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Prevalence of diabetic neuropathy among type 1

and 2 diabetic
patients in Saudi Arabia
Banderi Abduallah M. Ahmad
Dalal Hamed A. AlEesa
Nuha Ali M. AlHefdhi
Supervisor:
Dr. Fahad El Eidan

Introduction
Diabetes mellitus (DM) is a chronic metabolic disorder which occurs when
the pancreas does not produce enough insulin or when the body cannot
effectively use the insulin it produces, which leads to hyperglycemia.
Saudi Arabia: ranked as the 7th highest country with diabetes mellitus
prevalence. (24%)
Types: DM type 1, DM type 2
Complications:
1. Macro-vascular: CVS disease, CVD
2. Micro-vascular: DPN, retinopathy, nephropathy.
WHO

Diabetic Peripheral Neuropathy (DPN)


Definition: it is the presence of symptoms and/or signs of peripheral nerve dysfunction
in people with DM after the exclusion of other causes.
Prevalence:
22 60 % in low-middle income countries
12 - 50 % in US
36.6 in Bahrain

DPN is associated with a wide range of complications and increases the risk for foot ulcer
and lower extremity amputations.
25% of DPN patients will develop a foot ulcer. 85% of lower limb amputations are due to
a foot ulcer in a diabetic patient.
ADA

Objective and rationale


This study was designed to determine the prevalence
of diabetic peripheral neuropathy in Saudi patients of
both types of diabetes, and to investigate other related
factors associated with DPN.
Rationale:

Results
Total of 293 diabetic subjects
54 type 1
239 type 2

Mean age is 66 years old


Overall prevalence of DPN is 3.4%
Prevalence of DPN in type 1 diabetic 1.3%
Prevalence of DPN in type 2 diabetic 4.1%

Prevalence of DPN was higher among females (63%)


than males

Non-DPN
N=220(75.1)

DPN
N=73(24.9)

Age years

P-value
0.006

<60

107(48.6)

22(30.1)

=>60

113(51.4)

51(69.9)

Gender

0.096

Male

106(48.2)

27(37.0)

Female

114(51.8)

46(63.0)

Duration of
diabetes years

0.04

<5

109(78.4)

44(91.7)

=>5

30(21.6)

4(8.3)

Gender
37%
63%

Male
Female

Non-DPN
N=220(75.1)

DPN N=73(24.9)

Type of DM

0.025

Type I

47(21.4)

7(9.6)

Type II

173(78.6)

66(90.4)

Type of treatment

0.072

Insulin

158(72.8)

62(86.1)

Oral
hypoglycemic

53(24.4)

9(12.5)

6(2.8)

1(1.4)

Diet
Median number
of comorbidities

120
100
80
60
40
20
0

0.0001

<5

130 (59.3%)

22 (30.1%)

=> 5

89 (40.7%)

48 (69.9%)

Diet

Insulin
DPN

P-value

Non-DPN

Oral
Hypogycemic
Agents

Diabetic subjects
10%

90%

Type 1
Type 2

Non-DPN

DPN

BMI

p-value
0.063

<25

70 (38.5%)

14 (22.2%)

25-29

41 (22.5%)

17 (27%)

=> 30

71 (39%)

32 (50.8%)

Smoking status

0.131

Yes

29 (13.2%)

15 (20.5%)

No

190 (86.8%)

58 (79.5%)

Alcohol status

0.413

Yes

2(0.9)

0(0.0)

No

217(99.1)

73(100)

<7

52 (23.7%)

22 (30.6%)

=> 7

167 (76.3%)

50 (69.4%)

HbA1C (Median)

<6.5

19 (9.5%)

11 (15.9%)

180 (90.5%)

58 (84.1)

Fasting blood glucose


mmol/L (Median)

=> 6.5

0.25

0.147

Significant co-morbidities
Non-DPN

Peripheral
vascular disease
Yes
No
Foot ulcer
Yes
No
Gangrene
Yes
No
Lower limb
amputation
Yes
No
DKA
Yes
No

DPN

p-value
0.0001

15 (6.9%)
203 (93.1%)

17 (23.3%)
56 (79.7%)
0.006

15 (6.9%)
203 (93.1%)

13 (17.8%)
60 (82.2%)
0.001

3 (1.4%)
215 (98.6)%

7 (9.6%)
66 (90.4%)
0.001

7 (3.2%)
211 (96.8%)

10 (13.7%)
63 (86.3%)
0.003

30 (13.8%)
188 (86.2%)

1 (1.4%)
72 (98.6%)

Hypertension

0.005

Yes

160 (73.1%)

65 (89%)

No

59 (26.9%)

8 (11%)

Cerebral stroke

0.027

Yes

32 (14.7%)

19 (26%)

No

186 (85.3%)

54 (74%)

Odds ratio (95% CI)


Variable

Odds ratio (95% CI)

Age

Variable

Odds ratio (95% CI)

Fasting blood glucose


<60

0.40

2.19 odds of
OR=1=>60
Exposure does not affect
outcome
Duration of diabetes
OR>1 Exposure associated with higher
<5
0.33
odds of outcome
3.02 lower
OR<1=>5
Exposure associated with
odds
ofDM
outcome
Type of
1

0.39

2.56

Type of treatment
insulin

2.31

OHA

0.44

diet

0.49

<7

0.76

=>7

1.41

HbA1C
<6.5

0.55

=>6.5

1.79

Number of
comorbidities
<5

0.31

=>5

3.18

HTN

2.99

DLP

2.54

PVD

4.10

Foot ulcer

2.93

Amputation

4.78

Discussion
In this study we observed prevalence of DPN was 3.4%,
which is lower in comparison to previous studies.
Internationally: (1, 2)

In UK it was reported to be was reported to be 21%


In Canada, the prevalence was 15%.
In US reported a prevalence of 28.5%.
in Bahrain reported a prevalence of 36.6%

Locally: (3)
In Saudi Arabia the prevalence of painful DPN was
estimated to be 65.3%

DPN cases in these studies were diagnosed by


different tools of measurements and different
definitions of DPN.
Our data showed that DPN is more prevalent in type
2 (4.1%) diabetes than type 1 (1.3%), which
supported previous studies.

What we know
Factors were associated with DPN:

Age
Duration of diabetes
Type of treatment
Glycemic control

In our study
DPN was associated with these factors and this
association was similar to previous studies. However
contrasted other studies, our study did not show any
correlation between smoking and DPN.
Some diseases were associated with DPN such as
PVD, HTN, dyslipidemia, foot ulcer and amputation,
which supported some studies.

Recommendations
Good glycemic control could prevent or delay the
progression of DPN. Controlling other co-morbid
diseases like HTN and dyslipidemia could help in the
prevention of DPN.

Limitations

Retrospective
Poor documentation
No tool or criteria to diagnose DPN
We need a large prospective multicenter study to
evaluate the prevalence/incidence of DPN

Conclusion
The results of our study showed a relatively low
prevalence (3.4%) of DPN that was associated with
age, duration of diabetes, type of treatment, glycemic
control, and other comorbidities.
A significant difference existed in the prevalence of
DPN between type 1 (1.3%) and 2 (4.1%) diabetic
patients.

References
Abbott CA, Malik RA, van Ross ER, Kulkarni J, Boulton AJ.
Prevalence and characteristics of painful diabetic neuropathy in a
large community-based diabetic population in the UK. Diabetes
Care 34: 22202224, 2011.
Young MJ, Boulton AJM, Macleod AF. A multicentre study of the
prevalence of diabetic peripheral neuropathy in the United
Kingdom hospital clinic popula- tion. Diabetologia. 1993;36:150
54.
Halawa MR, Karawagh A, Zeidan A, Mahmoud AE, Sakr M, et al.
(2010) Prevalence of painful diabetic peripheral neuropathy
among patients suffering from diabetes mellitus in Saudi Arabia.
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