A Multicenter Study on the Prevalence of Diabetic Neuropathy in Italy
- Domenico Fedele, MD,
- Giancarlo Comi, MD,
- Carlo Coscelli, MD,
- Domenico Cucinotta, MD,
- Eva L Feldman, MD,
- Giovanni Ghirlanda, MD,
- Douglas A Greene, MD,
- Paolo Negrin, MD,
- Fausto Santeusanio, MD and
- The Italian Diabetic Neuropathy Committee
- Department of Metabolic Disease, University of Perugia Perugia, Italy
- Diabetes Center, University of Padova Padova Department of Neurology, University of Perugia Perugia, Italy
- S. Raffaele Hospital, University of Milan Milan Division of Internal Medicine, University of Perugia Perugia, Italy
- Hospital of Parma Parma Department of Internal Medicine and Metabolic Diseases, University of Perugia Perugia, Italy
- University of Messina Messina, Italy the Department of Neurology, University of Perugia Perugia, Italy
- University of Michigan Ann Arbor, Michigan the Diabetes Center, University of Perugia Perugia, Italy
- University of Sacro Cuore Rome, Italy Department of Internal Medicine, University of Perugia Perugia, Italy
- University of Michigan Ann Arbor, Michigan the Department of Neurology, University of Perugia Perugia, Italy
- Center of Neurophysiology, University of Padova Padova Department of Internal Medicine and Endocrinology, University of PerugiaPerugia, Italy
- Address correspondence and reprint requests to Domenico Fedele, MD, Centra Antidiabetico, Ospedale Geriatrico, Via Vendramini 7, 35137 Padua, Italy. E-mail:
OBJECTIVE The prevalence of neuropathy, a common complication of diabetes, was determined in diabetic patients recruited from 109 outpatient diabetes clinics in Italy.
RESEARCH DESIGN AND METHODS Neuropathy was diagnosed using the Diabetic Neuropathy Index (DNI), a standardized examination developed for use in the outpatient setting. A total of 8,757 diabetic patients were studied, 51.2% men and 48.8% women, with average and median ages of 56 and 58 years, respectively.
RESULTS Of the 8,757 patients, 32.3% had neuropathy, defined as a positive score of > 2 points on the DNI. A total of 2,033 (49.6% men and 50.4% women) were administered the Diabetic Neuropathy Score (DNS), the second component of the screening program, by a neurologist. This component consists of a quantitative neurological examination and nerve conduction studies that together provide a summated score. A total of 335 patients (16.5%) were not neuropathic, and 395 (19.4%) had borderline, 453 (22.3%) mild, 592 (29.1%) moderate, and 258 (12.7%) severe neuropathy. The concordance between a positive score on the DNI and a DNS indicating neuropathy was 83.5%. The severity of neuropathy increased with both age and disease duration. Of patients with neuropathy, 64.1% had an average age between 58 and 59 years with a disease duration between 12.4 ± 8.4 years (mild neuropathy) and 15.6 ± 9.7 years (severe neuropathy).
CONCLUSIONS Neuropathy is a common complication of diabetes and, in this study, was present in 32.3% of all patients. An increased awareness of the high prevalence of neuropathy can lead to early therapeutic intervention and possible prevention of later neuropathic complications, such as infection and foot ulcers.
- Received August 19, 1996.
- Accepted December 10, 1996.
- Copyright © 1997 by the American Diabetes Association