Frequency of peripheral neuropathy in pre diabetics in sub Himalayan region: a cross sectional observational study

Roshan Lal; Madan Kaushik; Sudhir Sharma; Rajiv Raina; Sanjay Mahajan; Satish Chaudhary; Ritin Sharma; Neeraj Kanwar; Manish Kumar Thakur

doi:10.18203/2320-6012.ijrms20181300

Authors

Roshan Lal Department of Medicine, IGMC Shimla, Shimla, Himachal Pradesh, India
Madan Kaushik Department of Medicine, IGMC Shimla, Shimla, Himachal Pradesh, India
Sudhir Sharma Department of Medicine, IGMC Shimla, Shimla, Himachal Pradesh, India
Rajiv Raina Department of Medicine, IGMC Shimla, Shimla, Himachal Pradesh, India
Sanjay Mahajan Department of Medicine, IGMC Shimla, Shimla, Himachal Pradesh, India
Satish Chaudhary Department of Medicine, IGMC Shimla, Shimla, Himachal Pradesh, India
Ritin Sharma Department of Medicine, IGMC Shimla, Shimla, Himachal Pradesh, India
Neeraj Kanwar Department of Medicine, IGMC Shimla, Shimla, Himachal Pradesh, India
Manish Kumar Thakur Department of Medicine, IGMC Shimla, Shimla, Himachal Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20181300

Keywords:

Neuropathy, Prediabetes

Abstract

Background: Peripheral neuropathy in pre diabetics has been studied in various studies till now. Many are in support and many against. No data was available in any study using all three criteria i.e. impaired fasting glucose, impaired glucose tolerance and HbA1C. Aim was to study the frequency of peripheral neuropathy in pre diabetics in a tertiary health care centre in sub Himalayan region.

Methods: A 50 patients of prediabetes were enrolled for this study; preformed proforma was used to collect the information, data on examination and investigations. Then these patients were subjected to nerve conduction studies.

Results: Out of total 50 pre diabetic patients 9(18%) were diagnosed having peripheral neuropathy. Maximum number of pre diabetic patients were (26) in the age group 46-55 years with mean age of 44.49 years ±7.01 (S.D.). 28 (56%) were males with a female to male ratio of 1:1.27. 20% patients had complaint of polyuria, 12% presented with polydipsia, 14% of total pre diabetic patients had paresthesia on history. 6% patients had impaired vibration and position sense on clinical examination. Out of total 9 patients having evidence of Peripheral Neuropathy 6 (66.66%) were meeting all three criteria for Prediabetes while 8 (88.88%) had IFG, 7 patients had IGT. 42% of the patients were fulfilling the criteria of metabolic syndrome. 28 had raised TGs and out of them 5 (17.8%) had peripheral neuropathy. Out of 24 obese patients, 4 (16.6%) had peripheral neuropathy. Out of 9 patients with peripheral neuropathy 66.66% patients were considered to be suffering with peripheral neuropathy on the basis of sensory symptoms and 33.33% were considered on the basis of impaired vibration and position sense on examination, one patient diagnosed on the basis of nerve conduction studies. 38% were in high risk group of developing T2DM in future as per Indian diabetes risk score. Mean compound motor action potential (CMAP) and nerve conduction velocity (NCV) were less in patients with peripheral neuropathy in comparison to patients without peripheral neuropathy.

Conclusions: Peripheral neuropathy can occur in prediabetes though it is difficult to confirm it. Most common is small fiber neuropathy which can be diagnosed on the basis of history and examination. But by diagnosing it early in the course of prediabetes, morbidity and mortality secondary to neuropathy can be prevented.

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References

Mohan V, Sandeep S, Deepa R. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res. 2007;125:217-30.

Siscree R. Shaw J. Zimmet P. Diabetes and impaired glucose tolerance. International diabetes federation. 3rd Edition; 2006:15-103.

Anjana RM, Pradeepa R, Deepa M. ICMR-INDIAB Collaborative Study Group. Prevalence of diabetes and prediabetes in urban and rural India: phase I results of Indian Council of Medical Research-India diabetes study. Diabetologia. 2011;54:3022-7.

Alvin CP. Diabetes Mellitus: Diagnosis, Classification, and Pathophysiology. In editors, Denis LK. Anthony SF, Stephen LH, Dan LL, Larry JJ, Joseph L. Harrison’s Principles of Internal Medicine 19th Edition (volume II). United States of America: McGraw-Hill Education; Chapter 417, 2015:2404.

Alvin CP. Diabetes Mellitus: Diagnosis, Classification, and Pathophysiology. In editors, Denis LK. Anthony SF, Stephen LH, Dan LL, Larry JJ, Joseph L. Harrison’s Principles of Internal Medicine. 19th Edition (volume II). United States of America: McGraw-Hill Education; Chapter 417, 2015:2399.

Alvin CP. Diabetes Mellitus: Diagnosis, Classification, and Pathophysiology. In editors, Denis LK. Anthony SF, Stephen LH, Dan LL, Larry JJ, Joseph L. Harrison’s Principles of Internal Medicine. 19th Edition (volume II). United States of America: McGraw-Hill Education; Chapter 417, 2015:2403.

Mohan V, Deepa R, Deepa M. A simplified Indian Diabetes Risk Score for screening of undiagnosed diabetic subjects. J Assoc Physcians India. 2005;53:759-63.

Chawla R. Diabetes is a vasculopathy: not lone endocrinopathy. In editor, Mittal N. Medicine Update. 26th (Volume I). New Delhi: Jaypee. The health science publisher; Chapter 2, 2016:9.

Rajasekar R, Natraj M. Peripheral neuropathy in Diabetes. In editors, Pareek KK, Wander GS. Progress in Medicine Volume 1. New Delhi: Jaypee, The health science publisher; Chapter 16, 2016;62-63.

Amato AA, Barohan RJ. Harrison’s Principles of Internal Medicine. 19th Edition (Volume II). United States of America: McGraw-Hill Education; Chapter 459, 2015:2676.

Poncelet AN. An algorithm for evaluation of peripheral neuropathy. American Family Physcian. 1998 Feb15;57(4):755-64.

Ziegler D, Rathmann W, Dickhaus T. Prevalence of polyneuropathy in pre-diabetes and diabetes is associated with abdominal obesity and macroangiopathy: the MONICA/KORA Augsburg Surveys S2 and S3. Diabetes Care. 2008;31:464-9.

Franklin GM, Kahn LB, Baxter J. Sensory neuropathy in non-insulin-dependent diabetes mellitus. The San Luis Valley Diabetes Study. Am J Epidemiol. 1990;131:633-43.

Gregory AN, Teresa AH, Jonathan B. Progression from newly acquired impaired fasting glucose to type 2 diabetes. Diabetes care. 2007;30:228-33.

Metascreen Writing Committee, Bonadonna R. The metabolic syndrome is a risk indicator of microvascular and macrovascular complications in diabetes: results from Metascreen, a multicenter diabetes clinic-based survey. Diabetes Care. 2006 Dec;29(12):2701-7.

Rathi N. Nerve conduction studies in prediabetes. Journal of the association of physicians of India. 2014;62.