Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics

• Published in: Diabetes & metabolism Vol. 35; no. 3; pp. 206 - 213
• Main Authors: Van Acker, K, Bouhassira, D, De Bacquer, D, Weiss, S, Matthys, K, Raemen, H, Mathieu, C, Colin, I.M
• Format: Journal Article
• Language: English
• Published: Paris Elsevier Masson SAS 01-06-2009; Masson
• Subjects: Adult; Belgium; Biological and medical sciences; Blood Pressure; Body Mass Index; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Diabetes Mellitus, Type 1 - physiopathology; Diabetes Mellitus, Type 1 - psychology; Diabetes Mellitus, Type 2 - physiopathology; Diabetes Mellitus, Type 2 - psychology; Diabetes. Impaired glucose tolerance; Diabetic Neuropathies - complications; Diabetic Neuropathies - physiopathology; Diabetic Neuropathies - psychology; Diabetic peripheral neuropathic pain; Diabetic peripheral neuropathy; DN4; Douleur neuropathique diabétique; Endocrine pancreas. Apud cells (diseases); Endocrinology & Metabolism; Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Inpatients; Internal Medicine; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Neuropathie périphérique diabétique; Neuropen; Outpatients; Pain - etiology; Pain - physiopathology; Pain - psychology; Peripheral Nervous System Diseases - physiopathology; Peripheral Nervous System Diseases - psychology; Quality of Life; Qualité de vie; Belgium; Diabetic peripheral neuropathic pain; Neuropathie périphérique diabétique; Diabetic peripheral neuropathy; Douleur neuropathique diabétique; DN4; Neuropen; Qualité de vie; Quality of life; Endocrinopathy; Type 2 diabetes; Human; Immunopathology; Nervous system diseases; Prevalence; Autoimmune disease; Metabolic diseases; Pain; Type 1 diabetes; Neuralgia; Peripheral nerve disease; Neurological disorder
• ISSN: 1262-3636; 1878-1780
• DOI: 10.1016/j.diabet.2008.11.004

Abstract Aims Diabetic polyneuropathy (DPN) without or with neuropathic pain (DPN-P) is one of the most frequent complications of diabetes. To better delineate their respective prevalences, we conducted a cross-sectional study that included 1111 patients (767 type 2 and 344 type 1 diabetic patients) followed up in diabetic outpatients clinics. The association of DPN and DPN-P with other diabetic complications, the impact on quality of life (QoL) and pain management were also investigated. Methods Two validated tools (Neuropen® and the DN4 questionnaire) were used to diagnose the two conditions. Pain intensity was measured using a visual analogue scale, and participants completed the 12-item Short-Form Health Survey to evaluate the physical and mental components of QoL. Univariate and multivariate models were used for the statistical analyses. Results The prevalence of DPN was 43% (95% CI 40.1–45.9), and was higher in type 2 (50.8%) than in type 1 (25.6%) diabetic patients. The prevalence of DPN-P was 14% (95% CI 12.1–16.2) which, again, was higher in type 2 (17.9%) than in type 1 (5.8%) patients. These prevalences both increased with age and diabetes duration. Nephropathy, obesity, low HDL cholesterol and high triglyceride levels were independently associated with DPN and/or DPN-P. Physical and mental components of QoL were significantly altered by DPN-P, but not DPN. Only half of the DPN-P patients were using analgesic treatment, while 28% were using anticonvulsants or antidepressants. Conclusion DPN and DPN-P are frequent complications of diabetes, especially in type 2, and can be identified with inexpensive and easy-to-use screening tools. Despite its profound impact on QoL, DPN-P remains undertreated.