Diabetic Peripheral Neuropathy in Ambulatory Patients with Type 2 Diabetes in a General Hospital in a Middle Income Country: A Cross-Sectional Study
Identifieur interne : 000C69 ( Ncbi/Merge ); précédent : 000C68; suivant : 000C70Diabetic Peripheral Neuropathy in Ambulatory Patients with Type 2 Diabetes in a General Hospital in a Middle Income Country: A Cross-Sectional Study
Auteurs : María De Los Angeles Lazo [Pérou] ; Antonio Bernabé-Ortiz [Pérou] ; Miguel E. Pinto [Pérou] ; Ray Ticse [Pérou] ; German Malaga [Pérou] ; Katherine Sacksteder [États-Unis] ; J. Jaime Miranda [Pérou] ; Robert H. Gilman [Pérou, États-Unis]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
Abstract
We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a low-middle income country setting.
Cross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (<10 vs. ≥10 years), glycaemic control (HbA1c <7% vs. ≥7%), microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios.
DPN was observed in 73/129 (56.6%) patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07–1.88) in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02–1.93) in patients with ≥10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p<0.001), onychomycosis (p = 0.012), abnormal Achilles reflex (p<0.001), pain perception (p<0.001) and vibration perception (p<0.001).
DPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin
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DOI: 10.1371/journal.pone.0095403
PubMed: 24789071
PubMed Central: 4006783
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Pinto</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru</addr-line></nlm:aff><country xml:lang="fr">Pérou</country><wicri:regionArea>Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima</wicri:regionArea><wicri:noRegion>Lima</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Servicio de Endocrinología, Hospital Nacional Cayetano Heredia, Lima, Peru</addr-line></nlm:aff><country xml:lang="fr">Pérou</country><wicri:regionArea>Servicio de Endocrinología, Hospital Nacional Cayetano Heredia, Lima</wicri:regionArea><wicri:noRegion>Lima</wicri:noRegion></affiliation></author><author><name sortKey="Ticse, Ray" sort="Ticse, Ray" uniqKey="Ticse R" first="Ray" last="Ticse">Ray Ticse</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru</addr-line></nlm:aff><country xml:lang="fr">Pérou</country><wicri:regionArea>Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima</wicri:regionArea><wicri:noRegion>Lima</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Servicio de Endocrinología, Hospital Nacional Cayetano Heredia, Lima, Peru</addr-line></nlm:aff><country xml:lang="fr">Pérou</country><wicri:regionArea>Servicio de Endocrinología, Hospital Nacional Cayetano Heredia, Lima</wicri:regionArea><wicri:noRegion>Lima</wicri:noRegion></affiliation></author><author><name sortKey="Malaga, German" sort="Malaga, German" uniqKey="Malaga G" first="German" last="Malaga">German Malaga</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru</addr-line></nlm:aff><country xml:lang="fr">Pérou</country><wicri:regionArea>CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima</wicri:regionArea><wicri:noRegion>Lima</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru</addr-line></nlm:aff><country xml:lang="fr">Pérou</country><wicri:regionArea>Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima</wicri:regionArea><wicri:noRegion>Lima</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru</addr-line></nlm:aff><country xml:lang="fr">Pérou</country><wicri:regionArea>Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima</wicri:regionArea><wicri:noRegion>Lima</wicri:noRegion></affiliation></author><author><name sortKey="Sacksteder, Katherine" sort="Sacksteder, Katherine" uniqKey="Sacksteder K" first="Katherine" last="Sacksteder">Katherine Sacksteder</name><affiliation wicri:level="2"><nlm:aff id="aff5"><addr-line>Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Miranda, J Jaime" sort="Miranda, J Jaime" uniqKey="Miranda J" first="J. Jaime" last="Miranda">J. Jaime Miranda</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru</addr-line></nlm:aff><country xml:lang="fr">Pérou</country><wicri:regionArea>CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima</wicri:regionArea><wicri:noRegion>Lima</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru</addr-line></nlm:aff><country xml:lang="fr">Pérou</country><wicri:regionArea>Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima</wicri:regionArea><wicri:noRegion>Lima</wicri:noRegion></affiliation></author><author><name sortKey="Gilman, Robert H" sort="Gilman, Robert H" uniqKey="Gilman R" first="Robert H." last="Gilman">Robert H. Gilman</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru</addr-line></nlm:aff><country xml:lang="fr">Pérou</country><wicri:regionArea>CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima</wicri:regionArea><wicri:noRegion>Lima</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:aff id="aff5"><addr-line>Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Aim</title><p>We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a low-middle income country setting.</p></sec><sec><title>Methods</title><p>Cross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (<10 vs. ≥10 years), glycaemic control (HbA1c <7% vs. ≥7%), microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios.</p></sec><sec><title>Results</title><p>DPN was observed in 73/129 (56.6%) patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07–1.88) in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02–1.93) in patients with ≥10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p<0.001), onychomycosis (p = 0.012), abnormal Achilles reflex (p<0.001), pain perception (p<0.001) and vibration perception (p<0.001).</p></sec><sec><title>Conclusion</title><p>DPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Chan, Jc" uniqKey="Chan J">JC Chan</name></author><author><name sortKey="Gagliardino, Jj" uniqKey="Gagliardino J">JJ Gagliardino</name></author><author><name sortKey="Baik, Sh" uniqKey="Baik S">SH Baik</name></author><author><name sortKey="Chantelot, Jm" uniqKey="Chantelot J">JM Chantelot</name></author><author><name sortKey="Ferreira, Sr" uniqKey="Ferreira S">SR Ferreira</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tres, Gs" uniqKey="Tres G">GS Tres</name></author><author><name sortKey="Lisboa, Hr" uniqKey="Lisboa H">HR Lisbôa</name></author><author><name sortKey="Syllos, R" uniqKey="Syllos R">R Syllos</name></author><author><name sortKey="Canani, Lh" uniqKey="Canani L">LH Canani</name></author><author><name sortKey="Gross, 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24789071</article-id><article-id pub-id-type="pmc">4006783</article-id><article-id pub-id-type="publisher-id">PONE-D-14-04554</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0095403</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine and Health Sciences</subject><subj-group><subject>Endocrinology</subject><subj-group><subject>Diabetic Endocrinology</subject></subj-group></subj-group><subj-group><subject>Epidemiology</subject><subj-group><subject>Clinical Epidemiology</subject></subj-group></subj-group><subj-group><subject>Metabolic Disorders</subject><subj-group><subject>Diabetes Mellitus</subject><subj-group><subject>Type 2 Diabetes</subject></subj-group></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Diabetic Peripheral Neuropathy in Ambulatory Patients with Type 2 Diabetes in a General Hospital in a Middle Income Country: A Cross-Sectional Study</article-title><alt-title alt-title-type="running-head">Diabetic Peripheral Neuropathy in Ambulatory Patients of a LMIC</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Lazo</surname><given-names>María de los Angeles</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bernabé-Ortiz</surname><given-names>Antonio</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pinto</surname><given-names>Miguel E.</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ticse</surname><given-names>Ray</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Malaga</surname><given-names>German</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sacksteder</surname><given-names>Katherine</given-names></name><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Miranda</surname><given-names>J. Jaime</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff3"><sup>3</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gilman</surname><given-names>Robert H.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru</addr-line></aff><aff id="aff4"><label>4</label><addr-line>Servicio de Endocrinología, Hospital Nacional Cayetano Heredia, Lima, Peru</addr-line></aff><aff id="aff5"><label>5</label><addr-line>Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>James</surname><given-names>Leighton R.</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>University of Florida, United States of America</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>Jaime.Miranda@upch.pe</email></corresp><fn fn-type="conflict"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: JJM RHG. Performed the experiments: MP RT. Analyzed the data: ML ABO JJM. Contributed reagents/materials/analysis tools: ABO. Wrote the paper: ML ABO GM KS JJM RHG.</p></fn></author-notes><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>1</day><month>5</month><year>2014</year></pub-date><volume>9</volume><issue>5</issue><elocation-id>e95403</elocation-id><history><date date-type="received"><day>29</day><month>1</month><year>2014</year></date><date date-type="accepted"><day>25</day><month>3</month><year>2014</year></date></history><permissions><copyright-year>2014</copyright-year><copyright-holder>Lazo et al</copyright-holder><license><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><sec><title>Aim</title><p>We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a low-middle income country setting.</p></sec><sec><title>Methods</title><p>Cross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (<10 vs. ≥10 years), glycaemic control (HbA1c <7% vs. ≥7%), microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios.</p></sec><sec><title>Results</title><p>DPN was observed in 73/129 (56.6%) patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07–1.88) in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02–1.93) in patients with ≥10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p<0.001), onychomycosis (p = 0.012), abnormal Achilles reflex (p<0.001), pain perception (p<0.001) and vibration perception (p<0.001).</p></sec><sec><title>Conclusion</title><p>DPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin</p></sec></abstract><funding-group><funding-statement>ML, ABO, KS, GM, JJM, RHG are affiliated with the CRONICAS Centre of Excellence in Chronic Diseases at Universidad Peruana Cayetano Heredia supported by the National Heart, Lung, and Blood Institute Global Health Initiative under the contract Global Health Activities in Developing Countries to Combat Non-Communicable Chronic Diseases (Project Number 268200900033C). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><page-count count="5"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>Pérou</li><li>États-Unis</li></country><region><li>Maryland</li></region></list><tree><country name="Pérou"><noRegion><name sortKey="Lazo, Maria De Los Angeles" sort="Lazo, Maria De Los Angeles" uniqKey="Lazo M" first="María De Los Angeles" last="Lazo">María De Los Angeles Lazo</name></noRegion><name sortKey="Bernabe Ortiz, Antonio" sort="Bernabe Ortiz, Antonio" uniqKey="Bernabe Ortiz A" first="Antonio" last="Bernabé-Ortiz">Antonio Bernabé-Ortiz</name><name sortKey="Gilman, Robert H" sort="Gilman, Robert H" uniqKey="Gilman R" first="Robert H." last="Gilman">Robert H. Gilman</name><name sortKey="Lazo, Maria De Los Angeles" sort="Lazo, Maria De Los Angeles" uniqKey="Lazo M" first="María De Los Angeles" last="Lazo">María De Los Angeles Lazo</name><name sortKey="Malaga, German" sort="Malaga, German" uniqKey="Malaga G" first="German" last="Malaga">German Malaga</name><name sortKey="Malaga, German" sort="Malaga, German" uniqKey="Malaga G" first="German" last="Malaga">German Malaga</name><name sortKey="Malaga, German" sort="Malaga, German" uniqKey="Malaga G" first="German" last="Malaga">German Malaga</name><name sortKey="Miranda, J Jaime" sort="Miranda, J Jaime" uniqKey="Miranda J" first="J. Jaime" last="Miranda">J. Jaime Miranda</name><name sortKey="Miranda, J Jaime" sort="Miranda, J Jaime" uniqKey="Miranda J" first="J. Jaime" last="Miranda">J. Jaime Miranda</name><name sortKey="Pinto, Miguel E" sort="Pinto, Miguel E" uniqKey="Pinto M" first="Miguel E." last="Pinto">Miguel E. Pinto</name><name sortKey="Pinto, Miguel E" sort="Pinto, Miguel E" uniqKey="Pinto M" first="Miguel E." last="Pinto">Miguel E. Pinto</name><name sortKey="Ticse, Ray" sort="Ticse, Ray" uniqKey="Ticse R" first="Ray" last="Ticse">Ray Ticse</name><name sortKey="Ticse, Ray" sort="Ticse, Ray" uniqKey="Ticse R" first="Ray" last="Ticse">Ray Ticse</name></country><country name="États-Unis"><region name="Maryland"><name sortKey="Sacksteder, Katherine" sort="Sacksteder, Katherine" uniqKey="Sacksteder K" first="Katherine" last="Sacksteder">Katherine Sacksteder</name></region><name sortKey="Gilman, Robert H" sort="Gilman, Robert H" uniqKey="Gilman R" first="Robert H." last="Gilman">Robert H. Gilman</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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