2 diabetes mellitus in Rural South India. Indian J Community Med 2019;44:88-91.

Vibha SP, Kulkarni MM, Kirthinath Ballala AB, Kamath A, Maiya GA. Community based study to assess the prevalence of diabetic foot syndrome and associated risk factors among people with diabetes mellitus. BMC Endocr Disord 2018;18:43. DOI: https://doi.org/10.1186/s12902-018-0270-2 PMid:29940924 PMCid:PMC6020220

Rakesh P, Abraham V, Alex R, George H, George K, Krishna M, et al. Foot care knowledge and practices and the prevalence of peripheral neuropathy among people with diabetes attending a secondary care rural hospital in southern India. J Fam Med Prim Care 2013;2(1):27-32. DOI: https://doi.org/10.4103/2249-4863.109938 PMid:24479039 PMCid:PMC3894008

MD Abu Bashar. Prevalence and Determinants of Diabetic Peripheral Neuropathy/Foot Syndrome in a rural population of North India, 18 August 2020, PREPRINT (Version 1) available at Research Square DOI: https://doi.org/10.21203/rs.3.rs-59734/v1

Pawde PP, Thampi RR, Renish RK, Resmi RU, Vivek MR. Prevalence and risk factors of diabetic peripheral neuropathy among type-2 diabetic patients presenting to SMIMS hospital, Kulasekharam, Kanyakumari district, Tamil Nadu, India. Int J Med Sci Public Health. 2013 Jan 1;2(1):73-76. DOI: https://doi.org/10.5455/ijmsph.2013.2.73-76

Jasmine A, GV A, Durai V, Shriraam V, V S, Mahadevan S. Prevalence of peripheral neuropathy among type 2 diabetes mellitus patients in a rural health centre in South India. International Journal of Diabetes in Developing Countries. 2021 Jun;41:293-300. DOI: https://doi.org/10.1007/s13410-020-00885-6

Wickramasinghe TP, Subasinghe S, Withana AK, Wellala DA. Prevalence, burden and treatment response of diabetic peripheral neuropathy among attendees of the Diabetic Clinic in the Sri Jayewardenepura General Hospital. Journal of the Ceylon College of Physicians. 2016 Sep 27;47(1):20. DOI: https://doi.org/10.4038/jccp.v47i1.7765

Shamim A, Haq A, Ali M. Prevalence of Peripheral diabetic Neuropathy and its Association with patients related factors. Pak J Med Health Sci. 2017 Jul 1;11:1130-2.

BONDAR AC, POPA AR. Diabetic neuropathy prevalence and its associated risk factors in two representative groups of type 1 and type 2 diabetes mellitus patients from Bihor county. Maedica. 2018 Sep;13(3):229.

Al Washali AY, Azuhairi AA, Hejar AR, Amani YW. Prevalence and associated risk factors of diabetic peripheral neuropathy among diabetic patients in national center of diabetes in Yemen. International Journal of Public Health and Clinical Sciences. 2014 Sep 6;1(1):141-50.

Kärvestedt L, Mårtensson E, Grill V, Elofsson S, von Wendt G, Hamsten A, Brismar K. The prevalence of peripheral neuropathy in a population-based study of patients with type 2 diabetes in Sweden. Journal of Diabetes and its Complications. 2011 Mar 1;25(2):97-106. DOI: https://doi.org/10.1016/j.jdiacomp.2010.04.001 PMid:20488731

Rani P, Raman R, Rachapalli S, Pal S, Kulothungan V, Sharma T. Prevalence and risk factors for severity of diabetic neuropathy in type 2 diabetes mellitus. Indian J Med Sci 2010;64:51-7. DOI: https://doi.org/10.4103/0019-5359.94400 PMid:22466493

Mohanty M, Patle RA, Narlawar UW. Modified BG Prasad and modified Kuppuswami socio-economic status scales: revision and updates for January 2024. Preventive Medicine: Research & Reviews. 2024 May 1;1(3):166-7. DOI: https://doi.org/10.4103/PMRR.PMRR_28_24