Cases of Pain Linked to Diabetes Set to Grow Rapidly in UAE Warn Experts at Dubai Summit
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Cases of Pain Linked to Diabetes Set to Grow Rapidly in UAE Warn Experts at Dubai Summit
Diabetic Painful Neuropathy Affects 26% of Patients with Type 2 Diabetes (1),High Cholesterol Affects > 40% of patients with Type 2 Diabetes (4),Erectile Dysfunction Affects 70% of patients with Diabetes (6)120 Attend the 3rd Middle East Regional Diabetes Summit in Dubai
Growing numbers of people across the UAE and the Middle East are set to suffer from pain linked to diabetes as a result of the rise in the prevalence of type 2 diabetes and the ageing population, according to medical experts attending the 3rd Middle East Regional Diabetes Summit which aimed to address multiple co-morbidities suffered by those with the condition.
More than 120 delegates attending the summit heard that as the prevalence of diabetes rises across the region – where the disease already affects 20 percent of the UAE population (3) and between three and 30 percent in other Middle East countries (3) – the number of people suffering from DPN will increase.
“Diabetic nerve pain is going to become a concern for the UAE and the Middle East population in the near future as a result of the increase in the burden of diabetes. The pain can be very severe with some patients not even able to tolerate the weight of their bed sheets on their thighs and treatment with medications specifically designed to address nerve pain can be very useful” said Dr. Ammar Salti, Consultant Anaesthetist and Pain Management Expert at Zayed Military Hospital, Abu Dhabi, who presented at the summit.
“Furthermore, the longer people live with diabetes the more likely they are to suffer from DPN. In my experience, as many as 50 percent of patients who have had diabetes for more than 10 years, will experience painful neuropathy. This means that cases of the condition will grow rapidly as the population with diabetes ages across the UAE and the Middle East region,” he added.
DPN is caused by damage to the nerves caused by raised blood glucose levels that circulate in the body as a result of diabetes. It is one of a list of complications and co-morbidities that must be regularly checked and treated by doctors caring for diabetes patients. Other conditions include dyslipidaemia (high cholesterol), cardiovascular disease (CVD), and erectile dysfunction (ED).
More than 60 percent of type 2 diabetic patients in the Eastern Mediterranean Region suffer from some degree of dyslipidaemia (high ‘bad’ cholesterol, low ‘good’ cholesterol and high triglycerides), according to the World Health Organization (WHO) (4). Dyslipidaemia results in a disease called atherosclerosis that leads to narrowing of arteries which in turn increases the risk of a heart attack and stroke.
WHO guidelines state that a fasting lipid profile should be taken every year for all diabetic patients and if cholesterol levels are higher than recommended, then lifestyle advice and treatment with statins should be initiated (4). Studies show that treatment with statins can reduce LDL-C (“bad” cholesterol) levels by up to 60 percent, significantly reducing the overall risk of a heart attack or stroke. (5)
Doctors should also regularly check male diabetic patients for signs of erectile dysfunction(ED) which affects up to 70 percent of men with diabetes .(6) In fact, many men who subsequently are diagnosed with diabetes present to their doctors with ED, which can be effectively treated with medications that improve blood flow to the penis.
The 3rd Middle East Regional Diabetes Summit was held at Sheraton Jumeirah Hotel on March 24-25 and was led by Pfizer. Presentations were given by both local and international speakers.
References:
(1) The Prevalence, Severity, and Impact of Painful Diabetic Peripheral Neuropathy in Type 2 Diabetes. Diabetes Care July 2006 vol. 29 no. 7 1518- (3): doi: 10.2337/dc05-2228.
http://care.diabetesjournals.org/content/29/7/1518.short
(2) International Diabetes Federation – 2006 National Prevalence Estimates
(3) Diabetes in the Eastern Mediterranean Region. World Health Organisation http://www.emro.who.int/ncd/pdf/Diabetes_in_EMRO.pdf
(4) Guidelines for the Management of Dyslipidaemia in Patients with Diabetes Mellitus. 2006. World Health Organization. Regional Office for the Eastern Mediterranean
(5) American Heart Association, Reduction of LDL Cholesterol by 25 to 60% in Patients with Primary Hypercholesterolemia by Atorvastatin, a new HMG-COA Reductase Inhibitor
(6) Prevalence of erectile dysfunction among 7689 patients with diabetes or hypertension, or both. Urology 2004 vol. 64. No 6 1196 -1201
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References:
(1) The Prevalence, Severity, and Impact of Painful Diabetic Peripheral Neuropathy in Type 2 Diabetes. Diabetes Care July 2006 vol. 29 no. 7 1518- (3): doi: 10.2337/dc05-2228.
http://care.diabetesjournals.org/content/29/7/1518.short
The Prevalence, Severity, and Impact of Painful Diabetic Peripheral Neuropathy in Type 2 Diabetes
Abstract
OBJECTIVE—To determine the prevalence of painful diabetic peripheral neuropathy (PDPN) in a population-based sample and to estimate its severity and impact.
RESEARCH DESIGN AND METHODS—A cross-sectional descriptive study consisting of two phases: phase 1, a postal survey to patients with type 2 diabetes (an initial screening questionnaire including one question about pain); phase 2, neurological history and examination using the Toronto Clinical Scoring System. Subjects with PDPN or mixed (PDPN and nonneuropathic) pain completed the Neuropathic Pain Scale and Neuroqol to assess severity and nature of the pain and impact on quality of life. Those without PDPN completed the Neuroqol only.
RESULTS—In phase 1, there was a 92.7% response (n = 326), with 208 (63.8%) subjects reporting pain. In phase 2, 269 (82.5%) subjects attended and 51 (19.0%) were found to have PDPN: 99 (36.8%) nonneuropathic pain, 20 (7.4%) mixed pain, and 99 (36.8%) no pain (PDPN prevalence 26.4%). Of those with PDPN, 80% stated that their pain was moderate or severe. Those affected had poorer quality of life than those with no pain (difference in mean scores 3.6 [95% CI 2.5–4.6%]) compared with those with nonneuropathic pain (1.7 [0.4–2.9%]). Both pain and neuropathy score were independently associated with quality of life, and subjects with PDPN had significantly higher neuropathy scores.
CONCLUSIONS—Our study showed a prevalence of PDPN of 26.4%. Having PDPN has a significant negative effect on quality of life, and increasing neuropathy is associated with an increasing risk of developing PDPN.
(2) International Diabetes Federation – 2009 Diabetes Atlas
Go to: www.diabetesatlas.org/map and select UAE. (cannot be screen or page saved due to formatting)
(3) Diabetes in the Eastern Mediterranean Region. World Health Organisation http://www.emro.who.int/ncd/pdf/Diabetes_in_EMRO.pdf
(4) Guidelines for the Management of Dyslipidaemia in Patients with Diabetes Mellitus. 2006. World Health Organization. Regional Office for the Eastern Mediterranean
http://www.emro.who.int/dsaf/dsa699.pdf
(5) American Heart Association, Reduction of LDL Cholesterol by 25 to 60% in Patients with Primary Hypercholesterolemia by Atorvastatin, a new HMG-COA Reductase Inhibitor
http://atvb.ahajournals.org/cgi/content/short/15/5/678
Arteriosclerosis, Thrombosis, and Vascular Biology. 1995;15:678-682
© 1995 American Heart Association, Inc.
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Reduction of LDL Cholesterol by 25% to 60% in Patients With Primary Hypercholesterolemia by Atorvastatin, a New HMG-CoA Reductase Inhibitor
James W. Nawrocki; Stuart R. Weiss; Michael H. Davidson; Dennis L. Sprecher; Sherwyn L. Schwartz; Paul-J. Lupien; Peter H. Jones; Harry E. Haber; Donald M. BlackFrom Parke-Davis Pharmaceutical Research, Division of Warner-Lambert Co (J.W.N., H.E.H., D.M.B.), Ann Arbor, Mich; San Diego Endocrine and Medical Clinic (S.R.W.), San Diego, Calif; Chicago Center for Clinical Research (M.H.D.), Chicago, Ill; University of Cincinnati, Lipid Research Clinic (D.L.S.), Cincinnati, Ohio; Diabetes and Glandular Research Clinic (S.L.S.), San Antonio, Tex; Lipid Research Center (P.-J.L.), St Foy, Quebec, Canada; and Baylor College of Medicine (P.H.J.), Houston, Tex.
Abstract This 6-week, double-blind clinical trial evaluated lipid parameter responses to different dosages of atorvastatin in patients with primary hypercholesterolemia. Atorvastatin is a new 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor under development. After completing an 8-week placebo-baseline dietary phase, 81 patients were randomly assigned to receive either placebo or 2.5, 5, 10, 20, 40, or 80 mg atorvastatin once daily for 6 weeks. Plasma LDL cholesterol reductions from baseline were dose related, with 25% to 61% reduction from the minimum dose to the maximum dose of 80 mg atorvastatin once a day. Plasma total cholesterol and apo B reductions were also dose related. Previously, reductions in LDL cholesterol of the magnitude observed in this study have been seen only with combination drug therapy. In this study, atorvastatin was well tolerated by hyperlipidemic patients, had an acceptable safety profile, and provided greater reduction in cholesterol than other previously reported HMG-CoA reductase inhibitors.
Key Words: atorvastatin • coronary disease • LDL cholesterol • hydroxymethylglutaryl CoA reductase • hypercholesterolemia
(6) Prevalence of erectile dysfunction among 7689 patients with diabetes or hypertension, or both. Urology 2004 vol. 64. No 6 1196 -1201
http://www.ncbi.nlm.nih.gov/pubmed/15596196
Prevalence of erectile dysfunction among 7689 patients with diabetes or hypertension, or both.
Department of Urology, CHU de Bicetre, AP-HP, Hopital de Bicetre, Bicetre, France.
Abstract
OBJECTIVES: To survey the presence of, and attitudes toward, erectile dysfunction (ED) among patients with hypertension and/or diabetes mellitus who sought general medical care for any reason.METHODS: The abbreviated five-item version of the International Index of Erectile Function (IIEF-5) was used to determine the presence of ED. A patient questionnaire was used to assess attitudes about ED.
RESULTS: We surveyed 7689 patients (mean +/- SD age 58.9 +/- 9.2 years), including 6719 (87%) in a stable sexual relationship. In patients with hypertension alone (n = 3906) and diabetes alone (n = 2377), ED was reported by 2379 (61%) and 1603 (67%) and was present in 2634 (67%) and 1677 (71%), respectively, as defined by an IIEF-5 score of less than 21. The corresponding mean scores were 12.0 (+/-4.6) and 11.5 (+/-4.6) in patients with ED and 20.5 (+/-3.6) and 20.2 (+/-3.8) in those without ED. Prevalence was affected by disease characteristics and history, and the number and type of antihypertensive medications. ED was reported by 924 (78%) of 1186 patients with both diseases and was present in 917 (77%) according to the IIEF-5 score. Overall, ED was reported by 5063 patients (66%) with hypertension and/or diabetes, was present in 5391 (70%) according to the IIEF-5 score, and increased in prevalence with age. ED was fairly to very bothersome in 4027 (80%) but untreated in 3312 (65%), of whom 2278 (69%) wanted treatment. Most of those wanting treatment would have welcomed discussion with their physician (1861 [82%] of 2278), and most wanted their physician to broach the subject (1292 [69%] of 1861).
CONCLUSIONS: Our study results have shown that patients with diabetes and/or hypertension have a high prevalence of bothersome untreated ED and want their general practitioner to initiate a discussion and provide treatment.
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