Incidence of diabetic peripheral neuropathic pain in primary care - a retrospective cohort study using the United Kingdom General Practice Research Database

High leukotriene B4 serum levels increase risk of painful diabetic neuropathy among type 2 diabetes mellitus patients

Background

Painful diabetic neuropathy is one of the most common complications of type 2 diabetes mellitus, with approximately 30–50% of people will experience diabetic neuropathy. Chronic hyperglycemia will cause an inflammatory process that will trigger an immune response included leukotrienes. Leukotriene B4 is associated with hemoglobin glycation levels. This study aimed to determine high serum leukotriene B4 levels and other factors as a risk factor for painful diabetic neuropathy in type 2 diabetes mellitus patient.

Results

Forty-two subjects with 22 cases (median age 56.5 ± 4.9 years) and 20 controls (median age 56.5 ± 5.2 years) group were collected. In bivariate analysis, significant factor for high risk PDN was high leukotriene B4 serum level (OR 5.10; 95% CI 1.34–19.4, p 0.014). Meanwhile, insignificant factors were anti-diabetic drugs (OR 2.139; 0.62–7.37; p = 0.226), and duration of diabetes mellitus (OR 2.282; 0.56–9.25; p = 0.315). Independent risk factor was serum leukotriene B4 levels (OR 5.10; 95% CI 1.336–19.470; p = 0.017).

Conclusions

In this study, high leukotriene B4 serum levels increase the risk of painful diabetic neuropathy among type 2 diabetes mellitus. The leukotriene B4 may consider as a potential biomarker for early detection in high risk for PDN and early treatment.

Factors associated with choice of intensification treatment for type 2 diabetes after metformin monotherapy: a cohort study in UK primary care

PURPOSE

To understand the patient characteristics associated with treatment choice at the first treatment intensification for type 2 diabetes.

PATIENTS AND METHODS

This is a noninterventional study, using UK electronic primary care records from the Clinical Practice Research Datalink. We included adults treated with metformin monotherapy between January 2000 and July 2017. The outcome of interest was the drug prescribed at first intensification between 2014 and 2017. We used multinomial logistic regression to calculate the ORs for associations between the drugs and patient characteristics.

RESULTS

In total, 14,146 people started treatment with an intensification drug. Younger people were substantially more likely to be prescribed sodium-glucose co-transporter-2 inhibitors (SGLT2is), than sulfonylureas (SUs): OR for SGLT2i prescription for those aged <30 years was 2.47 (95% CI 1.39-4.39) compared with those aged 60-70 years. Both overweight and obesity were associated with greater odds of being prescribed dipeptidyl peptidase-4 inhibitor (DPP4i) or SGLT2i. People of non-white ethnicity were less likely to be prescribed SGLT2i or DPP4i: compared with white patients, the OR of being prescribed SGLT2i among South Asians is 0.60 (95% CI 0.42-0.85), and for black people, the OR is 0.54 (95% CI 0.30-0.97). Lower socioeconomic status was also independently associated with reduced odds of being prescribed SGLT2is.

CONCLUSION

Both clinical and demographic factors are associated with prescribing at the first stage of treatment intensification, with older and non-white people less likely to receive new antidiabetic treatments. Our results suggest that the selection of treatment options used at the first stage of treatment intensification for type 2 diabetes is not driven by clinical need alone.

Incidence of microvascular complications of type 2 diabetes: A 12 year longitudinal study from Karachi-Pakistan

OBJECTIVES

To estimate the incidence of microvascular complications among subjects with type 2 diabetes at a tertiary care hospital.

METHODS

This retrospective longitudinal follow-up study assessed the data records of type 2 diabetic subjects who visited the outpatient department of Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, from January 2005 to April 2016. Subjects with gestational diabetes, type 1 diabetes and with history of any microvascular complication were excluded. Medical records were obtained through electronic database (Health Management System). Statistical analyses were conducted using STATA version 14 and SPSS version 20.

RESULTS

The incidence of microvascular complications was 92.8, 106.2, and 130.2 per 1000 person per years for retinopathy, neuropathy and nephropathy respectively. Retinopathy, neuropathy and nephropathy were significantly high among diabetic patients with duration of diabetes >10 years followed by 5-10 years. Incidence of retinopathy and nephropathy was significantly higher in patients who had HbA1c>7% than patients with HbA1c≤7% (p-value<0.05). Higher incidence rate of all three microvascular complications were seen in subjects with hypertension than subjects without hypertension.

CONCLUSION

A high incidence of microvascular complications is found in subjects with type 2 diabetes. Poor glycaemic control, longer duration of diabetes and hypertension was found to be associated with the occurrence of these complications.

Use of Spinal Cord Stimulation in Elderly Patients with Multi-Factorial Chronic Lumbar and Non-Radicular Lower Extremity Pain

Spinal cord stimulation (SCS) is an effective treatment for chronic back and limb pain. The criteria for use of SCS for specific problems such as failed back surgery syndrome (FBSS), peripheral neuropathic pain and residual pain after joint replacement is well established. With an aging population, there are more patients presenting with a combination of various multi-factorial chronic pain problems rather than from a single clear cause. It is not uncommon to see patients with chronic back pain years after spine surgery with new additional pain in the area of joint replacement or due to peripheral neuropathy. In most of these patients, one area is the primary cause of their pain, while the other more secondary. Multiple chronic problems complicate the pain management of the primary cause and also can diminish the effect of SCS that only targets the primary problem. The primary and secondary causes of pain were ranked by the patient including the duration of their chronic pain for each area. This helped establish criteria for use of SCS in these complex pain patients. The patients were evaluated initially with an epidural stimulator trial and if they obtained 50% or greater pain relief to the primary pain generating area, permanent implantation of one or more arrays of spinal cord electrodes was performed but planned to cover also the secondary pain areas. Post-implant follow-up evaluation at one, three and six months included measurement of visual analog scale (VAS), use of pain medication and degree of functional activity and behavior. This report looks at the effectiveness of using multiple overlapping electrodes for SCS in patients with multi-factorial chronic pain.