THE PREVALENCE OF CLINICAL DIABETIC POLYNEUROPATHY IN SPAIN - A STUDYIN PRIMARY-CARE AND HOSPITAL CLINIC GROUPS

A multiregional cross-sectional study of clinical diabetic polyneuropa thy (DPN) was carried out among Spanish diabetes patients using a stan dard system for scoring symptoms and signs of polyneuropathy. The main patient sample comprised 2644 patients (54.7% women) aged 15-74 years (mean 57.2 +/- 0.3 years), 86.9% of whom had Type II (noninsulin-depe ndent) diabetes mellitus and 29.4% were attending hospital clinics. Me an duration of diabetes since diagnosis was 10.2 +/- 0.2 years. The pr evalence of DPN was 22.7% (95% confidence interval 21.2-24.3%) in the whole sample, 12.9% (9.3-16.5%) among patients with Type I (insulin-de pendent) diabetes mellitus and 24.1% (22.4-25.9%) among patients with Type II diabetes; there was no significant difference in prevalence be tween men and women. Prevalence increased with age (from < 5% in the 1 5- to 19-year-old age group to 29.5% in the 70- to 74-year-old group) and with duration of diabetes since diagnosis (from 14.2% among those with duration < 5 years to 44.2% among those with duration > 30 years) . In a supplementary sample of 161 diabetic patients aged 75 to 79 yea rs (excluded from the main sample to prevent confusion between diabete s-induced and ageing-induced neuropathies), prevalence was 37.8%. Nine ty-three patients (3.3%) had or had had foot ulcers and 21 of these 93 (0.7%) had undergone amputation; 90.8% of ulcerated patients had Type II diabetes, and 54% had DPN (in most cases with loss of perception o f vibration), as against a prevalence of DPN of 19.9% among patients w ithout ulcers. We conclude that nearly a quarter of Spanish diabetic p atients have DPN; that over 90.8% of DPN patients have Type II diabete s; that the prevalence of DPN increases with age and with the duration of the disease, and that the risk of foot ulcers among DPN patients i s about three times the risk among diabetic patients without DPN. We a ccordingly emphasize the responsibility of primary care physicians to try to prevent diabetic foot lesions by early diagnosis of DPN.