Pruitt Jimmy, Moracho-Vilrriales Carolina, Threatt Tiffaney, Wagner Sarah, Wu Jun, Romero-Sandoval E Alfonso
Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC, USA.
Department of Biochemistry and Biotechnology, University of Alcalá de Henares, Madrid, Spain.
J Pain Res. 2017 Apr 7;10:833-843. doi: 10.2147/JPR.S129139. eCollection 2017.
Diabetic peripheral neuropathy (DPN) represents significant burdens to many patients and the public health-care system. Patients with diabetes in rural areas have higher risk of developing complications and having less access to proper treatment. We studied a rural population of patients with diabetes who attended a pharmacist-led free clinic for a diabetic education program. Our objectives were to 1) determine the prevalence of DPN and painful diabetic neuropathy (p-DN) in patients with type 2 diabetes; 2) assess the proportion of patients with DPN and p-DN left undocumented upon physician referral to a pharmacist-led free clinic; and 3) determine the appropriateness of pain medication regimen. We performed a retrospective analysis of clinical records of patients from the Presbyterian College School of Pharmacy (PCSP) Wellness Center located in Clinton, SC. Diagnoses of DPN and/or p-DN were obtained from referral notes in the clinical records and compared with results from foot examinations performed in the free clinic and clinical features. Medication regimens were also obtained and compared using American Academy of Neurology (AAN) treatment guidelines. Within our study population (n=111), the prevalence of DPN was 62.2% (national average of 28%-45%) and that of p-DN was 23.4% (national average of 11%-24%). In p-DN patients (n=26), 53.8% (n=14) had a documented diagnosis of p-DN by the referring physician, and 46.2% (n=12) were identified by the pharmacists. A total of 95% (19 of 20) of the patients treated for p-DN received adequate pharmacological agents, though suboptimal as per clinical guidelines. More than 50% of the patients used subtherapeutic doses of their medications. Gabapentin was the most frequently used medication in our population (65.4%). Patients in rural South Carolina had a higher prevalence of DPN and p-DN with >60% undocumented cases of p-DN. More than 95% of treated patients did not receive optimum therapy according to AAN guidelines.
糖尿病周围神经病变（DPN）给许多患者和公共卫生保健系统带来了沉重负担。农村地区的糖尿病患者发生并发症的风险更高，且获得适当治疗的机会更少。我们对参加了由药剂师主导的免费糖尿病教育诊所的农村糖尿病患者群体进行了研究。我们的目标是：1）确定2型糖尿病患者中DPN和疼痛性糖尿病神经病变（p-DN）的患病率；2）评估在医生转诊至由药剂师主导的免费诊所时，未记录在案的DPN和p-DN患者比例；3）确定疼痛药物治疗方案的适宜性。我们对位于南卡罗来纳州克林顿市的长老会学院药学院（PCSP）健康中心的患者临床记录进行了回顾性分析。DPN和/或p-DN的诊断从临床记录中的转诊记录中获取，并与在免费诊所进行的足部检查结果及临床特征进行比较。还获取了药物治疗方案，并根据美国神经病学学会（AAN）的治疗指南进行比较。在我们的研究人群（n = 111）中，DPN的患病率为62.2%（全国平均水平为28%-45%），p-DN的患病率为23.4%（全国平均水平为11%-24%）。在p-DN患者（n = 26）中，53.8%（n = 14）的转诊医生记录了p-DN的诊断，46.2%（n = 12）是由药剂师识别出来的。接受p-DN治疗的患者中，共有95%（20例中的19例）接受了足够的药物治疗，尽管根据临床指南并不理想。超过50%的患者使用了低于治疗剂量的药物。加巴喷丁是我们研究人群中最常用的药物（65.4%）。南卡罗来纳州农村地区的患者DPN和p-DN患病率更高，p-DN未记录在案的病例超过60%。超过95%接受治疗的患者未按照AAN指南接受最佳治疗。
