ORIGINAL ARTICLE

Prevalence of Peripheral diabetic Neuropathy and its Association

with patients related factors
1 2 3
ARIFA SHAMIM , AROOJ HAQ , MARYAM ALI

ABSTRACT
Aim: To determine the prevalence of peripheral diabetic neuropathy (PDN) in patients of type-2
diabetes and association of patient related variables with PDN.
Methods:This case control study was conducted in Bakhtawar Amin hospital Multan. We included 110
patients of typer-2 diabetes within duration of 7 months (From Nov-2016 to May-2017) in this study.
Diagnosis of PDN was made using previous history, physical examination and vibration perception test
of the patients. We noted age, gender, BMI,HbA1c levels, smoking history, diabetes duration and
duration of diabetes in all patients.
The data was analysed by using SPSS v23. Association of age, duration of diabetes and BMI with
PDN was compared Student’s t-test. Moreover, association of gender and smoking history with PDN
was compared using Chi-square t-test.
Results: In our study, the prevalence of PDN was 51.8%. The mean age was higher in patients having
PDN, 56.43±6.96 years versus 48.42±6.18 years in patients without PDN (p-value <0.001). Duration of
diabetes mellitus was also prolonged in PDN patients 10.7±6.3 years versus 8.9±4.8 years in patients
without PDN with p-value of <0.001. There were 43.90% patients belonging to lower class in PDN
patients and only 15.10% patients were of lower class that did not have PDN. There were 45.30%
patients belonging to upper class in non-PDN group and only 10.50% in PDN group (p-value <0.001).
Conclusion: Patients age, duration of diabetes mellitus and socioeconomic status are independent
predictors of the development of peripheral diabetic neuropathy in diabetic patients.
Keywords: Type 2-diabetes mellitus, peripheral diabetic neuropathy

INTRODUCTION
diabetes in effected patients. These are also a major
Diabetes mellitus has become very common. About cause of absence from duties, disturbed working
371 million people are diagnosed each year with a 8
hours and disability in these patients .
prevalence rate of about 8.3%. Type-2 diabetes The estimated prevalence of diabetes in
1
mellitus is the most common form . Most of the Pakistan is 6.8% and there are more than 87
patients remains asymptomatic for a longer duration thousands death every year in Pakistan due to
of time until the symptoms of complications of 9
diabetes. There is little data published from Pakistan
diabetes mellitus begins to appear. Among the about the prevalence and risk factors of PDN. In
various complications of type-2 diabetes, peripheral present study, we evaluated the prevalence of PDN
diabetic neuropathy (PDN) ―that effects and association of patient related variables with PDN.
2,3,4
microcirculation‖ is one of them .PDN is defined as
the diabetic patients having dysfunction of peripheral
METHODS
nerves in the absence of other causes of
4
dysfunction. PDN significantly increases the risk of This case control study was conducted in Bakhtawar
infections especially foot ulcers and ultimately limb Amin hospital Multan. We included 110 patients of
amputations. The initial symptom of PDN is loss of type-2 diabetes within duration of 7 months (From
sensation in toe, then whole foot and the leg after Nov-2016 to May-2017) in this study. Patients having
5,6
that . fasting blood sugar levels >7mmol/L or random blood
Many patients (≈40-50%) of PDN develop pain sugar levels >11.1 mmol/L, along with other clinical
7
along neuropathy known as painful PDN .PDN and symptoms such as weight loss, polydipsia and
painful PDN has significant effects on health care polyuria, were diagnosed as diabetics. Diagnosis of
cost and increase the cost of management of PDN was made using previous history, physical
----------------------------------------------------------------------- examination and vibration perception test of the
1
Demonstrator Biochemistry, 2Demonstrator Biochemistry, patients. Patients having neuropathy due to other
3
Women Medical Officer,
causes and having chronic kidney failure were
Bakhtawar Amin Medical and Dental College Multan
Correspondence to Dr. ArifaShamim Email Id: excluded.
[email protected] Cell: 0334-6032445,

P J M H S Vol. 11, NO. 3, JUL – SEP 20171130

Prevalence of Peripheral diabetic Neuropathy and its Association with Patients related Factors

Patients were divided into case and control patients. Duration of diabetes mellitus was also
group on the basis of diagnosis of PDN. We noted prolonged in PDN patients 10.7+6.3 years versus
age, gender, BMI, HbA1c levels, smoking history and 8.9+4.8 years in patients without PDN with p-value of
duration of diabetes in all patients. <0.001. Mean HbA1c levels and BMI of patients were
The data was analysedusing SPSS v23. similar in patients with PDN and without PDN. There
Association of age, duration of diabetes, height and were 15.8% smokers in PDN group and 13.2%
BMI with PDN was compared Student’s t-test. smokers in non-PDN group of patients (Table 1).
Moreover, association of gender and smoking history Most of the patients who presented with PDN
with PDN was compared using Chi-square t-test. were belonging to poor socio-economic status. Most
of the patients who presented with PDN were
RESULTS belonging to lower socioeconomic status. There were
43.90% patients belonging to lower class in PDN
In our study, the prevalence of PDN was 51.8%. The patients and only 15.10% patients were of lower
mean age of patients in this study was 56.24+8.24 class that did not have PDN. There were 45.30%
years. The mean age was higher in patients having patients belonging to upper class in non-PDN group
PDN 56.43+6.96 years versus 48.42+6.18 years in and only 10.50% in PDN group (p-value <0.001).
patients without PDN (p-value <0.001). There were
52.6% females in PDN group and 52.8% in non-PDN

Table 1.Comparison of study variables.

PDNpatients (n=57) Non-PDN patients (n=53) P-value
Age (Years) 56.43±6.96 48.42±6.18 <0.001
HbA1c 8.5±2.3 8.7±2.2 0.3
Duration ofdiabetes (Yrs) 10.7±6.3 8.9±4.8 <0.001
2
Body Mass Index (Kg/m ) 27.10±4.43 26.04±4.22 0.2
Male Gender (%) 27 (47.4%) 25 (47.2%) 0.98
Female Gender (%) 30 (52.6%) 28 (52.8%)
Smoking History (%) 9 (15.8%) 7 (13.2%) 0.70

Fig. 1: Association of Socio-economic Status with PDN

P-value <0.001
45.30% 43.90%
45.60% 39.60%
50.00%
40.00%
15.10%
30.00% 10.50%
20.00%
10.00%
0.00%
Upper Class Middle Class Lower Class

PDN-Patients Non-PDN Patients

12
DISCUSSION .Studies conducted in other Asian countries have
found 29.2% to 61% prevalence of PDN in these
Peripheral diabetic neuropathy (PDN) is a patients
13,14
.Soyupeket al. found neuropathy in his
devastating complication of diabetes mellitus. In this 80.4% diabetic patients .
15

study, we evaluated the prevalence of PDN in In our study, we found significant association of
diabetic patients. We also determined the association age with PDN, with a mean age of 56.43 years in
of various patient related variables with PDN. In our PDN group and 48.42 years in Non-PDN patients.
study, the prevalence of PDN was 51.8%. Other Mean age was more in PDN patients in the study by
studies conducted in Pakistan have found 39.6% to Bansal et al. with a mean age of 57.1 years in PDN
10-
74.8% prevalence of PDNin diabetic patients patients and 52.5 years in patients without PDN(14).

1131P J M H S Vol. 11, NO. 3, JUL – SEP 2017

 ArifaShamim, AroojHaq, Maryam Ali

Mean age of patients in study by Rai et al. was 62 6. Happich M, John J, Stamenitis S, Clouth J, Polnau D. The
years in PDN patients and 56 years in Non-PDN quality of life and economic burden of neuropathy in diabetic
13 patients in Germany in 2002—results from the Diabetic
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among females. Beghi et al., Barbosa et al. and Clin Practice. 2008;81(2):223-30.
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prevalence of PDN is highest in patients with duration 9. Federation ID. IDF diabetes atlas. Brussels: International
Diabetes Federation. 2013.
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19 10. Nisar MU, Asad A, Waqas A, Ali N, Nisar A, Qayyum MA, et
diabetes duration <5 years. Young et al. found al. Association of Diabetic Neuropathy with Duration of Type
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23
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