1. Neuropathic pain may occur as an isolated diabetic complication- a prospective survey on adult subjects with DPNP attending a hospital specialist clinic.
DAVIES SJ, COPPINI DV. DEPARTMENT OF DIABETES, POOLE HOSPITAL NHS FOUNDATION TRUST, POOLE, DORSET, UK
BACKGROUND
Diabetic peripheral neuropathic pain (DPNP) is present in 13-26% of diabetic patients. Despite its common occurrence, it is still poorly recognised and under-diagnosed (1).
The assessment and management of DPNP both remain a considerable challenge.
Various validated scores and questionnaires have been developed to diagnose and monitor this condition.
These tools often overlook its full impact on quality of life (2).
METHODS
45 consecutive patients with lower extremity pains for at least 6 months were identified as having a diagnosis of DPNP based on typical symptoms and supported by means of web-based supportive clinical tools:-
The presence of microvascular complications was recorded at the time of diagnosis of DPNP. Diabetic sensory neuropathy was defined as a Vibration Perception Threshold (VPT, Neurothesiometer) at the pulp of the hallux >20 Volts.
DPNP Patient Characteristics
No. of subjects 45
Age (years)*
66.2 ± 12.8
Gender (male %)
62.0
HbA1c (mmol/mmol)*
85.3 ± 8.3
Diabetes duration (years)*
17.0 ± 4.3
Type 2 DM (%) 80
VPT (Volts, mean and range)
24 (6-50)
VPT > 20 Volts (%) 60
Presence of retinopathy and/or albuminuria (%) 61
* Mean ± SD
CONCLUSIONS
40% of subjects with DPNP in our series had no objective evidence of sensory neuropathy or other concomitant microvascular complications.
DPNP can occur as an isolated diabetic complication.
Symptoms may not always be typical of DPNP and an accurate diagnosis should be based on a good history complemented if necessary by tools such as LANSS and Pain-detect.
The absence of microvascular complications, including sensory neuropathy itself, should not deter the clinician from considering the possible presence of DPNP in subjects complaining of lower extremity symptoms.
Misdiagnosis or delayed diagnosis of this condition is not uncommon and may lead to poor patient management with serious long term consequences.
RESULTS
The range of vibration perception thresholds varied widely amongst subjects from 6 to 50 volts, with only 60% having a VPT > 20 Volts, indicative of sensory neuropathy.
Only 29/46 (61%) of affected subjects had at least one or more extra-neural microvascular complications (retinopathy and/or micro/macroalbuminuria).
REFERENCES:
1. Daousi C et al. The natural history of chronic painful peripheral neuropathy in a community diabetes population. Diabetic Medicine 23 (9), , 2006.
2.Quattrini C, Tesfaye S. Understanding the impact of painful diabetic neuropathy. Diabetes Metab Res Rev 19: S2-S8, 2003.