Determinants of peripheral neuropathy among diabetic patients under follow-up in chronic care clinics of public hospitals at Gamo and Gofa zones, southern Ethiopia

Prevalence of microvascular complications and associated factors among diabetes mellitus patients in Ethiopia: Systematic review and meta-analysis

BACKGROUND

Diabetes mellitus (DM) is a metabolic abnormality affecting 537 million people worldwide. Poor glycemic control, longer duration, and poor medication adherence increased the risk of DM complications. Comprehensive evidence on the pooled prevalence of microvascular complications in DM patients in Ethiopia is not available. Furthermore, individual study findings for the prevalence of microvascular complications in DM patients, and associated factors were not consistent.

OBJECTIVE

This systemic review and meta-analysis aimed to assess the pooled prevalence of microvascular complications in DM patients, and its associated risk factors in Ethiopia.

METHODS

Systematic search on Scopus, PubMed, Science Direct electronic database, Google Scholar search engine, and library registration was used to identify relevant studies following reviews and meta-analysis guidelines. Microsoft Excel spreadsheets were used to extract data, and Extracted data was analyzed using STATA software version 17.0. A Sensitivity analysis was conducted to assess the role of each study in the final result and the presence of publication bias was assessed by Egger's test. Heterogeneity across studies was checked by Cochran's Q statistic and I2 statistics and significant heterogeneity was assessed using subgroup analysis.

RESULTS

The pooled prevalence of microvascular complications in DM patients was 32.89 % (95 % CI: 28.17-37.60). In addition, the pooled prevalence of retinopathy, neuropathy, and nephropathy in DM patients was 17.16 % (95 % CI: 12-22 %), 10.49 % (95 % CI: 8-13 %) and 11.52 % (95 % CI: 9-15 %) respectively. Age >60 years old (AOR = 1.08 (95%CI = 1.02-1.15), longer duration of DM (AOR = 1.57 (95 % CI = 1.31-1.84), poor glycemic control (AOR = 2.21 (95 % CI = 1.52-2.91), poor adherence to diabetic medications (AOR = 3.61 (95 % CI = 1.83-5.38) and presence of hypertension (AOR = 2.26 (95 % CI = 1.73-2.80) ware associated risk factors for microvascular complications in DM patients.

CONCUSSION

Around one-third of DM patients had one or more microvascular complications. Patients with advanced age, longer duration of DM, poor glycemic control, poor medication adherence, and comorbidity like hypertension should be targeted to tackle the occurrence and severity of microvascular complications in DM patients.

PROTOCOL REGISTRATION

The review protocol was developed and was registered with PROSPERO registration number (CRD42023486459).

Peripheral neuropathy and associated factors among type 2 diabetic patients attending referral hospitals in the Amhara region, a multi-center cross-sectional study in Ethiopia

Diabetic peripheral neuropathy is one of the diabetes most common microvascular complications. It is very prevalent in Sub-Saharan Africa due to a combination of causes, including rising diabetes prevalence, limited healthcare resources, and a lack of access to competent medical care. However, just a few studies have been undertaken in the study area. Institution-based cross-sectional study was conducted in the Amhara region referral hospitals, in 2022. By using a systematic random sampling technique, a total of 627 respondents were included. The data was entered into EPI Data version 4.6 and exported to SPSS version 25 for further analysis. A binary logistic regression was used to determine the relationship between the dependent and predictor variables. The association between predictor variables and the dependent variable was determined using multivariate logistic regression [p value < 0.05, 95% confidence interval]. The overall prevalence of diabetic peripheral neuropathy among the study participants was 48.2% (95% CI; 44.2, 52.1). Aged between 40 and 60 years (AOR = 4:27; 95% CI 2.62, 6.94), and 60 years and older (AOR = 4:47; 95% CI 2.40, 8.35), participants who have lived alone (AOR = 2:14; 95% CI 1.21, 3.79), patients with comorbidity (AOR = 1:83; 95% CI 1.22, 2.76), and being physically inactive (AOR = 1:69; 95% CI 1.14, 2.49) were significantly associated with Diabetic peripheral neuropathy. Diabetic peripheral neuropathy was high among diabetic patients. Healthcare providers should prioritize regular screening and early intervention for individuals at higher risk, particularly those aged 40 and above, those living alone, patients with comorbid conditions, and those who are physically inactive. Implementing community-based support programs, encouraging physical activity, and providing comprehensive management plans for diabetes and associated comorbidities can help mitigate the risk and improve the quality of life for these patients.

Diabetic peripheral neuropathy among adult type 2 diabetes patients in Adama, Ethiopia: health facility-based study

Diabetic peripheral neuropathy is the most prominent microvascular complication of diabetes mellitus and the leading cause of ulceration, amputation, and extended hospitalization. Evidence regarding the magnitude and factors associated with diabetic peripheral neuropathy is not well documented in Ethiopia, particularly in the study area. A facility-based cross-sectional study was conducted among 293 adult type 2 diabetic patients who were on treatment and follow-up from May to June 31, 2023. To select participants in the study, a systematic random sampling method was utilized. Data were collected using semi-structured questionnaires and medical record reviews. The Michigan Neuropathy Screening Instrument (MNSI) was employed to assess diabetic peripheral neuropathy. To model the association between diabetic peripheral neuropathy and independent variables, binary logistic regression model was used. An adjusted odds ratio with a 95% confidence interval was used to estimate the association and statistical significance was proclaimed at a p-value < 0.05. The magnitude of diabetic peripheral neuropathy was 14.3% (95% CI 10.4-18.0). It was 13.4% (95% CI 8.4-19.1) among males and 15.4% (95% CI 10.1-22.2) among females. Age above 60 years (AOR = 5.06, 95% CI 1.60-15.96), being rural resident (AOR = 2.41; 95% CI 1.15-5.06), duration of diabetes above 5 years (AOR = 2.48, 95% CI 1.16-5.27) and having comorbid hypertension (AOR = 2.56, 95% CI 1.24-5.28) were independently associated with diabetic peripheral neuropathy. One in seven adult type 2 diabetes patients in the study area had diabetic peripheral neuropathy. Factors such as age, place of residence, duration of diabetes, and comorbid hypertension showed positive associations with diabetic peripheral neuropathy. Thus, it is imperative to give special consideration to diabetic patients who are elderly, living in rural areas, experiencing a prolonged duration of diabetes, or dealing with comorbid hypertension.

Why too soon? Predictors of time to diabetic peripheral neuropathy among newly diagnosed diabetes mellitus patients: a multicenter follow-up study at health-care setting of Ethiopia

BACKGROUND

Due to the rising number of diabetic patients, the burden of diabetic peripheral neuropathy (DPN) is clearly posing a major challenge to the long-term viability of the health-care system. Despite this, most DPN epidemiological research in eastern Africa, including Ethiopia, has so far been limited to survey studies. Thus, we determined the incidence of DPN and its predictors among diabetic patients in tertiary health-care setting of southwest Ethiopia.

METHODS

A multicenter retrospective follow-up study was carried out on 567 randomly selected diabetic patients. Data were entered using Epi-Data v4.6 and analyzed using R v4.0.4. The survival curves were estimated using the Kaplan-Meier, and compared using Log-rank test between groups of categorical variables. The PHA were evaluated using the Schoenfeld residuals test. Multivariable Gompertz proportional hazard model was used to examine the predictors of DPN at 5% level of significance.

RESULTS

Overall, of 567 DM patients 119 developed DPN with an incidence rate of 3.75, 95%CI [3.13, 4.49] per 100 PY. About 15.13% and 69% of DPN cases occurred within 2 and 5 years of DM diagnosis, respectively. In the multivariable Gompertz PH model, being female [AHR = 1.47; 95% CI (1.01, 2.15)], T2DM [AHR = 3.49 95% CI (1.82, 6.71)], having diabetic retinopathy [AHR = 1.9 95% CI (1.25, 2.91)], positive proteinuria [AHR = 2.22 95% CI (1.35, 3.65)], being obese [AHR = 3.94 95% CI (1.2, 12.89)] and overweight [AHR = 3.34 95% CI (1.09, 10.25)] significantly predicts the future risk of DPN.

CONCLUSION

Nearly, 7 in 10 of DPN cases occurred within short period of time (5 year) of DM diagnosis. Being female, T2DM, DR, positive proteinuria, obese and overweight significantly predicts the risk of DPN. Therefore, we recommend screening and early diagnosis of diabetes with its complication. While doing so, attention should be given for DM patients with DR and positive proteinuria at baseline.

Development and validation of risk prediction model for diabetic neuropathy among diabetes mellitus patients at selected referral hospitals, in Amhara regional state Northwest Ethiopia, 2005-2021

BACKGROUND

Diabetic neuropathy is the most common complication in both Type-1 and Type-2 DM patients with more than one half of all patients developing nerve dysfunction in their lifetime. Although, risk prediction model was developed for diabetic neuropathy in developed countries, It is not applicable in clinical practice, due to poor data, methodological problems, inappropriately analyzed and reported. To date, no risk prediction model developed for diabetic neuropathy among DM in Ethiopia, Therefore, this study aimed prediction the risk of diabetic neuropathy among DM patients, used for guiding in clinical decision making for clinicians.

OBJECTIVE

Development and validation of risk prediction model for diabetic neuropathy among diabetes mellitus patients at selected referral hospitals, in Amhara regional state Northwest Ethiopia, 2005-2021.

METHODS

A retrospective follow up study was conducted with a total of 808 DM patients were enrolled from January 1,2005 to December 30,2021 at two selected referral hospitals in Amhara regional state. Multi-stage sampling techniques were used and the data was collected by checklist from medical records by Kobo collect and exported to STATA version-17 for analysis. Lasso method were used to select predictors and entered to multivariable logistic regression with P-value<0.05 was used for nomogram development. Model performance was assessed by AUC and calibration plot. Internal validation was done through bootstrapping method and decision curve analysis was performed to evaluate net benefit of model.

RESULTS

The incidence proportion of diabetic neuropathy among DM patients was 21.29% (95% CI; 18.59, 24.25). In multivariable logistic regression glycemic control, other comorbidities, physical activity, hypertension, alcohol drinking, type of treatment, white blood cells and red blood cells count were statistically significant. Nomogram was developed, has discriminating power AUC; 73.2% (95% CI; 69.0%, 77.3%) and calibration test (P-value = 0.45). It was internally validated by bootstrapping method with discrimination performance 71.7 (95% CI; 67.2%, 75.9%). It had less optimism coefficient (0.015). To make nomogram accessible, mobile based tool were developed. In machine learning, classification and regression tree has discriminating performance of 70.2% (95% CI; 65.8%, 74.6%). The model had high net benefit at different threshold probabilities in both nomogram and classification and regression tree.

CONCLUSION

The developed nomogram and decision tree, has good level of accuracy and well calibration, easily individualized prediction of diabetic neuropathy. Both models had added net benefit in clinical practice and to be clinically applicable mobile based tool were developed.

Time to diabetic neuropathy and its predictors among adult type 2 diabetes mellitus patients in Amhara regional state Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022: A retrospective follow up study

BACKGROUND

Diabetic neuropathy is the primary cause of foot ulcers and amputations in both industrialized and poor countries. In spite of this, most epidemiological research on diabetic neuropathy in Ethiopia have only made an effort to estimate prevalence, and the information underlying the condition's beginning is not well-established. Therefore, determining the time to diabetic neuropathy and its variables among adult patients with type 2 diabetes mellitus at the Compressive Specialized Hospitals of the Amhara region was the aim of this study.

METHODS

An institutional-based retrospective follow-up study was undertaken among 669 newly recruited adult patients with type 2 diabetes mellitus who were diagnosed between the first of March 2007 and the last day of February 2012. Patients with diabetic neuropathy at the time of the diagnosis for type 2 diabetes mellitus (T2DM), patients without a medical chart, patients with an unknown date of DM diagnosis, and patients with an unknown date of diabetic neuropathy diagnosis were excluded from the study. All newly diagnosed type 2 diabetes mellitus (T2DM) patients aged 18 years and older who were enrolled from 1st March 2007 to 28th February 2012 in selected hospitals were included in this study. Cox proportional hazard model was fitted to determine predictors of time to diabetic neuropathy, and the Kaplan Meier survival curve was used to assess the cumulative survival time. Variables with a p-value < 0.05 were considered to be statistically significance at 95% confidence interval.

RESULTS

The restricted mean survival time of this study was 179.45 (95% CI: 173.77-185.14) months. The overall incidence rate of diabetic neuropathy was 2.14 cases per 100 persons-years. Being aged > 60 years [AHR = 2.93(95% CI: 1.29-6.66)], having diabetic retinopathy [AHR = 2.76(95% CI: 1.84-4.16)], having anemia [AHR = 3.62 (95% CI: 2.46-5.33)], having hypertension [AHR = 3.22(95% CI: 2.10-4.93)], and baseline fasting blood sugar > 200 mg/dl [AHR = 2.56(95% CI: 1.68-3.92)] were the predictors of diabetic neuropathy.

CONCLUSION

The risk of occurrence of diabetic neuropathy among type two diabetes mellitus patients was high in the early period. Age > 60 years, diabetic retinopathy, anemia, baseline fasting blood sugar level > 200 mg/dl, and hypertension were the main predictors of incidence of diabetic neuropathy. Therefore, early detection and appropriate interventions are important for patients with old age, diabetic retinopathy, anemia, hypertension, and FBS > 200mg/dl.

Common and contrast determinants of peripheral artery disease and diabetic peripheral neuropathy in North Central Nigeria

BACKGROUND

Peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN) are two of the leading causes of non-traumatic amputation worldwide with tremendous negative effects on the quality of life, psychosocial well-being of persons with diabetes mellitus; and a great burden on health care expenditure. It is therefore imperative, to identify the common and contrast determinants of PAD and DPN in order to ease adoption of common and specific strategies for their early prevention.

METHODS

This was a multi-center cross-sectional study which involved the consecutive enrolment of one thousand and forty (1040) participants following consent and waiver of ethical approval. Relevant medical history, anthropometric measurements, other clinical examinations including measurement of ankle-brachial index (ABI) and neurological examinations were undertaken. IBM SPSS version 23 was used for statistical analysis and logistic regression was used to assess for the common and contrast determinants of PAD and DPN. Significance level used was p < 0.05.

RESULTS

Multiple stepwise logistic regression showed that common predictors of PAD vs DPN respectively include age, odds ratio (OR) 1.51 vs 1.99, 95 % confidence interval (CI) 1.18-2.34 vs 1.35-2.54, p = 0.033 vs 0.003; duration of DM (OR 1.51 vs 2.01, CI 1.23-1.85 vs 1.00-3.02, p = <.001 vs 0.032); central obesity (OR 9.77 vs 1.12, CI 5.07-18.82 vs 1.08-3.25, p = <.001 vs 0.047); poor SBP control (OR 2.47 vs 1.78, CI 1.26-4.87 vs 1.18-3.31, p = .016 vs 0.001); poor DBP control (OR 2.45 vs 1.45, CI 1.24-4.84 vs 1.13-2.59, p = .010 vs 0.006); poor 2HrPP control (OR 3.43 vs 2.83, CI 1.79-6.56 vs 1.31-4.17, p = <.001 vs 0.001); poor HbA1c control (OR 2.59 vs 2.31, CI 1.50-5.71 vs 1.47-3.69, p = <.001 vs 0.004). Common negative predictors or probable protective factors of PAD and DPN respectively include statins (OR 3.01 vs 2.21, CI 1.99-9.19 vs 1.45-3.26, p = .023 vs 0.004); and antiplatelets (OR 7.14 vs 2.46, CI 3.03-15.61 vs 1.09-5.53, p = .008 vs 0.030). However, only DPN was significantly predicted by female gender (OR 1.94, CI 1.39-2.25, p = 0.023), height (OR 2.02, CI 1.85-2.20, p = 0.001), generalized obesity (OR 2.02, CI 1.58-2.79, p = 0.002), and poor FPG control (OR 2.43, CI 1.50-4.10, p = 0.004) CONCLUSION: Common determinants of PAD and DPN included age, duration of DM, central obesity, and poor control of SBP, DBP, and 2HrPP control. Additionally, the use of antiplatelets and statins use were common inverse determinants of PAD and DPN which means they may help protect against PAD and DPN. However, only DPN was significantly predicted by female gender, height, generalized obesity, and poor control of FPG.

Association of Non-Dipping Blood Pressure Patterns with Diabetic Peripheral Neuropathy: A Cross-Sectional Study among a Population with Diabetes in Greece

Diabetic peripheral neuropathy (DPN) is present in 20-50% of cases with diabetes. The pathophysiology of DPN is not yet clear regarding hypertension (HTN). The aim of this study was to assess the association between the stages of DPN and HTN in a Greek population with diabetes. We examined 102 adults for diabetic neuropathy (DPN) from November 2020 to December 2021, using the Toronto Clinical Neuropathy Scale System (TCNSS) to categorize them into two groups (no/mild DPN versus medium/severe DPN). Ambulatory blood pressure monitoring was performed to evaluate their hypertensive status. Univariate and multivariate logistic regression analyses were performed to assess the association between the stage of DPN and HTN. The multivariate analysis, considering sex, age, and dipping status, did not show statistically significant associations between stages of HTN and DPN. However, in contrast to dippers, non-dippers had an almost four-times higher risk of developing medium-to-severe DPN (odds ratio (OR) 3.93; 95% confidence interval (CI) [1.33-11.64]); females, in contrast to males, had a 65% lower risk of developing moderate/severe DPN (OR 0.35; 95%CI [0.14-0.92]). In conclusion, our findings showed no statistically significant associations between DPN and HTN; however, dipping status, hyperglycemia, and female sex were shown to play a role in the pathophysiology of DPN.