A Multicenter Study on the Prevalence of Diabetic Neuropathy in Italy

Domenico Fedele; Giancarlo Comi; Carlo Coscelli; Domenico Cucinotta; Eva L Feldman; Giovanni Ghirlanda; Douglas A Greene; Paolo Negrin; Fausto Santeusanio

doi:10.2337/diacare.20.5.836

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: link-ita{at}pianeta.it

Abstract

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.