title: Socioeconomic deprivation independently predicts symptomatic painful diabetic neuropathy in type 1 diabetes.
abstract: BACKGROUND
  Painful peripheral neuropathy in people with type 1 diabetes is a disabling and costly complication. A greater understanding of predisposing factors and prescribing may facilitate more effective resource allocation.
  
  
  METHODS
  The Townsend index of deprivation (numerically higher for greater disadvantage) was examined in the pseudonymised records of 1621 (684 females) individuals with type 1 diabetes and related to prevalence of drug treated severe diabetes related neuropathic pain.
  
  
  RESULTS
  Treatment for neuropathic pain was initiated in 280 patients, who were older at 57.1 vs 45.6 years and had greater BMI (29.8 vs 27.8kg/m(2); p<0.0001). HbA1C was similar between groups, whilst eGFR was lower in the neuropathic pain group. Amitriptyline was the most commonly prescribed agent (46.8% of total prescriptions). Duloxetine (60mg daily) was prescribed in 9.3% of cases. There were significant differences between the groups for the Townsend index, with a greater proportion (34.3% vs 21.7%) of patients with treated neuropathic pain having a score of ≥1 (X(2)=19.9, p<0.001). Multivariate logistic regression analyses indicated that each unit increment in Townsend index was associated with a 11% increased odds of requiring neuropathic pain treatment [odds ratio (95% CI) 1.11 (1.05-1.17), p<0.001]. This was independent of age: 1.04 (1.02-1.05), BMI: 1.03 (1.01-1.05), HbA1C: 1.15 (1.05-1.24), male gender: 0.74 (0.55-0.98), systolic BP and eGFR. Inclusion of depression and mixed anxiety/depressive disorder did not change the risk estimates.
  
  
  CONCLUSIONS
  Amitriptyline was the most commonly used agent for treatment of diabetes related neuropathic pain with Duloxetine much less used. A higher level of socioeconomic deprivation may predispose to severe neuropathic pain in diabetes. Differential allocation of resources may benefit this group.
authors.affiliation: Cardiovascular Sciences Research Group, Core Technology Facility (3rd Floor), University of Manchester, 46 Grafton Street, Manchester, United Kingdom.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Anderson
authors.affiliation: Department of Medicine, Leighton Hospital, Crewe, United Kingdom.
authors.forename: Nagaraj S
authors.initials: NS
authors.lastname: Malipatil
authors.affiliation: Department of Medicine, Leighton Hospital, Crewe, United Kingdom.
authors.forename: Hugh
authors.initials: H
authors.lastname: Roberts
authors.affiliation: Podiatry, East Cheshire NHS Trust, Macclesfield, United Kingdom.
authors.forename: George
authors.initials: G
authors.lastname: Dunn
authors.affiliation: Department of Medicine, Leighton Hospital, Crewe, United Kingdom; School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom. Electronic address: adrian.heald@manchester.ac.uk.
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Heald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000639:Amitriptyline / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D016009:Chi-Square Distribution; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D000068736:Duloxetine Hydrochloride; D004739:England / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011203:Poverty; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013876:Thiophenes / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000639:Amitriptyline; D000700:Analgesics; D015415:Biomarkers; D000068736:Duloxetine Hydrochloride; D006442:Glycated Hemoglobin; D013876:Thiophenes; C517652:hemoglobin A1c protein, human
keywords: Foot complications; Primary care; Type 1 diabetes