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Ahtar Hussain
Ibrar Ahmad
Muhammad Nawaz Khan
Adnan Zar
Shahid Shahzad



Objective: To determine the frequency of peripheral neuropathy and associated factors among patients with type 2 diabetes mellitus (T2DM), attending a tertiary care hospital via Michigan Neuropathy Screening Instrument (MNSI).

Methodology: This cross-sectional study was conducted in the department of endocrinology and metabolic dise­aes, Medical Teaching Institute, Lady Reading Hospital Peshawar, from March to December 2019. A total of 365 patients with T2DM were included in the study. All patients were evaluated for peripheral neuropathy using the two sets of MNSI (symptoms and examinations).

Results: Mean age of the patients was 49.0±7.52 years. Mean body mass index (BMI) was 28.1±5.21 kg/m2, and mean glycated haemoglobin (HbA1c) was 10.1±1.56%. There wew 150 (41.10%) males and 215 (58.90) females. Based on the scoring of MNSI questionnaire, 239 (65.5%) had diabetic peripheral neuropathy (DPN) while using MNSI examination 252 (69.0%) had DPN. By combining both questionnaire and examination, DPN was present in 290 (79.5%) of the study participants. The factors associated with DPN after controlling for potential confounders were age of > 50, high levels of total cholesterol (TC) and low density lipoproteins (LDL).

Conclusion: The frequency of DPN was found to be higher in our study population; the burden being high among males. Age, TC and LDL were found to have significant association.

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Hussain A, Ahmad I, Khan MN, Zar A, Shahzad S. PERIPHERAL NEUROPATHY AMONG PATIENTS WITH TYPE 2 DIABETES USING MICHIGAN NEUROPATHY SCREENING INSTRUMENT. J Postgrad Med Inst [Internet]. 2021 Mar. 31 [cited 2022 Aug. 13];35(1):7-11. Available from:
Original Article


Centers for Disease Control and Preven¬tion: National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: US Dept of Health and Human Services;2014.

N H Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-81. https://doi. org/10.1016/j.diabres.2018.02.023.

Ijaz M, Ali I, Hussain A. Diabetes mellitus in Pakistan: the past, present, and future. Int J Diabetes Dev Ctries. 2020;40:153- 4. 00754-x

Basit A, Fawwad A, Qureshi H, Shera A. Prevalence of diabetes, pre-dia¬betes and associated risk factors: second National Diabetes Survey of Pakistan (NDSP), 2016–2017. BMJ Open. 2018;8(8):e020961. https://doi. org/10.1136/bmjopen-2017-020961

Singh R, Kishore L, Kaur N. Diabet¬ic peripheral neuropathy: current per¬spective and future directions. Pharma¬col Res. 2014;80:21-35. https://doi. org/10.1016/j.phrs.2013.12.005

Tesfaye S, Boulton AJM, Dyck PJ, Free¬man R, Horowitz M, Kempler P, et al. Diabetic neuropathies: update on defi-nitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33(10):2285-93. https://doi. org/10.2337/dc10-1303

Tesfaye S, Selvarajah D. Advances in the epidemiology, pathogenesis and manage¬ment of diabetic peripheral neuropathy. Diabetes Metab Res Rev. 2012;28:8-14.

Tesfaye S, Vileikyte L, Rayman G, Sindrup SH, Perkins BA, Baconja M, et al. Pain¬ful diabetic peripheral neuropathy: con¬sensus recommendations on diagnosis, assessment and management. Diabetes Metab Res Rev. 2011;27(7):629-38.

Ndosi M, Wright-Hughes A, Brown S, Backhouse M, Lipsky BA, Bhogal M, et al. Prognosis of the infected diabetic foot ul¬cer: a 12-month prospective observation¬al study. Diabet Med. 2018;35(1):78-88.

Callaghan BC, Xia R, Banerjee M, de Rekeneire N, Harris TB, Newman AB, et al. Metabolic syndrome components are associated with symptomatic polyneurop¬athy independent of glycemic status. Di¬abetes Care. 2016;39(5):801-7. https://

Callaghan B, Feldman E. The metabolic syndrome and neuropathy: therapeutic challenges and opportunities. Ann Neu¬rol. 2013;74(3):397-403. https://doi. org/10.1002/ana.23986

Bril V, Tomioka S, Buchanan RA, Perkins BA. Reliability and validity of the modified Toronto Clinical Neuropathy Score in dia¬betic sensorimotor polyneuropathy. Diabet Med. 2009;26(3):240-6. https:/// 10.1111/j.1464-5491.2009.02667.x

Won JC, Kwon HS, Kim CH, Lee JH, Park TS, Ko KS, et al. Prevalence and clini¬cal characteristics of diabetic peripher¬al neuropathy in hospital patients with Type 2 diabetes in Korea. Diabet Med. 2012;29(9):e290-6. 10.1111/j.1464-5491.2012.03697.x

American Diabetes Association: 2.Classi¬fication and diagnosis of diabetes: stan¬dards of medical care in diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S13- 27.

Moghtaderi A, Bakhshipour A, Rashi¬di H. Validation of Michigan neuropathy screening instrument for diabetic periph-eral neuropathy. Clin Neurol Neurosurg. 2006;108(5):477-81. https://10.1016/j. clineuro.2005.08.003

Fateh HR, Madani SP, Heshmat R, Larija¬ni B. Correlation of Michigan neuropathy screening instrument, United Kingdom screening test and electrodiagnosis for early detection of diabetic peripheral neu¬ropathy. Journal of Diabetes & Metabolic Disorders. 2015;15(1):8-12. https://doi. org/10.1186/s40200-016-0229-7

Won JC, Kwon HS, Kim CH, Lee JH, Park TS, Ko KS, et al. Prevalence and clini¬cal characteristics of diabetic peripher¬al neuropathy in hospital patients with type 2 diabetes in Korea. Diabet Med. 2012;29(9):e290-6. 10.1111/j.1464-5491.2012.03697.x.

Herman WH, Pop-Busui R, Braffett BH, Martin CL, Cleary PA, Albers JW, et al. Use of the Michigan Neuropathy Screening Instrument as a measure of distal sym¬metrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Con¬trol and Complications Trial/ Epidemiology of Diabetes Interventions and Compli-cations. Diabet Med. 2012;29(7):937- 44. 5491.2012.03644.x

Mete T, Aydin Y, Saka M, Cinar Yavuz H, Bilen S, Yalcin Y, et al. Comparison of efficiencies of michigan neuropathy screening instrument, neurothesiome¬ter, and electromyography for diagnosis of diabetic neuropathy. Int J Endocri¬nol. 2013;2013 :821745. htpps://doi. org/10.1155/2013/821745

D’Souza M, Kulkarni V, Unnikrishnan Bhaskaran HA, Naimish H, Prakash A, Ta¬breez S, et al. Diabetic peripheral neurop¬athy and its determinants among patients attending a tertiary health care centre in Mangalore, India. Journal of public health research. 2015;4(2):450-4. https://doi. org/ 10.4081/jphr.2015.450

Lu B, Hu J, Wen J, Zhang Z, Zhou L, Li Y, et al. Determination of peripheral neu¬ropathy prevalence and associated fac¬tors in Chinese subjects with diabetes and pre-diabetes – ShangHai Diabetic neuRopathy Epidemiology and Molecu¬lar Genetics Study (SH-DREAMS). PLoS One. 2013;8(4):e61053. https://doi. org.10.1371/journal.pone.0061053

Khawaja N, Abu-Shennar J, Saleh M, Dahbour SS, Khader YS, Ajlouni KM. The prevalence and risk factors of peripher¬al neuropathy among patients with type 2 diabetes mellitus; the case of Jordan. Diabetol Metab Syndr. 2018;10(1):8-17. 0309-6.

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