Endocrine Abstracts

Introduction: Peripheral diabetic neuropathic pain (PDNP) as a significant complication of diabetes mellitus (DM), which is present in 16–26% of patients. NICE UK guidelines recommend that physicians should make an formal enquiry about distressing neuropathic symptoms annually and that either duloxetine, amitriptyline, gabapentin, or pregabalin should be used as first-line treatment for neuropathic pain.

Aims: To assess the prevalence PDNP in a diabetic cohort and whether management was according to NICE guidelines. Patients attending an outpatient clinic in SWBH, Birmingham were prospectively consented to answer questions regarding sensations in their feet and lower legs using an adapted and validated questionnaire from the ‘Lily Toolkit‘ and validated ‘S-LANSS score’ for identifying pain of neuropathic origin.

Results: A total of 100 patients (July–Oct 2014) agreed to answer questions, of which 65% were males (average age 62 years). 98% of patients had an annual foot check: via GP (88), podiatrist (6), or hospital specialist (4), with formal assessment of their ulcer risk but did not include questions about painful neuropathy. 27% (n=27) patients admitted getting pain in their feet or lower legs, which was consistent with PDNP. The average pain score in this group was seven out of ten and two-thirds had spoken to a healthcare professional about their symptoms in the past. Of these, 5/27 (19%) were on one of the recommended medications for PDNP; amitriptyline (n=1), gabapentin (n=2), and combined amitriptyline and gabapentin (n=2).

Discussion: In this diabetic cohort, foot checks with respect to ulcer risk were reliably undertaken by the GP. However, 27% of patients had symptoms consistent with PDNP but nearly 79% weren’t on any of the first line treatments recommended by NICE. Would incorporation of questions about symptoms of PDNP into the annual primary care foot checks improve the detection rates and subsequently the management of these patients?