Prevalência de polineuropatia simétrica distal e de neuropatia autonômica cardiovascular em indivíduos com diabetes mellitus tipo 2 acompanhados em um serviço de atenção primária

Abstract

Diabetic neuropathy (DN) is one of the main complications of Diabetes Mellitus (DM) and affects more than 50% of the individuals with this medical condition. This frequently overlooked complication compromises both the somatic and the autonomic nervous systems, and its prevalence rates vary according to the diagnostic criteria. Two of the main types of DN, Distal Symmetric Polyneuropathy (DSP) and Cardiovascular Autonomic Neuropathy (CAN), are among the diabetic complications with the greatest clinical repercussion, being responsible for high morbidity and mortality rates. The objective of this cross-sectional study was (1) to evaluate the 18 prevalence rates of DSP and of CAN in individuals with type 2 DM (T2D) followed in a primary care unit in the city of São Paulo and (2) to validate the equivalence of the performance of a nylon line to the performance of the Semmes-Weinstein monofilament in the assessment of foot ulcer risk. A total of 551 individuals with T2D (59.3% women, 65 [59–72] years old; diabetes duration of 10 [5–15] years; HbA1c of 7.2 [6.3–9.1] %; as median [interquartile interval]) were included. DSP was diagnosed by the sum of the Neuropathy symptoms score (NSS) and modified Neuropathy disability score (NDS) or presence of lower limb amputation. CAN was diagnosed by cardiovascular autonomic reflex tests (CARTs) combined with spectral analysis of the heart rate variability (HRV). The assessment of foot ulcer risk was performed with the two tools, the nylon line and the Semmes-Weinstein monofilament, in the three sites recommended by the Internacional Consensus on the Diabetic Foot and Practical Guidelines for the test with Semmes-Weinstein monofilament. The prevalence rate of DSP was 6.3% and the prevalence rate of foot ulcer risk as evaluated by Semmes-Weinstein monofilament was 14.3%. The prevalence rates of incipient and definitive CAN were 12.5% and 10%, respectively. The kappa coefficient of correlation between the nylon line and the Semmes-Weinstein monofilament was 0.94 (almost perfect). These findings suggest that the Semmes-Weinstein monofilament or even the nylon line may be more appropriate tools to diagnose DSP in the primary care setting in Brazil.