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Socioeconomic deprivation independently predicts symptomatic painful diabetic neuropathy in type 1 diabetes.
MedLine Citation:
PMID:  24211151     Owner:  NLM     Status:  Publisher    
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 27.8kg/m(2); p<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 (60mg 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 (X(2)=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.
Simon G Anderson; Nagaraj S Malipatil; Hugh Roberts; George Dunn; Adrian H Heald
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-11-7
Journal Detail:
Title:  Primary care diabetes     Volume:  -     ISSN:  1878-0210     ISO Abbreviation:  Prim Care Diabetes     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101463825     Medline TA:  Prim Care Diabetes     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
Cardiovascular Sciences Research Group, Core Technology Facility (3rd Floor), University of Manchester, 46 Grafton Street, Manchester, United Kingdom.
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