Transcript Research presentation Group 6

Research presentation
Group 6
STUDY OF RELATION
BETWEEN DIABETIC FOOT SYMPTOMS
AND DIABETIC NEUROPATHY
Research members
Mr. Sonam
Dorji
Mr. Thanasit Prakobphon
Student ID no. 50461274
Student ID no. 51460834
Mrs. Ruchjirin Wongkhamlue Student ID no. 51461022
Research advisers
Dr. Rawisut Deoisares
Dr. Suwit
(Content Expert)
Lertkajornsin (Methodology Expert)
Rationale of the study
 Diabetes mellitus is a non communicable chronic illness with
its prevalence increasing at an alarming rate in Thailand. The
prevalence of DM in Thai population increased from 4.4 in
year 1997 to 6.9 in 2009.
 According to Thai DM association the incidence and rate (per
100000 population) of DM for year 2008 and 2009 were 5200,
2672.12 and 5677, 2916.37 respectively. The prevalence of
complication due to DM was 14.3% or 746 people.
Rationale of the study
 Diabetic neuropathy is the most common complication found
in DM type 2 patients. its prevalence of 23% leading poor
quality of life for DM patients by its symptom and other
related complication due to neuropathy like wounds,
infection and amputation of leg. Diabetic neuropathy is also
second leading cause of leg amputation.
Rationale of the study
 According to Thai clinical practice guideline for DM 2011, DM
patients should go through complete foot examination each
year to assess risk of neuropathy to prevent DM foot ulcer
and further complication, but due increasing number of DM
patients and limitations in time.
Rationale of the study
 The screening processes are limited to patient’s symptoms of
neuropathy like “presence of numbness of feet”. There is also
a knowledge gap about the reliability about using patient’s
symptoms for screening of diabetic neuropathy.
 Almost question that asked about the symptom such as “ Do
you have feeling at finger tip and feet tip ? ” but now no
research support or guarantee for diagnosis that use symptom
shown are reliability or correctly and suitable for diagnosis
enough.
Purpose of the study
1. To study the relationship between the sign and symptoms*of
peripheral numbness in Type2 diabetic patient and diabetic
neuropathy.
2. To study about the factors causing to diabetic neuropathy in
Type2 diabetic patient such as sex, BMI, duration, associate
disease, drinking , smoking and glucose level control.
(sign and symptoms* including numbness, decrease level
of consciousness, burning pain or electric shock feeling)
Research question
Primary research question
 Can patient’s symptom be used for screening of diabetic
neuropathy ?
Secondary research question
 Other factor such as Age, Sex , Onset and duration, BMI,
Smoking , Drinking , Co-morbidity, Blood sugar control have
effect for diabetic neuropathy ?
(sign and symptoms* including numbness, decrease level of
consciousness, burning pain or electric shock feeling)
Research Questions
P (Patient or Problem)
Type2 diabetic patient who came for the screening test at Thaphoe
primary care unit, diabetic clinic at Naresuan university hospital and
Medical ward at Naresuan university hospital.
I (Intervention or Exposure)
Symptom of diabetic neuropathy
C (Comparison intervention)
Patients who have and don’t have symptoms of diabetic neuropathy
O (Outcome)
Result from screening Diabetic neuropathy at feet by monofilament
Methodology
Study design
 Cross sectional study
Samples
Inclusion criteria :
 DM type 2 patients who came for screening of Diabetic
neuropathy at Thaphoe PCU on 24 November 2011
 DM type 2 patients who agreed for screening of Diabetic
neuropathy in IPD at Naresuan university hospital on 24
November 2011
 DM type 2 patients who came for screening of Diabetic
neuropathy in OPD at Naresuan university hospital on 28
November 2011
Methodology
samples
Exclusion criteria :
 Neuropathy due to other causes
 Foot ulcer, edema, hypothermia
 Limb amputation due to diabetes mellitus
 Neuromuscular deficit and other complication
 Skin and soft tissue infection
 Patient with psychiatric problem
Methodology
Setting of research
 Diabetic clinic at Naresuan university hospital
 OPD medicine Naresuan university hospital
 PCU Thaphoe
Sources of information’s

History taking of patients.
 10 g monofilament examination of patients
 OPD files of patients.
Methodology
Tools of research
 Questionnaire about general health and risk factors of
diabetic neuropathy
 10 g monofilament
 Program STATA, SPSS, EXCEL
Methodology
Research process (in order)
 Contemplate research topic and seek advice from counseling
teacher .
 Review articles related to the research topic.
 Presentation of research topic to the research teachers.
 Develop of research model.
 Presentation of research model .
Methodology
Research process (in order)
 Planning and testing of research.
 studying proper handling of 10 g monofilament and the
testing it with real patients. The test was carried out on 4
patients in medical ward at Naresuan hospital
 contracting officials in Naresuan university hospital for
facilitating patients and places for research.
Methodology
Research process (in order)
 contacting medical personals at Thaphoe PCU for
appointment with patients coming for diabetic neuropathy
screening.
 Introduction, explanation about our research, signing of
agreement for research.
 Asking patient risk factors for diabetic neuropathy
 10 g monofilament examination of patients feet.
Research timeline
Analyzing of data and statistics
 Sensitivity
 Specificity
 Positive predictive value
 Negative predictive value
 Chi-square test and Fisher’s Exact Test
 Odd Ratio
The ethics review
 confidentiality of patients information was maintained by
without using true name and keeping information within the
research members.
 patients were informed of the confidentiality measures before
signing the research agreement’s.
 patient don’t have financial benefit from this research but
have the benefit of free screening of Diabetic neuropathy
with 10 g monofilament. Monofilament examination
procedure doesn’t have any risk and is not painful to the
patient
Research result
Table1. Characteristics of the type 2 diabetic patients (n=106)
Research result
Table1. Characteristics of the type 2 diabetic patients (n=106)
Research result
Primary research question
 Patient symptoms can be used for screening of Diabetic
neuropathy or not ?
Research result
 Sensitivity, Specificity
 Positive & Negative predictive value
Research result
Table 4. Univariate logistic regression
Research result
Table 5. Multivariate logistic regression
Limitation and suggestion
1. we should have sample that follow by calculation
formulas.
2. If possible, you should used the better standard test
procedure for more accuracy result.
3. The test should be done in diversity people because this
thesis was done in the hospital only and patient should
be take care of themselves, so the information we got
may be not match with fact.
Limitation and suggestion
4. We should used blood sugar control procedure and kept
FBS/HbA1C then compare in each person for different
result or not by 10g-monofilament
5. You should add special characteristic belong to each
person in quiz. To let us know what clinical that effect
with 10 g monofilament test and got result in positive
6. You should kept more information that relate with
onset of clinical then compare to the duration from
onset to the testing time was done.
References
1. Kärvestedt, L., E. Mårtensson, et al. (2010). "The prevalence of peripheral
neuropathy in a population-based study of patients with type 2 diabetes in
Sweden." Journal of Diabetes and its Complications 25(2): 97-106.
2. Franse, L. V., G. D. Valk, et al. (2000). "‘Numbness of the feet’ is a poor
indicator for polyneuropathy in Type 2 diabetic patients." Diabetic Medicine
17(2): 105-110.
3. Mueller, M. J. (January 1996 ). "Identifying Patients With Diabetes Mellitus
Who Are at Risk for Lower-Extremity Complications: Use of SemmesWeinstein Monofilaments".
4. Valk, G. D., J. J. J. de Sonnaville, et al. (1997). "The assessment of diabetic
polyneuropathy in daily clinical practice: Reproducibility and validity of
Semmes Weinstein monofilaments examination and clinical neurological
examination." Muscle & Nerve 20(1): 116-118.
References
5. Bruce A. Perkins, F., David Olaleye, PHD, Bernard Zinman, FRCPC and Vera
Bril, FRCPC (February 2001 ). "Simple Screening Tests for Peripheral
Neuropathy in the Diabetes Clinic "
6. Rahman, M., S. J. Griffin, et al. (2003). "How should peripheral neuropathy
be assessed in people with diabetes in primary care? A population-based
comparison of four measures." Diabetic Medicine 20(5): 368-374.
7. Nather, A., S. H. Neo, et al. (2008). "Assessment of sensory neuropathy in
diabetic patients without diabetic foot problems." Journal of Diabetes and its
Complications 22(2): 126-131.
8. M Mafauzy, F., Z Hussein, MRCP**, S P Chan, FRCP*** (2008). "The Status
of Diabetes Control in Malaysia: Results of Diabetic Care ".
9. Appropriate body-mass index for Asian populations and its implications for
policy and intervention strategies. Lancet 2004; 363:157-63
References
10. Boulton, A. J. M. (2010). "Chapter 4 Diagnosis of diabetic peripheral
neuropathy-clinical practice and research".
11. American Diabetes Association (2011)
12. สำนักนโยบำยและยุทธศำสตร์ กระทรวงสำธำรณสุข (2552). "รำยงำนผู้ป่วยใน(รง 505)."
13. สมำคมโรคเบำหวำนแห่งประเทศไทยในพระรำชูปถัมภ์สมเด็จพระเทพพระรัตนรำชสุดำฯสยำม
บรมรำชกุมำรี (2554). "แนวทำงเวชปฏิบตั ิสำหรับโรคเบำหวำน "