title: Ambulatory screening of diabetic neuropathy and predictors of its severity in outpatient settings.
abstract: BACKGROUND
  Diabetic neuropathy is one of the most common causes of chronic neuropathic symptomatology and the most disabling and difficult-to-treat diabetic microangiopathic complication. The neuropathies associated with diabetes are typically classified into generalized, focal and multifocal varieties. There exists a scarcity of literature studying the correlation of different patient- and disease-related variables with severity of neuropathy.
  
  
  OBJECTIVE
  This study aims to delineate the prevalence of diabetic neuropathy in type 2 diabetes, describe its characteristics and find out predictors of its severity.
  
  
  METHODS
  Eight hundred consecutive diabetic patients presenting to outpatient department (OPD) of Khan Research Labs (KRL) General Hospital and Centre for Diabetes and Liver diseases, Islamabad, during March-June, 2015 were made to complete a self-administered questionnaire (Michigan Neuropathy Screening Instrument-MNSI) and underwent a thorough physical examination according to MNSI protocols. A score of >2 was considered to be diagnostic for DPN. Patient and disease variables were noted. MNSI score was used as an index of severity of diabetic peripheral neuropathy (DPN). Correlation of several patient- and disease-related variables with the severity of DPN was determined using multivariate regression.
  
  
  RESULTS
  Out of a total 800 patients screened, 90 (11.25%) were found to have diabetic neuropathy. Of these 90, 45.5% were males, the median age was 54.47 ± 10.87 years and the median duration of diabetes was 11.12 ± 9.8 years. The most common symptom was found to be numbness (63.6%) followed by generalized body weakness (61.5%). The common findings on physical examination were dry skin/callus (38.7%) and deformities (14.7%). Duration of diabetes was found to be the strongest predictor for development and severity of diabetic neuropathy followed by glycemic controls (HbA1c values) and age.
  
  
  CONCLUSIONS
  Duration of diabetes rather than diabetic controls predicts better the development and severity of diabetic neuropathy indicating a failure of intensive treatment to avert such complications.
authors.affiliation: Department of Medicine, Khan Research Laboratories (KRL) Hospital, Islamabad, 44000, Pakistan.
authors.forename: M S
authors.initials: MS
authors.lastname: Qureshi
authors.affiliation: Centre for Diabetes and Liver Diseases, Islamabad, 44000, Pakistan.
authors.forename: M
authors.initials: M
authors.lastname: Iqbal
authors.affiliation: Department of Medicine, Khan Research Laboratories (KRL) Hospital, Islamabad, 44000, Pakistan. sidrazahoor@hotmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Zahoor
authors.affiliation: Department of Medicine, Khan Research Laboratories (KRL) Hospital, Islamabad, 44000, Pakistan.
authors.forename: J
authors.initials: J
authors.lastname: Ali
authors.affiliation: Department of Medicine, Khan Research Laboratories (KRL) Hospital, Islamabad, 44000, Pakistan.
authors.forename: M U
authors.initials: MU
authors.lastname: Javed
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D012720:Severity of Illness Index
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetes; Neuropathy; Screening