Content uploaded by Nikhil Patil
Author content
All content in this area was uploaded by Nikhil Patil on Jan 16, 2023
Content may be subject to copyright.
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b194
QUALITY OF LIFE IN PATIENTS WITH TYPE
2 DIABETIC PERIPHERAL NEUROPATHY
USING NEUROPATHY SPECIFIC QOL
INSTRUMENT (NEURO QOL)
1Hemant Londe, 2Dr. Nikhil Patil, 3Dr. Kalyani Nagulkar, 4Dr. Ashish Patil
1B.P.Th. Dr. Ulhas Patil College Of Physiotherapy, 2Assisstant Professor, 3Associate Professor, 4Assistant Professor
1Department Of Physiotherapy,
1Dr. Ulhas Patil College Of physiotherapy, Jalgaon, India
Abstract :
Background : Diabetic peripheral neuropathy (DPN) affects an average of 50% of diabetic patients and is one of the major
causes of increased mortality and morbidity, with increase risk of burns, injuries and foot ulcerations. This affects the patients’
life as well as the life of the their families. The assessment of QoL of such patients helps to determine the impact of disease on the
patients’ life.
Aim and Objective : To Assess Quality of life (QoL) in patients with Diabetic Peripheral Neuropathy and the impact of in
quality of life on their lives.
Results : Total 45 subjects were screened for DPN using Mod. Neuropathy Diability Score, their QoL was assessed by using
Neuropathy - Specific QoL Instrument. Significant differences were found between four domains of Neuro QoL Instrument and
severity of DPN. Painful symptoms and Paresthesia, Diffused Sensory Motor Symptoms, Interpersonal problems and emotional
distress increased with increase in Severity of DPN with P values <0.001, 0.018, 0.004, 0.006 respectively. Throbbing pain,
numbness, weakness in legs/feet, emotional dependence and physical dependence had greatest impact on patients’ QoL.
Conclusion : In this study, the findings concluded that Diabetic Peripheral Neuropathy can have a profound effect on patients’
Quality Of Life in various Physical and Psycho-social areas of their lives and there is direct relation between severity of DPN and
the various aspects of QoL.
Keywords: Diabetes, Diabetic Peripheral Neuropathy, Neuropathy disability score, Quality of Life.
I. INTRODUCTION
Diabetes Mellitus (DM) is a carbohydrate metabolism disorder1. This disorder is characterized by hyperglycemia
resulting directly from excessive glucagon secretion, insulin resistance or inadequate insulin secretion2. Diabetes mellitus can be
classified into: Type-I diabetes mellitus (Insulin Dependent) and Type-II diabetes mellitus (insulin Independent)2,3.
Diabetic Neuropathy or Diabetic Peripheral Neuropathy is the presence of certain signs or specific symptoms which
are suggestive for neuropathy in patients suffering from Diabetes mellitus, without other possible causes of neuronal damage4.The
symptoms include:
1. Tingling sensation prominently in toes and feet, which spreads upwards in legs and trunks.
2. Numbness in arms and legs spreading distal to proximal.
3. Weakness.
4. Cramping pain in feet,legs and/or hands.
5. Sensitive skin (painful to the touch)
6. Prickling, burning and sharp stabbing pain sensations
7. Impaired balance and co-ordination, Difficulty in walking4,5.
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b195
Peripheral Neuropathy is one of the most common complications of Diabetes that affects patient’s Quality of Life
(QoL).It is considered to be the most important precursor to plantar ulcers and amputations of feet in patients with diabetes
mellitus6.The Motor nerve impairments in DM determines muscular hypotrophy, abnormal pressure points and deformities of the
lower limbs.
In Health Care, Quality of life is viewed as multidimensional, including emotional, physical, material, and social well-
being6,7.
Diabetes mellitus type 2 causes permanent changes in patients’ lives. Patients‘ self-care gets affected, which includes
oral anti-diabetic medications, monitoring of blood glucose levels and the changes in diet. This has a profound effect on Quality
of Life8,9,11.
Diabetic peripheral neuropathy (DPN) affects an average of 50% of diabetic patients and is one of the major causes of
increased mortality and morbidity, with increase risk of burns, injuries and foot ulcerations. This affects the patients’ life as well
as the life of the their families. The assessment of Quality Of Life of such patients helps to determine the impact of disease on the
patient and the changes in patients’ quality of life. It would also be helpful as an outcome measure in further clinical interventions
and also enables us to aim the treatment plans towards improving particular aspects of impaired health in respective patients.
II. AIM AND OBJECTIVE
To Assess Quality of life (QoL) in patients with DIABETIC PERIPHERAL NEUROPATHY.
To study the impact and changes in quality of life of patients with diabetic peripheral neuropathy .
III. MATERIALS AND METHODOLOGY
METHODOLOGY:
1. Sample size : 45 ( N = z2pq/e2 )
2. Study design : Observational
3. Method of sampling: Convenient sampling
4. Place of study: Dr. Ulhas Patil Medical college and Hospital, Jalgaon
5. Study duration: 6 Months
6. Inclusion criteria:
- Diabetic patients (Type 2) with DPN
- Neuropathy Disability Score (NDS) ≥3.
7. Exclusion criteria:
Subjects with -
- Foot ulceration
- Peripheral vascular disease (defined as <1 palpable foot pulse
or previous bypass surgery/angioplasty)
- A history of amputation
- Other severe chronic medical diseases or
complications of diabetes that would affect the QoL.
MATERIALS:
1. Tunning fork (128 Hz )
2. 10mm micro-filament
3. Modified Neuropathy Disability Score
Neuropathy - Specific QoL Instrument (Neuro QoL)
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b196
IV. PROCEDURE
To conduct the following study, permission was taken from Dr. Ulhas Patil College of Physiotherapy, Jalgaon. Subjects
were taken according to the inclusion and exclusion criteria. The procedure was explained and a written consent was obtained
from the patients. Initially, the demographic data i.e. Name, age, gender,etc. of the subject was taken. Subjects were included after
taking history in regards to the inclusion and exclusion criteria. Modified Neuropathy disabilty score(NDS) was taken. Subjects
were diagnosed as having peripheral neuropathy if their Neuropathy Disability Score (NDS) was ≥3. Total 47 subjects were
assessed from which 2 subjects were excluded as per the exclusion criteria. Subjects quality of life was assessed using
Neuropathy-Specific QoL Instrument (Neuro QoL).
SCREENING TOOL :
Modified Neuropathy Disability Score (NDS)
The modified neuropathy disability score was developed by Vileikyteet al. (2003). It is used to assess the severity of
peripheral neuropathy. It is derived from examination of ankle reflex with the tendon hammer. Vibration Perception Threshold
(VPT) was tested with a tuning fork (128 Hz) placed at the apex of great toe. Pain sensation was assessed by using 10-g mono
filament (plantar surface of distal hallux was tested on each foot) and temperature sensation on the dorsum of the foot was
assessed by a cold tuning fork. Patients were asked to close their eyes while being tested. The sensations were scored as either
present = 0 or reduced / absent = 1 for each side; and reflexes were scored as normal = 0, present with reinforcement = 1 or absent
= 2 per side. The total maximum abnormal score is 10. Neuropathy scores of 2-5 indicated mild, 6-8 moderate and 9-10 severe
peripheral neuropathy.
OUTCOME MEASURES :
Neuropathy-Specific QoL Instrument (Neuro QoL)
Neuro QoL is a multidimensional scale, developed by Vileikyteet al. (2003) to assess the QoL of diabetic patients with
peripheral neuropathy. It comprises 27 items to evaluate diabetic peripheral neuropathy related symptoms and psychosocial
functioning in six primary domains: (1) painful symptoms and paresthesia (seven items), e.g. burning or throbbing in the feet; (2)
symptoms of reduced/lost feeling in the feet (three items), e.g. inability to feel temperature and/or objects with the feet; (3)
diffused sensory motor symptoms (three items), e.g. unsteadiness while standing/walking; (4) limitations in daily activities (three
items), e.g.in ability to perform paid work or leisure activities;5) interpersonal problems (four items), e.g. physical/emotional
dependence on others; and 6) emotional burden (seven items), e.g. being handled otherwise from different people. The Neuro
QoL permits humans to reply with the frequency of the signs or how the foot problems have affected their HRQoL over the
previous four weeks, marking on the scale of one to five. Depending on the type of question, number one represents a ―never or
not at all‖, and the number five ―all of the time. After marking the reaction to a specific item, the individuals have
been requested to additionally mark how plenty the contents of that item represent a discomfort or how important it is, on a scale
of one to three, with a reaction of 1 = not at all, 2 = a little, and 3 = a lot.
To acquire the weighted rankings for every object of the respective domains, the fee obtained on each item (1-5) is
multiplied by the value assigned to the corresponding discomfort/importance (1-3). This
multiplication affords the degree of effect of the objects which compose the instrument. The general values of
the rankings in every area are calculated through the imply of the weighted items of the respective domains, with the highest
value corresponding to poor HRQoL.
V. STATISTICAL ANALYSIS
The data thus collected shall be subjected to statistical analysis.The Data will be analysed using SPSS software.
Descriptive statistics were used and frequencies, means and standard deviations (SDs) are presented. ANOVA test was used to
compare sample means for the various categories. Weighted frequencies were used to rank items within each parameter of QoL;
values of P 0.05 ≤ were considered significant.
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b197
VI. RESULTS
In the analysis of demographic data, the findings indicated that there were 29 males (64.4%) and 16 females (35.6%)
included in this study with mean age 52.51 year and 57.8% individuals were aged 40-59 years. The population had Type II DM
and had no history of foot ulceration. According to the Modified Neuropathy Disability Score one third of the individuals (66.7%)
had mild DPN, followed by Moderate DPN (31.1%) and only (2.2%) had severe DPN. On the basis of Duration of Diabetes, one
third of the individuals (68.9%) had been diagnosed for 2-9 years and 26.7% for 10-19 years.
GENDER DISTRIBUTION
MODIFIED NDS SCORING
29, 64%
16, 36%
Gender MALE
FEMALE
GENDER
FREQUENCY (n)
PERCENTAGE (%)
Male
29
64.4
Female
16
35.6
Total
45
100
NDS SCORE
SEVERITY
FREQUENCY (n)
PERCENTAGE (%)
Mild
30
66.7
Moderate
14
31.1
Severe
1
2.2
Total
45
100
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b198
AGE DISTRIBUTION
67%
31%
2%
NDS SCORE
mild moderate severe
0%
2%
0% 13%
31%
27%
16%
11%
AGE
RANGE 1O-19 20-29 30-39 40-49 50-59 60-69 70-79
AGE
RANGE
FREQUENCY (n)
PERCENTAGE (%)
10-19
1
2.2
30-39
6
13.3
40-49
14
31.1
50-59
12
26.7
60-69
7
15.6
70-79
5
11.1
TOTAL
45
100
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b199
DISTRIBUTION OF DURATION OF DIABETES
Table 1 shows that significant differences were found between four domains of Neuro QoL Instrument i.e. mean Painful
symptoms and Paresthesia (Graph 1), Diffused Sensory Motor Symptoms (Graph 2), Interpersonal problems (Graph 3),
Emotional distress(Graph 4) and Severity of DPN with P value <0.001, 0.018, 0.004, 0.006 respectively (Table 1). Increased pain
and paresthesia was associated with increased severity of DPN(mean 4.66) and Diffuse sensory motor symptoms increased with
increase in severity of DPN(mean 4.409). Moreover, Increase in Interpersonal problems and Emotional distress increased with
severity of DPN. No significant differences were found for two domains i.e. Loss/reduction of sensitivity(Graph 5), limitations in
daily activities(Graph 6) and severity of DPN, P value being 0.55 and 0.366 respectively (Table 1).
Table 1. Differences between severity of Diabetic Peripheral Neuropathy and Domains Of Neuro QoL of DPN Patients.
ANOVA TEST
27%
42%
16%
11% 4%
DURATION OF DIABETES
<5 years 5 - 9 years 10 –14 years 15 –19 years 20 –24 years
DURATION OF DIABETES (IN YEARS)
RANGE
FREQUENCY (n)
PERCANTAGE (%)
<5 years
12
26.7
5 - 9 years
19
42.2
10 – 14 years
7
15.6
15 – 19 years
5
11.1
20 – 24 years
2
4.4
TOTAL
45
100
NEURO QoL
DOMAINS
SEVERITY OF DPN
F
P ( Sig. )
Mild (n=30)
Moderate
(n=14)
Severe (n=1)
Total (45)
Mean
SD
Mean
SD
Mean
SD
Mean
SD
Pain
4.03
1.15
5.91
1.65
5.90
-
4.66
1.57
9.969
< 0.001
Loss /
Reduction of
sensitivity
2.80
1.60
3.36
1.50
3.00
-
2.98
1.55
0.606
0.550
Diffuse
Sensory Motor
Symptoms
3.03
1.61
4.59
1.96
5.30
-
3.56
1.85
4.409
0.018
Limitations in
Daily
Activities
3.4
1.35
3.97
1.95
2.00
-
3.58
1.57
1.029
0.366
Interpersonal
Problems
3.44
1.67
5.07
2.38
8.50
-
4.06
2.13
6.177
0.004
Emotional
Distress
4.15
1.44
5.63
2.51
8.90
-
4.72
2.02
5.705
0.006
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b200
Graph 1. Relation between Pain and paresthesia and severity of DPN
Graph 2. Relation between Diffused sensory and motor symptoms and severity of DPN
Graph 3. Relation between interpersonal problems and severity of DPN
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b201
Graph 4. Relation between emotional distress and severity of DPN
Graph 5. Relation between Loss/reduction of Sensitivity
Graph 6. Relation between Limitations in daily activities
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b202
Table 2 and Graph 7 shows the ranking of the impact of individual items in domain of Pain and paresthesia in the neuro
QoL instrument as reported by the patients. Highest ranking was for patients’ feeling of throbbing pain in your legs or feet,
followed by feeling of pins and needles (weighted score 409 and 299 respectively). Lowest ranking was for sensations in your
legs or feet that make you jump and Shooting or stabbing pain in your legs and feet(weighted score of 86 and 106 respectively).
Table 2. RANKING THE IMPACT PAINFULL SYMPTOMS AND PARESTHESIA
Graph 7. RANKING THE IMPACT PAINFULL SYMPTOMS AND PARESTHESIA
0
50
100
150
200
250
300
350
400
450
Burning in
your legs
or feet
Excessive
heat or
cold in
your feet
Pins and
needles in
your feet
Shooting or
stabbing
pain in
your legs
or feet
Throbbing
pain in
your legs
or feet
Sensations
in your legs
or feet that
make you
jump
Irritation of
skin caused
by
something
touching
your feet
WEIGHTED SCORE
WEIGHTED SCORE
ITEMS
Weighted score
RANK
Burning in your legs or feet
219
3
Excessive heat or cold in your
feet
153
5
Pins and needles in your feet
299
2
Shooting or stabbing pain in
your legs or feet
106
6
Throbbing pain in your legs or
feet
409
1
Sensations in your legs or feet
that make you jump
86
7
Irritation of skin caused by
something touching your feet
173
4
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b203
Table 3. and Graph 8 shows the ranking of symptoms of reduced or lost feeling in the feet on patients’ QoL. Highest
ranking was for numbness in your legs or feet (weighted score 151), followed by inability to feel the difference between hot and
cold and inability to feel objects with your feet(weighted score of 137 and 108 respectively).
Table 3. RANKING THE IMPACT OF SYMPTOMS OF REDUCED OR LOST FEELING IN THE FEET ON
PATIENTS’ QoL.
Graph 8. RANKING THE IMPACT OF SYMPTOMS OF REDUCED OR LOST FEELING IN THE FEET ON PATIENTS’
QoL.
Table 4 and Graph 9 shows the ranking of impact of diffuse sensory motor symptoms on patients’ QoL. Highest ranking
was given to weakness in legs/feet (weighted score 175), followed by problems with balance or unsteadiness while walking and
problems with balance or unsteadiness while standing(weighted scores 151 and 142 respectively).
TABLE 4. DIFFUSED SENSORY MOTOR SYMPTOMS
ITEMS
Weighted score
RANK
Weakness in your feet or legs
175
1
Problems with balance or
unsteadiness while standing
142
3
Problems with balance or
unsteadiness while walking
151
2
0
20
40
60
80
100
120
140
160
Numbness in your legs or feet Inability to feel difference
between hot and cold
Inability to feel objects with
your feet
WEIGHTED SCORE SUM
WEIGHTED SCORE SUM
ITEMS
Weighted score
RANK
Numbness in your legs or feet
151
1
Inability to feel difference
between hot and cold
137
2
Inability to feel objects with your
feet
108
3
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b204
GRAPH 9. DIFFUSED SENSORY MOTOR SYMPTOMS
Table 5 and Graph 10 shows ranking the impact of limitations in daily activities on patients QoL. Highest ranking was
for inability to perform daily tasks around house(209), followed by inability to perform paid work and inability to perform leisure
activities(weighted score of 139 and 126 respectively).
Table 5. IMPACT OF LIMITATIONS IN DAILY ACTIVITIES
Graph 10. IMPACT OF LIMITATIONS IN DAILY ACTIVITIES
0
20
40
60
80
100
120
140
160
180
200
Weakness in your feet or
legs
Problems with balance or
unsteadiness while standing
Problems with balance or
unsteadiness while walking
WEIGHTED SCORE SUM
WEIGHTED SCORE SUM
0
50
100
150
200
250
Inability to perform paid
work
Inability to perform daily
tasks around house
Inability to perform leisure
activities
Weighted score
Weighted score
ITEMS
Weighted score
RANK
Inability to perform paid work
139
2
Inability to perform daily tasks
around house
209
1
Inability to perform leisure
activities
126
3
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b205
Table 6 and graph 11 shows ranking the impact of interpersonal problems on patients problems QoL. Highest ranking
was for feeling of emotional dependence and physical dependence (weighted score 293 and 202 respectively), followed by foot
problems interfering with family relations and changed role in family (weighted score 130 and 79).
Table 6. IMPACT OF INTERPERSONAL PROBLEMS
Graph 11. IMPACT OF INTERPERSONAL PROBLEMS
VII. DISCUSSION
Diabetes mellitus (DM) is a chronic metabollic disorder which is characterized by persistent hyperglycemia. Globally
about 1 in 11 adults have Diabetes mellitus (DM), 90% of whom have type 2 diabetes mellitus (T2DM).
In type 2 DM, there is diminished response to insulin and this is also known as Insulin Resistance. Initially insulin is
ineffective during this state and then it is countered by the increase in insulin production to maintain the homeostasis of glucose.
As time passes, the production of insulin becomes normal and there is insulin resistance that results in Type 2 DM.
Type 2 DM is most commonly seen in people older than 45 years of age but it is increasingly seen in children,
adolescents, and younger adults. This may be due to the rising levels of obesity, decreased physical activities, energy dense diets
and other lifestyle changes. Asia is a one of the major areas where there is rapidly emerging T2DM with China and India being
the top two epicenters.
Peripheral neuropathy is one of the most common complications of diabetes and it has extensive impacts on patients‘
QoL. The monetary effects of diabetic foot issues are major, each to society in addition to to the sufferers and their families.
Diabetic Peripheral Neuropathy is the important thing beginning element withinside the improvement of diabetic foot ulceration.
It is a predominantly sensory neuropathy with autonomic nervous system involvement although there are often motor features
with the advancement of the disease. DPN is not only the commonest cause of non-traumatic Lower limb Amputations, but also a
motive of impaired stability and gait and distressing Neuropathic ache this is regularly unresponsive to therapy. The neuropathy is
symmetrical and length-dependent, affecting the longest nerves, for this reason entails the toes first.
159 193 278
129
427
107 177
0
100
200
300
400
500
Weighted score sum
Weighted score sum
ITEMS
Weighted score
RANK
Your foot problems interfere with
my family relationship
130
3
You feel more physically
dependent
202
2
You feel more emotionally
dependent
293
1
Your role in family changed
79
4
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b206
The demographic data of this study indicated that more than half of the subjects i.e 64.4% were male and 35.6% were
female. More than half of the subjects i.e. 57.8% were aged between 40-59 years. Regarding the severity of DPN, the highest
percentage of subjects i.e. 66.7% had mild neuropathy, 31.1 % had moderate neuropathy and only 2.2% had severe neuropathy
out of the total 45 subjects. This interpretation may be due to nearly half of the subjects i.e. 42.2% had duration of diabetes 5-9
years. Regarding this, a study indicated that prevalence of DPN ranges from 16% to as high as 66% and its prevalence is believed
to increase with the duration of diabetes and poor glucose control (International diabetes federation 2017).
The study shows that increased severity of DPN was assoiciated with four Domains of Neuro QoL i.e. Pain and
paresthesia, diffuse sensory motor symptoms, interpersonal problems and emotional distress with statistically significant
differences. In this respect, previous studies reported that the presence of DPN significantly affects patients‘ QoL, especially
physical function. Moreover, it was associated with a significantly worse trajectory of QoL outcomes over time and long-term
increased total costs.
Concerning the impact of painful symptoms and paresthesia on patients‘ QoL, the findings indicated that the highest
rank was for patients‘ feeling Throbbing pain in their legs or feet followed by pins and needles in their feet. Similarly, Marchettini
et al. (2006) reported that pain is a significant medical issue with a moderate-to-substantial impact on QoL in some patients with
diabetic neuropathy. The most common type of peripheral neuropathy in diabetic patients is the chronic distal symmetrical
polyneuropathy, and is often associated positive sensory symptoms, i.e. dysesthesia, numbness, paresthesia and pain. This
condition represents the major source for Painful Diabetic Neuropathy (PDN) patients in clinical trials. Switlyk and Smith et al.
(2016) also mentioned in a study that neuropathic pain affects 20-30% of patients with DPN and is one of the major reasons for
this group to seek medical care.
Regarding the impact of symptoms of reduced or lost feeling in the feet on patients’ QoL the highest rank was for
numbness in patients‘ feet followed by inability to differentiate between hot and cold with the feet. These symptoms may be
related to nerve damage due to metabolic factors such as high blood glucose, and long duration of diabetes. According to
Bradbury and Price (2011), participants described their pain in various ways - Sharp, unexpected, variable
in incidence however of intense intensity, intermittent, spontaneous, non-stop and unrelenting. A study by Switlyk and Smith et
al. (2016) revealed that the pathogenesis of DPN is complex and is marked by both metabolic and vascular factors.
Hyperglycemia is only one of many key metabolic events known to cause axonal and micro-vascular injury.
Regarding diffused sensory motor symptom, the results of the study the highest ranking was for weakness in the feet or
legs, followed by instability while walking. Difficulty in maintaining the balance may be related to instability in the muscles.
These is in agreement with the finding of Irshad et al. (2017) that 30% of people with DPN experience muscle weakness, loss of
ankle reflexes, and decreased balance, coordination and gait control.the findings of this study also indicate that more than half of
the patients were reported to be aged between 40-59 years. Irshad et al. (2017) also mentioned that balance and gait characteristics
change as one‘s age progresses, and the presence of DPN in elderly populations plays a significant role in the incidence of falls.
In this study, the findings about the impact of limitations in daily activities on patients‘ QoL, the results indicated that
the highest rank was for Inability to perform daily tasks around house followed by inability to perform paid work. Similarly,
Mazlinaet al. (2011), reported that DPN has been found to be significantly associated with reduced physical aspects of diabetic
patients‘ QoL. The findings suggest the need to have a better understanding of the consequences of diabetic foot problems on
patients‘ QoL.
Regarding the impact of interpersonal problems on patients‘ QoL, the findings of the study indicated that the highest
ranking was for patients feeling that they are more emotionally dependent as a consequence of their foot problems, followed by
their feeling of more physically dependent, while their family role changing received the lowest ranking. Similarly, Dr. Amal
Samir Ahmed et al. (2017) in a study reported that the patients were more emotionally dependent and their role in the family
changed. Zamanzadeh et al. (2015) revealed that all participants remarked that they were unable to perform all their activities of
daily living independently, while help and support from family members enabled them to cope.
Regarding the impact of emotional burden on patients‘ QoL. The findings indicated that the highest rank was for patients
feeling frustrated, followed by feeling their lives are a struggle, their self-confidence affected and they felt depressed. The lowest
rank was for the feeling of being embarrassed. These results support that the impact of physical limitations from DPN has more or
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b207
less same prevalent effect on psycho-social well-being of the patients as well. These findings might indicate to the need for
increased awareness among clinicians of the potential for such issues to arise when dealing with patients with diabetic peripheral
neuropathy. In respect to this, Peimani et al. (2010) reported that as diabetes educators,therapists and nurses should consider
patient-centered care and have effective communication with patients and their families, making use of their unique skills as
patient advocates and the health providers who spend the most time interfacing with service users to comprehensively assess
patients‘ stress, provide useful problem solving strategies to help them make decisions and to explain medical information and the
relative advantages and disadvantages of treatment options.
Moreover, Kazama et al. (2011) reported that the impact of ADL restrictions on depression may depend on the extent to
which being unable to perform daily activities has a negative impact on sense of self. Dempsey et al. (2012) reported that the
perception of the self as a burden on one‘s caregiver is a mediator of depressive symptoms among chronically ill care recipients.
This study may indicate the used of Clinical and QoL instruments together to get better picture of the heath status of the patients
with Diabetic Neuropathy and also QoL measures should be employed more frequently in clinical situations.
VIII. CONCLUSION
In this study, the findings concluded that Diabetic Peripheral Neuropathy can have a profound effect on patients’ Quality
Of Life in various Physical and Psycho-social areas of their lives. There is a direct relation between severity of DPN and the
various aspects of Quality of Life in patients with DPN. Evaluation of Diabetic Peripheral Neuropathy is usually based on
objective clinical outcomes and complementary examinations, therefore it is also increasingly important to assess the Quality of
Life in such patients. The assessment Quality of Life may be a better option for monitoring the patients with DPN, as it might be
difficult to extrapolate it from routine clinical variables.
IX. SUGGESTIONS
Further Studies can be done in type 1 diabetic patients.
Further studies can include association of age, gender and duration of diabetes with severity of DPN
Further studies can be done using more samples.
More studies are needed for the impact of DPN on peoples’ Quality Of life
REFERENCES
1. Yamini Chauhan, Aakanksha Gaur, Robert Lewis, J.E. Luebering - editors et.al Encyclopedia Britanica. "Diabetes mellitus".
28 Nov. 2019.
2. Blair M. Diabetes Mellitus Review. Urol Nurs. 2016 Jan-Feb;36(1):27-36. PMID: 27093761.
3. Mouri MI, Badireddy M. Hyperglycemia. [Updated 2021 May 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2021 Jan.
4. Bondar, Andrei et al. “Diabetic neuropathy: A narrative review of risk factors, classification, screening and current pathogenic
treatment options (Review).” Experimental and therapeutic medicine vol. 22,1 (2021): 690. doi:10.3892/etm.2021.10122
5. Bromberg M. Seminars In Neurology, June 2005. National Institute of Neurological Disorders and Stroke. The Official Patient's
Sourcebook on Peripheral Neuropathy: A Revised and Updated Directory for the Internet Age, October 1, 2002. Sghirlanzoni
A. Lancet Neurology, June 2005.
6. Jenkinson, Crispin. "Quality of life". Encyclopedia Britannica, 6 May. 2020, https://www.britannica.com/topic/quality-of-life.
Accessed 8 June 2021.
7. Dr. Amal Samir Ahmed. ―Assessment of Quality of Life of Patients with Diabetic Peripheral Neuropathy.‖ IOSR Journal of
Nursing and Health Science (IOSR-JNHS) , vol. 6, no. 5, 2017, pp. 37–46.
8. American Diabetes Association (2008). Diagnosis and classification of diabetes mellitus. Diabetes Care, 32(S1):S55-S60.
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b208
9. Xavier, A. T. F., Foss, M. C., Marques Jr, W., Santos, C. B., Onofre, P. T. B. N., &Pace, A. E. (2011). Cultural adaptation and
validation of the Neuropathy - and Foot Ulcer - Specific Quality of Life instrument (NeuroQol) for Brazilian Portuguese: Phase 1.
Rev Latino Am Enfermagem, 19(6):1352-61.
10. Tesfaye, Solomon, and Dinesh Selvarajah. "Advances in the epidemiology, pathogenesis and management of diabetic
peripheral neuropathy." Diabetes/metabolism research and reviews 28 (2012): 8-14.
11. Dr. Amal Samir Ahmed. ―Assessment of Quality of Life of Patients with Diabetic Peripheral Neuropathy.‖ IOSR Journal of
Nursing and Health Science (IOSR-JNHS) , vol. 6, no. 5, 2017, pp. 37–46.
12. Goyal R, Jialal I. Diabetes Mellitus Type 2. [Updated 2022 Jun 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-.
13. Javeed N, Matveyenko AV. Circadian Etiology of Type 2 Diabetes Mellitus. Physiology (Bethesda). 2018 Mar 1;33(2):138-
150. doi: 10.1152/physiol.00003.2018. PMID: 29412061; PMCID: PMC5899235.
14. Goiet T., & Naidoo, M. (2016). Awareness of diabetic foot disease amongst patients with type 2 diabetes mellitus attending
the chronic outpatients department at a regional hospital in Durban, South Africa. African Journal of Primary Health Care &
Family Medicine, 8(1): 1170.
15. Singh, N., D.G. Armstrong, and B.A. Lipsky, Preventing foot ulcers in patients with diabetes. JAMA, 2005; 293: 217-28.
16. Selvarajah D1, Kar, D, Khunti K, Davies M, Scott A ,Walker J, Tesfaye S (2019) Diabetic peripheral neuropathy : advances
in diagnosis and strategies for screening and early intervention. The Lancet Diabetes & Endocrinology, 7 (12). pp. 938-948. ISSN
2213-8587
17. Menz HB, Lord SR, St George R, Fitzpatrick RC. Walking stability and sensorimotor function in older people with diabetic
peripheral neuropathy. Arch Phys Med Rehabil. 2004; 85: 245–252
18. Morrison S, Colberg SR, Parson HK, Vinik AI. Relation between risk of falling and postural sway complexity in diabetes.
Gait Posture 2012; 35: 662–668.
19. Tesfaye S, Boulton AJ, Dickenson AH. Mechanisms and management of diabetic painful distal symmetrical polyneuropathy.
Diabetes Care. 2013; 36: 2456-65
20. Dyck PJ, Albers JW, Andersen H, et al.; Toronto Expert Panel on Diabetic Neuropathy. Diabetic polyneuropathies: update on
research definition, diagnostic criteria and estimation of severity. Diabetes Metab Res Rev 2011; 27: 620–628
21. International Diabetes Federation (2017). Clinical practice recommendation on the diabetic foot: A guide for health care
professionals. Brussels, Belgium: International Diabetes Federation.
22. Al-Shehri, F. (2014). Quality of life among Saudi diabetics. Journal of Diabetes Mellitus, 4(3): 225-231.
23. Kulkantrakorn, K., &Lorsuwansiri, C. (2013). Sensory profile and its impact on quality of life in patients with painful diabetic
polyneuropathy. Journal of Neurosciences in Rural Practice, 4(3):267-270.
24. Marchettini, P., Lacerenza, M., Mauri, E., & Marangoni, C. (2006). Painful peripheral neuropathies. Current
Neuropharmacology, 4(3), 175-181.
25. Juster-Switlyk, K., & Smith, A. G. (2016). Updates in diabetic peripheral neuropathy. F1000Research 2016, 5(F1000 Faculty
Rev): 738.
26. Irshad, A., Ejaz, H., Deepika, S., Shalini, V., & Kamran, A. (2017). Balance training in diabetic peripheral neuropathy: A
narrative review. JSM Diabetology and Management, 2(1): 1002.
27. Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., &Taleghani, F. (2015). Effective factors in providing holistic care: A
qualitative study. Indian Journal of Palliative Care, 21(2): 214-224.
28. Peimani, M., Tabatabaei, M. O., &Pajouhi, M. (2010). Nurses‘ role in diabetes care; A review. Iranian Journal of Diabetes
and Lipid Disorders, 9: 1-9.
29. Kazama,M., Kondo,N., Suzuki,K. , Minai,J., Hisashi, I.,Yamagata,Z. (2011) . Early impact of depression symptoms on the
decline in activities of daily living among older Japanese: Y-HALE cohort study. Environmental Health and Preventive Medicine,
16:196– 201
30. Dempsey, L. E., Karver, M. S., Labouliere, C., Zesiewicz, T. A, & Alessandro, S. (2012). Self-perceived burden as a mediator
of depression symptoms amongst individuals living with a movement disorder. Journal of Clinical Psychology, 68(10): 1149-
1160.
© 2022 JETIR November 2022, Volume 9, Issue 11 www.jetir.org (ISSN-2349-5162)
JETIR2211142
Journal of Emerging Technologies and Innovative Research (JETIR) www.jetir.org
b209
31. Pera, P. I. (2011). Living with diabetes: Quality of care and quality of life. Patient Preferred Adherence, 5: 65-72.
32. Tabatabaei M. O., Sanjari M., Peimani, M.,& Tehrani, M. (2012). Nurses‘ role in diabetic foot prevention and care:A review.
Journal of Diabetes & Metabolic Disorders, 11(1):24.
33. S J Benbow, M E Wallymahmed, I A MacFarlane, Diabetic peripheral neuropathy and quality of life., QJM: An International
Journal of Medicine, Volume 91, Issue 11, Nov 1998, Pages 733–737,
34. Vileikyte, L., Peyrot, M., Bundy, C., Rubin, R. R., Leventhal, H.,& Mora P. (2003). The development and validation of a
neuropathy- and foot ulcer-specific quality of life instrument. Diabetes Care, 26(9):2549-55.
35. Asad A, Hameed MA, Khan UA, Ahmed N, Butt MU. Reliability of the neurological scores for assessment of sensorimotor
neuropathy in type 2 diabetics. J Pak Med Assoc. 2010 Mar;60(3):166-70. PMID: 20225769.
36. Young MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH. A multicentre study of the prevalence of diabetic
peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993 Feb;36(2):150-4. doi:
10.1007/BF00400697. PMID: 8458529.
37. Zohaib Iqbal, Shazli Azmi, Rahul Yadav, Maryam Ferdousi, Mohit Kumar et al. (2018) Diabetic Peripheral Neuropathy:
Epidemiology, Diagnosis, and Pharmacotherapy, Elsevier HS Journals, Inc. Clinical Therapeutics, 2018-06-01, Volume 40, Issue
6, Pages 828-849
