Prevalence of peripheral neuropathy, amputation, and quality of life in patients with diabetes mellitus | Scientific Reports – Nature.com

A cross-sectional observational study was conducted on 225 patients (42.2% males and 57.8% females) with type I (2.2%) and type II DM (97.8%), having a diabetic history of fewer than five years in 56% of participants of age ranging from 35-70 years, The study aimed to scrutinize the prevalence of peripheral neuropathy and amputation in patients with DM and evaluate their quality of life by utilizing the Michigan Neuropathy Screening Instrument and the Asian Diabetic Quality of Life Questionnaire. The levels of amputation from toe amputations to hemipelvectomy were observed.

Martin CL et al. in 2014 found that the most common of these neuropathic disorders is chronic diabetic peripheral sensorimotor neuropathy (DPN), which affects up to 50% of persons with DM14. The study's findings revealed a significant prevalence of peripheral neuropathy among the participants, emphasizing the considerable burden of this complication in patients with DM. Our study conducted on 225 patients with DM demonstrates the prevalence of DNP (diabetic peripheral neuropathy) using the Michigan neuropathy screening instrument (MNSI) self-administer questionnaire (SAQ) was 44.4% and 51.1% on the basis of the lower extremity examination part of the MNSI. Whereas, 55.6% and 48.9% were observed for the population without DPN using SAQ and the physical examination part of MNSI, respectively. Peripheral neuropathy is a well-recognized consequence of DM, characterized by nerve damage that can lead to various sensory and motor deficits, including pain, tingling, numbness, loss of sensation, muscle weakness, and impaired balance. The high prevalence rate underscores the need for early detection and effective management strategies to prevent or mitigate its adverse effects on patients well-being.

Hazari et al. (2023) reported that the risk of DPN is ethnic origin-dependent in residents of the United Arab Emirates and is high in Arab-origin residents. According to the findings of MNSI, 62% of the participants were screened with DPN28. The current study's findings are in line with their results in terms of DPN on the basis of MNSI but are limited in terms of information regarding the ethnicity and geographical background of the participants.

Amputation, another severe complication associated with DM, was also found to be prevalent in the study sample. This outcome raises concerns about the impact of DM on vascular health and underscores the significance of comprehensive diabetic foot care programs. Amputations can have profound physical, psychological, and social implications for individuals, leading to long-term disability and reduced quality of life. The identification of factors such as age, duration of DM, and glycemic control as predictors of peripheral neuropathy and amputation provides valuable insights for risk stratification and targeted interventions. In this study, the prevalence of amputations observed in patients with DM in the right and left lower limb are 0.4% and 0% hemipelvectomy, respectively, with short above knee amputation being 0.4%, 2.2%, respectively, standard below the knee in 9.8%, 3.6% respectively, toe disarticulation or amputation in 2.7%, 1.8 respectively, and Symes being 0.4% in both lower limbs. Baumfeld D et al. in 2018 found that in Pakistan, the rate of amputation (number of amputations due to diabetes per year) has been reported to be 21%-48%, despite the prevalence of diabetic foot ulcerations that is comparable to that of other countries29. The total rate of amputation, according to our study among the sample population, is 21.7%, which is similar to other research done before.

Furthermore, the study demonstrated the quality of life of the participants. This finding highlights the multidimensional nature of quality of life and the significant impact that these complications have on various aspects of a patient's well-being. According to the results of our study, DPN and amputation may have a negative association with four components of Asian DQOL in patients with DM. Our study showed that 96.9% of the population had poor QOL (score<45), 2.2% had moderate QOL (score 4550), and 0.9% had good QOL (score 5055). The study concluded results for four components of the Asian DQOL questionnaire with lower scores indicating poor QOL and vice versa. Total energy score 83.6% with (scores of 04) 14.7%, and 1.8% (scores 58 and 912, respectively), total memory scores 04, 58, 912, and 1316 with 30.0%, 34.7%, 20.9%, and 14.2% respectively, total finance score 05, 610, 1115, and 1620 with 51.1%, 39.6%, 6.7%, and 2.7% respectively, and total diet score of 04, 58, 912 with 67.1%, 30.2%, and 2.7% respectively. The mean energy score is 2.811.82 out of 12, which seems to be very low; the mean memory score is 7.974.53 out of 16, appearing as less than half of the total score, mean finance score is 6.384.34 out of 20 which is also very poor, mean diet score is 3.772.17 out of 12 and total score is 20.9510.40 out of 60. Most of the results depict poor quality of life in the study population.

Physical functioning is often compromised due to the sensory and motor deficits associated with peripheral neuropathy, limiting mobility and impairing daily activities. Psychological well-being is affected by chronic pain, anxiety, depression, and the psychological adjustment to the loss of a limb in the case of amputation. Social interactions may also be impacted as individuals may experience social stigma, reduced participation in social activities, and a sense of isolation. Overall, life satisfaction is significantly diminished as a result of the limitations imposed by these complications. According to our findings, numerous studies from different countries have indicated that type II DM has a detrimental effect on QOL30,31,32,33.

While this study provides valuable insights into the prevalence of peripheral neuropathy, amputation, and quality of life in patients with DM, it is important to acknowledge certain limitations. The cross-sectional design of this study limits the ability to establish causal relationships between variables. Longitudinal studies would be beneficial in determining temporal relationships and understanding the long-term effects of these complications.

Healthcare providers should prioritize early detection and screening of peripheral neuropathy in patients with Diabetic mellitus. A multidisciplinary approach involving healthcare professionals from various specialities, such as endocrinology, podiatry, and physical therapy, is recommended, along with long-term follow-up. Collaboration among these specialists can provide comprehensive care, including education, foot care guidance, wound management, and rehabilitation services for individuals with peripheral neuropathy or amputation. Recognizing the impact of peripheral neuropathy and amputation on the quality of life, healthcare providers should offer psychological support and rehabilitation services to affected patients. Access to counselling, prosthetics and mobility aids can help individuals cope with the physical, emotional, and social challenges associated with these complications.

The present study had a few limitations which need to be mentioned here. The study's sample was drawn from patients attending a specific healthcare facility, which may introduce sampling bias and limit the generalizability of the findings to a broader population. Patients seeking care at these facilities may have different characteristics or access to healthcare compared to the general population. Individuals with concurrent chronic illnesses like heart disease, cancer, or renal disorders, with a history of trauma, severe psychiatric conditions, or addiction were excluded due to some ethical limitation. This prevented the analysis from having external validity. Many patients have multiple comorbidities, and it is difficult for neuropathy to be the only complication.

Only MNSI was used, and it could not be compared with nerve conduction study, which is a gold standard for diagnosing patients with peripheral neuropathy. Due to ethical considerations, the interpersonal relationship component of Asian DQOL was not included in this study. The study relied on self-reported data, which was subjected to recall bias. Patients may have inaccurately reported their medical history, symptoms, or quality of life. Additionally, subjective assessments of QoL may be influenced by individual perceptions and experiences.

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Prevalence of peripheral neuropathy, amputation, and quality of life in patients with diabetes mellitus | Scientific Reports - Nature.com