Neuropathy in non-insulin-dependent diabetes mellitus - The significance of symptoms

Objective - Clinical evaluation of significance of symptoms suggestive of n europathy in non-insulin-dependent diabetics in general practice. Design - Case control study. Interviewer-administered questionnaire. Physic al examination by general practitioner researcher. Setting - Government family practice clinic in Singapore. Subjects - 55 patients with non-insulin-dependent diabetes (NIDDM) aged 35- 84 years (51% males), and 53 non-diabetic controls matched for age (+/-5 ye ars) and gender. Main outcome measures - Proportions of subjects with prese nce of symptoms and physical signs. Results - More patients than controls experienced symptoms suggestive of di stal neuropathy (paraesthesiae: 13 vs. 4%), and lower extremity proximal my opathy (weakness climbing stairs: 42 vs. 19%, getting up from squatting pos ition: 31 vs. 11%). No difference in proportions of patients and controls e xperiencing symptoms suggestive of autonomic neuropathy. More patients than controls had absent tendon reflexes (35 vs. 13%) and weaker hip muscles (2 4 vs. 6%). Of all who experienced symptoms indicating peripheral neuropathy , 36% of patients had absent tendon reflexes, compared with 8% of controls; and of those who experienced weakness of hip muscles 31% of patients and 1 2% of controls had diminished power in the hip muscles. Conclusion - Symptoms suggestive of diabetic neuropathy are common and shou ld be asked about in the routine follow-up of patients with diabetes. Up to a third of patients with symptoms will have clinical signs of diabetic neu ropathy.