Diagnosing peripheral neuropathy in South-East Asia: A focus on diabetic neuropathy

Abstract

Burning and stabbing pain in the feet and lower limbs can have a significant impact on the activities of daily living, including walking, climbing stairs and sleeping. Peripheral neuropathy in particular is often misdiagnosed or underdiagnosed because of a lack of awareness amongst both patients and physicians. Furthermore, crude screening tools, such as the 10-g monofilament, only detect advanced neuropathy and a normal test will lead to false reassurance of those with small fiber mediated painful neuropathy. The underestimation of peripheral neuropathy is highly prevalent in the South-East Asia region due to a lack of consensus guidance on routine screening and diagnostic pathways. Although neuropathy as a result of diabetes is the most common cause in the region, other causes due to infections (human immunodeficiency virus, hepatitis B or C virus), chronic inflammatory demyelinating polyneuropathy, drug-induced neuropathy (cancer chemotherapy, antiretrovirals and antituberculous drugs) and vitamin deficiencies (vitamin B₁ , B₆ , B₁₂ , D) should be actively excluded.

Keywords: Diagnosis; Peripheral neuropathy; South-East Asia.

Figure 1

Prevalence of diabetic neuropathy in different South‐East Asian countries, confirmed with the specified tests. Data shown for Singapore (Nather 2010 ¹⁶ ), Myanmar (Win 2019 ³² ), Thailand (Nitiyanant 2007 ³¹ ), Malaysia (Abougalambou 2012 ²² ), the Philippines (Dagang 2016 ²⁶ ) and Indonesia (Fitri 2019 ²⁸ ). No data available for Vietnam, Cambodia, Brunei and Laos. NCV, nerve conduction velocity.

Figure 2

Comparison of 5‐year mortality rates in patients after myocardial infarction (MI) and stroke (Malik 2016 ³⁶ ), vitrectomy for proliferative diabetic retinopathy (PDR; Liu 2019 ³⁸ ), diabetic foot ulceration (DFU; Walsh 2016 ³⁴ ), end‐stage renal disease in diabetes mellitus (ESRD‐DM; Lu 2017 ³⁷ ) and DFU with amputation (Apelqvist 1993 ³⁵ ).