Tip 2 Diyabetli Hastalarda Diyabetik Periferik Nöropati Sıklığı, İlişkili Faktörler ve Farkındalık Durumunun Değerlendirilmesi

Yıl 2020, Cilt: 6 Sayı: 3, 180 - 185, 02.10.2020

Esen Ertur , Miraç Vural Keskinler , İrem Bozkurt Çakır , Ayse Erbakan , Aytekin Oğuz

https://doi.org/10.30934/kusbed.669099

Cited By: 2

Öz

Amaç: Diyabetik nöropati sıklıkla hastanın şikayeti olursa veya önlenebilecek komplikasyonlar gelişmişse tanı almaktadır. Tip 2 diyabetli (T2DM) hastalarda diyabetik periferik nöropati (DPN) varlığının bildirildiğinden daha sık olduğu hipotezinden yola çıkarak bu hasta grubunda DPN sıklığını ve ilişkili olduğu durumları araştırmayı planladık.
Yöntem: Diyabet polikliniklerimize başvuran 336 tip 2 diyabetli hasta çalışmaya alındı. Anamnezleri, demografik ve antropometrik bilgileri, kullandıkları ilaçlar ve laboratuvar verileri kaydedildi. Diyabetik nöropatiyi saptamak amacıyla MNSI (Michigan Neuropathy Screening Instrument) skorlaması ve Semmes-Weinstein monofilaman testi uygulandı.
Bulgular: Bu 336 hastanın (yaş ortalaması 57,9±10 yıl, %63,7’si kadın) ortalama diyabet süresi 9,5±7,8 yıldı. HbA1c, açlık kan şekeri ve vücut kütle indeksi ortalaması sırasıyla %8,7±2, 182±89 mg/dl ve 32±5,8 kg/m2 bulundu. DPN sıklığı %38,7 (n=130) saptandı. Daha önce nöropati tedavisi başlanmış olan 32 hasta (%9.5) ilaç kullanımları nedeniyle diğer analizlere katılmadı. Diyabetik nöropatisi olan grupla (n=107) olmayan grup (n=197) arasında kadın cinsiyet (%71 vs %59,9, p=0,054), yaş (60,6 yıl vs 55,9 yıl, p<0,001), diyabet süresi (15,2 yıl vs 5,7 yıl, p<0,001), açlık kan şekeri (207 mg/dl vs 167 mg/dl, p<0,001), HbA1c (%9,6 vs %8,1, p<0,001), hipertansiyon öyküsü, aterosklerotik kardiyovasküler hastalık öyküsü, diyabetik retinopati ve insülin kullanımı istatistiksel anlamlı olarak farklı bulundu.
Sonuç: Çalışmamızda tip 2 diyabeti olan hastalarda yaklaşık %40 oranında diyabetik periferik nöropati saptandı. Bu bulgular, T2DM hastalarının periferik nöropatinin tarama testleri ile rutin değerlendirilmesinin gerekliliğini vurgulamaktadır.

Anahtar Kelimeler

tip 2 dyabet, nöropati, diyabetik perferik nöropati, MNSI

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

Yok

The Evaluation of Peripheral Diabetic Neuropathy; Frequency, Associated Factors and Awareness in Patients with Type 2 Diabetes

Öz

Objective: Diabetic neuropathy is often diagnosed only if the patient complains or after the development of complications. We hypothesized that diabetic peripheral neuropathy (DPN) is more common than reported and aimed to investigate the incidence and related conditions of DPN in type 2 diabetic (T2DM) patients.
Methods: Three hundred and thirty six patients with type 2 diabetes who presented to our diabetes outpatient clinics were recruited. Patients’ history, demographic and anthropometric characteristics, medications and laboratory data were recorded. MNSI (Michigan Neuropathy Screening Instrument) and Semmes-Weinstein monofilament test were applied to detect diabetic neuropathy.
Results: In the 336 patients (mean age, 57.9±10 years; 63.7% female), the mean duration of diabetes was 9.5±7.8 years. The mean HbA1c and fasting blood glucose (FBG) concentrations, and body mass index (BMI) were 8.7±2%, 182±89 mg/dL and 32±5.8 kg/m2, respectively. The incidence of DPN was 38.7% (n=130). Female gender (71% vs 59.9%, p=0.054), age (60.6 years vs 55.9 years, p<0.001), diabetes duration (15.2 years vs 5.7 years, p<0.001), FBG (207 mg/dl vs 167 mg/dl, p<0.001), HbA1c levels (9.6% vs 8.1%, p<0.001) were statistically significant between patients with and without neuropathy, as were presence of hypertension, atherosclerotic cardiovascular disease, and diabetic retinopathy, and insulin usage.
Conclusion: Diabetic peripheral neuropathy was detected in approximately 40% of the patients with type 2 diabetes. Our findings emphasizes the need for routine evaluation of peripheral neuropathy by screening tests in all diabetic patients.

Anahtar Kelimeler

Type 2 diabetes, neuropathy, diabetic neuropathy, MNSI

Proje Numarası

Yok

Kaynakça

• Diabetes Mellitus Çalışma ve Eğitim Grubu. Diabetes mellitus ve komplikasyonlarının tanı, tedavi ve izlem kılavuzu 2019: Glisemik bozukluklarda tanı, sınıflama ve Tarama. Ankara, TEMD yayınları, 2019; 15-32
• Satman I, Yılmaz T, Sengül A, et al. Population-based study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP). Diabetes care. 2002;25(9):1551-6.
• Satman I, Omer B, Tutuncu Y, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. European journal of epidemiology. 2013;28(2):169-80.
• American Diabetes Association. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes−2020. Diabetes Care. 2020;43(Suppl. 1):S135-S51. doi: 10.2337/dc20-S011.
• Singleton JR, Smith AG, Russell J, Feldman EL. Polyneuropathy with impaired glucose tolerance: implications for diagnosis and therapy. Curr Treat Options Neurology. 2005;7(1):33-42.
• Pop-Busui R, Boulton AJM, Feldman EL, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-54. doi: 10.2337/dc16-2042.
• Feldman EL, Stevens M, Thomas P, Brown M, Canal N, Greene D. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes care. 1994;17(11):1281-9.
• Singleton JR, Bixby B, Russell JW, et al. The Utah Early Neuropathy Scale: a sensitive clinical scale for early sensory predominant neuropathy. J Peripher Nerv Syst. 2008;13(3):218-27.
• Young M, Boulton A, MacLeod A, Williams D, Sonksen P. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993;36(2):150-4.
• Herman WH, Pop-Busui R, Braffett BH, et al. Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications. Diabet Med. 2012;29(7):937-44. doi: 10.1111/j.1464-5491.2012.03644.x.
• Davies M, Brophy S, Williams R, Taylor A. The Prevalence, Severity, and Impact of Painful Diabetic Peripheral Neuropathy in Type 2 Diabetes. Diabetes Care. 2006;29(7):1518-22. doi: 10.2337/dc05-2228.
• Ziegler D, Rathmann W, Dickhaus T, Meisinger C, Mielck A. Prevalence of Polyneuropathy in Pre-Diabetes and Diabetes Is Associated With Abdominal Obesity and Macroangiopathy. The MONICA/KORA Augsburg Surveys S2 and S3. 2008;31(3):464-9. doi: 10.2337/dc07-1796.
• Ziegler D. Painful diabetic neuropathy: treatment and future aspects. Diabetes Metab Res Rev. 2008;24 Suppl 1:S52-7. doi: 10.1002/dmrr.817.
• Erbas T, Ertas M, Yucel A, Keskinaslan A, Senocak M, Group TS. Prevalence of peripheral neuropathy and painful peripheral neuropathy in Turkish diabetic patients. J Clin Neurophysiol. 2011;28(1):51-5. doi: 10.1097/WNP.0b013e3182051334.
• Börü UT, Alp R, Sargin H, et al. Prevalence of peripheral neuropathy in type 2 diabetic patients attending a diabetes center in Turkey. Endocr J. 2004;51(6):563-7. doi: 10.1507/endocrj.51.563.
• Salvotelli L, Stoico V, Perrone F, et al. Prevalence of neuropathy in type 2 diabetic patients and its association with other diabetes complications: The Verona Diabetic Foot Screening Program. J Diabetes Complications. 2015;29(8):1066-70. Epub 2015/07/02. doi: 10.1016/j.jdiacomp.2015.06.014.
• Li L, Chen J, Wang J, Cai D. Prevalence and risk factors of diabetic peripheral neuropathy in Type 2 diabetes mellitus patients with overweight/obese in Guangdong province, China. Prim Care Diabetes. 2015;9(3):191-5. Epub 2014/08/20. doi: 10.1016/j.pcd.2014.07.006.
• Oguz A, Gedik O, Hatemi H, et al. Glycemic control of Turkish adult diabetic patients. Turkish Journal of Endocrinology and Metabolism 2008;12:50-4.
• Daousi C, MacFarlane IA, Woodward A, Nurmikko TJ, Bundred PE, Benbow SJ. Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. Diabet Med. 2004;21(9):976-82. doi: 10.1111/j.1464-5491.2004.01271.x.
• Ziegler D, Strom A, Lobmann R, Reiners K, Rett K, Schnell O. High prevalence of diagnosed and undiagnosed polyneuropathy in subjects with and without diabetes participating in a nationwide educational initiative (PROTECT study). J Diabetes Complications. 2015;29(8):998-1002. Epub 2015/09/14. doi: 10.1016/j.jdiacomp.2015.09.008.