A STUDY ON THE PREVALENCE OF PERIPHERAL NEUROPATHY AND ITS RISK FACTORS IN PREDIABETICS

Dr. ARAVIND; Dr. G ELUMALAI

Volume : VIII, Issue : II, February - 2019

A STUDY ON THE PREVALENCE OF PERIPHERAL NEUROPATHY AND ITS RISK FACTORS IN PREDIABETICS

Dr. Aravind, Dr. G Elumalai

Abstract :

INTRODUCTION: Diabetic Peripheral Neuropathy (DPN) is the commonest symptomatic complication of Diabetes. Prevalence of Diabetic peripheral Neuropathy is 15 to 40 percent in various study groups. It predisposes to foot ulceration and gangrene. In view of poor awareness and lack of regular screening programs, the initial presentation to the physicians is delayed frequently. This may predispose to increased rate of micro vascular complication at onset. There is emerging evidence that Peripheral Neuropathy begins in the early stages of Diabetes pathogenesis. AIM: 1.To estimate the prevalence of Diabetic Peripheral Neuropathy in subjects with Pre-diabetes. 2. To study the distribution of risk factors for Diabetic Peripheral Neuropathy in Pre-diabetic subjects. METHOD: A Cross sectional study on the prevalence of distal sensory peripheral neuropathy in Pre-diabetics and the relation of it with risk factors was done in 216 patients attending Outpatient clinic in Government Vellore Medical College. RESULTS: In the study, 61 subjects had peripheral neuropathy according to Michigan Neuropathy Screening Instrument (MNSI) score of ≥3. Out of these 61 patients, 30 were male and 31 were female. Out of 155 pre-diabetics who were not having diabetic peripheral neuropathy, 80 were male and 75 were female. The prevalence of diabetic peripheral neuropathy in the study population was 28.24% { Pearson Chi-Square (X2) = 0.104 and P value was 0.747 (>0.05)}; hence statistically insignificant. Out of 61 patients with diabetic peripheral neuropathy, 32 patients had systemic hypertension. In 155 subjects without DPN, 33 had systemic hypertension. The prevalence of systemic hypertension in subjects with DPN was 52.5 %. Out of 32 patients, 17 were male and 15 were female. The prevalence of systemic hypertension in subjects without DPN was 21.29 %( X2 = 20.214 and the P value was 0.001); thus statistically highly significant. 38 out of 61 subjects with DPN were obese and similarly out of 155 subjects without DPN 33 were obese. The prevalence of obesity in subjects with DPN was 62.30 % and that of subjects without DPN was 21.30 % (X2 = 33.355 and P value was 0.001); hence statistically highly significant. Among subjects with DPN, 3 (4.92%) had HbA1C less than 5.5, 22 (36.07%) had HbA1C levels between 5.6- 6, 36 (59.02%) had HbA1C levels between 6.1-6.4. Most of the subjects with DPN belonged to the group where the HbA1C levels were between 6.1-6.4. The prevalence was 59.02 %. Among subjects without DPN, 53 (34.19%) had HbA1C below 5.5, 71(45.81%) had HbA1C between 5.6 and 37 (23.87%). The relationship between DPN and HbA1C more than 6.1 was plotted (X2 = 30.881 and P value was less than 0.001); thus statistically highly significant. The prevalence of hypercholesterolemia (serum cholesterol level of ≥ 200 mg/dl) in patients with Peripheral Neuropathy was 63.9% and patients without DPN had normal serum cholesterol levels were 5.8 %. Mean cholesterol level of the subjects with peripheral neuropathy was 214.75 mg/dl and that of subjects without peripheral neuropathy was 169.61 mg/dl. (X2 = 85.573 and the P value was <0.001); thus statistically highly significant. Mean triglyceride (TGL) levels in subjects with DPN were 146.95 mg/dl and in subjects without DPN was 130.45 mg/dl. In subjects with Peripheral Neuropathy, 23 out of 61 patients had increased TGL levels. The prevalence of hypertriglyceridemia in peripheral neuropathy was 37.7%. Out of 155 subjects, who did not have peripheral neuropathy, only 8 patients had hypertriglyceridemia . The prevalence was 5.2% (X2 = 79.489 and P value <0.001). Out of 61 subjects, who had DPN, 39 subjects (63.93%) had dyslipidemia. Out of 155 subjects without DPN, only 11 subjects (7.10%) had dyslipidemia. The prevalence of dyslipidemia in subject with DPN was 63.93 % and the relationship between DPN and dyslipidemia is statistically significant; (X2 = 79.489 and P value <0.05). In subjects diagnosed to have peripheral neuropathy, 17 were smokers and 44 were non smokers. The prevalence of smokers in DPN was 27.87%. Among subjects without DPN, 18 were smokers and 137 were non smokers. The prevalence of smokers in subjects without DPN was 11.6% (X2 = 8.519 and the P value was 0.004); thus statistically significant. Out of 61 subjects with DPN, 32 (17 male and 15 female) had abnormal waist circumference. Out of 155 subjects without DPN, 37 had abnormal waist circumference. The prevalence of abnormal waist circumference in subjects with peripheral neuropathy was 52.46 % and the prevalence of abnormal waist circumference in subjects without peripheral neuropathy was 23.87% (X2 = 12.614 and P value was <0.05); hence there is statistically high significant correlation between abnormal waist circumference and DPN. CONCLUSION: Peripheral Neuropathy is equally common in both diabetic and pre-diabetic individuals. It is more prevalent in elderly pre-diabetic individuals of age more than 70 years. Both males and females are equally affected; there is no sex predilection for the occurrence of peripheral neuropathy. Hypertensive individuals are affected more than non hypertensives. There is strong relationship between obesity and peripheral neuropathy in pre-diabetic individuals. Prevalence of dyslipidemia is higher in pre-diabetic people with peripheral neuropathy. People with pre-diabetics who have peripheral neuropathy have higher HbA1c values. Smokers have higher prevalence of peripheral neuropathy among pre-diabetics. Lastly since the prevalence of peripheral neuropathy is high even in pre-diabetic population, the study emphasizes the need for the early diagnosis of peripheral neuropathy in people who are at high risk for developing diabetes and to screen for the possible associated risk factors.