title: Utility of DN4 questionnaire in assessment of neuropathic pain and its clinical correlations in Turkish patients with diabetes mellitus.
abstract: We aimed to assess the utility of DN4 questionnaire (Douleur Neuropathique en 4 questions) to define the frequency and severity of neuropathic pain (NP) and also its clinical correlation to daily clinical practice.
  
  
  
  We included 1357 patients with diabetes (56.5% women, 90.4% type 2 diabetes) who were followed up in our diabetes outpatient clinic. Presence of NP was evaluated by performing simultaneous DN4 questionnaires and physical examination. Those who had a DN4 score ≥4 were considered to have NP.
  
  
  
  The mean age was 58.2±12.1 years, mean duration was 12.5±7.5; (min-max: 1-45) years, mean HbA1c level was 7.8±1.6% (min-max: 5-16.2%), (61.7±6.0mmol/mol; min-max: 31.1-153.6mmol/mol). Three hundred thirteen patients (23%) were diagnosed with NP using the DN4 tool. Male gender (p=0.01), receiving antihypertensive treatment (p=0.01), presence of retinopathy (p<0.001), cardiovascular disease (CVD) (p=0.01) and previously diagnosed neuropathy (p<0.001) were significantly associated with higher NP scores. Those who had increased DN4 scores were more likely to be on oral hypoglycemic agents (OHA)+insulin combinations (p<0.001), had longer diabetes duration (p<0.001) and higher HbA1c levels (p=0.001). Logistic regression model revealed that diabetes duration (OR: 1.02, 95% CI: 1.00-1.04, p=0.007), elevated HbA1c levels (1.11, 1.02-1.21, 0.015), presence of retinopathy (1.41, 1.20-1.64, <0.001), management with at least one OHA (1.47; 1.12-1.92; 0.004) or any insulin regimen (1.62; 1.16-2.27; 0.005) (compared with diet only-regimens) were significantly associated with NP.
  
  
  
  Utilization of DN4 questionnaire in daily clinical practice is an effective tool in the identification of pain related with peripheral diabetic polyneuropathy.
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey. Electronic address: seldacelik40@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Celik
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey. Electronic address: gulsah_y@hotmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Yenidunya
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey. Electronic address: temel_elif204@hotmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Temel
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Biostatistics, Istanbul, Turkey. Electronic address: purisa@istanbul.edu.tr.
authors.forename: S
authors.initials: S
authors.lastname: Purisa
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey. Electronic address: akubatuzum@gmail.com.
authors.forename: A Kubat
authors.initials: AK
authors.lastname: Uzum
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey. Electronic address: n_gul@hotmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Gul
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey. Electronic address: gulc@hotmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Cinkil
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey. Electronic address: drdinccag@superonline.com.
authors.forename: N
authors.initials: N
authors.lastname: Dinccag
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey. Electronic address: satmandiabet@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Satman
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000209:etiology; D003930:Diabetic Retinopathy / Q000209:etiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D014421:Turkey
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: DN4; Diabetes mellitus; Neuropathic pain; Turkey