The prevalence, clinical features and management of periphral neuropathy among diabetic patients in Tikur Anbessa and St. Paul's Specialized University Hospitals, Addis Ababa, Ethiopia

Abstract

Background: Neuropathy is one of the common chronic complications of diabetes. There are many forms of diabetic neuropathy, one of which is distal symmetric polyneuropathy (DSP). There are only few data on diabetic neuropathy in Ethiopia.

Objective: The objectives of this study were to determine the prevalence of peripheral neuropathy, describe the clinical features, identify risk factors and treatment of neuropathy among diabetic patients.

Methods: A cross-sectional study was conducted at Tikur-Anbessa (TASH) and St. Paul's Specialized (SPH) University Hospitals in Addis Ababa. A total of 384 diabetic patients were selected using systematic random sampling method taking every third patients from clinics attendees from December 2009 to February 2010. Data were collected using structured questionnaires containing sociodemographic data, risk factors and UK neuropathy screening test score, Neurological examination for pain, Achilles tendon reflex, Vibration, and temperature.

Results: A total of 176 males and 208 females were included, 27% were type 1 and 73% were type 2 diabetic patients. The overall prevalence of distal symmetrical polyneuropathy (DSP) was 48.2% (53.6% in type 2 and 33.3% in type 1 diabetic patients). DSP was present in 37% of patient with duration of diabetes < 5yrs and 53% of those with diabetic duration > 10yrs. Autonomic neuropathy was identified in 30% of patients. Out of 185 patients with peripheral Neuropathy 136 (77%) had moderate and severe symptom scores; while 101 (58%) had moderate and severe sign scores. Type of Diabetes, duration of diabetes, systolic hypertension, and age were significantly associated with DSP (p < 0.05). Amitriptylline in 14 (28.6%), Carbamazepine in 4 (8.2%), and other NSAIDs 7 (12.2%) were used for treatment of painful neuropathy.

Conclusions: Distal symmetrical polyneuropathy is common. The commonest presenting features are pain and loss of sensation. Duration of diabetes 10yrs, type 2 D, old age and hypertension were the major risk factors for DSP. Treatment of painful diabetic neuropathy was not optimal. RECOMMENDATIONSs: We recommend strengthening of routine screening for neuropathy, to emphasis on foot ulcer risk reduction, management of co-morbidities like hypertension and dyslipidemia, to optimize treatment of painful neuropathy.