Journal of Endocrinological Investigation

, Volume 40, Issue 4, pp 425–430 | Cite as

Ambulatory screening of diabetic neuropathy and predictors of its severity in outpatient settings

  • M. S. Qureshi
  • M. Iqbal
  • S. ZahoorEmail author
  • J. Ali
  • M. U. Javed
Original Article



Diabetic neuropathy is one of the most common causes of chronic neuropathic symptomatology and the most disabling and difficult-to-treat diabetic microangiopathic complication. The neuropathies associated with diabetes are typically classified into generalized, focal and multifocal varieties. There exists a scarcity of literature studying the correlation of different patient- and disease-related variables with severity of neuropathy.


This study aims to delineate the prevalence of diabetic neuropathy in type 2 diabetes, describe its characteristics and find out predictors of its severity.

Material and methods

Eight hundred consecutive diabetic patients presenting to outpatient department (OPD) of Khan Research Labs (KRL) General Hospital and Centre for Diabetes and Liver diseases, Islamabad, during March–June, 2015 were made to complete a self-administered questionnaire (Michigan Neuropathy Screening Instrument—MNSI) and underwent a thorough physical examination according to MNSI protocols. A score of >2 was considered to be diagnostic for DPN. Patient and disease variables were noted. MNSI score was used as an index of severity of diabetic peripheral neuropathy (DPN). Correlation of several patient- and disease-related variables with the severity of DPN was determined using multivariate regression.


Out of a total 800 patients screened, 90 (11.25%) were found to have diabetic neuropathy. Of these 90, 45.5% were males, the median age was 54.47 ± 10.87 years and the median duration of diabetes was 11.12 ± 9.8 years. The most common symptom was found to be numbness (63.6%) followed by generalized body weakness (61.5%). The common findings on physical examination were dry skin/callus (38.7%) and deformities (14.7%). Duration of diabetes was found to be the strongest predictor for development and severity of diabetic neuropathy followed by glycemic controls (HbA1c values) and age.


Duration of diabetes rather than diabetic controls predicts better the development and severity of diabetic neuropathy indicating a failure of intensive treatment to avert such complications.


Diabetes Neuropathy Screening 


Authors’ contributions

All the authors contributed equally to this work; they designed the article, did data collection, did thorough search, analyzed the data, wrote, reviewed and approved the final form of this manuscript.


This work has been carried out without any grants or funds. This work has been completed without external financial support, and the extra expenses whatsoever for the purpose of this study have been contributed solely by the author’s themselves and no one else.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Watson JC, Dyck PJB (2015) Peripheral neuropathy: a practical approach to diagnosis and symptom management. Mayo Clinic Proc 90(7):940–951CrossRefGoogle Scholar
  2. 2.
    Martyn CN, Hughes RA (1997) Epidemiology of peripheral neuropathy. J Neurol Neurosurg Psychiatry 62:310–318CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Italian General Practitioner Study Group (IGPSG) (1995) Chronic symmetric symptomatic polyneuropathy in the elderly: a field screening investigation in two Italian regions, I: prevalence and general characteristics of the sample. Neurology 45:1832–1836CrossRefGoogle Scholar
  4. 4.
    Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O (2003) Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 348:383–393CrossRefPubMedGoogle Scholar
  5. 5.
    Tesfaye S, Boulton AJ, Dyck PJ et al (2010) Toronto Diabetic Neuropathy Expert Group. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 33:2285–2293CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Partanen J, Niskanen L, Lehtinen J, Mervaala E, Siitonen O, Uusitupa M (1995) Natural history of peripheral neuropathy in patients with non-insulin-dependent diabetes mellitus. N Engl J Med 333:89–94CrossRefPubMedGoogle Scholar
  7. 7.
    Boulton AJM (2005) Management of diabetic peripheral neuropathy. Clin Diabetes. 23:9–15CrossRefGoogle Scholar
  8. 8.
    Boulton AJ, Vinik AI, Arezzo JC et al (2005) Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care 28:956–962CrossRefPubMedGoogle Scholar
  9. 9.
    Davies JL, Clark VM et al (2006) Modeling chronic glycemic exposure variables as correlates and predictors of microvascular complications of diabetes. Diabetes Care 29:2282–2288CrossRefPubMedGoogle Scholar
  10. 10.
    Gaballa MR, Farag YM (2013) Predictors of diabetic nephropathy. Cent Eur J Med 8(3):287–296Google Scholar
  11. 11.
    Viberti GC, Jarrett RJ, Mahmud U, Hill RD, Argyropoulos A, Keen H (1982) Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. The Lancet 319(8287):1430–1432CrossRefGoogle Scholar
  12. 12.
    Tesfaye S, Chaturvedi N, Eaton SE, Ward JD, Manes C, Ionescu-Tirgoviste C, Witte DR, Fuller JH (2005) Vascular risk factors and diabetic neuropathy. N Engl J Med 352(4):341–350CrossRefPubMedGoogle Scholar
  13. 13.
    Jia WP et al (2006) Evaluation of the four simple methods in the diagnosis of diabetic peripheral neuropathy. Zhonghuayixuezazhi 86(38):2707–2710Google Scholar
  14. 14.
    Ahmed A, Bril V, Orszag A et al (2012) Detection of diabetic sensorimotor polyneuropathy by corneal confocal microscopy in type 1 diabetes: a concurrent validity study. Diabetes Care 35:821–828CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, Lauria G, Malik RA, Spallone V, Vinik A, Bernardi L, Valensi P (2010) Toronto diabetic neuropathy expert group. Diabetes Care 33(10):2285–2293CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Lee CC, Perkins BA, Kayaniyil S, Harris SB, Retnakaran R, Gerstein HC et al (2015) Peripheral neuropathy and nerve dysfunction in individuals at high risk for type 2 diabetes: the PROMISE cohort. Diabetes Care 38(5):793–799CrossRefPubMedGoogle Scholar
  17. 17.
    Dyck PJ, Kratz KM, Karnes JL et al (1993) The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology 43:817–824CrossRefPubMedGoogle Scholar
  18. 18.
    Ishaq M, Khan GJ, Rahman S, Zulfiqar S (2013) Prevalence of complications in type 2 diabetes mellitus patients. Pak J Physiol 9(2):35–37Google Scholar
  19. 19.
    George H, Rakesh P, Krishna M et al (2013) Foot Care knowledge and practices and the prevalence of peripheral neuropathy among people with diabetes attending a secondary care rural hospital in Southern India. J Fam Med Prim Care 2(1):27–32. doi: 10.4103/2249-4863.109938 CrossRefGoogle Scholar
  20. 20.
    Tracy JA, Dyck PJB (2008) The spectrum of diabetic neuropathies. Phys Med Rehabil Clin Am. doi: 10.1016/j.pmr.2007.10.010 Google Scholar
  21. 21.
    Dyck PJ, Davies JL, Wilson DM, Service FJ, Melton LJ (1999) Risk factors for severity of diabetic polyneuropathy: intensive longitudinal assessment of the Rochester Diabetic Neuropathy Study cohort. Diabetes Care 22(9):1479–1486CrossRefPubMedGoogle Scholar
  22. 22.
    Ziegler D, Behler M, Schroers-Teuber M, Roden M (2015) Near-normoglycaemia and development of neuropathy: a 24-year prospective study from diagnosis of type 1 diabetes. BMJ Open. 5(6):e006559. doi: 10.1136/bmjopen-2014-006559 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Partanen J, Niskanen L, Lehtinen J, Mervaala E, Siitonen O, Uusitupa M (1995) Natural history of peripheral neuropathy in patients with non-insulin-dependent diabetes mellitus. N Engl J Med 333(2):89–94CrossRefPubMedGoogle Scholar
  24. 24.
    Martin CL, Albers JW, Pop-Bussi R (2013) Neuropathy and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care 37:131–138Google Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2016

Authors and Affiliations

  • M. S. Qureshi
    • 1
  • M. Iqbal
    • 2
  • S. Zahoor
    • 1
    Email author
  • J. Ali
    • 1
  • M. U. Javed
    • 1
  1. 1.Department of MedicineKhan Research Laboratories (KRL) HospitalIslamabadPakistan
  2. 2.Centre for Diabetes and Liver DiseasesIslamabadPakistan

Personalised recommendations