Clinical and electrophysiological correlation of peripheral neuropathy in newly diagnosed type 2 diabetes mellitus

Abstract

Background: The study was undertaken to evaluate the prevalence of peripheral neuropathy in newly diagnosed type2 Diabetes mellitus (DM) by clinical examination and nerve conduction study (NCS), and to correlate them with risk factors.Methods: Eighty newly detected cases of type2DM of age ≥18 years attending Endocrinology Department of Gauhati Medical College and Hospital, Assam, India were evaluated. Grading of symptoms and signs was done using the Neuropathy Symptoms Score (NSS) and Neuropathy Disability Score (NDS) respectively followed by NCS. Neuropathy was diagnosed based on abnormal NSS, NDS or NCS.Results: Prevalence of peripheral neuropathy was 68.75 % based on abnormal NCS/NDS/NCS. The most common symptom was presence of paraesthesia in 70.9%, followed by weakness in lower limbs in 16.36%. The most common sign was impairment of vibration perception in 76.3%, followed by absent ankle reflex in 56.36%. Abnormal NCS finding was seen in 55% of patients with neuropathy. Of all the patients with neuropathy, only 2.5% had subclinical neuropathy that is abnormal NCS finding in absence of sign and symptoms. Peripheral neuropathy had significant association with age at diagnosis, presence of hypertension, fasting plasma glucose(FPG), HbA1c, serum creatinine and estimated glomerular filtration rate(eGFR) (p<0.05). On multiple linear regression analysis, only age at diagnosis and FPG were independently associated with neuropathy (p<0.05).Conclusions: Patients with type 2DM have a high prevalence of peripheral neuropathy at diagnosis and very few of them harbour subclinical neuropathy. This study has shown that clinical examination still remains the main tool for detection of neuropathy.

The pattern of Electrophysiological Abnormality in Long-Standing Type-2 Diabetes Mellitus Patients: Experience at Referral Neurology Hospital in Bangladesh

“…In most of the cases, both myelin and axons were involved which is a mixed pattern of neuropathy followed by only demyelinating in 22(23.9%)] patients and only axonal in 6(6.5%) patients. Similar findings were found in other studies 14 . The most common nerve affected was the median nerve followed by the sural nerve.…”

Electrophysiological estimation of subclinical neuropathy and its types in diabetes mellitus patients

“…11 Regarding the pathological types of neuropathy, axonal neuropathy predominated in our study (29.4%), followed by mixed (both axonal and demyelinating-9.8%) and then demyelinating (3.9%). This finding was consistent with the study done by Bhuyan AK 3 where axonal neuropathy was the most common finding in diabetes patients.…”

“…Male gender was affected more than females with a prevalence of 13%. This finding was consistent with a previous study done by Bhuyan AK, 3 Singh, 15 Salem 5 were male sex of middle age group predominantly had diabetic neuropathy.…”

“…Overall sensory neuropathy was found to be the most common (12%) neuropathy in our study followed by mixed (sensory-motor) neuropathy (6%) and then motor neuropathy (4%). This finding were sensory neuropathy is the most common in diabetics was consistent with the studies undertaken by Bhuyan AK, 3 Singh RB, 15 Salem, 5 Patel, 10 Zhijun. 11 Regarding the pathological types of neuropathy, axonal neuropathy predominated in our study (29.4%), followed by mixed (both axonal and demyelinating-9.8%) and then demyelinating (3.9%).…”

“…2 Diabetic neuropathy is responsible for 50-75% of nontraumatic amputations. 3 It predisposes patients to severe functional limitations and are associated with substantial health care costs, loss of work and reduced quality of life. So it is better to identify such patients at an early stage and control their blood sugar adequately to prevent these adverse outcomes.…”