Background: Diabetic peripheral neuropathy (DPN) is one of the commonest complications of diabetes mellitus with devastating clinical, economic and psychological consequences. The management and preventive strategies for this microvascular disorder require an understanding on its burden and determinants in specific population.
Aim: In the context of almost no data on DPN any Bangladeshi population, the present study was designed to explore the prevalence and determinants of the disorder among a group of type 2 diabetic (T2DM) subjects, Bangladesh.
Method: A cross-sectional study was conducted among 640 urban (M/F, 244/396; age in years, 52.23±11.8; BMI, 25.95±3.9 Kg/m2) and 560 rural (M/F, 244/396; age in years, 50.89±11.9; BMI, 24.13±4.6) T2DM subjects, selected purposively from various health care facilities in Dhaka and Northern Districts of Bangladesh. The World Bank criteria were followed for the selection of the urban and rural areas. Diagnosis of T2DM was done by WHO Study Group Criteria (following a 2-sample OGTT) and DPN was assessed using the Neuropathy Symptom Score (NSS) as well as Neuropathy Disability Score (NDS) respectively. The Neuropathy Symptom Score (NSS) was recorded by interview following the standard guidelines which consists of five questions like do you have burning/numbness/tingling sensation in the lower extremity?. The Neuropathy Disability Score (NDS) consists of four clinical tests on both feet done by the physicians like, Achilles tendon reflex (Babinski), sensory test using 5.07 (10-g) Semmes-Weinstein monofilament (applied in 10 point of the feet), vibration perception using 128-Hz tuning fork (Hartmann C128), and two types of sensation test (fine, crude touch). The patient had to close the eyes during all the examinations. Data were collected by face-to-face interview and by physical examinations through interviewer-administered pretested semi-structured questionnaires and check-list. Data were analyzed by univariate, bivariate and multivariate statistics as appropriate.
Results: DPN was present among 21.1% (95% CI, 18.8-23.4) of T2DM subjects. Regarding the sex specific, women (24.1%; CI, 21.0-27.2) showed about 1.5 times higher prevalence compared to that of men (16.0%; CI, 12.6-19.4) and the difference was highly significant (p<0.001). The prevalence of DPN was much higher among rural subjects (24.5%; CI, 20.9-28.1) compare to the urban subject (18.1%; CI, 15.1-21.1) and the difference was highly significant (p<0.001) between the two demographic locations. In Chi-square test and t-test, respondents educational status, economic status, random blood sugar (RBS) and duration of wearing footwear had significant (p<0.05) difference for DPN subjects compare to counterpart in urban area; occupation, economic status, household monthly income, RBS and duration of diabetes had significant (p<0.05) difference for DPN subject compare to counterpart in rural area. On multiple regression analysis, raised RBS (p<0.001; OR=2.3, CI, 1.3-3.9), long duration of diabetes (p<0.001; OR=3.0, CI, 1.7-4.3 and long duration of wearing footwear (p<0.001; OR=2.7, CI, 1.4-4.0) were the main predictors in urban area whereas, raised RBS (p<0.001; OR=1.9; CI, 0.8-3.0), long duration of diabetes (p<0.001; OR=3.3; CI, 1.8- 4.8) and poor economic status (p<0.001; OR=2.9; CI, 0.6-14.0) were the main predictors in rural area.
Discussion: A large proportion of T2DM subjects in Bangladesh, both men and women, irrespective of urban or rural origin suffer from neuropathy which is almost similar to a study conducted among urban diabetic population by Kjersti Mørkrid in Bangladesh. Women are more suffering from DPN compare to men for their working pattern like almost all the women respondent were house wife, so always, they have to do their home work in bare foot in water and mud and always they are not concern about their foot hygiene. Rural diabetic subjects are suffering more by DPN compare to the counterpart; it could be due to the poor hygienic condition and walking more in bare foot. Raised random blood sugar, long duration of diabetes and long duration of wearing footwear were the predictors for diabetic peripheral neuropathy in urban area in the present study which is also almost similar to the above mentioned study; whereas, raised random blood sugar, long duration of diabetes and poor economic status were the predictors for diabetic peripheral neuropathy in rural area, no similar data has been found to compare. A strong glycemic control measure can be minimized the risk of neuropathy among T2DM subjects which will help to avert the unwanted non-traumatic lower extremities amputation.
Conclusion: Two in every ten diabetes subjects are suffering from peripheral neuropathy which is more serious in rural area. A strong glycemic control measure can be minimized the risk of neuropathy among T2DM subjects which will help to avert the unwanted non-traumatic lower extremities amputation.

Prevalence and determinants of peripheral neuropathy among urban and rural Bangladeshi type 2 diabetic subjects