SG Anderson, NS Malipatil, H Roberts, G Dunn; Primary Care Diabetes 2014

Socioeconomic deprivation independently predicts symptomatic painful diabetic neuropathy in type 1 diabetes

Volume 8, Issue 1, April 2014, Pages 65–69

George Dunn of East Cheshire Trust Podiatry Service co-authored this article published in Primary Care Diabetes.

Introduction: Painful peripheral neuropathy in people with type 1 diabetes is a disabling and costly complication. A greater understanding of predisposing factors and prescribing may facilitate more effective resource allocation.

Methods: The Townsend index of deprivation (numerically higher for greater disadvantage) was examined in the pseudonymised records of 1621 (684 females) individuals with type 1 diabetes and related to prevalence of drug treated severe diabetes related neuropathic pain.

Results: Treatment for neuropathic pain was initiated in 280 patients, who were older at 57.1 vs 45.6 years and had greater BMI (29.8 vs 27.8 kg/m2p < 0.0001). HbA1C was similar between groups, whilst eGFR was lower in the neuropathic pain group.

Amitriptyline was the most commonly prescribed agent (46.8% of total prescriptions). Duloxetine (60 mg daily) was prescribed in 9.3% of cases.

There were significant differences between the groups for the Townsend index, with a greater proportion (34.3% vs 21.7%) of patients with treated neuropathic pain having a score of ≥1 (X2 = 19.9, p < 0.001).

Multivariate logistic regression analyses indicated that each unit increment in Townsend index was associated with a 11% increased odds of requiring neuropathic pain treatment [odds ratio (95% CI) 1.11 (1.05–1.17), p < 0.001]. This was independent of age: 1.04 (1.02–1.05), BMI: 1.03 (1.01–1.05), HbA1C: 1.15 (1.05–1.24), male gender: 0.74 (0.55–0.98), systolic BP and eGFR. Inclusion of depression and mixed anxiety/depressive disorder did not change the risk estimates.

Conclusion: Amitriptyline was the most commonly used agent for treatment of diabetes related neuropathic pain with Duloxetine much less used.

A higher level of socioeconomic deprivation may predispose to severe neuropathic pain in diabetes. Differential allocation of resources may benefit this group.

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