Diabetic Distal Polyneuropathies In Outpatient Clinic In Togo

Abstract

Introduction: In sub-Saharan Africa, diabetes is on the rise. The most common clinical form of diabetic neuropathies is represented by distal polyneuropathy characterized by its bilateral, synchronous and distal systematization to the limbs. Data on this clinical form are scarce or non-existent as in Togo. Objectives: To describe the epidemiological, clinical and electrophysiological profile of diabetic distal polyneuropathy in Togo. Method: A descriptive study with prospective data collection, carried out over a period of 06 months, (March 1 to August 31, 2020) included patients seen in neurology and diabetology consultation of the two Lomé University Hospitals during the study period and in whom the diagnosis of diabetic distal polyneuropathy had been retained. The Michigan neuropathy screening instrument (MNSI) score was used to establish the diagnosis and neuropathic pain was diagnosed based on the DN4 score. Results: A total of 101 patients met the inclusion criteria. The average age was 58 years, with a sex ratio M/F of 0.84. Hypertension was the main cardiovascular risk factor (63.4%). Non-insulin-dependent diabetes was the most common (98%) and 70.3% had unbalanced diabetes. Distal polyneuropathy revealed diabetes in 8.9% of cases. The average time to onset of distal polyneuropathy symptoms compared to the date of diagnosis of diabetes was 1.8 ± 2.4 years, with extremes of 14 days and 10 years. Pain was the most represented sensory symptomatology (75.2%); 90.8% had a DN4 score greater than 4 and 25% of patients had non-painful sensory symptomatology. No patients had a motor deficit. The monofilament test was abnormal in 74.3% of cases. Electromyographically, 34.5% of patients had a chronic axonal form sensitivomotor dependent length and 65.5% a myelin axono form. Vitamins of group B (58.4%) and tricyclic antidepressants (26.7) were the main therapeutic remedies. The severity of diabetic distal polyneuropathy was correlated with dyslipidemia, glycemic imbalance, diabetic retinopathy and erectile dysfunction. Conclusion: The relatively short time to onset of neurological complications attests in more ways than one that the correct follow-up of diabetics is essential to avoid the occurrence of diabetic distal polyneuropathy. Therapeutic strategies currently used in symptomatic treatment indicate that there are real management problems.