Elsevier

Primary Care Diabetes

Volume 1, Issue 3, September 2007, Pages 129-134
Primary Care Diabetes

Diagnosis of diabetic peripheral neuropathy among patients with type 1 and type 2 diabetes in France, Italy, Spain, and the United Kingdom

https://doi.org/10.1016/j.pcd.2007.07.006Get rights and content

Abstract

Aims

The objective of this study was to describe the proportion and characteristics of patients with type 1 and type 2 diabetes diagnosed with diabetic peripheral neuropathy (DPN) in France, Italy, Spain, and the United Kingdom (UK).

Methods

A cross-sectional survey was administered to general practitioners and diabetes specialists. Existing physicians’ records were used to quantify the frequency of DPN diagnoses, and notes from patients’ medical charts were used to characterize symptoms.

Results

The average number of physicians per country was 41 (range of 34–49). The proportion of diabetes patients diagnosed with DPN ranged from 9.6% (95% CI, 7.1–12.2) in Spain to 23.1% (95% CI, 15.4–30.7) in Italy. Of 913 DPN study patients, 55.0% were male, and 78.5% had type 2 diabetes. Mean age was 64.5 ± 12.5 years. A DPN diagnosis was based primarily on symptoms. Approximately 27% of patients had no documented neurological examination. “Prickling” was the most common DPN symptom recorded in France, Italy, and Spain, and “numbness” was the most common in the UK.

Conclusions

Country-specific estimates of DPN diagnosis may reflect clinical management of diabetes and DPN. A substantial number of diagnoses were not associated with a record of a neurological examination.

Introduction

Type 1 and type 2 diabetes mellitus are associated with a broad spectrum of microvascular complications, including diabetic peripheral neuropathy (DPN), the most common type of neuropathy. DPN is a complex and progressive disorder associated with a broad range of neuropathic symptoms, including numbness, prickling/tingling, burning, aching, lancinating pain, and allodynia (i.e., pain that is due to a stimulus that does not normally cause pain). While symptomatic presentation can occur at any point in the disease state, nerve damage typically develops insidiously as an asymptomatic loss or change in sensation and nerve function. In the United States (US), Gregg et al. found that an estimated 62% of DPN cases in patients with diabetes were asymptomatic [1].

Subclinical signs often present at the onset of DPN and can be detected by electrophysiological testing and nerve conduction studies. Early symptoms frequently include numbness and tingling, often occurring prior to pain symptoms.

As nerve damage continues, patients lose protective sensory defenses, such as vibration detection and pressure sensation, which are often assessed by quantitative sensory testing. Patients may have reduced or absent ankle reflexes, and in some cases, may have reduced or absent knee reflexes.

In a European survey of 4798 patients with type 2 diabetes across five countries (Belgium, Italy, the Netherlands, Spain, and Sweden), Bagust and Beale studied the impact of diabetes complications on health-related quality of life using the EuroQol (EQ-5D) visual analogue scale. The most important complications from the patient's perspective were end-stage renal disease, amputations, foot ulcers, blindness, and stroke [2]. In 2002, more than 60% of nontraumatic lower-limb amputations in the US were due to DPN and amounted to about 82,000 lower-limb amputations [3].

An understanding of diagnosed DPN and the severity of its symptoms are essential to appreciate the full burden of diabetes and its complications. The primary goals of this study were (1) to quantify diagnoses of DPN among patients with type 1 and type 2 diabetes in France, Italy, Spain, and the United Kingdom (UK); (2) to characterize patients with a diagnosis of DPN by age, gender, body mass index (BMI), smoking, and selected comorbidities; and (3) to describe symptoms associated with DPN that were recorded in the medical notes.

Section snippets

Design

The study was a cross-sectional survey of physicians who practice within the primary care setting in France, Italy, Spain, and the UK. Additionally, diabetes specialists were enrolled in Italy and Spain. In France and the UK, general practitioners (GPs) are responsible for the routine management of patients with diabetes; thus their medical records were deemed the most reliable and readily available for data collection. However, in Italy and Spain, GPs as well as diabetes specialists manage

Study physicians

We enrolled 49 physicians in France, 38 physicians in Italy, 34 in Spain, and 41 in the UK. Across countries, approximately 38% of the physicians reported that they routinely examine a high proportion (81–100%) of their patients for DPN, while 26% of physicians reported examining only a few (0–20%) of their patients. However, notable differences existed between countries. For instance, in the UK, the large majority of physicians (85.4%, n = 35) reported that they examined 81–100% of their

Main study findings

We conducted a cross-sectional study to assess the frequency of a DPN diagnosis in patients with type 1 and type 2 diabetes in France, Italy, Spain, and the UK. Furthermore, we conducted a descriptive analysis of DPN patients. Results from this investigation indicated that the frequency of diagnosed DPN in patients with diabetes varied considerably across the four European study countries.

There have been few community-based studies that have specifically examined the prevalence of symptomatic

Conflict of interest

The authors state that they have no conflict of interest.

Funding

This study was funded by Eli Lilly and Company.

Ethical approval

The study was reviewed by the Institutional Review Board (IRB) of RTI International and approved by Dr. Wendy Visscher. The IRB reference number is B0523.

Ethic approval was given by the Central Office for Research Ethics Committees (COREC) in the United Kingdom and approved by Thames Valley. The COREC application number for this study is 05/MRE 12/27.

A declaration was filed to the Conseil National de l’Ordre des Médecine, but as there is no formal approval foreseen, one does not necessarily

References (14)

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