1 in 10 people and 1 in 2 diabetic suffer from Peripheral Neuropathy while 80% of patients remain undiagnosed

1 in 10 people and 1 in 2 diabetic suffer from Peripheral Neuropathy while 80% of patients remain undiagnosed

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Leading Global Health Experts converge at P&G’s ‘Demystifying Neuropathy Forum’ to address the growing Public Health Concern of Peripheral Neuropathy

As part of Neuropathy Awareness Week 2023, P&G Health, brought together globally renowned health experts with 6000 Healthcare Professionals from across Asia, India, Middle East, and Africa at the ‘Demystifying Neuropathy Forum’. Hosted out of Mumbai and simulcast to 8 countries, the signature event saw deliberations on the latest clinical guidance and research findings on screening and management of the growing public health concern of Peripheral Neuropathy

Peripheral neuropathy (PN) is a chronic clinical condition, wherein the peripheral nervous system is damaged. Symptoms of peripheral neuropathy include numbness, tingling, prickling, and burning sensations in the hands and feet. Sufferers of PN report impacts on their quality of life including reduced physical abilities and poor sleep. Besides diabetes mellitus, obesity, alcohol misuse, and B vitamins deficiencies are other high-risk factors leading to peripheral nerve damage.

Peripheral neuropathy (PN) is a chronic clinical condition, wherein the peripheral nervous system is damaged. Symptoms of peripheral neuropathy include numbness, tingling, prickling, and burning sensations in the hands and feet. Sufferers of PN report impacts on their quality of life including reduced physical abilities and poor sleep. Besides diabetes mellitus, obesity, alcohol misuse, and B vitamins deficiencies are other high-risk factors leading to peripheral nerve damage.

Expert Speak:

  • Speaking at the forum, Prof.  Rainer Freynhagen,Head of Department, Anaesthesiology, Critical Care Medicine & Pain Medicine at Benedictus Hospitals Tutzing & Feldafing Germany stated, “Peripheral neuropathy and pain with neuropathic components are highly prevalent in the general population. Doctors around the globe see millions of patients suffering daily of these conditions which are relatively easy to diagnose but challenging to treat, particularly in advanced stages.  Around 10% of the general population worldwide is affected by neuropathic pain and 50% of these patients are not sufficiently managed1. Although identifying a patient with PN is not rocket science, currently published studies across different countries confirm that up to 80% of patients remaining undiagnosed and untreated. Many people may report their painful sensations only after they become unbearable but for me much more important is the fact, that only less than 1/3rd of physicians are confident to recognize symptoms and signs of PN accordingly. To me it’s appalling that for many physicians’ neuropathic pain has often the lowest importance in comparison to other symptoms, even though it’s one of the most burdenful problems with a tremendous impact on our patients quality of life.”

Dr Satish V Khadilkar, Renowned Neurologist, Professor and Head of Department of Neurology at Bombay Hospital Institute of Medical Sciences in Mumbai, India stated, “Diagnosing Peripheral Neuropathy is an unmet need. If PN is not diagnosed and treated in early stages, it usually progresses into neuropathic pain which can lead to several comorbidities which significantly impact the patient’s quality of life, social life and working life5. These include depression, sleep disturbances, anxiety which also require treatment adding to the economic burden of the patient. Painful diabetic PN is significantly associated with disruptions in employment status and work productivity. Of working patients, 59% reported being less productive at work 6”

According to Dr Ankia Coetzee, Endocrinologist, University of Stellenbosch Faculty of Medicine and Health Sciences, Cape Town, South Africa, “Each contact with a patient is an opportunity and primary care physicians can play a key role in diagnosing neuropathy7. As some patients might have difficulties in describing their symptoms properly, proactively probing for characteristics of PN such as numbness, pins and needles and tingling sensation, lancinating, stabbing or electric shock like pain can be a good starting point. Easy to perform sensory tests such as vibration perception testing, pin prick test, monofilament test etc. take no longer than a few minutes and guide the diagnosis, while laboratory tests can help refine the diagnoses.”

5-Steps of Diagnoses

Dr Inna Eiberger, Global Medical Director, P&G Health Nerve Care Franchise shared, “Neurotropic B vitamins are essential for nerve health and support nerve regeneration. Vitamin B1 provides energy to the nerves, vitamin B6 helps with signal transmission in nerves, while vitamin B12 supports nerve regeneration.   An in-vitro study initiated by P&G Health showed that when Vitamin B1, B6, and B12 were added to nerve cultures with healthy nerve cells, there was an increase in total neurite length of 124% and an increase in the total cell body area of 55%. Nerve network of cells nourished with B1, B6, and B12, also doubled. Further in-vitro experiments have proven that Vitamins B1, B6, and B12 support nerve cell recovery after nerve cell damage.”

PERIPHERAL NEUROPATHY IN NUMBERS:in 10 people1 and 1 in 2 diabetics2 suffer from Peripheral Neuropathy. In 2021, there were 393 Mn diabetic patients8 in the Asia Pacific, Middle East, and African regions projected to rise to 603 Mn by 20458. An estimated 80% patients remain undiagnosed and untreated3, with ratio being similar across different countries globally Diabetic PN is seen in very high proportion of diabetes patients in Southeast Asia; in some countries up to almost 60%7 A study from the Philippines in 2000 from the Diabcare-Asia project, which assessed 2,708 patients in diabetes centres, reported a prevalence of 42% for diabetic neuropathy, based on medical records9. Peripheral Neuropathy affects 34–35% of UAE population with diabetes10. Saudi Arabia ranks the second highest in the Middle East and is seventh in the world for the rate of diabetes11. Painful Diabetic Peripheral Neuropathy is seen in over 65% of the patients with Diabetes in Saudi Arabia12. In Indonesia, the number of diabetic people increased from 10.7 million in 2019 to 19.5 million in 2021 rising from seventh to fifth rank for the highest number of diabetes sufferers in the world13. In a study from Bali, of 110 patients with type 2 diabetes mellitus and neuropathy based on electromyography, 54% had painful diabetic neuropathy 14.  

In Singapore, prevalence of diabetic Peripheral Neuropathy was reported to be 28% and the significant risk factors are age, Indian ethnicity, insulin use, diabetic retinopathy and stoke 15.   Various epidemiological studies from India showed wide prevalence of nerve damage varying from 5 to 2400 per 10,000 population in different community studies16. The estimates on prevalence of nerve damage in India vary widely from 13.1–45.0% in different populations which could be attributed to different types of diabetes 17.  In Malaysia, 51% of diabetics were found to be diagnosed with peripheral neuropathy 18  Painful diabetic PN is significantly associated with disruptions in employment status and work productivity. Of working patients, 59% reported being less productive at work 6. Around 10% of the general population is affected by neuropathic pain globally, and 50% of neuropathic pain sufferers are not sufficiently treated1. < 1/3rd of physicians recognizes signs of DPN. Undiagnosed cases contributing greatly to the high rates of morbidity and mortality of diabetes8. Up to 50 % of patients are asymptomatic and therefore often remain undiagnosed and are at risk of insensate injury 19.  Other than knowledge about the condition, information on who is at risk, the consequences of PN in relation to reduced quality of life and increased risk of foot ulcers needs to be disseminated to the public, to encourage early self-referral 20. Once the diagnosis of PN has been made, it is important to educate patients of the dangers of PN.   

As part of Neuropathy Awareness Week 2023, P&G Health also announced its collaboration with EcoMatcher, a social entreprise to plant a ‘Global Forest of Care’ with 2000 trees across India, Indonesia, Philippines, Thailand, and Malaysia to mark the tireless efforts of the collective ecosystem of healthcare professionals (HCP), medical associations

About ‘Put Life Back in Your Hands’ campaign: ‘P&G Health Put Life Back in Your Hands’ campaign is inspired by the symptoms such as numbness and tingling felt by those suffering with PN, shedding light on how those with the condition are not able to feel the same joy and delight when going about routine activities, negatively impacting their ability to get things done and consequently their emotional wellbeing.

References:

  1. Attal N et al, Lancet Neurol 2018; 17: 456–66
  2. Kumar S, et al. Laser Therapy 2016;25: 141–144
  3. Ponirakis G et al, J Diabetes Investig 2019; 10: 1558–1564
  4. Smith P O et al, Int J Phys Med Rehabil, Vol.11 Iss.4 No:1000667
  5. O‘Connor AB. Pharmacoecon. 2009;27: 95–112.
  6. Allemann CJM. Diab Res Clin Practice. 2015;109: 215–225.
  7. Malik RA, et al.J Diabetes Investig 2020 Vol. 2 No. 5
  8. International Diabetes Federation. IDF Diabetes Atlas. 10th edition; 2021.
  9. Lantion-Ang LC. Epidemiology of diabetes mellitus in Western pacific region: focus on Philippines. Diabetes Res Clin Pract 2000; 50(Suppl 2): S29–S34.
  10. https://www.mdpi.com/20734409/12/1/198/pdf#:~:text=A%20recent%20study%20among%20the,diabetes%20%5B3%2C4%5D.
  11. https://pubmed.ncbi.nlm.nih.gov/26206092/#:~:text=Abstract,3%20million%20have%20pre%2Ddiabetes.
  12. Halawa MR et al, 2010
  13. International Diabetes Federation (IDF) Atlas 2021, 10th edition
  14. Purwata TE et al. J Pain Res2011; 4: 169–175.
  15. Arnold Hu et.al, Proceedings of Singapore Healthcare, Volume 30 (4) 2020
  16. Ann Indian Acad Neurol. 2017 Jul-Sep; 20(3): 173–184.)
  17. DIABETICMedicineDOI: 10.1111/j.1464-5491.2008.
  18. Azidah, A. K., & Hasniza, H. (2014). Peripheral neuropathy among elderly diabetes in a tertiary center, Malaysia. International Journal of Collaborative Research on Internal Medicine & Public Health, 6(3), 0-0.
  19. Miranda-Massari JR, et al. Curr Clin Pharmacol. 2011;6: 260–273.
  20. Iqbal Z, Azmi S, Yadav R, et al. Diabetic peripheral neuropathy: epidemiology, diagnosis, and pharmacotherapy. Clin Ther 2018; 40: 828–849.

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