Anderson Simon G, Malipatil Nagaraj S, Roberts Hugh, Dunn George, Heald Adrian H
Cardiovascular Sciences Research Group, Core Technology Facility (3rd Floor), University of Manchester, 46 Grafton Street, Manchester, United Kingdom.
Department of Medicine, Leighton Hospital, Crewe, United Kingdom.
Prim Care Diabetes. 2014 Apr;8(1):65-9. doi: 10.1016/j.pcd.2013.08.004. Epub 2013 Nov 8.
Painful peripheral neuropathy in people with type 1 diabetes is a disabling and costly complication. A greater understanding of predisposing factors and prescribing may facilitate more effective resource allocation.
The Townsend index of deprivation (numerically higher for greater disadvantage) was examined in the pseudonymised records of 1621 (684 females) individuals with type 1 diabetes and related to prevalence of drug treated severe diabetes related neuropathic pain.
Treatment for neuropathic pain was initiated in 280 patients, who were older at 57.1 vs 45.6 years and had greater BMI (29.8 vs 27.8kg/m(2); p<0.0001). HbA1C was similar between groups, whilst eGFR was lower in the neuropathic pain group. Amitriptyline was the most commonly prescribed agent (46.8% of total prescriptions). Duloxetine (60mg daily) was prescribed in 9.3% of cases. There were significant differences between the groups for the Townsend index, with a greater proportion (34.3% vs 21.7%) of patients with treated neuropathic pain having a score of ≥1 (X(2)=19.9, p<0.001). Multivariate logistic regression analyses indicated that each unit increment in Townsend index was associated with a 11% increased odds of requiring neuropathic pain treatment [odds ratio (95% CI) 1.11 (1.05-1.17), p<0.001]. This was independent of age: 1.04 (1.02-1.05), BMI: 1.03 (1.01-1.05), HbA1C: 1.15 (1.05-1.24), male gender: 0.74 (0.55-0.98), systolic BP and eGFR. Inclusion of depression and mixed anxiety/depressive disorder did not change the risk estimates.
Amitriptyline was the most commonly used agent for treatment of diabetes related neuropathic pain with Duloxetine much less used. A higher level of socioeconomic deprivation may predispose to severe neuropathic pain in diabetes. Differential allocation of resources may benefit this group.
1型糖尿病患者的疼痛性周围神经病变是一种致残且代价高昂的并发症。对易感因素和处方用药有更深入的了解可能有助于更有效地分配资源。
在1621名（684名女性）1型糖尿病患者的匿名记录中检查了汤森贫困指数（数值越高表示劣势越大），并将其与药物治疗的严重糖尿病相关神经病理性疼痛的患病率相关联。
280名患者开始接受神经病理性疼痛治疗，这些患者年龄较大，为57.1岁，而未治疗患者为45.6岁，且体重指数更高（29.8 vs 27.8kg/m²；p<0.0001）。两组之间的糖化血红蛋白相似，而神经病理性疼痛组的估算肾小球滤过率较低。阿米替林是最常用的药物（占总处方的46.8%）。度洛西汀（每日60mg）的处方率为9.3%。两组在汤森指数上存在显著差异，接受神经病理性疼痛治疗的患者中，得分≥1的比例更高（34.3%对21.7%）（X²=19.9，p<0.001）。多因素逻辑回归分析表明，汤森指数每增加一个单位，需要进行神经病理性疼痛治疗的几率就增加11%[比值比（95%置信区间）1.11（1.05 - 1.17），p<0.001]。这与年龄无关：1.04（1.02 - 1.05），体重指数无关：1.03（1.01 - 1.05），糖化血红蛋白无关：1.15（1.05 - 1.24），男性无关：0.74（0.55 - 0.98），收缩压和估算肾小球滤过率无关。纳入抑郁症和混合性焦虑/抑郁障碍并未改变风险估计值。
阿米替林是治疗糖尿病相关神经病理性疼痛最常用的药物，度洛西汀的使用则少得多。社会经济剥夺程度较高可能易导致糖尿病患者出现严重的神经病理性疼痛。差异化的资源分配可能使该群体受益。
