Independent Clinical and Demographic Factors Predicting Diabetic Polyneuropathy

Abstract

Aim: Diabetic peripheral polyneuropathies (DPP) in patients with diabetes mellitus (DM) are important complications that adversely
affect the quality of life. In the Internal Medicine and Physical Medicine and Rehabilitation (PMR) outpatient clinic, predicting high-risk
patients for DPP will help to diagnose it more quickly and accurately while preventing missed diagnosis.

Material and Methods: A total of 399 DM patients, 173 males and 226 females, were admitted to the PMR and Internal Medicine
outpatient clinic of Karabuk University Training and Research Hospital between January 2018 and August 2019 for various reasons.
The diagnosis of DPP was made using the LANSS scale (Leeds Assessment of Neuropathic Symptoms and Signs), and the patients were
then divided into two groups as polyneuropathic (DPP +) and non-polyneuropathic (DPP - ). Demographic data, BMI, HbA1c level,
DM duration, oral antidiabetic (OAD) and / or insulin use were all compared between the groups. Independent predictors for DPP were
examined by logistic regression analysis.

Results: DPP was present in 38.6% of the patients. Mean age, duration of DM and BMI were significantly higher in DPP + group
compared to DNP-[[respectively; (62.47 ± 11.17 and 59.35 ± 12.48 months, p = 0.014), (72.73 ± 29.91 and 54.04 ± 26.53 months,
p<0.001), (33.69 ± 6.38 and 31.39 ± 6.52, p=0.001)]. DPP was more common in patients with a HbA1clevel of >7 than those with ≤7 (p
= 0.02). OAD, insulin use and HbA1c levels were similar between the groups (p = 0.10, p = 0.07 and 0.23). In logistic regression analysis,
there was no independent correlation between HbA1c level, gender, insulin or oral antidiabetic use and DPP (p>0.05), while long disease
duration (>61 months), advanced age and obesity were found to be independent predictors of DPP [respectively; Hazard ratio (HR):
2.78 (95% Confidence Interval (CI); 1.832-4.228, p<0.001), HR: 1.62, 95% Cl; 1.053-2.493), p=0.028 and HR: 1.78, 95% Cl; 1.143-2.789),
p=0.011)].

Conclusion: In patients with DM, elderly age, duration of the disease for more than five years and obesity were found to be independent
clinical parameters for DPP. These criteria, which can predict DPP in daily practice, should be considered because of their cheapness
and easy applicability.

Diyabetik Polinöropatiyi Predikte Eden Bağımsız Klinik ve Demografik Faktörler

Abstract

Amaç: Diabetes Mellitus (DM) hastalarındaki diyabetik periferik polinöropatiler (DNP) yaşam kalitesini olumsuz etkileyen önemli bir
komplikasyondur. İç Hastalıkları ve Fiziksel Tıp ve Rehabilitasyon (FTR) polikliniğinde DNP açısından yüksek riskli hastaları öngörmek,
daha hızlı ve doğru şekilde DNP tanısı koymaya ve tanının atlanmasının önüne geçmeye yardımcı olacaktır.

Gereç ve Yöntemler: Ocak 2018-Ağustos 2019 tarihleri arasında Karabük Üniversitesi Eğitim ve Araştırma Hastanesi FTR ve İç
Hastalıkları polikliniğine herhangi bir nedenle başvuran 173 erkek ve 226 kadın olmak üzere toplam 399 DM tanılı hasta dahil edildi.
DNP tanısı LANSS ölçeği (Leeds Assessment of Neuropathic Symptoms and Signs) ile konuldu ve sonrasında hastalar polinöropatik
olan (DNP+) ve olmayanlar (DNP-) olarak iki gruba ayırıldı. Gruplar arasındaki demografik veriler, VKİ (vücut kütle indeksi), HbA1c
düzeyi, DM süreleri, oral antidiyabetik (OAD) ve/veya insülin kullanımları karşılaştırıldı. DNP için bağımsız prediktörler lojistik
regresyon analiziyle incelendi.

Bulgular: Hastaların %38,6’sında DNP mevcuttu. Ortalama yaş, DM süresi ve VKİ DNP+ grupta DNP-’lere kıyasla anlamlı derecede
yüksekti [sırasıyla; (62.4 ± 11.1 ve 59.3 ± 12.4 ay, p = 0.014), (72.7 ± 29.9 ve 54.0 ± 26.5 ay, p < 0.001), (33.6 ± 6.3 ve 31.3 ± 6.5, p = 0.001)].
DNP, HbA1c değeri >7 olanlarda ≤7 olanlara göre daha sık görülmekteydi (p=0,026). OAD, insülin kullanımları ve HbA1c düzeyleri
gruplar arasında benzerdi (p=0,107, p=0,075 ve 0,232). Lojistik regresyon analizinde, HbA1c düzeyi, cinsiyet ve insülin ya da oral
antidiyabetik kullanımları ile DNP arasında bağımsız bir ilişki saptanmazken (P>0,05), hastalık süresinin uzun (>61 ay) olması, ileri yaş
(>60,5 yaş) ve obezitenin DNP için bağımsız prediktörler oldukları saptandı [sırasıyla; Odds ratio (OR): 2,78 (%95 Güven Aralığı (CI);
1,832 – 4,228, p<0.001), OR: 1,62, %95CI; 1,053 – 2,493), P=0,028 ve OR: 1,78, %95CI; 1,143 – 2,789), P=0,011)].

Sonuç: DM’li hastalarda ileri yaş, beş yıldan uzun hastalık süresi ve obezitenin DNP için bağımsız klinik parametreler oldukları
saptanmıştır. Günlük pratikte DNP’yi predikte edebilen bu kriterler ucuz ve kolay uygulanabilirliği nedeniyle göz önünde tutulmalıdır

Keywords

• Diyabetes Mellitus
• HbA1c
• obezite
• polinöropati
• süre

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