P&G HEALTH, MEDICAL EXPERTS ADDRESS PERIPHERAL NEUROPATHY AMONG DIABETIC PATIENTS
THE number of diabetic patients in the Asia Pacific, the Middle East and African regions is projected to rise from 393 million in 2021 to 603 million by 2045. Of these, more than half are reported to develop peripheral neuropathy in their lifetimes.
Procter and Gamble Health, the health-care division of the multinational consumer goods company P&G, recently brought together multidisciplinary medical experts from across Asia-pacific and the Middle East at the “Winning the Fight Against Neuropathy in Diabetic Patients” forum ahead of World Diabetes Day on November 14.
The event, which was hosted out of Manila and simulcasted to more than 10 countries and 3,000 participants, saw the rollout of clinical guidance on simple diagnostic procedure for peripheral neuropathy and sharing of clinical experiences by health-care professionals working in the field, one of whom is Dr. Rayaz Malik.
Malik is a professor of medicine at Weill Cornell Medicine and a consultant physician at the Central Manchester University Teaching Hospital. Speaking at the forum, he shared that peripheral neuropathy is highly underdiagnosed in Southeast Asia and the Middle East due to a lack of consensus guidance on routine screening and diagnostic pathways. Further, this complication often progresses asymptomatically.
“It’s kind of silent, almost,” said Malik. “Why do you go to the doctor? Because you’ve got pain somewhere. Diabetic peripheral neuropathy (DPN) is different because your nerves aren’t working. You don’t feel pain, so you don’t go to the doctor,” he added.
If not diagnosed and treated early, DPN can manifest with neuropathic pain that can lead to disability and even death.
“A long time ago, somebody called it a ‘Cinderella’ complication. When you think of diabetes, you think of heart attacks, strokes and kidney failures. But actually, peripheral neuropathy is more common than any of those complications. At least 50 percent of people diagnosed with diabetes get it,” said Malik.
DPN can also sometimes cause other medical problems, such as foot ulcers, heart rhythm changes and blood circulation problems.
If a patient with diabetes gets a wound infection, there’s a risk this could lead to gangrene and, in some cases, may result in amputation.
“This has a major impact on the quality of life [of the patients as] foot ulceration and amputation [have] an associated five-year mortality of 40 percent and 80 percent, respectively,” Malik said.
The first critical step to combating peripheral neuropathy is to increase the public’s awareness of the complication and communicate with patients a sense of urgency to seek medical consultation, according to him.
“While identifying a patient with early onset DPN may sound challenging, it is not and doesn’t require complex diagnostic tools to diagnose peripheral neuropathy. Simple tools like questionnaires and sensory tests can be a good start,” said Malik.
Diagnostic screening questionnaires, such as the Mcgill Pain Questionnaire, Neuroqol and Neuropathy Symptom Score, are available and accessible to most health-care professionals.
Other commonly used tools for screening and diagnosing peripheral neuropathy include the monofilament test, ankle reflex and vibration perception testing.
The most simple method is to ask patients at the onset of their consultation if they experience burning or tingling, like “pins and needles,” or lancinating pains in their feet, and if these symptoms are often worse at night.
“By asking the right questions and listening to the patient, we can help them avoid severe complications. The primary care physician has a key role to play in this,” he added.
When asked about the recommended course of treatment for DPN, Malik said it would be based on the patient’s individual needs and comprehensive treatment targets depending on their peripheral neuropathy.
“Having higher glucose [levels], high blood pressure, and cholesterol—these are medical risk factors that you can treat, and it’s been shown that if you can improve these, you can delay the progression of your complication,” said Malik.