Improving Diabetic Neuropathy Screening in Primary Health Care: a proposal (Atena Editora)

Abstract

The early detection of diabetes mellitus (DM) and its complications are real challenges for public health. In a hierarchically organized public system such as the SUS (primary, secondary and tertiary levels), Primary Care (PHC) is the entrance to the health system. Therefore, it becomes fundamental that the screening of DM and its complications be effective, in order to avoid functional losses and early retirements. One of the most fearsome complications of DM is diabetic neuropathy (DN), a highly prevalent condition responsible for approximately 70% of cases of non-traumatic amputation. Thus, screening for DN can reduce the personal, family and social impacts of this chronic condition. Objective: to develop a simple and easy-to-apply screening test for early detection of DN by PHC nurses. Method: Cross-sectional study in which 269 medical records of diabetic patients treated at Centro Hiperdia/ Juiz de Fora - MG were evaluated. Demographic, clinical and neurological data of the population assessed from 2010 to 2014 were tabulated.Results: Sixty-two percent of diabetics were female; the mean age was 58.7 years and the mean BMI was 30.6; the mean time since DM diagnosis was 11.5 years and glycated hemoglobin (HbA1c) was equal to 9.1%. Foot burning (64.9%), paresthesia (83.8%), numbness (73%) and neuropathic pain (54.1%) were the most prevalent symptoms. Symptoms were poor predictors for the diagnosis of probable DN. On the other hand, changes in thermal and pain sensitivity and the absence of the Achilles reflex were the abnormalities most frequently related to the presence of diabetic neuropathy.