Early Diagnosis of Peripheral Diabetic Neuropathy – Something Old that Should Always Be Considered Something New

Abstract

Introduction: Diabetic peripheral neuropathy is a frequent complication and disability of diabetes mellitus that requires complex management. The importance of an early diagnosis is emphasized by the high risk of subsequent foot ulceration or amputation and an increase in the mortality rate. The aim of the study was to evaluate the utility of quantitative sensory testing in monitoring peripheral diabetic neuropathy and its correlation with micro- and macrovascular complications of di­abetes mellitus. Material and Methods: We included 136 patients admitted to N. C. Paulescu National Institute for Diabe­tes, Nutrition and Metabolic Diseases over six months, and analyzed their clinical and paraclinical data using Excel and PSPP software. Each patient had quantitative sensory testing performed. Results: The group consisted of 61.03% males and 38.97% females, with a mean age of 55.97±15.2 years. Of them, 22.79% presented type 1 diabetes mellitus, 30.88% had type 2 diabe­tes mellitus, and 46.32% had insulin-treated type 2 diabetes mellitus, with a mean glycated hemoglobin of 9.64%±2.49% and a mean duration of diabetes mellitus of 11.94 years. Diabetes complications were diabetic peripheral neuropathy (68.38%), di­abetic retinopathy (27.94%), chronic kidney disease (25.74%), atherosclerotic disease (38.24%). Diabetic peripheral neurop­athy diagnosis positively correlated with age (p=0.031), body mass index (p<0.0001), albumin to creatinine ratio (p=0.049), presence of chronic kidney disease (p=0.01) and diabetic retinopathy (p=0.001), and diabetes duration (p<0.001). Conclusions: Diabetic peripheral neuropathy accounts for considerable morbidity and mortality and reduced quality of life. Clin­ical recognition is required for allowing early symptomatic management in order to reduce the morbidity associated with this condition. Quantitative sensory testing is used for screening and diagnosing diabetic peripheral neuropathy. Given the significant association with other microvascular complications, such as chronic kidney disease and diabetic retinopathy, neuropathy’s diag­nosis should immediately lead to screening for other complications of diabetes and certain risk factors and consequent measures.