Endocrine Abstracts

Background: Diabetic neuropathy, especially distal symmetric polyneuropathy (DSPN), is a common but under-recognized problem among people living with diabetes, particularly in developing countries. Aims: We aimed to describe the clinical characteristics, associated factors, treatment practices, outcomes and impact of DSPN among Sri Lankan adults living with diabetes.

Methods: A cross sectional study was conducted at the Diabetes Clinic of National Hospital of Sri Lanka over 4 consecutive months. Clinic attendees were screened for presence of symptoms and/or signs of DSPN and were invited to participate. Data was collected using an interviewer administered questionnaire which included a SF-36 questionnaire, and through findings from routine end-organ screening.

Results: A total of 201 patients (mean age 60.7 +9.5 years, men 38.8%, mean duration of diabetes 14.4 +8.5 years) were interviewed. Mean HbA1c was 9.3 +2.2% and 87.5% were on metformin. Overall, 92.0% had symptoms of DSPN (numbness 83.6%, pain 64.2%, hyperesthesia 32. 2%), whereas 99.0% had loss of protective sensation (73.9% on 3-point monofilament, 88.6% on increased vibration threshold). 11.9% had foot deformities (hammertoe 10.0%, bunion 2.0%, overlapping toes 1.0%, Charcot 0.5%). While 57.7% had pre-ulcer lesions (toe web infections 50.2%, callosities 13.9%, in-grown toenails 1.5%), 4.5% had active ulcers, and 4.5% had evidence of lower limb amputations. Evidence of diabetic retinopathy was noted only in 41.0% and 19.9% had at least one macrovascular complication. No clinical or demographic factors were associated with DSPN on multivariate logistic regression. Among 129 patients with neuropathic pain, only 35 (27.1%) were given treatment and among them only 8 (24.2%) reported symptom improvement. Painful neuropathy was associated with poor scores in physical functioning, energy level and general health. Despite the presence of diabetic neuropathy, 57.0% were barefoot most of the time.

Conclusions: Feet pain is common among people with DSPN. It remains undertreated and affects QoL. Deformities and toe-web infections are common, placing the feet at high risk of ulceration. There is room to improve foot-care provision and self-management among adults with DSPN.