Diabetic Neuropathy: An Intensive Review

Jeremiah John Duby; R. Keith Campbell; Stephen M. Setter; John Raymond White; Kristin A. Rasmussen

Disclosures

Am J Health Syst Pharm. 2004;61(2) 

In This Article

Epidemiology: Prevalence, Incidence, and Risk Factors

Diabetes is the leading cause of neuropathy in the Western world, and neuropathy is the most common complication and greatest source of morbidity and mortality in diabetes patients.[1] It is estimated from a comprehensive collection of epidemiologic studies that the prevalence of neuropathy in diabetes patients is approximately 30% in hospital patients and 20% in community patients.[2] The overall annual incidence of neuropathy was ~2% in the United Kingdom Prospective Diabetes Study (UKPDS) and the Diabetes Control and Complications Trial (DCCT).[3] A commonly cited study in 1977 reported that roughly 7% of patients had neuropathy upon diagnosis of diabetes, and the incidence approached 50% for patients with diabetes for more than 25 years.[4] However, it is impossible to accurately approximate the true prevalence of diabetic neuropathy, because the criteria for diagnosis vary, epidemiologic studies are limited to patients receiving medical care, and diabetes remains undiagnosed in a large population of diabetes patients.[5] Therefore, the frightening statistic that diabetic neuropathy is implicated in 50-75% of nontraumatic amputations is merely an exclamation point in the overall impact.[1]

The primary risk factor for diabetic neuropathy is hyperglycemia.[2] As noted above, the annual incidence of diabetic neuropathy in the DCCT was approximately 2% in conventionally treated patients, but that rate dropped to 0.56% in intensively treated type 1 diabetes mellitus patients.[3] The UKPDS failed to support a similar correlation between the incidence of neuropathy and glycemic control in type 2 diabetes patients, but the progression of diabetic neuropathy is dependent on glycemic control in both type 1 and 2 diabetes patients, and the pathologies are considered similar.[2,3,6] The duration of diabetes also increases the risk of neuropathy, but the association between duration and prevalence may depend in part upon patient age, which itself is a risk factor.[2,7] Cigarette smoking, alcohol consumption, hypertension, height, and hypercholesterolemia are all considered independent risk factors for diabetic neuropathy.[2,7,8]

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