Prevalence and risk factors of clinical diabetic polyneuropathy in a Portuguese primary health care population

OBJECTIVE

Distal symmetrical polyneuropathy in diabetics (DPN) has a variable prevalence around 30% and increases the risk for foot ulcers and amputations. We aimed at evaluating the prevalence of clinical DPN and associated risk factors in patients followed in primary care centers.

MATERIAL AND METHODS

101 type 2 diabetics were evaluated and 8 were excluded due to the presence of other causes of neuropathy. The remaining 93 had a mean age of 65.4 +/- 10.1 years and a mean diabetes duration of 10.1 +/- 11.1 years, 60.2% were women and 39.8% men. DPN was defined as the presence of both altered sensitivities and reflexes, regardless of symptoms.

RESULTS

Seventy-two (80%) patients had symptoms of polyneuropathy, but DPN was present only in 29 (32.2%). Calluses (37.8%) and trophic skin (74.4%) and nail (75.6%) changes were found in both feet. There was a significant positive association of DPN with age (69.0 +/- 9.1 vs 63.3 +/- 9.9 years, p=0.01), disease duration (15.7 +/- 13.5 vs 7.2 +/- 8.8 years, p=0.001), feet skin changes (38.8 vs 13.0%, p=0.04) and myocardial infarction/ischemia (14.8 vs 1.7%, p=0.03).

CONCLUSIONS

This sample of diabetic patients cared by family doctors presented a high prevalence of DPN. Aging, disease duration, the presence of feet skin changes and myocardial infarction/ischemia are factors that increase the prevalence of the disease. Primary care doctors awareness of the problem might help to decrease the associated morbidity.

[Anatomical and clinical features of a case of gall-bladder abnormality. Results of arteriographic and micro-angiographic studies (author's transl)]

The authors describe a perplexing clinical picture in which an important factor for diagnosing the lesion in the gall-bladder was hyperselective arteriography of the coeliac trunk, and more especially the hepatic artery. The association of a truc septum in the gall-bladder, without gall-stones, and of another digestive tube lesion, megadolicho-sigmoid and diverticulosis of the sigmoid, would appear to be an extremely rare entity, and this has been the cause of the pain reported by the patient over many years. The cholecystectomy performed appears to be the right choice, and the most effective therapeutic procedure.