| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 2680720 | Primary Care Diabetes | 2016 | 6 Pages |
•Twenty three percent of the study group was diagnosed as NP using the DN4 tool.•Diabetes duration, high HbA1c levels, presence of retinopathy were related with NP.•DN4 questionnaire is easy and effective to evaluate NP.•In order to evaluate these patients for diabetic neuropathy use of both DN4 and foot examination is valuable.
AimWe 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.MethodsWe 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.ResultsThe 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 ± 6.0 mmol/mol; min–max: 31.1–153.6 mmol/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.ConclusionUtilization of DN4 questionnaire in daily clinical practice is an effective tool in the identification of pain related with peripheral diabetic polyneuropathy.
