Subjective versus objective assessment of painful diabetic peripheral neuropathy

Abstract

Introduction Diabetic peripheral neuropathy (DPN) is one of the commonest chronic complications of diabetes mellitus. It is documented that 26.4% of the cases with type 2 diabetes mellitus have painful DPN, whereas approximately half of the DPN cases may not have symptoms. Although neurophysiologic studies represent an objective and sensitive tool in the diagnosis of diabetic neuropathy, they remain limited owing to many factors; thus, there is a need to develop simpler tools that can fit into this gap, hence the development of different neuropathy scores. Aim To evaluate different tools and methods either subjective or objective in diagnosis of painful DPN in type 2 diabetic patients. Patients and methods We included 200 cases with type 2 diabetes mellitus recruited from the diabetes and diabetic neuropathy clinics in Mansoura Specialized Medical Hospital fulfilling the inclusion and exclusion criteria. They were divided into two groups: group 1 included 150 diabetic cases with painful peripheral diabetic neuropathy, and group 2 included 50 diabetic cases without neuropathy. Results Glycated hemoglobin was significantly elevated in the peripheral neuropathy group compared with the other group (8.24 vs. 7.27%; P<0.001). Regarding neutrophil/lymphocytic ratio in our study, it was not significantly different between the two groups (P=0581). It had mean values of 2.17 and 2.1 in groups 1 and 2, respectively. Conclusion Higher grades of the scores performed in this study were associated with a severe form of neuropathy. Both duration of diabetes and glycated hemoglobin levels had a significant positive correlation with these scores. Regarding neutrophil/lymphocytic ratio in our study, it did not show a significant difference between the two groups.