Evaluation of Peripheral Neuropathy in Type 2 Diabetes Mellitus and its correlation with other microvascular complications

INTRODUCTION : Diabetic Neuropathy is one of the most common troublesome complications of diabetes mellitus. One of the aims of the present study was clinical and electrophysiological evaluation of diabetic peripheral neuropathy and do a comparative analysis. The present study used the Diabetic Neuropathy Examination Score (DNE), which was designed by Meijer. Nerve conduction studies were done according to a standard protocol as already mentioned. In the study it was observed that out of the 29 subjects who were found to have neuropathy by Nerve Conduction Studies, 26 tested positive by the DNE score which gave a sensitivity of 89.7%. There is statistically significant association between clinical examination scores(DNE) and nerve conduction study. Thus it can be inferred that the clinical examination by the DNE scores is a simple, reliable and reproducible method of diagnosing diabetic peripheral neuropathy. Vascular complications both micro and macrovascular predominate the features of Indian diabetes due to delayed diagnosis. Various microvascular complications in diabetes mellitus includes • Diabetic Retinopathy • Diabetic Nephropathy • Diabetic Neuropathy Presence of microvascular complications at the time of diagnosis of diabetes mellitus are showing increasing trend in India. Early detection of microvascular complications and its treatment at this time by intensive therapy can prevent progression of these complications and hence morbidity and mortality among patients. Diabetic Neuropathy is one of the most common troublesome complications of diabetes mellitus. The prevalence of neuropathy is related to age, duration of diabetes and the quality of metabolic control, by the time a diabetic patient has severe neuropathy, retinopathy and albuminuria are also usually present. Diabetic neuropathy is clinically present in 30-50% of all diabetes patients. Diabetic foot accounts for one of the largest inpatients admissions in India. AIMS AND OBJECTIVES : 1. To evaluate peripheral neuropathy in type 2 diabetes patients by clinical examination and electrophysiologicaly by nerve conduction study and thus do a comparative analysis. 2. To study the correlation of diabetic peripheral neuropathy with other microvascular complications by assessing microalbuminuria and retinopathy. 3. To study the correlation of diabetic peripheral neuropathy with age, sex, duration of diabetes, body mass index, systemic hypertension and total serum cholesterol. MATERIALS AND METHODS : DESIGN : Cross sectional study. Study Population : 50 patients with type 2 diabetes attending diabetology OP in Coimbatore medical college hospital from September 2009 to September 2010 were selected for this study after getting informed written consent. Inclusion Criteria : Patients were included for study if they had o Onset of type 2 diabetes > 35 years of age. o Duration of diabetes > 5 yrs. Exclusion Criteria : Patients were excluded from study if they had o Gross albuminuria. o Non diabetic neuropathies. o Non diabetic retinopathy and other chronic ophthalmological illness. CONCLUSIONS : 1. There is statistically significant association between clinical examination scores (DNE) and nerve conduction study. Thus it can be inferred that the clinical examination by the DNE scores is a simple, reliable and reproducible method of diagnosing diabetic peripheral neuropathy. 2. There is statistically significant correlation of diabetic neuropathy with other microvascular complications namely diabetic retinopathy(P<0.05) and microalbuminuria (P<0.001) 3. There was statistically significant correlation between diabetic peripheral neuropathy with age (p< 0.05), duration of diabetes (P<0.01), HbA1C levels (P<0.05) and systemic hypertension (P<0.01). It was also found that the correlation of diabetic peripheral neuropathy with sex, BMI, total serum cholesterol was not statistically significant.