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

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.

References

  1. 1.

    Goodman JL, Baumoel S, Frankel L, Marcus LJ, Wasserman S (1953) The diabetic neuropathies. CC Thomas Springfield, Illinois, pp 1–66

    Google 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: 168–188

    Google 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: 633–643

    Google Scholar 

  4. 4.

    The DCCT Research Group (1988) Factors in the development of diabetic neuropathy. Diabetes 37: 476–481

    Google 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: 1307–1313

    PubMed  Google 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: 1456–1461

    PubMed  Google 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: 125–128

    PubMed  Google 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: 1332–1339

    PubMed  Google Scholar 

  9. 9.

    Fry IK, Hardwick C, Scott GW (1962) Diabetic neuropathy: a survey and follow-up of 66 cases. Guys Hosp Rep 111: 113–129

    PubMed  Google 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: 263–268

    Google 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: 608–613

    PubMed  Google 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: 861–880

    PubMed  Google Scholar 

  13. 13.

    Dyck PJ (1988) Detection, characterization and staging of polyneuropathy assessed in diabetics. Muscle Nerve 11: 21–32

    PubMed  Google 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 327–348

    Google 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: 25–28

    Article  PubMed  Google 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: 799–807

    PubMed  Google Scholar 

  17. 17.

    Steiness IB (1957) Vibratory perception in diabetics. Acta Medica Scand 158: 327–355

    Google 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: 685–690

    Google 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: 724–728

    Article  PubMed  Google Scholar 

  20. 20.

    Consensus Statement (1988) Report and recommendations of the San Antonio conference on diabetic neuropathy. Diabetes 37: 1000–1004

    Google Scholar 

  21. 21.

    Mayne N (1965) Neuropathy in the diabetic and non-diabetic populations. Lancet II: 1313–1316

    Article  Google 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: 79–84

    PubMed  Google Scholar 

  23. 23.

    Boulton AJM (1990) The diabetic foot — neuropathic in origin? RD Lawrence Lecture. Diabetic Med 7: 852–858

    PubMed  Google Scholar 

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Young, M.J., Boulton, A.J.M., Macleod, A.F. et al. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia 36, 150–154 (1993). https://doi.org/10.1007/BF00400697

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Key words

  • Diabetes Mellitus
  • peripheral neuropathy
  • epidemiology