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and 2 diabetic
patients in Saudi Arabia
Banderi Abduallah M. Ahmad
Dalal Hamed A. AlEesa
Nuha Ali M. AlHefdhi
Supervisor:
Dr. Fahad El Eidan
Introduction
Diabetes mellitus (DM) is a chronic metabolic disorder which occurs when
the pancreas does not produce enough insulin or when the body cannot
effectively use the insulin it produces, which leads to hyperglycemia.
Saudi Arabia: ranked as the 7th highest country with diabetes mellitus
prevalence. (24%)
Types: DM type 1, DM type 2
Complications:
1. Macro-vascular: CVS disease, CVD
2. Micro-vascular: DPN, retinopathy, nephropathy.
WHO
DPN is associated with a wide range of complications and increases the risk for foot ulcer
and lower extremity amputations.
25% of DPN patients will develop a foot ulcer. 85% of lower limb amputations are due to
a foot ulcer in a diabetic patient.
ADA
Results
Total of 293 diabetic subjects
54 type 1
239 type 2
Non-DPN
N=220(75.1)
DPN
N=73(24.9)
Age years
P-value
0.006
<60
107(48.6)
22(30.1)
=>60
113(51.4)
51(69.9)
Gender
0.096
Male
106(48.2)
27(37.0)
Female
114(51.8)
46(63.0)
Duration of
diabetes years
0.04
<5
109(78.4)
44(91.7)
=>5
30(21.6)
4(8.3)
Gender
37%
63%
Male
Female
Non-DPN
N=220(75.1)
DPN N=73(24.9)
Type of DM
0.025
Type I
47(21.4)
7(9.6)
Type II
173(78.6)
66(90.4)
Type of treatment
0.072
Insulin
158(72.8)
62(86.1)
Oral
hypoglycemic
53(24.4)
9(12.5)
6(2.8)
1(1.4)
Diet
Median number
of comorbidities
120
100
80
60
40
20
0
0.0001
<5
130 (59.3%)
22 (30.1%)
=> 5
89 (40.7%)
48 (69.9%)
Diet
Insulin
DPN
P-value
Non-DPN
Oral
Hypogycemic
Agents
Diabetic subjects
10%
90%
Type 1
Type 2
Non-DPN
DPN
BMI
p-value
0.063
<25
70 (38.5%)
14 (22.2%)
25-29
41 (22.5%)
17 (27%)
=> 30
71 (39%)
32 (50.8%)
Smoking status
0.131
Yes
29 (13.2%)
15 (20.5%)
No
190 (86.8%)
58 (79.5%)
Alcohol status
0.413
Yes
2(0.9)
0(0.0)
No
217(99.1)
73(100)
<7
52 (23.7%)
22 (30.6%)
=> 7
167 (76.3%)
50 (69.4%)
HbA1C (Median)
<6.5
19 (9.5%)
11 (15.9%)
180 (90.5%)
58 (84.1)
=> 6.5
0.25
0.147
Significant co-morbidities
Non-DPN
Peripheral
vascular disease
Yes
No
Foot ulcer
Yes
No
Gangrene
Yes
No
Lower limb
amputation
Yes
No
DKA
Yes
No
DPN
p-value
0.0001
15 (6.9%)
203 (93.1%)
17 (23.3%)
56 (79.7%)
0.006
15 (6.9%)
203 (93.1%)
13 (17.8%)
60 (82.2%)
0.001
3 (1.4%)
215 (98.6)%
7 (9.6%)
66 (90.4%)
0.001
7 (3.2%)
211 (96.8%)
10 (13.7%)
63 (86.3%)
0.003
30 (13.8%)
188 (86.2%)
1 (1.4%)
72 (98.6%)
Hypertension
0.005
Yes
160 (73.1%)
65 (89%)
No
59 (26.9%)
8 (11%)
Cerebral stroke
0.027
Yes
32 (14.7%)
19 (26%)
No
186 (85.3%)
54 (74%)
Age
Variable
0.40
2.19 odds of
OR=1=>60
Exposure does not affect
outcome
Duration of diabetes
OR>1 Exposure associated with higher
<5
0.33
odds of outcome
3.02 lower
OR<1=>5
Exposure associated with
odds
ofDM
outcome
Type of
1
0.39
2.56
Type of treatment
insulin
2.31
OHA
0.44
diet
0.49
<7
0.76
=>7
1.41
HbA1C
<6.5
0.55
=>6.5
1.79
Number of
comorbidities
<5
0.31
=>5
3.18
HTN
2.99
DLP
2.54
PVD
4.10
Foot ulcer
2.93
Amputation
4.78
Discussion
In this study we observed prevalence of DPN was 3.4%,
which is lower in comparison to previous studies.
Internationally: (1, 2)
Locally: (3)
In Saudi Arabia the prevalence of painful DPN was
estimated to be 65.3%
What we know
Factors were associated with DPN:
Age
Duration of diabetes
Type of treatment
Glycemic control
In our study
DPN was associated with these factors and this
association was similar to previous studies. However
contrasted other studies, our study did not show any
correlation between smoking and DPN.
Some diseases were associated with DPN such as
PVD, HTN, dyslipidemia, foot ulcer and amputation,
which supported some studies.
Recommendations
Good glycemic control could prevent or delay the
progression of DPN. Controlling other co-morbid
diseases like HTN and dyslipidemia could help in the
prevention of DPN.
Limitations
Retrospective
Poor documentation
No tool or criteria to diagnose DPN
We need a large prospective multicenter study to
evaluate the prevalence/incidence of DPN
Conclusion
The results of our study showed a relatively low
prevalence (3.4%) of DPN that was associated with
age, duration of diabetes, type of treatment, glycemic
control, and other comorbidities.
A significant difference existed in the prevalence of
DPN between type 1 (1.3%) and 2 (4.1%) diabetic
patients.
References
Abbott CA, Malik RA, van Ross ER, Kulkarni J, Boulton AJ.
Prevalence and characteristics of painful diabetic neuropathy in a
large community-based diabetic population in the UK. Diabetes
Care 34: 22202224, 2011.
Young MJ, Boulton AJM, Macleod AF. A multicentre study of the
prevalence of diabetic peripheral neuropathy in the United
Kingdom hospital clinic popula- tion. Diabetologia. 1993;36:150
54.
Halawa MR, Karawagh A, Zeidan A, Mahmoud AE, Sakr M, et al.
(2010) Prevalence of painful diabetic peripheral neuropathy
among patients suffering from diabetes mellitus in Saudi Arabia.
Curr Med Res Opin 26: 337343