1. Prevalence of Diabetic Peripheral Neuropathy in a Secondary Care Diabetes Service and Alcohol Use in Patients with Diabetic Peripheral Neuropathy and Neuropathic Ulceration
Haidei A,1 Rourke C,2,4 Kelly M,2 Costelloe M,2 Gately M,3 Watterson D,4 Murphy P,5 O’Loughlin A2,4
1. Department of Medicine, National University of Ireland, Galway;
2. Department of Diabetes, Roscommon University Hospital, Saolta Healthcare Group;
3. Diabetes Day Centre, Galway University Hospital; Merlin Park Podiatry Clinic,
4. Merlin Park University Hospital, Galway;
5. Department of Psychology, Saolta Healthcare Group
Introduction
Peripheral neuropathy is one of the most common complications of diabetes mellitus
with currently no treatment to reverse the condition1 Excess alcohol use may cause
peripheral neuropathy and is a modifiable risk factor for neuropathy. Subsequently,
diabetic peripheral neuropathy (DPN) may result in diabetic foot ulceration.
The CAGE questionnaire is a widely used quick screening test for excessive drinking
and alcoholism. It is a validated screening technique, and answering yes to >/= 2 of the
questions results in a specificity of 76% and a sensitivity of 93% for excessive drinking,
and a specificity of 77% and a sensitivity of 91% for excessive alcoholism.2
The detection of alcoholism and subsequent treatment may reduce the burden of diabetic
foot disease.
Aims
Table 1. CAGE questionnaire results for patients with diabetic peripheral
neuropathy
1. To determine the prevalence of DPN in a secondary care diabetes service
2. To determine the prevalence of alcohol dependence in a cohort of patients with DPN and
neuropathic foot ulceration.
Methods
The prevalence of DPN was derived from audit of an electronic diabetes database
(DIAMOND).3 Ethical approval was obtained for the study and informed consent was
obtained for undertaking of the study. Consecutive patients attending Roscommon
Hospital Diabetes Podiatry clinics and Merlin Park Hospital Complex Foot clinics with
DPN or neuropathic foot ulceration. ulceration were screened using the CAGE
questionnaire. Patient demographics were recorded. A score of ≥ 2 indicates alcohol
dependence.
The Questions includes
Have you ever felt you need to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about drinking?
Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
Table 2. CAGE questionnaire results for patients with active diabetic
neuropathic foot ulceration
Conclusion
DPN is present in a significant number of patients attending a secondary care
diabetes clinic. Alcoholism was detected in patients with diabetic foot
complications. As alcohol dependence is a modifiable risk factor for DPN,
the potential presence of alcohol dependence should be determined in the
clinical assessment of these patients, and may reduce the burden of diabetic foot
disease. Further research is warranted to detect the true impact of alcoholism in
patients with diabetic foot disease.
Results
References
The prevalence of DPN for patients attending Roscommon diabetes services
was 22.2%.
50% of subjects with DPN scored ≥ 2 on the CGAE questionnaire.
7% of subjects with active diabetic neuropathic foot ulceration scored ≥ 2 on the CAGE
questionnaire.
82% of the study participants were male.
 1. World Health Organization, "Diabetes Programme," [Online]. Available: [Accessed ].
2. M. Bernadt, C. Taylor, J. Mumford, B. Smith and R. M. Murray, "Comparison of Questionnaire and Laboratory Tests in the Detection of Excessive Drinking and Alcoholism," The Lancet, vol. 319, no. 8267, pp , 6 February 1982.
3. P. Kopelman, J. Michell and A. Sanderson, "DIAMOND: a computerized system for the management and evaluation of district wide diabetes care," Diabet Med, vol. 12, no. 1, p. 83, January 1995.
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