Research presentation Group 6

1
Research presentationGroup 6

• STUDY OF RELATION
• BETWEEN DIABETIC FOOT SYMPTOMS AND DIABETIC
  NEUROPATHY

2

• Research members
• Mr. Sonam Dorji Student ID no. 50461274
• Mr. Thanasit Prakobphon Student ID no. 51460834
• Mrs. Ruchjirin Wongkhamlue Student ID no.
  51461022
• Research advisers
• Dr. Rawisut Deoisares (Content Expert)
• Dr. Suwit Lertkajornsin (Methodology Expert)

3
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.

4
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.

5
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.

6
Rationale of the study

• The screening processes are limited to patients
  symptoms of neuropathy like presence of numbness
  of feet. There is also a knowledge gap about the
  reliability about using patients 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.

7
Purpose of the study

• 1. To study the relationship between the sign
  and symptomsof peripheral numbness in Type2
  diabetic patient and diabetic neuropathy.
• 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)

8
Research question

• Primary research question
• Can patients 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)

9
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 dont have symptoms of
  diabetic neuropathy
• O (Outcome)
• Result from screening Diabetic neuropathy at
  feet by monofilament

10
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

11
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

12
Methodology

• Setting of research
• Diabetic clinic at Naresuan university hospital
• OPD medicine Naresuan university hospital
• PCU Thaphoe
• Sources of informations
• History taking of patients.
• 10 g monofilament examination of patients
• OPD files of patients.

13
Methodology

• Tools of research
• Questionnaire about general health and risk
  factors of diabetic neuropathy
• 10 g monofilament
• Program STATA, SPSS, EXCEL

14
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 .

15
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.

16
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.

17
Research timeline
18
Analyzing of data and statistics

• Sensitivity
• Specificity
• Positive predictive value
• Negative predictive value
• Chi-square test and Fishers Exact Test
• Odd Ratio

19
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
  agreements.
• patient dont have financial benefit from this
  research but have the benefit of free screening
  of Diabetic neuropathy with 10 g monofilament.
  Monofilament examination procedure doesnt have
  any risk and is not painful to the patient

20
Research result

• Table1. Characteristics of the type 2 diabetic
  patients (n106)

21
Research result

• Table1. Characteristics of the type 2 diabetic
  patients (n106)

22
Research result

• Primary research question
• Patient symptoms can be used for screening of
  Diabetic neuropathy or not ?

23
Research result

• Sensitivity, Specificity
• Positive Negative predictive value

24
Research result

• Table 4. Univariate logistic regression

25
(No Transcript)
26
Research result

• Table 5. Multivariate logistic regression

27
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.

28
Limitation and suggestion

• We should used blood sugar control procedure and
  kept FBS/HbA1C then compare in each person for
  different result or not by 10g-monofilament
• 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
• You should kept more information that relate with
  onset of clinical then compare to the duration
  from onset to the testing time was done.

29
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
  Semmes-Weinstein 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.

30
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 363157-63

31
References

• 10. Boulton, A. J. M. (2010). "Chapter 4
  Diagnosis of diabetic peripheral
  neuropathy-clinical practice and research".
• 11. American Diabetes Association (2011)
• 12. ????????????????????????????????????????
  (2552). "???????????????(?? 505)."
• 13. ??????????????????????????????????????????????
  ???????????????????????????????????????? (2554).
  "???????????????????????????????? "