Elsevier

Primary Care Diabetes

Volume 8, Issue 3, October 2014, Pages 250-255
Primary Care Diabetes

Original research
Prevalence and risk factors of neuropathy in newly diagnosed type 2 diabetes in primary care practices: A retrospective database analysis in Germany and UK

https://doi.org/10.1016/j.pcd.2014.01.011Get rights and content

Abstract

Aims

To estimate the prevalence and risk factors of diabetic neuropathy in newly diagnosed type 2 diabetes in general practices.

Methods

Longitudinal data from nationwide general practices in Germany (n = 630) and UK (n = 100) (Disease Analyzer) were analyzed. Patients with newly diagnosed (<1 year) type 2 diabetes (2008–2012) were identified including 45,633 patients (age: 66, SD: 12 years) in Germany and 14,205 patients (age: 63, SD: 13 years) in UK. Neuropathy was identified by ICD code (E11.4) or the original diagnosis. Associations of potential risk factors with neuropathy were investigated using logistic regression.

Results

The prevalence of diagnosed neuropathy was 5.7% (95% CI: 5.5–5.9%) in Germany and 2.4% (1.9–2.9%) in UK. In Germany, factors independently associated with neuropathy in stepwise logistic regression were age (>70 years: OR; 95% CI 2.1; 1.6–2.8), retinopathy (3.0; 2.1–4.2), peripheral artery disease (PAD: 1.9; 1.4–2.5), insulin treatment (4.6; 3.5–6.2) and oral antidiabetic drugs (OAD: 1.6; 1.2–2.0). In UK, male sex (1.4; 1.01–1.9), nephropathy (1.7; 1.2–2.5), PAD (1.5; 1.1–2.1), antihypertensives (1.7; 1.1–2.5), insulin (2.1; 1.1–3.8) and OAD (1.4; 1.01–1.8) were identified.

Conclusions

The prevalence of diabetic neuropathy at time of type 2 diabetes diagnosis was low in primary care (Germany, UK). Neuropathy was associated with age, PAD and microvacular complications.

Introduction

Diabetes mellitus is a major cause of peripheral neuropathy [1], [2]. The typical diabetic neuropathy is a chronic, symmetrical sensorimotor polyneuropathy [1], [2]. Long-term hyperglycemia is the most important risk factor, which is associated with alterations of microvessels, similar to those in diabetic retinopathy and nephropathy [2]. Thus, diabetic neuropathy has been considered a chronic complication that occurs after long diabetes duration.

Evidence is growing that after careful testing neuropathy already manifests in up to 20% of subjects with prediabetes [3], [4]. In addition, nerve disorders can already be present at the time of diabetes diagnosis. However, there are few studies on the prevalence and determinants of diabetic neuropathy at onset of type 2 diabetes [5], [6], [7], [8]. Based on these mostly small study samples, neuropathy was already present in 2–10% [5], [6], [7], [8]. Therefore, the aim of the current study was to study the prevalence and risk factors of diabetic neuropathy in patients with newly diagnosed type 2 diabetes in primary care in Germany and UK.

Section snippets

Patients and methods

The Disease Analyzer database (IMS HEALTH) assembles drug prescriptions, diagnoses, basic medical and demographic data directly obtained from the practice computer system of general practitioners [9]. Diagnoses (ICD-10), prescriptions (Anatomical Therapeutic Chemical (ATC) Classification System) and the quality of reported data were monitored by IMS based on a number of criteria (e.g. completeness of documentation, linkage of diagnoses and prescriptions).

In Germany, the sampling methods for the

Patient characteristics

There were 45,633 primary care patients with newly diagnosed type 2 diabetes in the German practices. The prevalence of diagnosed diabetic neuropathy (n = 2,583) was 5.7% (95% CI: 5.5–5.9%). The clinical characteristics stratified by neuropathy status are shown in Table 1. There was no sex difference between the two groups. The mean age was 66 years, which was 3 years higher in patients with neuropathy (p < 0.05). Patients with diabetic neuropathy also had higher HbA1c levels and were substantially

Discussion

This real world data shows that prevalence of diagnosed neuropathy at time of type 2 diabetes diagnosis was low in primary care practices (Germany: 5.7%, UK: 2.4%). Diabetic neuropathy was associated with male sex, age, peripheral vascular disease and microvacular complications. There was also a significant relationship with prescription use of antihypertensive agents.

The prevalence estimates are in line with previous smaller studies, although it is challenging to compare prevalences, in

Conflict of interest

K.K. is an employee of IMS Health, W.R. has received a consulting fee from IMS Health.

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