Vinyo Kodzo Kumako*, Marleine Dzobosse Watouo, Léhleng Agba, Kossivi Apetse, Damelan Kombate, Komi Assogba, Mofou Belo and Ayelola Balogou
Introduction: In sub-Saharan Africa, diabetes is on the rise. The most frequent clinical form of diabetic neuropathy is distal polyneuropathy characterized by its bilateral, synchronous, and distal systematization in the limbs. Data on this clinical form are rare or even non-existent as in Togo.
Objectives: To describe the epidemiological, clinical, and electrophysiological profile of diabetic distal polyneuropathy in Togo.
Setting and method: A descriptive study with prospective data collection, carried out over a period of 6 months (March 1 to August 31, 2020) included patients seen in neurology and diabetology consultations at the two university hospitals of Lomé during the study period and in whom the diagnosis of diabetic distal polyneuropathy had been retained. The Michigan Neuropathy Screening Instrument (MNSI) was used to establish the diagnosis and neuropathic pain was diagnosed on the basis of the DN4 score.
Results: A total of 101 patients met the inclusion criteria. The mean age was 58 ± 10 years, with a sex ratio M/F of 0.84. High blood pressure was the main cardiovascular risk factor (63.4%). Type 2 diabetes was the most common (98%) and 70.3% had unbalanced diabetes. Distal polyneuropathy revealed diabetes in 8.9% of cases. The mean time to onset of distal polyneuropathy symptoms from the date of diabetes diagnosis was 1.8 ± 2.4 years, with extremes of 14 days and 10 years. The pain was the most represented sensitive symptomatology (75.2%). The DN4 score was greater than 4 in 90.8% of patients, and 25% of patients had non-painful sensory symptomatology. No patient had a motor deficit. The monofilament test was abnormal in 74.3% of cases. Electromyographically, 34.5% of the patients had a sensory-motor-dependent chronic axonal form and 65.5% had an axon-myelin form. Group B vitamins (58.4%) and tricyclic antidepressants (26.7%) were the main therapeutic options. The severity of diabetic distal polyneuropathy was correlated with dyslipidemia, glycemic imbalance, diabetic retinopathy, and erectile dysfunction.
Conclusion: The relatively rapid onset of neurological complications is evidence that proper monitoring of diabetic patients is crucial to preventing the occurrence of diabetic distal polyneuropathy. The therapeutic strategies currently used in the symptomatic treatment indicate that there are real problems with management.
Published Date: 2022-09-30; Received Date: 2022-09-08
