Survey Reveals Delayed Diagnosis of Diabetic Peripheral Neuropathy in Korean Patients
A recent survey conducted in five countries sheds light on the delay in diagnosing diabetic peripheral neuropathy (DPN) in Korean patients. Experts attribute this delay to the prioritization of other complications of diabetes, such as cardiovascular disease, and a medical environment that fails to adequately explore patients’ symptoms.
Diabetic peripheral neuropathy is a common complication of diabetes, affecting approximately 33.5% of diabetic patients in Korea. Among these patients, 43.1% suffer from painful diabetic peripheral neuropathy (pDPN), which significantly impacts their quality of life.
The survey, conducted on 963 diabetic patients with neuropathic pain in Korea, Italy, Spain, Malaysia, and Mexico, revealed that Korean patients experienced an average delay of 6 months in being diagnosed with neuropathic pain after the onset of symptoms. This is approximately 2 months longer than the average delay in other countries, which is less than 4 months.
Furthermore, while the final diagnosis for the five countries typically took an average of 6 months, it took 12 months in Korea. Alarmingly, 61% of Korean patients reported receiving treatment for other diseases before receiving a final diagnosis, compared to the average of 43% in the other countries surveyed.
Experts attribute this delay to the relatively low attention and awareness given to DPN compared to other complications of diabetes. “The reality is that other complications, such as cardiovascular disease, are given more priority,” stated Kim Jong-hwa, head of the Department of Endocrinology at Bucheon Sejong Hospital. He also highlighted the lack of sufficient time for patients to discuss their symptoms freely and for specialists to provide accurate diagnoses.
Complicating matters is the intermittent nature of DPN symptoms, which can lead patients to mistakenly believe that their pain has improved. However, the complications associated with DPN continue to develop and pose significant risks to patients’ health, including an increased risk of cardiovascular disease-related deaths.
In light of these findings, early diagnosis and management of diabetic peripheral neuropathy are crucial. Severe cases can lead to deformity of the feet and the formation of non-healing ulcers, which may require amputation. To address this, diagnostic guidelines recommend screening patients with type 1 diabetes 5 years after diagnosis and those with type 2 diabetes immediately after diagnosis and annually thereafter.
However, challenges remain in clinical settings, as the lengthy screening process lacks a separate fee, making it difficult to provide adequate testing and diagnosis. The Korean Diabetes Association is working to address this issue by seeking recognition and a separate fee for these tests, aiming to create a more conducive and supportive diagnostic environment.
“While efforts have been made, the existing technology was rejected for separate recognition. Nevertheless, the society is committed to developing a new protocol and creating an environment that facilitates accurate diagnosis,” emphasized Manager Kim.
It is crucial to address the delayed diagnosis of diabetic peripheral neuropathy in Korean patients to prevent further complications and improve the overall management of diabetes. The findings of this survey serve as a wakeup call for the medical community and underline the need for increased attention and resources to detect and manage DPN effectively.
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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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