Oguejiofor O C, Odenigbo C U, Oguejiofor C B N
Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State.
Niger J Clin Pract. 2010 Sep;13(3):240-7.
Risk factors predisposing to foot ulceration in diabetic subjects are multiple. Long duration of diabetes mellitus is a major risk factor, likewise peripheral neuropathy (PN), which globally, is recognized as the commonest risk factor for foot disease in diabetic subjects.
To evaluate the effect of duration of diabetes mellitus on peripheral neuropathy using the United Kingdom Screening Test (UKST) Scoring System, Bio-thesiometry and Aesthesiometry, in Nigerian diabetic subjects without current or previous foot ulceration.
One hundred and twenty (120) diabetes mellitus (DM) subjects with and without symptoms of peripheral neuropathy receiving care at the medical outpatient department (MOPD) and the diabetic clinic of the Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria, were recruited consecutively as they presented. Data collected included subjects age (years), gender, age at first diagnosis of DM, duration of DM (years) and baseline fasting venous plasma glucose. The United Kingdom Screening Test (UKST) symptom score was used to separate the participants into two groups those with symptoms of PN and those without and the subjects further assessed by three methods the UKST Signs score, Bio-thesiometry and Aesthesiometry to determine the presence . of PN.
Among the 120 diabetic participants, 83(69.2%) had neuropathic symptoms (the symptomatic participants) while 37 (30.8%) were asymptomatic (the asymptomatic participants). The different methods of diagnosing PN increasingly detected PN with increasing duration of diabetes. For the symptomatic group, the UKST method detected PN least in those with duration of DM <5 years (73.9%) and 100.0% in those with duration of DM >15 years while for the asymptomatic group, it detected PN in 25.0% of those with duration of DM <5 years, and 100.0% for those with duration of DM >15 years. For the symptomatic group, Aesthesiometry detected PN in 65.2% of those with duration of DM <5 years and 91.7% in those with duration of DM >15 years. For the asymptomatic group, it detected PN in 29.2% of those with duration of DM <5 years and 100.0% in those with duration of DM >15 years. Likewise, for the symptomatic group, Bio-thesiometry detected PN in 47.8% of those with duration of DM <5 years and 100.0% in those with duration of DM >15 years. For the asymptomatic group, it detected PN in 16.7% of those with duration of DM <5 years and 100.0% in those with duration of DM >15 years.
Long duration of diabetes mellitus and peripheral neuropathy are risk factors for foot complication in Nigerians with diabetes mellitus. Diabetic subjects with long duration of diabetes (>10 years) almost always have associated peripheral neuropathy, and should be recognized as a special group at high risk for foot disease from DM. Specific preventive programs should target this group to reduce the rate of avoidable loss of limbs to diabetes.
糖尿病患者足部溃疡的诱发危险因素众多。糖尿病病程长是主要危险因素，同样，周围神经病变（PN）在全球范围内被认为是糖尿病患者足部疾病最常见的危险因素。
在无当前或既往足部溃疡的尼日利亚糖尿病患者中，使用英国筛查试验（UKST）评分系统、生物感觉定量法和触觉测量法评估糖尿病病程对周围神经病变的影响。
在尼日利亚恩纳姆迪·阿齐克韦大学教学医院纽维分院的内科门诊（MOPD）和糖尿病诊所，连续招募了120名有或无周围神经病变症状的糖尿病（DM）患者。收集的数据包括受试者年龄（岁）、性别、首次诊断糖尿病时的年龄、糖尿病病程（年）以及基线空腹静脉血浆葡萄糖。使用英国筛查试验（UKST）症状评分将参与者分为两组，即有PN症状的参与者和无PN症状的参与者，然后通过三种方法进一步评估受试者，即UKST体征评分、生物感觉定量法和触觉测量法，以确定PN的存在情况。
在120名糖尿病参与者中，83名（69.2%）有神经病变症状（有症状参与者），而37名（30.8%）无症状（无症状参与者）。诊断PN的不同方法随着糖尿病病程的延长越来越多地检测到PN。对于有症状组，UKST方法在糖尿病病程<5年的患者中检测到PN的比例最低（73.9%），在糖尿病病程>15年的患者中为100.0%；而对于无症状组，在糖尿病病程<5年的患者中检测到PN的比例为25.0%，在糖尿病病程>15年的患者中为100.0%。对于有症状组，触觉测量法在糖尿病病程<5年的患者中检测到PN的比例为65.2%，在糖尿病病程>15年的患者中为91.7%。对于无症状组，在糖尿病病程<5年的患者中检测到PN的比例为29.2%，在糖尿病病程>15年的患者中为100.0%。同样，对于有症状组，生物感觉定量法在糖尿病病程<5年的患者中检测到PN的比例为47.8%，在糖尿病病程>15年的患者中为100.0%。对于无症状组，在糖尿病病程<5年的患者中检测到PN的比例为16.7%，在糖尿病病程>15年的患者中为100.0%。
糖尿病病程长和周围神经病变是尼日利亚糖尿病患者足部并发症的危险因素。糖尿病病程长（>10年）的糖尿病患者几乎总是伴有周围神经病变，应被视为糖尿病足部疾病的高危特殊群体。应针对该群体制定具体的预防方案，以降低糖尿病导致的可避免肢体丧失率。
