Esen ERTUR, Miraç VURAL KESKİNLER, İrem Bozkurt ÇAKIR, Ayse ERBAKAN, Aytekin OĞUZ

Tip 2 Diyabetli Hastalarda Diyabetik Periferik Nöropati Sıklığı, İlişkili Faktörler ve Farkındalık Durumunun Değerlendirilmesi

Amaç: Diyabetik nöropati sıklıkla hastanın şikayeti olursa veya önlenebilecek komplikasyonlar gelişmişse tanı almaktadır. Tip 2 diyabetli (T2DM) hastalarda diyabetik periferik nöropati (DPN) varlığının bildirildiğinden daha sık olduğu hipotezinden yola çıkarak bu hasta grubunda DPN sıklığını ve ilişkili olduğu durumları araştırmayı planladık. Yöntem: Diyabet polikliniklerimize başvuran 336 tip 2 diyabetli hasta çalışmaya alındı. Anamnezleri, demografik ve antropometrik bilgileri, kullandıkları ilaçlar ve laboratuvar verileri kaydedildi. Diyabetik nöropatiyi saptamak amacıyla MNSI (Michigan Neuropathy Screening Instrument) skorlaması ve Semmes-Weinstein monofilaman testi uygulandı. Bulgular: Bu 336 hastanın (yaş ortalaması 57,9±10 yıl, %63,7’si kadın) ortalama diyabet süresi 9,5±7,8 yıldı. HbA1c, açlık kan şekeri ve vücut kütle indeksi ortalaması sırasıyla %8,7±2, 182±89 mg/dl ve 32±5,8 kg/m2 bulundu. DPN sıklığı %38,7 (n=130) saptandı. Daha önce nöropati tedavisi başlanmış olan 32 hasta (%9.5) ilaç kullanımları nedeniyle diğer analizlere katılmadı. Diyabetik nöropatisi olan grupla (n=107) olmayan grup (n=197) arasında kadın cinsiyet (%71 vs %59,9, p=0,054), yaş (60,6 yıl vs 55,9 yıl, p<0,001), diyabet süresi (15,2 yıl vs 5,7 yıl, p<0,001), açlık kan şekeri (207 mg/dl vs 167 mg/dl, p<0,001), HbA1c (%9,6 vs %8,1, p<0,001), hipertansiyon öyküsü, aterosklerotik kardiyovasküler hastalık öyküsü, diyabetik retinopati ve insülin kullanımı istatistiksel anlamlı olarak farklı bulundu. Sonuç: Çalışmamızda tip 2 diyabeti olan hastalarda yaklaşık %40 oranında diyabetik periferik nöropati saptandı. Bu bulgular, T2DM hastalarının periferik nöropatinin tarama testleri ile rutin değerlendirilmesinin gerekliliğini vurgulamaktadır.

Anahtar Kelimeler:

tip 2 dyabet, nöropati, diyabetik perferik nöropati, MNSI

The Evaluation of Peripheral Diabetic Neuropathy; Frequency, Associated Factors and Awareness in Patients with Type 2 Diabetes

Objective: Diabetic neuropathy is often diagnosed only if the patient complains or after the development of complications. We hypothesized that diabetic peripheral neuropathy (DPN) is more common than reported and aimed to investigate the incidence and related conditions of DPN in type 2 diabetic (T2DM) patients. Methods: Three hundred and thirty six patients with type 2 diabetes who presented to our diabetes outpatient clinics were recruited. Patients’ history, demographic and anthropometric characteristics, medications and laboratory data were recorded. MNSI (Michigan Neuropathy Screening Instrument) and Semmes-Weinstein monofilament test were applied to detect diabetic neuropathy. Results: In the 336 patients (mean age, 57.9±10 years; 63.7% female), the mean duration of diabetes was 9.5±7.8 years. The mean HbA1c and fasting blood glucose (FBG) concentrations, and body mass index (BMI) were 8.7±2%, 182±89 mg/dL and 32±5.8 kg/m2, respectively. The incidence of DPN was 38.7% (n=130). Female gender (71% vs 59.9%, p=0.054), age (60.6 years vs 55.9 years, p<0.001), diabetes duration (15.2 years vs 5.7 years, p<0.001), FBG (207 mg/dl vs 167 mg/dl, p<0.001), HbA1c levels (9.6% vs 8.1%, p<0.001) were statistically significant between patients with and without neuropathy, as were presence of hypertension, atherosclerotic cardiovascular disease, and diabetic retinopathy, and insulin usage. Conclusion: Diabetic peripheral neuropathy was detected in approximately 40% of the patients with type 2 diabetes. Our findings emphasizes the need for routine evaluation of peripheral neuropathy by screening tests in all diabetic patients.

Keywords:

Type 2 diabetes, neuropathy, diabetic neuropathy, MNSI,

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