title: Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K.
abstract: OBJECTIVE
  To assess, in the general diabetic population, 1) the prevalence of painful neuropathic symptoms; 2) the relationship between symptoms and clinical severity of neuropathy; and 3) the role of diabetes type, sex, and ethnicity in painful neuropathy.
  
  
  METHODS
  Observational study of a large cohort of diabetic patients receiving community-based health care in northwest England (n = 15,692). Painful diabetic neuropathy (PDN) was assessed using neuropathy symptom score (NSS) and neuropathy disability score (NDS).
  
  
  RESULTS
  Prevalence of painful symptoms (NSS ≥5) and PDN (NSS ≥5 and NDS ≥3) was 34 and 21%, respectively. Painful symptoms occurred in 26% of patients without neuropathy (NDS ≤2) and 60% of patients with severe neuropathy (NDS >8). Adjusted risk of painful neuropathic symptoms in type 2 diabetes was double that of type 1 diabetes (odds ratio [OR] = 2.1 [95% CI 1.7-2.4], P < 0.001) and not affected by severity of neuropathy, insulin use, foot deformities, smoking, or alcohol. Women had 50% increased adjusted risk of painful symptoms compared with men (OR = 1.5 [1.4-1.6], P < 0.0001). Despite less neuropathy in South Asians (14%) than Europeans (22%) and African Caribbeans (21%) (P < 0.0001), painful symptoms were greater in South Asians (38 vs. 34 vs. 32%, P < 0.0001). South Asians without neuropathy maintained a 50% increased risk of painful neuropathy symptoms compared with other ethnic groups (P < 0.0001).
  
  
  CONCLUSIONS
  One-third of all community-based diabetic patients have painful neuropathy symptoms, regardless of their neuropathic deficit. PDN was more prevalent in patients with type 2 diabetes, women, and people of South Asian origin. This highlights a significant morbidity due to painful neuropathy and identifies key groups who warrant screening for PDN.
authors.affiliation: Division of Cardiovascular Medicine, Core Technology Facility, University of Manchester, Manchester, UK. caroline.abbott@manchester.ac.uk
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Abbott
authors.forename: Rayaz A
authors.initials: RA
authors.lastname: Malik
authors.forename: Ernest R E
authors.initials: ER
authors.lastname: van Ross
authors.forename: Jai
authors.initials: J
authors.lastname: Kulkarni
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
mesh_terms: D000284:Administration, Oral; D000328:Adult; D017677:Age Distribution; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D003929:Diabetic Neuropathies / Q000453:epidemiology* / Q000208:ethnology / Q000473:pathology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents