High prevalence of diagnosed and undiagnosed polyneuropathy in subjects with and without diabetes participating in a nationwide educational initiative (PROTECT study).
OBJECTIVE
Since neuropathy screening may be underutilized in primary care practice, we conducted a nationwide educational initiative to determine the prevalence of diagnosed and previously undiagnosed polyneuropathy.


METHODS
Among 1017 individuals participating in the initiative, 983 with complete data were analyzed, 359 of whom had no diabetes by history (ND), 80 had type 1 diabetes, and 544 had type 2 diabetes. Polyneuropathy was assessed by history and foot examination including pressure, temperature, and vibration perception and was classified as possible, probable, and severe. Foot pulses and HbA1c were determined in subsets of participants.


RESULTS
Polyneuropathy was detected in 53.8% of ND, 43.8% of type 1, and 55.6% of type 2 diabetes subjects and was associated with higher age. In a subset of participants with polyneuropathy, the latter was declared as previously undiagnosed by 79.1% of ND, 35.7% of type 1, and 61.5% of type 2 diabetes participants. After adjustment for age and sex, prevalent polyneuropathy was associated with peripheral arterial disease.


CONCLUSIONS
More than half of subjects with and without diabetes participating in an educational initiative had polyneuropathy which was reported as previously undiagnosed by two thirds. Effective strategies to avoid underdiagnosis of neuropathy and to improve preventive foot care should be implemented.
Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany. Electronic address: dan.ziegler@ddz.uni-duesseldorf.de.
Dan
D
Ziegler
Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.
Alexander
A
Strom
Clinic for Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart Bürgerhospital, Stuttgart, Germany.
Ralf
R
Lobmann
Department of Neurology, University Hospital, Würzburg, Germany.
Karlheinz
K
Reiners
Department of Endocrinology and Diabetology, Sachsenhausen Hospital, Frankfurt, Germany.
Kristian
K
Rett
Forschergruppe Diabetes e.V. at the Helmholtz Center Munich, Neuherberg, Germany.
Oliver
O
Schnell
D000328:Adult; D000367:Age Factors; D000368:Aged; D057210:Delayed Diagnosis / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D003929:Diabetic Neuropathies / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005528:Foot; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010353:Patient Education as Topic; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D011115:Polyneuropathies / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D012720:Severity of Illness Index
Diagnosis; Foot care; Glycemic control; PROTECT study; Peripheral arterial disease; Polyneuropathy; Screening