Diabetic neuropathy

A 55-year-old female presents to your clinic with pain in the back and associated tingling, numbness, and pain in both her legs for the past year. The symptoms are worse at night. She has an antalgic broad-based gait and has been using a walker to get around. She was working as a school teacher, but has been on short-term disability for the last 4 months. She is depressed about her prognosis and is asking you to fix her so she can return to work. 1. How prevalent is this disease presentation? Could you explain some of the epidemiologic features of this disease? Are there any cost concerns? The 2011 Diabetes fact sheet published by the Centers for Disease Control confirmed that 25 million Americans have diabetes, a disease now affecting one in every four patients. Five percent of these individuals have type 1 diabetes mellitus (DM) and 95% have type 2 DM. Diabetic patients have a life time prevalence of 60% of developing diabetic neuropathy.[1] There are currently 8 million people in the USA who have symptomatic diabetic polyneuropathy. Diabetic polyneuropathy is a length-dependent disorder of peripheral nerve fibers, characterized by a distal-to-proximal loss of peripheral nerve axons and function. The progression of disease from painful neuropathy to loss of sensation and development of foot ulcers and amputations causes a significant burden to society both in social and financial ways. The cost of diabetic neuropathy was estimated to be $50 billion in 2007, which is 25% of total costs related to DM. This number is expected to rise exponentially.[2] Patients with painful diabetic peripheral neuropathy (PDPN) are more likely to have foot ulcers and amputations, further increasing the burden of the disease and decreasing quality of life for those affected. The prevalence of diabetic polyneuropathy (DPN) and PDPN increases with age, duration of diabetes, and worsening of glucose tolerance. The overall prevalence of PDPN in the diabetic population is 15%.[3]