Diabetologia

, Volume 36, Issue 2, pp 150–154 | Cite as

A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population

  • M. J. Young
  • A. J. M. Boulton
  • A. F. Macleod
  • D. R. R. Williams
  • P. H. Sonksen
Originals

Summary

A cross-sectional multicentre study of randomly selected diabetic patients was performed using a standardised questionnaire and examination, to establish the prevalence of peripheral neuropathy in patients attending 118 hospital diabetes clinics in the UK. Vibration perception threshold was performed in two centres to compare with the clinical scoring systems. A total of 6487 diabetic patients were studied, 53.9% male, median age 59 years (range 18– 90 years), 37.4% Type 1 (insulin-dependent) diabetes mellitus, with a median duration of diabetes 8 years (0–62 years). The overall prevalence of neuropathy was 28.5% (27.4– 29.6 %) (95 % confidence interval) in this population. The prevalence in Type 1 diabetic patients was 22.7% (21.0– 24.4 %) and in Type 2 (non-insulin-dependent) diabetic patients it was 32.1 % (30.6–33.6 %). The prevalence of diabetic peripheral neuropathy increased with age, from 5% (3.1– 6.9 %) in the 20–29 year age group to 44.2 % (41.1–47.3 %) in the 70–79 year age group. Neuropathy was associated with duration of diabetes, and was present in 20.8 % (19.1–22.5 %) of patients with diabetes duration less than 5 years and in 36.8 % (34.9–38.7 %) of those with diabetes duration greater than 10 years. Mean vibration perception threshold measured at the great toe was 21.1±13.5 SD volts and correlated with the neuropathy disability score, r=0.8 p<0.001. In conclusion, diabetic peripheral neuropathy is a common complication associated with diabetes. It increases with both age and duration of diabetes, until it is present in more than 50% of Type 2 diabetic patients aged over 60 years. An increased awareness of the high prevalence of peripheral neuropathy, especially in older patients, should result in improved screening programmes in order to reduce the high incidence of neuropathic diabetic foot ulceration.

Key words

Diabetes Mellitus peripheral neuropathy epidemiology 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Goodman JL, Baumoel S, Frankel L, Marcus LJ, Wasserman S (1953) The diabetic neuropathies. CC Thomas Springfield, Illinois, pp 1–66Google Scholar
  2. 2.
    Pirart J (1979) Diabetes mellitus and its degenerative complications: a prospective study of 4400 patients observed between 1947 and 1973. Diabetes Care 1: 168–188Google Scholar
  3. 3.
    Franklin GM, Kahn LB, Bacter J, Marshall JA, Hamman RF (1990) Sensory neuropathy in non-insulin dependent diabetes mellitus. The San Luis Valley study. Amer J Epidemiol 131: 633–643Google Scholar
  4. 4.
    The DCCT Research Group (1988) Factors in the development of diabetic neuropathy. Diabetes 37: 476–481Google Scholar
  5. 5.
    Lehtinen JM, Uusitupa M, Siitonen O, Pyörälä K (1989) Prevalence of neuropathy in newly diagnosed NIDDM and nondiabetic control subjects. Diabetes 38: 1307–1313PubMedGoogle Scholar
  6. 6.
    Maser RE, Steenkiste AR, Dorman JS et al. (1989) Epidemiological correlates of diabetic neuropathy: report from Pittsburgh epidemiology of diabetes complications study. Diabetes 38: 1456–1461PubMedGoogle Scholar
  7. 7.
    Boulton AJM, Knight G, Drury J, Ward JD (1985) The prevalence of symptomatic, diabetic neuropathy in an insulin-treated population. Diabetes Care 8: 125–128PubMedGoogle Scholar
  8. 8.
    Knuiman MW, Welborn TA, McCann VJ, Stanton KG, Constable IJ (1986) Prevalence of diabetic complications in relation to risk factors. Diabetes 35: 1332–1339PubMedGoogle Scholar
  9. 9.
    Fry IK, Hardwick C, Scott GW (1962) Diabetic neuropathy: a survey and follow-up of 66 cases. Guys Hosp Rep 111: 113–129PubMedGoogle Scholar
  10. 10.
    Newrick PG, Boulton AJM, Ward JD (1986) The distribution of diabetic neuropathy in a British clinic population. Diabetes Res Clin Prac 2: 263–268Google Scholar
  11. 11.
    Neil HAW, Thompson AV, Thorogood M, Fowler GH, Mann JI (1989) Diabetes in the elderly: the Oxford community diabetes study. Diabetic Med 6: 608–613PubMedGoogle Scholar
  12. 12.
    Dyck PJ, Karnes JL, Daube J, O'Brien P, Service FJ (1985) Clinical and neuropathologic criteria for the diagnosis and staging of diabetic polyneuropathy. Brain 108: 861–880PubMedGoogle Scholar
  13. 13.
    Dyck PJ (1988) Detection, characterization and staging of polyneuropathy assessed in diabetics. Muscle Nerve 11: 21–32PubMedGoogle Scholar
  14. 14.
    Melzack R (1984) The McGill pain questionnaire. In: Bromm P (ed) Pain measurement in man. Neurophysiological correlates of pain. Elsevier Scientific Publishers, Amsterdam pp 327–348Google Scholar
  15. 15.
    Masson EA, Gem J, Hunt L, Boulton AJM (1989) A novel approach to the diagnosis and assessment of symptomatic diabetic neuropathy. Pain 38: 25–28CrossRefPubMedGoogle Scholar
  16. 16.
    Dyck PJ, Kratz KM, Lehman KA et al. (1991) The Rochester diabetic neuropathy study: design, criteria for types of neuropathy, selection bias, and reproducibility of neuropathic tests. Neurology 41: 799–807PubMedGoogle Scholar
  17. 17.
    Steiness IB (1957) Vibratory perception in diabetics. Acta Medica Scand 158: 327–355Google Scholar
  18. 18.
    Bertlesmann FW, Heimans JJ, Weber EJM, van der Veen EA, Schouten JA (1985) Thermal discrimination thresholds in normal subjects and in patients with diabetic neuropathy. J Neurol Neurosurg Psychiatry 48: 685–690Google Scholar
  19. 19.
    Masson EA, Veves A, Fernando D, Boulton AJM (1989) Current perception thresholds: a new, quick and reproducible method for the assessment of peripheral neuropathy in diabetes mellitus. Diabetologia 32: 724–728CrossRefPubMedGoogle Scholar
  20. 20.
    Consensus Statement (1988) Report and recommendations of the San Antonio conference on diabetic neuropathy. Diabetes 37: 1000–1004Google Scholar
  21. 21.
    Mayne N (1965) Neuropathy in the diabetic and non-diabetic populations. Lancet II: 1313–1316CrossRefGoogle Scholar
  22. 22.
    Jarrett RJ, McCartney P, Keen H (1982) The Bedford survey: ten year mortality rates in newly diagnosed diabetics, borderline diabetics and normoglycaemic controls and risk indices for coronary heart disease in borderline diabetics. Diabetologia 22: 79–84PubMedGoogle Scholar
  23. 23.
    Boulton AJM (1990) The diabetic foot — neuropathic in origin? RD Lawrence Lecture. Diabetic Med 7: 852–858PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • M. J. Young
    • 1
  • A. J. M. Boulton
    • 1
  • A. F. Macleod
    • 2
  • D. R. R. Williams
    • 3
  • P. H. Sonksen
    • 2
  1. 1.Manchester Royal InfirmaryUniversity Department of MedicineManchester
  2. 2.Department of Endocrinology and Chemical PathologySt. Thomas' HospitalLondon
  3. 3.Department of Community MedicineAddenbrookes HospitalCambridgeUK

Personalised recommendations