Detekcija dijabetesne polineuropatije u ambulanti porodične medicine korišćenjem monofilamenta
Abstract
Uvod/Cilj. Dijabetesna polineuropatija (DPN) je najčešća mikrovaskularna komplikacija dijabetesa melitusa (DM) koja može da bude prisutna i u trenutku samog otkrivanja bolesti. Screening na DPN se radi svim obolelim od DM tipa 2 u trenutku postavljanja dijagnoze, a kod DM tipa 1, 5 godina od postavljene dijagnoze. Osnovni cilj ovog istraživanja bio je da se utvrdi prevalencija DPN kod bolesnika sa DM korišćenjem najlonskog monofilamenta u ambulanti porodične medicine. Metode. U istraživanju sprovedenom po tipu studije preseka praćena je učestalost DPN kod bolesnika sa DM na području Banja Luke. Za detekciju DPN korišćen je Semmes-Weinstein najlonski monofilament od 10 g. Analizirani su dob, pol, trajanje DM, simptomi, vrsta terapije, glikozilirani hemoglobin (HbA1c) i faktori rizika (hipertenzija, pušenje, dislipidemija, gojaznost, fizička neaktivnost). Podaci su prikupljani u periodu od 01. juna 2017. do 31. maja 2018. godine. Rezultati. Istraživanje je obuhvatilo 228 pacijenata, 132 (57,9%) muškarca i 96 (42,1%) žena. Utvrđena je statistički značajna razlika u prisustvu svih simptoma DPN (trnjenje, gorenje, peckanje i žarenje) kod bolesnika sa različitim trajanjem DM (p < 0,01). Multivarijantnom logističkom regresijom utvrđeno je da najveću verovatnoću pojave DPN ima bolesnik sa hipertenzijom [odds ratio (OR) = 26,2; 95% confidence interval (CI): 4,070–168,488; p = 0,001], koji koristi oralnu antidijabetesnu terapiju (OR = 12,3; 95% CI: 1,300–116,309; p = 0,029), ima simptom trnjenje (OR = 5,2; 95% CI: 1,431–18,571; p = 0,012) i duže trajanje DM (OR = 4,27; 95% CI: 1,983–9,175; p = 0,000). Zaključak. Prevalencija DPN kod bolesnika sa DM, korišćenjem najlonskog mono filamenta u ambulanti porodične medicine, iznosila je 24,2%. DPN je bila udružena sa prisustvom simptoma trnjenja, trajanjem dijabetesa, hipertenzijom i upotrebom samo oralne antidijabetesne terapije.
References
Albers JW, Pop-Busui R. Diabetic neuropathy: mechanisms, emerging treatments, and subtypes. Curr Neurol Neurosci Rep 2014; 14(8): 473.
Dyck PJ, Albers JW, Andersen H, Arezzo JC, Biessels GJ, Bril V, et al. Diabetic polyneuropathies: update on research defini-tion, diagnostic criteria and estimation of severity. Diabetes Metab Res Rev 2011; 27(7): 620–8.
Lee CC, Perkins BA, Kayaniyil S, Harris SB, Retnakaran R, Ger-stein HC, et al. Peripheral neuropathy and nerve dysfunction in individuals at high risk for type 2 diabetes: the PROMISE cohort. Diabetes Care 2015; 38(5): 793–800.
Perkins BA, Orszag A, Ngo M, Ng E, New P, Bril V. Prediction of Incident Diabetic Neuropathy Using the Monofilament Examination. A 4-year prospective study. Diabetes Care 2010; 33(7): 1549‒54.
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 U.K. Diabetes Care 2011; 34(10): 2220‒4.
Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care 2017; 40(1): 136‒54.
Boulton AJM. The pathway to foot ulceration in diabetes. Med Clin North Am 2013; 97(5): 775–90.
Morrison S, Colberg SR, Parson HK, Vinik AI. Relation between risk of falling and postural sway complexity in diabetes. Gait Posture 2012; 35(4): 662–8.
American Diabetes Association. Standards of medical care in dia-betes: 2007. Diabetes Care 2007; 30(Suppl 1): S4–S41.
International Diabetes Federation. IDF Diabetes Atlas. 7th ed. Brussels: International Diabetes Federation; 2015.
Park JH, Kim DS. The Necessity of the Simple Tests for Dia-betic Peripheral Neuropathy in Type 2 Diabetes Mellitus Pa-tients without Neuropathic Symptoms in Clinical Practice. Diabetes Metab J 2018; 42(5): 442‒6.
Boulton AJM, Rayaz MA. Neuropathy of Impaired Glucose Tolerance and Its Measurement Diabetes Care 2010; 33(1): 207–9.
Putz Z, Tabák AG, Tóth N, Istenes I, Németh N, Gandhi RA, et al. Noninvasive Evaluation of Neural Impairment in Subjects With Impaired Glucose Tolerance. Diabetes Care 2009; 32(1): 181–3.
Vincent AM, Hinder LM, Pop-Busui R, Feldman EL. Hyper-lipidemia: a new therapeutic target for diabetic neuropathy. J Peripher Nerv Syst 2009; 14(4): 257‒67.
Stino AM, Smith AG. Peripheral neuropathy in prediabetes and the metabolic syndrome. J Diabetes Investig 2017; 8(5): 646–55.
Chetpet A, Dikshit B, Phalgune D. Evaluating a Risk Score for Lower Extremity Amputation in Patients with Diabetic Foot Infections. J Clin Diagn Res 2018; 12(10): PC14‒9.
Del Core MA, Ahn J, Lewis RB III, Raspovic KM, Lalli TAJ, Wukich DK. The Evaluation and Treatment of Diabetic Foot Ulcers and Diabetic Foot Infections. Foot Ankle Orthopae-dics 2018; 3(3): 1‒11.
Iftikhar M, Hussain A, Rizvi A. Frequency of peripheral neu-ropathy in patients with diabetes mellitus. Ayub Med Coll Abbottabad 2014; 26(4): 584‒6.
Vincent AM, Callaghan BC, Smith AL, Feldman EL. Diabetic neuropathy: cellular mechanisms as therapeutic targets. Nat Rev Neurol 2011; 7(10): 573–83.
Pop-Busui R, Lu J, Brooks MM, Albert S, Althouse AD, Escobedo J, et al. Impact of glycemic control strategies on the progres-sion of diabetic peripheral neuropathy in the Bypass Angio-plasty Revascularization Investigation 2 Diabetes (BARI 2D) Cohort. Diabetes Care 2013; 36(10): 3208‒15.
American Diabetes Association. Standards of medical care in dia-betes ‒ 2015. Diabetes Care 2015; 38(Suppl 1): S1‒S93.
National Expert Commission for the Development and Implementa-tion of Good Clinical Practice. National Diabetes Mellitus Good Clinical Practice Guide. 2th Ed. Belgrade: Ministry of Health of the Republic of Serbia; 2012. (Serbian)
WHO. Global recommendations on physical activity for health. Geneva: World Health Organization; 2010.
Salvotelli L, Stoico V, Perrone F, Cacciatori V, Negri C, Brangani C, et al. Prevalence of neuropathy in type 2 diabetic patients and its association with other diabetes complications: The Ve-rona Diabetic Foot Screening Program. J Diabetes Complica-tions 2015; 29(8): 1066‒70.
Amour AA, Chamba N, Kayandabila J, Lyaruu IA, Marieke D, Shao ER, et al. Prevalence, Patterns, and Factors Associated with Peripheral Neuropathies among Diabetic Patients at Ter-tiary Hospital in the Kilimanjaro Region: Descriptive Cross-Sectional Study from North-Eastern Tanzania. Intl J Endo-crinol 2019; 2019: 5404781.
Gill HK, Yadav SB, Ramesh V, Bhatia E. A prospective study of prevalence and association of peripheral neuropathy in In-dian patients with newly diagnosed type 2 diabetes mellitus. J Postgrad Med 2014; 60(3): 270‒5.
Khawaja N, Abu-Shennar J, Saleh M, Dahbour SS, Khader YS, Aj-louni KM. The prevalence and risk factors of peripheral neu-ropathy among patients with type 2 diabetes mellitus; the case of Jordan. Diabetol Metab Syndr 2018; 10: 8.
Aslam A, Singh J, Rajbhandari S. Prevalence of Painful Diabet-ic Neuropathy Using the Self-Completed Leeds Assessment of Neuropathic Symptoms and Signs Questionnaire in a Popula-tion with Diabetes. Can J Diabetes 2015; 39(4): 285–95.
Naqvi SSZH, Imani S, Hosseinifard H, Wen QL, Shahzad MN, Ijaz I, et al. Associations of serum low-density lipoprotein and systolic blood pressure levels with type 2 diabetic patients with and without peripheral neuropathy: systemic review, me-ta-analysis and meta-regression analysis of observational stud-ies. BMC Endocr Disord. 2019; 19(1): 125.
Li L, Chenb J, Wanga J, Caia D. Prevalence and risk factors of diabetic peripheral neuropathy in Type 2 diabetes mellitus pa-tients with overweight/obese in Guangdong province, China. Prim Care Diabetes 2014; 9(3): 191‒5.
Darivemula S, Nagoor K, Patan SK, Reddy NB, Deepthi CS, Chit-tooru CS. Prevalence and Its Associated Determinants of Dia-betic Peripheral Neuropathy (DPN) in Individuals Having Type-2 Diabetes Mellitus in Rural South India. Indian J Community Med 2019; 44(2): 88–91.
Lazo Mde L, Bernabé-Ortiz A, Pinto ME, Ticse R, Malaga G, Sacksteder K, et al. Diabetic Peripheral Neuropathy in Ambula-tory Patients with Type 2 Diabetes in a General Hospital in a Middle Income Country: A Cross-Sectional Study. PLoS One. 2014; 9 (5): e95403.