The prevalence, patterns and predictors of diabetic peripheral neuropathy in a developing country

Diabetes mellitus (DM) has reached epidemic proportions worldwide. Historically, diabetes was considered a disease confined to developed countries and affluent people. However, recent estimates suggest that the prevelence of diabetes is rising globally, particularly in developing countries [1]. Diabetes mellitus has become an important health concern in the South Asian region with an estimated increase in the prevalence of diabetes of over 151% between 2000 and 2030 [1]. Neuropathy is considered the most common micro-vascular complications of both types 1 and 2 diabetes mellitus [2,3]. Neuropathic disorders in diabetes can impair functioning of the central, peripheral and/or autonomic nervous systems [4]. Distal peripheral neuropathy (DPN), also known as diabetic polyneuropathy affects the peripheral nervous system and is by far the most common type of neuropathy seen in DM [5]. The resultant loss of function in peripheral nerves causes loss of protective sensations and impairs patient’s ability to perceive incipient or even apparent ulcerations in the feet. DPN is considered a main risk factor for amputation, and hence a significant cause of morbidity in DM [6]. Although a common and important complication of diabetes, neuropathy has not been studied as often or as extensively as macro-vascular complications or retinopathy and nephropathy [7]. In addition, the reported prevalence estimates vary widely between countries, in part due to the difference in sampling methods and lack of consensus on diagnostic criteria [8]. Hence, for comparative purposes it is important to use studies that utilize similar diagnostic criteria. However, the observed variations in prevalence could partly result from ethnic differences in predisposition and differential exposure to risk factors.Increasing age, longer duration of diabetes and poor glycaemic control are well recognized risk factors for DPN, while cigarette smoking, retinopathy, hypertension, obesity, hyperlipidaemia and micro