Prevalence, discomfort and self-relief behaviours of painful diabetic neuropathy in Taiwan: a cross-sectional study

Objectives: To explore the prevalence, discomfort, and self-relief behaviours of painful diabetic neuropathy (PDN) among rural community residents with type 2 diabetes. Design: A community-based, cross-sectional study. Setting: This study was part of a longitudinal cohort study of a nurse-led health promotion programme for preventing foot ulceration in Chiayi County, Taiwan. Participants: Six hundred and twenty-eight community adults with type 2 diabetes participated in this study. Outcome measures: Parameters assessed included peripheral neuropathy, peripheral vasculopathy, glycaemic control and metabolic biomarkers. Statistical analyses included descriptive statistics and a multivariate logistic regression model. Results: About 30.6% of participants (192/628) had PDN. Factors associated with PDN included an abnormal ankle brachial index (ABI; OR= 3.4; 95% CI 1.9 to 6.2; p< 0.001), Michigan neuropathy screening index (OR= 1.69; 95% CI 1.0 to 2.6; p= 0.021), triglyceride level (OR= 1.61; 95% CI 1.0 to 2.4; p= 0.036) and being female (OR= 1.68; 95% CI 1.1 to 2.4; p= 0.022). PDN was characterised by uncomfortable feelings of prickling, stinging or burning pain and inexplicable dullness around the base or dorsal areas of the feet, but received little attention or treatment from primary healthcare providers. Conclusions: A high prevalence of PDN was found in rural community residents with type 2 diabetes and the healthcare workers provided little attention to, or treatment of, discomfort. It is important to identify high-risk groups with PDN early in order to prevent foot ulceration and reduce the incidence of amputation of the extremities. It is also urgent to develop appropriate treatment and self-relief behaviours to halt or reverse the progression of PDN for this population living in rural areas.