A questionnaire for neurological symptoms in patients with diabetes — cross-sectional multicenter study in Saitama Prefecture, Japan

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Abstract

This study was designed to investigate the prevalence of neurological symptoms in diabetic patients living in Saitama Prefecture, Japan using 13-item questionnaire. A total of 6472 outpatients with diabetes (3417 men and 3055 women) were recruited from 100 centers. Mean age and mean disease duration were 60.9-year old and 10.4 years, respectively. The questionnaire for monitoring of neurological symptoms was completed at the clinic or hospital visited, and Achilles’ tendon reflex, ophthalmologic, blood and urinary examinations were also performed. Of the 6472 patients, 84.8% suffered from a mean of 3.3±2.2 neurological symptoms. However, half of these symptoms were not considered to be those of diabetic neuropathy by attending physicians. ‘Feeling as if a piece of paper is attached to the sole of the foot,’ ‘stinging and prickling sensations in feet,’ and ‘pain in feet’ were the most common symptoms of diabetic neuropathy. The prevalence of diabetic neuropathy as determined by attending physician increased with disease duration and worse control of diabetes. This study found that the majority of diabetics were suffered from neurological symptoms, although half of such symptoms were not considered to be those of diabetic neuropathy by physicians. Furthermore, it is important for diabetics to be diagnosed and treated earlier to prevent progression to severe neuropathic complications by means of optimal glycemic control and use of some chemicals such as aldose reductase inhibitor, and to develop this study to evaluate the efficacy of treatments.

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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