Objective : Diabetes mellitus (DM) is a public health problem worldwide, with diabetic neuropathy (DN) being a common & costly complication. As per recent studies, neurons can also develop Insulin Resistance (IR) and thus can’t respond to the neurotrophic properties of insulin, leading to neuronal injury. If IR is detected early & treated, it may be possible to delay the occurrence & worsening of DN. Although some research works exist on the relation between DN and glycemic exposure, the literature pertaining to correlation of the same with IR is unavailable in India. This study focused on the prevalence and patterns of neuropathies in DM patients & usefulness of IR as a marker of DN, if any.
Methods : A cross sectional observational study was done; cases were defined as ‘presence of symptoms and/or signs of peripheral nerve dysfunction in diabetic people after exclusion of other causes’ & selected by systematic random sampling. All patients satisfying ADA criteria and none of the exclusion criteria were included. Main parameters were FPG, PPPG, HbA1c, monofilament test, sensory examination, ankle reflex & nerve conduction study findings. Glycemic exposure index (GEI) was calculated from HbA1c & duration of diabetes. IR was found by HOMA2 calculator from FPG and fasting c-peptide levels. Dyck grading was used for severity of DN.
Results : 33.8% of the total calculated sample of 153 patients had neuropathy, of which 27.46% were clinical & 6.33% were subclinical. The commonest type of DN seen was distal symmetrical sensorimotor polyneuropathy (DSPN) (72.9%). Occurrence of DN was found to correlate significantly with age (p=0.0058), duration of diabetes (p<0.0001), GEI (p=0.0001) & IR (p=<0.0001). The severity of DSPN correlated significantly with GEI (Pearson’s R=0.5212/p=0.00187) & had insignificant weak positive correlation with IR (R=0.2568/p=0.1491).
Discussion : This study establishes IR as a risk factor for development of neuropathy. Studies can be conducted to extrapolate the hypothesis in other disease states with IR like pre-diabetes, non-diabetic obesity and poly cystic ovarian syndrome. Larger studies are needed in India to define geographical trends of prevalence and patterns of DN. Early focus on IR might be a crucial tool to prevent DN.
Conclusion : The prevalence of neuropathy, was found to be similar to western studies and DSPN was the most common presentation. Patient’s age, duration of diabetes and cumulative glycemic exposure positively correlated with occurrence of DN. Though there was increased occurrence of neuropathies in patients with increased IR, the severity of DSPN did not correlate with the extent of IR.
Manidipa Majumdar– Independant physician ( General Medicine), West Bengal University of Health Sciences, Kolkata, India
Chanchal Kumar Jana– PROFESSOR, DEPARTMENT OF MEDICINE, R G KAR MEDICAL COLLEGE, KOLKATA, LIFE MEMBER - ASSOCIATION OF PHYSICIAN OF INDIA, IMA, INDIAN COLLEGE OF PHYSICIANS, WBMES, KOLKATA, West Bengal, India
Biman Kanti Ray– Professor, Neurology, BIN and SSKM Hospital, West Bengal University of Health Sciences, West Bengal, India
Indira Maisnam– FACULTY, DEPARTMENT OF ENDOCRINOLOGY, R. G. KAR MEDICAL COLLEGE AND HOSPITAL, KOLKATA, INDIA, Kolkata, West Bengal, India
Mainak Banerjee– Post Doctoral Trainee (Fellow) Endocrinology, IPGMER and SSKM hospital, kolkata, West Bengal University of Health Sciences, India
Jinesh Sengupta– 3rd YEAR POST GRADUATE TRAINEE (JUNIOR RESIDENT), R. G. KAR MEDICAL COLLEGE AND HOSPITAL, MIDNAPORE, West Bengal, India
Ritwika Majumdar– Post Doctoral Trainee (Fellow) Neurology, IPGMER and SSKM hospital, Ex- Assistant Professor Medicine, West Bengal University of Health Sciences, Kolkata, West Bengal, India
Independant physician ( General Medicine)
West Bengal University of Health Sciences
I am from kolkata, born, raised and schooled in the same city. Being brought up in a family of doctors, the idea of being one always fascinated me. I was trained for my primary medical qualification (MBBS) in N.R.S. Medical College and completed my MD (residency) in General (Internal) Medicine in R.G. Kar Medical College and Hospital. I'm currently working as an independant physician in private capacity.
PROFESSOR, DEPARTMENT OF MEDICINE, R G KAR MEDICAL COLLEGE, KOLKATA
LIFE MEMBER - ASSOCIATION OF PHYSICIAN OF INDIA, IMA, INDIAN COLLEGE OF PHYSICIANS, WBMES
KOLKATA, West Bengal, India
He has been associated with patient care since 1978, in medical education since 1988 , working as Professor in Dept of General Medicine, RGKar Medical College, Kolkata over more than 10 years. He has been an examiner in Medicine in MBBS, MD in different universities and in DNB(Medicine) for more than 20 years. He is a regular Thesis guide in General Medicine over more than 20 years. He has got more than 25 publication in different national and international indexed journals. He is also involved in different medical social activities. He is held in high esteem and well respected by his students, colleagues and patients.
Professor, Neurology, BIN and SSKM Hospital
West Bengal University of Health Sciences, West Bengal, India
He is one of the revered teaching faculty of neurology in Kolkata. Having completed his MBBS, and MD from kolkata, he finished his higher speciality training in Neurology (DM) from the same city. He has vast clinical and teaching experience in this field, having guided many residents and fellows to success. He has a number of national and international publications to his name.
FACULTY, DEPARTMENT OF ENDOCRINOLOGY
R. G. KAR MEDICAL COLLEGE AND HOSPITAL, KOLKATA, INDIA
Kolkata, West Bengal, India
DR. INDIRA MAISNAM, MBBS, MD, DM (ENDOCRINOLOGY), is a Faculty at the Department of Endocrinology, R. G. Kar Medical College and Hospital. With multiple national and international publications to her name, she has guided many of her students to add various publications to their name. She has delivered invited lectures in many conferences of repute. She is a reviewer in many international and national journals of repute.
Post Doctoral Trainee (Fellow) Endocrinology, IPGMER and SSKM hospital, kolkata
West Bengal University of Health Sciences, India
He is a second year post doctoral trainee (fellow) in Endocrinology at IPGMER and SSKM hospital. He had completed his MBBS and MD (General Medicine) from Kolkata, and has presented various papers in national and international conferences.
3rd YEAR POST GRADUATE TRAINEE (JUNIOR RESIDENT)
R. G. KAR MEDICAL COLLEGE AND HOSPITAL
MIDNAPORE, West Bengal, India
After completing my MBBS, compulsory 1 year rotational internship and 1 year Housestaffship from Medical College and Hospital Kolkata, I am currently pursuing my MD (General Medicine) degree as a 3rd Year Post-Graduate Trainee (Junior Resident) in R. G. Kar Medical College and Hospital, with future plans of pursuing a superspeciality degree in Endocrinology.
Post Doctoral Trainee (Fellow) Neurology, IPGMER and SSKM hospital, Ex- Assistant Professor Medicine
West Bengal University of Health Sciences
Kolkata, West Bengal, India
Dr. Ritwika Majumdar is currently pursuing higher speciality training in Neurology, in IPGMER and SSKM hospital. She had completed her MBBS and MD in General Medicine followed by vast clinical and teaching experience in General Medicine (Ex-Assistant Professor). She has both national and international publications to her name.