Research presentationGroup 6

STUDY OF RELATION BETWEEN DIABETIC FOOT SYMPTOMS

AND DIABETIC NEUROPATHY

Research members

Mr. Sonam Dorji Student ID no. 50461274

Mr. Thanasit Prakobphon Student ID no. 51460834

Mrs. Ruchjirin Wongkhamlue Student ID no. 51461022

Research advisers

Dr. Rawisut Deoisares (Content Expert)

Dr. Suwit Lertkajornsin (Methodology

Expert)

Rationale of the study

Diabetes mellitus is a non communicable chronic illness with

its prevalence increasing at an alarming rate in Thailand. The

prevalence of DM in Thai population increased from 4.4 in

year 1997 to 6.9 in 2009.

According to Thai DM association the incidence and rate (per

100000 population) of DM for year 2008 and 2009 were 5200,

2672.12 and 5677, 2916.37 respectively. The prevalence of

complication due to DM was 14.3% or 746 people.

Rationale of the study

Diabetic neuropathy is the most common complication found

in DM type 2 patients. its prevalence of 23% leading poor

quality of life for DM patients by its symptom and other

related complication due to neuropathy like wounds,

infection and amputation of leg. Diabetic neuropathy is also

second leading cause of leg amputation.

Rationale of the study

According to Thai clinical practice guideline for DM 2011, DM

patients should go through complete foot examination each

year to assess risk of neuropathy to prevent DM foot ulcer

and further complication, but due increasing number of DM

patients and limitations in time.

Rationale of the study

The screening processes are limited to patient’s symptoms of

neuropathy like “presence of numbness of feet”. There is also

a knowledge gap about the reliability about using patient’s

symptoms for screening of diabetic neuropathy.

Almost question that asked about the symptom such as “ Do

you have feeling at finger tip and feet tip ? ” but now no

research support or guarantee for diagnosis that use

symptom shown are reliability or correctly and suitable for

diagnosis enough.

Purpose of the study

1. To study the relationship between the sign and symptoms*of

peripheral numbness in Type2 diabetic patient and diabetic

neuropathy.

2. To study about the factors causing to diabetic neuropathy in

Type2 diabetic patient such as sex, BMI, duration, associate

disease, drinking , smoking and glucose level control.

(sign and symptoms* including numbness, decrease level of consciousness, burning pain or electric shock feeling)

Research questionPrimary research question

Can patient’s symptom be used for screening of diabetic

neuropathy ?

Secondary research question

Other factor such as Age, Sex , Onset and duration, BMI, Smoking ,

Drinking , Co-morbidity, Blood sugar control have effect for diabetic

neuropathy ?

(sign and symptoms* including numbness, decrease level of consciousness, burning pain or electric shock feeling)

Research QuestionsP (Patient or Problem)

Type2 diabetic patient who came for the screening test at Thaphoe primary care unit, diabetic clinic at Naresuan university hospital and Medical ward at Naresuan university hospital.

I (Intervention or Exposure)

Symptom of diabetic neuropathy

C (Comparison intervention)

Patients who have and don’t have symptoms of diabetic neuropathy

O (Outcome)

Result from screening Diabetic neuropathy at feet by monofilament

Methodology Study design Cross sectional study

SamplesInclusion criteria :

DM type 2 patients who came for screening of Diabetic neuropathy at Thaphoe PCU on 24 November 2011

DM type 2 patients who agreed for screening of Diabetic neuropathy in IPD at Naresuan university hospital on 24 November 2011

DM type 2 patients who came for screening of Diabetic neuropathy in OPD at Naresuan university hospital on 28 November 2011

Methodologysamples

Exclusion criteria :

Neuropathy due to other causes

Foot ulcer, edema, hypothermia

Limb amputation due to diabetes mellitus

Neuromuscular deficit and other complication

Skin and soft tissue infection

Patient with psychiatric problem

MethodologySetting of research

Diabetic clinic at Naresuan university hospital

OPD medicine Naresuan university hospital

PCU Thaphoe

Sources of information’s

History taking of patients.

10 g monofilament examination of patients

OPD files of patients.

Methodology

Tools of research

Questionnaire about general health and risk factors of

diabetic neuropathy

10 g monofilament

Program STATA, SPSS, EXCEL

Methodology

Research process (in order)

Contemplate research topic and seek advice from counseling

teacher .

Review articles related to the research topic.

Presentation of research topic to the research teachers.

Develop of research model.

Presentation of research model .

Methodology

Research process (in order)

Planning and testing of research.

studying proper handling of 10 g monofilament and the

testing it with real patients. The test was carried out on 4

patients in medical ward at Naresuan hospital

contracting officials in Naresuan university hospital for

facilitating patients and places for research.

Methodology

Research process (in order)

contacting medical personals at Thaphoe PCU for

appointment with patients coming for diabetic neuropathy

screening.

Introduction, explanation about our research, signing of

agreement for research.

Asking patient risk factors for diabetic neuropathy

10 g monofilament examination of patients feet.

Research timeline

Analyzing of data and statistics

Sensitivity

Specificity

Positive predictive value

Negative predictive value

Chi-square test and Fisher’s Exact Test

Odd Ratio

The ethics review confidentiality of patients information was maintained by

without using true name and keeping information within the research members.

patients were informed of the confidentiality measures before signing the research agreement’s.

patient don’t have financial benefit from this research but have the benefit of free screening of Diabetic neuropathy with 10 g monofilament. Monofilament examination procedure doesn’t have any risk and is not painful to the patient

Research resultTable1. Characteristics of the type 2 diabetic patients (n=106)

Research resultTable1. Characteristics of the type 2 diabetic patients (n=106)

Research result

Primary research question Patient symptoms can be used for screening of Diabetic

neuropathy or not ?

Research result

Sensitivity, Specificity

Positive & Negative predictive value

Research resultTable 4. Univariate logistic regression

Research result

Table 5. Multivariate logistic regression

Limitation and suggestion

1. we should have sample that follow by calculation formulas.

2. If possible, you should used the better standard test procedure for more accuracy result.

3. The test should be done in diversity people because this thesis was done in the hospital only and patient should be take care of themselves, so the information we got may be not match with fact.

Limitation and suggestion

4. We should used blood sugar control procedure and kept FBS/HbA1C then compare in each person for different result or not by 10g-monofilament

5. You should add special characteristic belong to each person in quiz. To let us know what clinical that effect with 10 g monofilament test and got result in positive

6. You should kept more information that relate with onset of clinical then compare to the duration from onset to the testing time was done.

References1. Kärvestedt, L., E. Mårtensson, et al. (2010). "The prevalence of peripheral neuropathy in a population-based study of patients with type 2 diabetes in Sweden." Journal of Diabetes and its Complications 25(2): 97-106.2. Franse, L. V., G. D. Valk, et al. (2000). "‘Numbness of the feet’ is a poor indicator for polyneuropathy in Type 2 diabetic patients." Diabetic Medicine 17(2): 105-110.3. Mueller, M. J. (January 1996 ). "Identifying Patients With Diabetes Mellitus Who Are at Risk for Lower-Extremity Complications: Use of Semmes-Weinstein Monofilaments".4. Valk, G. D., J. J. J. de Sonnaville, et al. (1997). "The assessment of diabetic polyneuropathy in daily clinical practice: Reproducibility and validity of Semmes Weinstein monofilaments examination and clinical neurological examination." Muscle & Nerve 20(1): 116-118.

References5. Bruce A. Perkins, F., David Olaleye, PHD, Bernard Zinman, FRCPC and Vera Bril, FRCPC (February 2001 ). "Simple Screening Tests for Peripheral Neuropathy in the Diabetes Clinic "6. Rahman, M., S. J. Griffin, et al. (2003). "How should peripheral neuropathy be assessed in people with diabetes in primary care? A population-based comparison of four measures." Diabetic Medicine 20(5): 368-374.7. Nather, A., S. H. Neo, et al. (2008). "Assessment of sensory neuropathy in diabetic patients without diabetic foot problems." Journal of Diabetes and its Complications 22(2): 126-131.8. M Mafauzy, F., Z Hussein, MRCP**, S P Chan, FRCP*** (2008). "The Status of Diabetes Control in Malaysia: Results of Diabetic Care ".9. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363:157-63

References10. Boulton, A. J. M. (2010). "Chapter 4 Diagnosis of diabetic peripheral neuropathy-clinical practice and research".11. American Diabetes Association (2011)

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