A questionnaire for neurological symptoms in patients with diabetes — cross-sectional multicenter study in Saitama Prefecture, Japan
Introduction
Neuropathy is a frequent complication of diabetes mellitus (DM) and a major cause for medical referral of diabetic patients. Pirart et al. [1] revealed that 8% of patients with DM had diabetic neuropathy at the time of diagnosis of DM, and that after 25 years of DM, 50% of patients had diabetic neuropathy. The Diabetes Control and Complications Trial (DCCT) found that 39% of type 1 DM had diabetic neuropathy as defined by signs and abnormal results of electrophysiological assessment [2]. Young et al. [3] reported that the incidence of diabetic neuropathy increased with age and reached 44% in older diabetics in the United Kingdom, and Comi et al. [4] reported that 66% of diabetics had a decline in lower extremity vibratory sensation over time in Italy.
This study was attempted to determine the cross-sectional prevalence of subjective and objective findings of diabetic neuropathy in patients with DM throughout Saitama Prefecture, Japan and would be developed to evaluate the efficacy of treatments for diabetic neuropathy.
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Materials and methods
A total of 6472 outpatients with DM (3417 men and 3055 women) were recruited from 100 centers throughout Saitama Prefecture, Japan. All patients met the Japanese Diabetes Association criteria for either type 1 or type 2 DM. A 13-item questionnaire (Table 1) was handed to the patients at the medical office visited. Patients were requested to fill out the questionnaire. Comments on symptoms and the value of hemoglobin Alc (HbA1c), presence or absence of proteinuria, strength of Achilles’ tendon
Results
The distribution of percent HbAlc values in patients was shown in Fig. 1. Of all patients, 44.6% had HbAlc below 6.9%. Since HbAlc was indicated as a range of values, it is not possible to calculate the mean values. The incidences of proteinuria, loss or decrease of Achilles’ tendon reflex and presence of diabetic retinopathy were 27.3, 41.4 and 34.5%, respectively. Surprisingly, of the 6472 patients, 84.8% (n=5490) suffered from one or more of 13 neurological symptoms, which were ‘always
Discussion
Neuropathy is one of the major complications of DM and results in severe problems in patients with DM. Neurological problems also result from cerebral vascular diseases, orthopedic diseases such as cervical or lumbar spondylosis and carpal tunnel syndrome, alcoholic neuropathy, circulatory disturbances such as ASO, neuropathy related some cancers. It is clinically important to clear the genesis of neuropathy in diabetics, because patients with DM are likely to suffer from these diseases. We
Acknowledgements
We fully acknowledged the participating institutions in Saitama Prefecture and the investigators therein for their cooperation to this Questionnaire Survey. This study was supported by Ono Pharmaceutical Co., Ltd, Japan. Participating investigators and institutions; Yoshiaki Akiba at Akiba Hospital, Toshio Ito at Ageo Digestive Surgical Hospital, Kengo Gouchi at Asano Hospital, Tetsuro Ikezawa at Ikezawa Clinic, Yasuaki Ishimaru at Ishimaru Hospital, Michio Sato at Ina Chuou Hospital, Yoshio
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