A meta-analysis of prevalence and incidence of diabetic peripheral neuropathy in Asia
Srinivas Martha, Asha Jyothi Gonela, Sai Prasanna Rasamalla, Suraj G. Bhansali
ClinPharm, Excelra Knowledge Solutions, 7th Floor, Wing B NSL SEZ ARENA, IDA Uppal, Habsiguda, Hyderabad, Telangana State 500039, India
Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder which contributes to many healthcare related problems globally and is more prevalent in Asia [1]. Diabetic Peripheral Neuropathy (DPN) is most common and devastating microvascular complication that increases potential for disability due to polyneuropathy [2]. There’s an absence of organized information on Systematic Literature Review (SLR), Meta-Analysis (MA), and different treatment modalities. We have compiled the information regarding prevalence of DPN in Asian population. The available pharmacological interventions can pose a greater effect on cost and quality of life (QoL) of DPN patients, preventive measures are at greater urge. Our analysis will be informative to the healthcare professionals to implement preventive approach in managing the DPN.
Objectives: To estimate the overall prevalence of DPN in DM patients in Asian population, using SLR and MA approaches and to explore possible sources of heterogeneity.
Methods: A systematic literature review (SLR) was performed online using PubMed, Embase, the Cochrane Library to retrieve related articles to DM and DPN. Search terms were “Diabetes mellitus”, “type-2 diabetes mellitus”, “type-1 diabetes mellitus”, “Diabetic Peripheral Neuropathy”, “diabetic polyneuropathy” and “Asian Countries”. Studies reported their outcome variable as prevalence or incidence of DPN in the Asian population, both T1DM and T2DM, any journal articles published in peer-reviewed journals or grey literature, all Randomized Controlled Trial (RCT) studies, Cross-sectional studies, retrospective studies, cohort studies, case-control studies were included in the analysis. The studies not relevant to DPN, patients with comorbidities, studies that included other kind of neuropathies such as carpal tunnel syndrome, cardiac autonomic neuropathy, cranial neuropathy, unclear peripheral neuropathic criteria, cases reports, and case series were excluded from analysis. The methodological quality of the prevalence studies evaluated according to the questionnaire developed by Loney et al [3]. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was followed. Inconsistency index (I^2) static was used to evaluate heterogeneity among included studies. Funnel plot and Egger’s regression test were used for publication bias. The random-effect model was fitted to estimate the pooled prevalence of DPN in Asians [4]. The meta-analysis was conducted by using RevMan 5.4.1 and R 4.1.2.
Results: Total of 1452 articles were retrieved, of these, 324 articles were identified as duplicates and were removed, remaining 1128 articles were screened for titles and abstracts as per pre-defined eligible criteria and 1094 articles were excluded, 34 full text articles were assessed, and after applying pre-defined criteria and quality assessment 24 articles were eligible for final analysis while 10 articles were excluded. All 24 studies were published from 2009 to 2021, sample sizes ranged from 42 to 3359. The included studies enrolled a total of 14,322 patients of which 5172 were identified as DPN cases which included patients from India, Saudi Arabia (KSA), China & Others. The mean age of patients was 55.34 years, mean duration of diabetes was 8.01 years and mean HbA1c levels were 8.5%. Majority of the studies (18) were cross-sectional & type 2 diabetes patients. The overall pooled prevalence rate of DPN was 0.38 (95% CI: 0.28, 0.48). Based on the subgroup analysis, the highest prevalence rate of DPN in DM patients was reported in China at 0.46 (95% CI: 0.35, 0.56).
Conclusion: This study revealed that the overall prevalence of DPN is relatively high in Asian countries. Hence, DPN needs situation-based interventions and preventive strategies, which are specific to the country.
References:
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[2] Almuhannadi H, Ponirakis G, Khan A, Malik RA. Diabetic neuropathy and painful diabetic neuropathy: Cinderella complications in South East Asia. J Pak Med Assoc. 2018 Jan;68(1):85-89
[3] Loney PL, Chambers LW, Bennett KJ, Roberts JG, Stratford PW. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can. 1998;19(4):170-6
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