Anderson S G, Narayanan R P, Malipatil N S, Roberts H, Dunn G, Heald A H
Cardiovascular Sciences Research Group, The University of Manchester, Manchester, United Kingdom.
Department of Obesity and Endocrinology, University of Liverpool.
Exp Clin Endocrinol Diabetes. 2015 Jul;123(7):423-7. doi: 10.1055/s-0035-1549966. Epub 2015 Jun 11.
Painful peripheral neuropathy in people with type 2 diabetes is a disabling complication. We explored associations of this condition with socioeconomic deprivation.
The Townsend index of socioeconomic deprivation was examined in the pseudonymised GP records of 15388 (44.1% female) individuals with type 2 diabetes in the Cheshire county of England, and related to prevalence of drug treated painful diabetic neuropathy. We also analysed prescription trends with respect to pharmacotherapy for neuropathy pain relief.
Treatment for neuropathic pain was initiated in 3 266 (21.2%) of patients. Those on treatment were older [68.2 (95% CI 67.8-68.7) vs. 66.6 (66.4-66.8) years] than those not on treatment. There was no difference in HbA1c (7%, 55 mmol/mol).There were significant differences between the groups for the Townsend deprivation index, with a greater proportion (30.6% vs. 22.8% of patients with treated neuropathic pain) having a score of ≥1 (Χ(2)=83.9, p<0.0001).Multivariate logistic regression analyses indicated that each unit increment in the Townsend index was associated with an 6% increased odds of requiring neuropathic pain treatment [odds ratio (95%CI) 1.06 (1.05-1.08), p<0.0001] independent of 5 year age band, BMI, gender, systolic BP, eGFR, HbA1C and total cholesterol.
In this study using pseudonymised clinical records, a higher level of socioeconomic deprivation seemingly may predispose to severe neuropathic pain in diabetes requiring pharmacological intervention. Targeted allocation of healthcare resources to this group may offer clinical benefits.
2型糖尿病患者的疼痛性周围神经病变是一种致残性并发症。我们探讨了这种疾病与社会经济剥夺之间的关联。
在英格兰柴郡15388名（44.1%为女性）2型糖尿病患者的假名全科医生记录中，研究了社会经济剥夺的汤森指数，并将其与药物治疗的疼痛性糖尿病神经病变的患病率相关联。我们还分析了用于缓解神经病变疼痛的药物治疗的处方趋势。
3266名（21.2%）患者开始接受神经性疼痛治疗。接受治疗的患者比未接受治疗的患者年龄更大[68.2（95%可信区间67.8 - 68.7）岁对66.6（66.4 - 66.8）岁]。糖化血红蛋白（HbA1c）无差异（7%，55 mmol/mol）。两组在汤森剥夺指数上存在显著差异，得分≥1的比例更高（接受治疗的神经性疼痛患者中为30.6%对22.8%）（Χ(2)=83.9，p<0.0001）。多因素逻辑回归分析表明，汤森指数每增加一个单位，需要进行神经性疼痛治疗的几率增加6%[优势比（95%可信区间）1.06（1.05 - 1.08），p<0.0001]，独立于5年年龄组、体重指数、性别、收缩压、估算肾小球滤过率、糖化血红蛋白和总胆固醇。
在这项使用假名临床记录的研究中，较高水平的社会经济剥夺似乎可能使糖尿病患者易患需要药物干预的严重神经性疼痛。针对该群体有针对性地分配医疗资源可能会带来临床益处。
