Delayed Diagnosis of Diabetic Peripheral Neuropathy in Korean Patients
By Jonghwa Kim, Department of Endocrinology, Bucheon Sejong Hospital
A recent survey conducted on diabetic patients in five countries has revealed that Korean patients are diagnosed with diabetic peripheral neuropathy (DPN) about two months later than patients in other nations. Experts attribute this delay to the prioritization of other complications of diabetes, such as cardiovascular disease, and the inadequate exploration of patients’ symptoms in the medical environment.
DPN is a prevalent complication of diabetes, affecting 33.5% of diabetic patients in Korea. Among them, 43.1% experience painful diabetic peripheral neuropathy (pDPN), with one in four diabetic patients suffering from this excruciating condition.
In a press conference held on the 21st, Beatrice Korea presented the findings of a survey conducted on 963 diabetic patients with neuropathic pain from Korea, Italy, Spain, Malaysia, and Mexico.
The survey revealed that Korean diabetic patients took an average of 6 months to be diagnosed with neuropathic pain after the initial symptoms appeared. This is approximately 2 months longer than the national average diagnosis time of less than 4 months in the other countries.
Furthermore, the average time for a final diagnosis was 12 months in Korea, while it was only 6 months in the other countries. 61% of Korean patients reported receiving treatment for other diseases before finally receiving a diagnosis, surpassing the average of 43% in the other countries.
Experts attribute the delayed diagnosis to the insufficient attention and recognition given to DPN compared to other complications. Kim Jong-hwa, head of the Department of Endocrinology at Bucheon Sejong Hospital, highlighted the prioritization of cardiovascular disease among diabetic patients and the lack of adequate time for patients to discuss their symptoms and for specialists to provide accurate diagnoses.
Compounding the issue is the intermittent nature of DPN symptoms, leading patients to mistakenly believe their pain has improved when it has, in fact, continued to progress.
Kim Jong-hwa stated, “Recent reports indicate that diabetic peripheral neuropathy often coincides with diabetic neuropathy, increasing the risk of cardiovascular disease and resulting in more deaths.”
Importance of Early Diagnosis and Management of Diabetic Peripheral Neuropathy
Diabetic peripheral neuropathy typically manifests in the pre-diabetic period, which underscores the need for early diagnosis and management. In severe cases, DPN can cause foot deformities, the formation of non-healing ulcers, and, in the worst scenarios, necessitate amputation. Even with successful amputations, complications such as worsening infections and sepsis can occur, potentially resulting in fatalities.
Diabetes guidelines recommend screening diabetic patients for DPN early on, with Type 1 diabetics screened 5 years after diagnosis and Type 2 diabetics screened immediately after diagnosis and annually thereafter. Screening methods include the monofilament nerve test, vibration-sensing test, ankle-test nerve test, and questionnaires that assess symptoms.
However, practical challenges hinder obtaining a prompt and accurate diagnosis in clinical settings. The tests required for diagnosis typically take 15 to 20 minutes, yet they are not separately billed, making it difficult to create an environment conducive to thorough examinations.
In an effort to address this issue, the Diabetes Association requested the evaluation of new medical technologies for DPN diagnosis two years ago. The hope was to secure recognition and separate billing for these technologies to increase attention and investment in clinical sites. Unfortunately, the request was denied due to it being considered an existing technology. However, the society remains committed to developing a new protocol and creating an enabling environment for DPN diagnosis.
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Survey of diabetic patients in 5 countries… 4 months on average “Relatively little attention compared to other complications, must be charged separately”
Jonghwa Kim, Department of Endocrinology, Bucheon Sejong Hospital ⓒ Korea Medical Association Newsletter
A survey showed that diabetic patients in Korea were diagnosed with diabetic peripheral neuropathy about two months later than in other countries. Experts pointed to the reality that other complications of diabetes, such as cardiovascular disease, take precedence and the medical environment where patients’ symptoms cannot be adequately explored as the causes.
Diabetic peripheral neuropathy (DPN) is a representative complication of diabetes. 33.5% of diabetic patients in Korea suffer from this complication.
Of these, 43.1% are patients with painful diabetic peripheral neuropathy (pDPN). One in four diabetic patients experience painful diabetic peripheral neuropathy.
In a press conference on the 21st, Beatrice Korea revealed the results of a survey conducted on 963 diabetic patients with neuropathic pain in five countries: Korea, Italy, Spain, Malaysia, and Mexico.
In a survey, the average time it took Korean diabetic patients to be diagnosed with neuropathic pain was 6 months after the first symptoms appeared. This is approximately 2 months later than the national average of less than 4 months.
The final diagnosis was also within 6 months on average for the five countries, while it took 12 months for Korea. The proportion of domestic patients who answered that they had received treatment for other diseases before receiving a final diagnosis was 61%, which was higher than the average of the five countries (43%).
The specialist’s diagnosis was a result of the relatively small attention and characteristics of the complication compared to other complications.
Kim Jong-hwa, head of the Department of Endocrinology at Bucheon Sejong Hospital, said, “The reality is that other complications of diabetes, such as cardiovascular disease, are given more priority,” and added, “This is also due to the lack of time for patients talk freely about their symptoms and for specialists to provide an adequate diagnosis.”
Here, symptoms also appear intermittently. This means that it is easy for patients to mistakenly believe that their pain has improved when it is relieved. But the problem is that complications continue to develop.
Manager Kim Jong-hwa explained, “If you look at a recent report, there are cases where diabetic peripheral neuropathy accompanies diabetic neuropathy. The risk of cardiovascular disease increases. There are reports that this causes more deaths .”
Diabetic peripheral neuropathy diagnosis guidelines ⓒNewspaper of the Korea Medical Association
Diabetic peripheral neuropathy usually occurs in the pre-diabetic period. Accordingly, when surveyed after a diabetes diagnosis, approximately one third of people have associated complications.
Manager Kim Jong-hwa said, “Diabetic peripheral neuropathy needs to be diagnosed and managed earlier. In severe cases, the bones in the feet may be deformed or ulcers may form. Ulcers have the characteristic of not healing quickly. well after they form, and in serious cases, “Amputation is necessary. Even with amputations off, it’s lucky if the treatment goes well, but if the infection gets worse and sepsis develops, there are cases where death can result,” he explained.
Diabetic peripheral neuropathy diagnosis guidelines recommend that patients with type 1 diabetes be screened 5 years after diagnosis and those with type 2 diabetes be screened immediately after diagnosis and then annually.
Screening methods include a monofilament nerve test, a nerve-test vibration-sensing test, and an ankle-test nerve test. There are 15 questionnaires that ask patients about their symptoms.
However, attention was also drawn to the fact that the time required was realistically too long, making it difficult to obtain an adequate diagnosis in clinical settings.
Manager Kim Jong-hwa noted, “It takes at least 15 to 20 minutes. The problem is that even when these tests are performed, they are all included in the exam fee. There is no separate fee. It’s a difficult environment to do a good test.”
According to the analysis, because there is no separate fee, an active diagnostic environment cannot be created and patients cannot talk sufficiently about their symptoms.
To solve this problem, the Diabetes Association commissioned NECA two years ago to evaluate new medical technologies for diagnosing diabetic peripheral neuropathy. It was an attempt to attract attention from clinical sites by receiving recognition for a separate fee.
Manager Kim said, “Despite the society’s efforts, it was rejected on the grounds that it is an existing technology. The society is making a long-term plan to try again by building a new protocol separately.” “It must create an environment,” he emphasized.
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