Review
English
Heba A El-Zawawi
Department of Medicine, Faculty of Medicine, Al-Arab Medical University Benghazi, Libya
JMJ 2009,Vol.9, No.1: 09-15
Abstract
Objectives: To present an update of the aetiology, differential diagnosis and management of diabetic peripheral neuropathy (DPN), as well as its impact on patients and services in Benghazi. Since no curative treatment is available for DPN, this study also aimed to answer the important questions of whether neuropathic symptoms can be improved by better diabetic and vascular risk factor control, and cure finally achieved through future scientific development and better strategies for care provision. Methods: Data from 587 patients attending the Neurology Outpatients Clinic of Al-Jala Hospital Benghazi over 11 months were reviewed retrospectively. Data from the Neurology (Neuropathy ) Clinic at the Diabetes Centre Sidi Hussein Polyclinic, over a period of 9 months (254 patients ) were analysed with regard to presence of DPN and its symptom response to standard vascular risk factor control with angiotensin converting enzyme (ACE) inhibitor or sartan, antilipidaemics, aspirin, vitamin and mineral supplementation plus dietary control. A review of the literature was performed and the results were compared and summarized on a background review of DPN. Results: Diabetic peripheral neuropathy (DPN) is the most frequently diagnosed cause of peripheral neuropathy in Benghazi. Peripheral neuropathy accounts for 10% of the cases seen in the neurology outpatients and is the fourth cause of referral preceded only by headache, epilepsy and spinal disease 38%. of 254 glycaemia well-controlled patients at the Neurology Clinic, Sidi Hussein, were found to have DPN. The most frequent types of diabetic neuropathy are distal sensory-motor and diabetic mononeuropathy followed by painful small fibre sensory neuropathy, diabetic plexopathy/ amyotrophy, mononeuritis multiplex and diabetic autonomic neuropathy. Comorbidities may be present and include hypothyroidism, renal failure, vitamin B12 and folate deficiency, connective tissue disease, exposure to toxins occupational or recreational, malignancy, infections, genetic diseases, trauma and compression. Controlling vascular risk factors alone improved patient symptoms by 40 -100 % in patients with DPN. Conclusions: Early detection and prevention of diabetic neuropathy and its complications is likely to impact positively on patient health and health- service expenditure. Recognition of the various forms of diabetic neuropathy leads to structured pathways of management and more effective therapies. Creative strategies to manage neuropathic pain and treatments for specific neuropathies e.g. for diabetic plexopathy are necessary. A multidisciplinary approach involving physicians, neurologists, rehabilitologists, specialist nurses, primary care physicians and research scientists is the ideal model for health-care delivery in diabetic peripheral neuropathy .
Keywords: Diabetic neuropathy, Peripheral, Types, Management.
Link/DOI: http://www.jmj.org.ly/PDF/Spring2009/9.pdf