A Cross-Sectional Study For Diabetic Peripheral Neuropathy Of Community Health Service Centers Managed Type 2 Diabetes Mellitus Patients In Shanghai.

Objective:Some screening researches on the prevalence of diabetic peripheral neuropathy(DPN)in type 2 diabetes mellitus were conducted in china nowadays.But the data was usually got from hospitals or the sample size was not big enough.And the community-based research about diabetic peripheral neuropathy lacked.Ascreening study on diabetic peripheral neuropathy in Shanghai Pudong new area and Yangpu area was carried out to look into the prevalence and risk factors of diabetic peripheral neuropathy.Methods:A total of 6 communities were randomly selected from Shanghai Pudong new area and Yangpu area.And5215 subjects with T2 DM were enrolled with cluster sampling method.Among these enrolled subjects,153 patients were excluded from this study due their unwilling to write questionnaire,leaving 5053 subjects included for analyses.Basic information,clinical data,laboratory data,fundus photography and score from Toronto clinical scoring system(TCSS)of the subjects were collected.Results:(1)Among the 5053 diabetic patients participating in this study,45.6%,20.1% and 80.8% of the patients were overweight,obese and with high waist-to-hip ratio(WHR).28.7% of the underweights patients were with high WHR.And more women had central obesity than men.(2)Standard-reaching rates of HbA1 C,fasting blood glucose(FBG)and postprandial blood glucose(PBG)are 47.9%,40.2% and 35.6%,while the rates of total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C)are 90.9%,61.4%,92.9% and 97.3%.(3)810(16.0%)patients had evidence of DPN including 612(12.1%)patients with mild diabetic peripheral neuropathy(DPN),158(3.1%)patients with moderate DPN,40(0.8%)patients with severe DPN,while 662 patients were new-diagnosed(81.7%).12.8% of the diabetic patients were suggested to have a fundus screening test.But only 10.1% of the diabetic patient received the fundus screening test.(4)The differences of onset,age,disease duration,postprandial blood glucose2h(2hPG),glycosylated hemoglobin(HbA1c),low density lipoprotein cholesterin(LDLC),high density lipoprotein cholesterol(HDL-C),urinary albumin to creatinine ratio(ACR)and diabetic retinopathy,between DPNpositive patient and DPNnegative patient according to screening result was statistically significant(p<0.05).(5)Age,disease duration,WHR,PBG,2hPG,HbA1 c,HDL-C between patientswith diabetic retinopathy(DR)and patients without diabetic retinopathy(DR)was significant different(p<0.05).(6)The relation between diabetic peripheral neuropathy and diabetic retinopathy was existant.The patients with diabetic peripheral neuropathy showed greater proportion of diabetic retinopathy.And the patients with diabetic retinopathy decreasing badly came up with moderate diabetic peripheral neuropathy,severe diabetic peripheral neuropathy more frequently.(3)Logistics regression was performed to determine the risk factors for diabetic peripheral neuropathy,which included age?65,disease duration?15 years,HbA1c?8.5%,HDL-C?0.9mmol/L,combines moderate or severe diabetic retinopathy as risk factorsin T2 DM patients.Conlusion:The prevalence of DPN based on population study was lower than that reported in previous study based on hospital patients.The DPN severity of most patients in this study was mild.But the diagnostic was low in T2 DM patients under community management.The diabetes duration over 15 years and poor control of blood glucose level could be the important risk factors of DPN.In comparison with FBG and PBG,the HbA1 c exceeding the standard of T2 DM was more sensitive to the cause and development of DPN.The patients with DPN and diabetic retinopathy had greater proportion of severe lesions,due to bad disease control.The association between DPN and diabetic retinopathy might be existent.