Diabetic neuropathy: the local experience - abstract

ABSTRACT

The prevalence of polyneuropathy in diabetic populations ranges from 0 to 93 percent depending on patient selection factors, criteria for diagnosing neuropathy and the sensitivity of the detection methods. Affected patients may be asymptomatic. Postural hypotension, gastric symptoms and hypoglycaemic unawareness are autonomic neuropathic indices of early death in diabetes mellitus. Long-term hyperglycaemia is the most important aetiologic factor. The recently published results of The Stockholm Diabetes Intervention Study and the Diabetes Control and Complications Trial confirm that control of hyperglycaemia can reduce the occurrence of clinical neuropathy and deterioration of nerve conduction velocity. Here at the Diabetes Clinic at the University Hospital of the West Indies a prevalence of 4 percent for neuropathy was noted, but that study did not include nerve conduction studies. In addition, many of these patients had had the disease for more than ten (10) years or were diabetics with complications or with poor metabolic control. This study was designed to determine the prevalence of diabetic neuropathy in a more representative group and to compare prevalence with metabolic control and other complications of diabetes mellitus. The patients were taken from the Clinics at the Diabetes Asssociation of Jamaica. This is a walk in clinic, centrally located in Kingston. The patients were questioned about symptoms of peripheral neuropathy and of autonomic neuropathy. A thorough neurological examination was performed and cardiac autonomic nerve testing done. Nerve conduction velocities were measured for the ulnar and radial nerves. Retinopathy was evaluated by findoscopy and nephropathy by 24-hr urine excertion of albumin and creatinine clearance. Serum cholesterol and triglycerides were measured. Metabolic control was assessed by random blood glucoes, fructosamine and glycosylated haemoglobin. The ages ranged from 25 years to over age 65 years. Symptoms of peripheral neuropathy were present in majority of patients. This was predominantly numbness and was so, regardless of age and duration of diabetes mellitus. Most have symptoms of bladder disfunction rather than bowel disfunction; 20 percent urinary incontinence and 10 percent involuntary faecal soiling. The majority had clinical neuropathy on examination, with the loss of ankle reflex followed by loss of vibration sense being the commonest manifestations. Unequivocal autonomic cardiac neuropathy was present in only a few patients. These patients were older than 55 years and had had diabetes melitus sor more than ten (10) years. Of those were symptomatic, the majority had poor blood glucose control. However, this was not so for those with autonomic neuropathy. Neuropathy and retinopathy were present in the majority of those with numbness but the presence of retinopathy correlated poorly with actual signs of nephropathy (AU)