- Do you feel numbness, pain, tingling or pins and needles in your hands and feet?
- 8 out of 10 patients with Peripheral Neuropathy don’t listen to what their nerves are telling them and go undiagnosed leading to worsening of symptoms.
- Don’t be one of them!
As part of World Diabetes Day 2024, P&G Health, makers of Neurobion brought together renowned health experts from Philippines, Indonesia and Malaysia for deliberations on the latest research findings on diagnoses and treatment of Peripheral Neuropathy (PN) in Diabetes and Pre-Diabetes. With 1 in 2 diabetics and 1 in 10 Pre-diabetics suffering from PN & its painful symptoms, and an estimated 8 out of 10 patients remaining undiagnosed, Health Experts highlighted the urgent importance of raising awareness of Peripheral Neuropathy among both the general population, doctors, and pharmacists.
FAST FACTS
1. In 2021, ~ 537 million people were diabetic .
-
- ~19.5 million from Indonesia, making it one of the top 10 countries for adults with diabetes.
- ~4.3 Million Filipinos, ~4.4 Million Malaysians, ~6 Million Thai and ~700,000 Singaporeans.
2. 1 in 2 Diabetics and 1 in 10 Pre-diabetics estimated to suffer from PN.
3. Up to 80% remain undiagnosed and untreated, with the ratio being similar across different countries.
-
- In a study conducted in Malaysia (425 diabetics), 99.8% were undiagnosed for Diabetic Peripheral Neuropathy.
4. Diabetic Peripheral Neuropathy causes pain and patients reported that their pain had a greater impact on sleep, anxiety, depression, ability to perform exercise, and ability to carry out work than did the physicians.
5. Early diagnosis and timely treatment prevent Diabetic Peripheral Neuropathy progression or symptom relapse.
6. By 2045, at least 441 million people will be pre-diabetic, making them especially at risk of Peripheral Neuropathy. This would mean an additional 122 million patients from 2021 onwards.
Have you ever heard of Peripheral Neuropathy?
Millions of people who suffer from this disease are unaware and remain undiagnosed and untreated for years, suffering in silence. Peripheral neuropathy caused by nerve damage is one of the most common diseases of the peripheral nervous system which controls all functions of our body, sensation in our hands and movements of our muscles. Symptoms include numbness, tingling, prickling, and stabbing or burning pain, mostly in the feet and hands.
With Diabetes Mellitus Type 2 being the leading cause of PN, its increasing prevalence is closely linked to the rise in the number of diabetics. According to Dr. Bien Matawaran (Consultant – Endocrinology, Diabetes, and Metabolism, UST Hospital & Past President – Philippine College of Endocrinology, Diabetes, and Metabolism), “Diabetic PN is seen in a very high proportion of patients with diabetes in Southeast Asia; in some countries up to almost 60%. A study from the Philippines in 2000 from the Diabcare-Asia project, which assessed 2,708 patients in diabetes centers, reported a prevalence of 42% for diabetic neuropathy, based on medical records. Often people are not even aware that they are at risk, as risk factors are not obvious, therefore it’s critical to watch out for symptoms and do an early check.”
Who is at Risk?
B vitamin deficiency and polymedication are other high-risk factors along with diabetes, leading to peripheral nerve damage. People particularly at risk of PN include diabetic patients, obese persons, chemotherapy or surgery patients, elderly, heavy drinkers, people with nutritional deficiencies, and smokers, but the disease can also affect younger and supposedly healthy people without any obvious reason.
8 out of 10 patients remain undiagnosed. Don’t be one of them.
According to Dr. Rizaldy Pinzon (Neurologist at Neurology Department, Bethesda Hospital, Yogyakarta – Indonesia), “Many people affected by the disease are not aware that their symptoms are due to PN because the disease often develops slowly, starting with mild symptoms, almost silently over long periods of time. At some point symptoms become more severe, bothersome and will affect various aspect of patient’s lives. Suddenly, patients start losing mobility, have difficulties walking stairs or driving, struggle while executing simple day to day activities such as cooking, have difficulties sleeping, have injuries in their feet which they did not notice – all due to the progressing nerve damage.”
Speaking on the barriers on the way to early diagnosis, Dr. Francis Pasaporte (Consultant – Diabetology at Iloilo Provincial Hospital and Past President, Diabetes Philippines) stated, “Barriers among patients and the community include lack of awareness of PN and risk factors, not noticing early signs, not seeing a doctor timely, and difficulties verbalizing the symptoms. Physicians on the other hand often struggle with crowded clinics and limited time, lack of awareness and routine to diagnose PN.
The disease is therefore often only recognized and diagnosed in a late stage when nerve damage — that could have been avoided earlier — has already progressed. When more than 50% of the nerve fibres are damaged, a ‘point of no return’ occurs after which nerve regeneration is no longer possible.”
NEW Neurometer Pro by P&G Health- a simple digital self-screening tool for patients
Many people are not aware that early diagnosis can help enable better treatment outcomes and better quality of life, and damaged nerves can be regenerated if nerve damage has not progressed too far. Early diagnosis and timely treatment prevent DPN progression or symptom relapse.
Aditya Gupta, Senior Marketing Director – Asia Pacific, P&G Health, shared “To address the need of a simple tool that can facilitate early diagnosis, P&G Health has launched NEW Neurometer Pro, a digital patient self-screening questionnaire with just five questions that assess the patient’s risk for nerve damage. Created by PN experts from 10 countries and multiple specialties, the NEW Neurometer Pro reduces screening time for physicians and empowers patients to act early to avoid long-term complications of PN. The tool is freely available for use for communities in the Philippines, Indonesia, and Malaysia to aid timely diagnosis of PN and improve patient care.”
Treatment with Neurotropic B Vitamins effective in overall relief from PN Symptoms
PN is associated with poor functional mobility and compromised motor symptoms, in addition to sensory symptoms. These symptoms significantly worsen the quality of life of patients. The 2023 NENOIN study findings had concluded that the synergistic combination of Neurotrophic B vitamins (B1, B6, and B12) can not only relieve symptoms but also significantly improve nerve function in patients measured via ankle and knee reflexes, muscle strength, and sensory perception in toes and fingers of patients with PN.
Unveiling NEW findings of a sub-group analysis of the NENOIN Clinical Study, Dr. Rizaldy Pinzon (Neurologist at Neurology Department, Bethesda Hospital, Yogyakarta – Indonesia) shared, “New sub-group analysis findings conclude that treatment with a fixed dose combination of neurotropic B vitamins (B1, B6 and B12) was effective in relieving multiple symptoms of Peripheral Neuropathy. Over 50% – 80% improvement was observed across symptoms such as stabbing pain, burning pain, paresthesia and numbness, and significantly improved quality of life of consumers with mild to moderate Peripheral Neuropathy.”
From Fear to Hope
Sharing his personal experience, Dr. Kenny P Merin (Pharmacist, & Assistant Vice President, Academics & Research of Lyceum of the Philippines University Davao) shared, “Other than knowledge about the condition, it is important for people to understand the consequences of PN in relation to reduced quality of life and increased risk of foot ulcers to encourage early self-referral 13. Painful diabetic PN is significantly associated with disruptions in employment status and work productivity. Of working patients, 59% reported being less productive at work 14. I am happy to see the consumer education efforts made by Companies such as P&G Health helping to change the dialogue from one of fear to one of empathy. By helping people understand signs and symptoms in a relatable manner, and the role of early diagnoses and timely treatment, we can empower them to take proactive steps towards seeking treatment and improving their quality of life.”
Collaborative Efforts needed to enhance management and improve outcomes
In conclusion, health experts highlighted the need for increased collaboration between healthcare professionals, early referral to specialists and stepping up on patient education.
- People & caregivers need to be vigilant on signs and symptoms and listen to what their nerves are telling them
- If suffering from symptoms such as tingling, numbness, they should discuss these with their healthcare providers, and utilize self-screening tools such as the NEW Neurometer Pro
- Primary care physicians can play a pivotal role in recognizing Diabetic PN by asking the right questions to patients and undertaking simple diagnostic testing to enable pain relief and prevention of foot ulceration and amputation.
- As some patients might have difficulties in describing their symptoms properly, proactive probing by healthcare practitioners for characteristics of PN such as numbness, pins and needles and tingling sensation, lancinating, stabbing or electric shock like pain can be a good starting point.
- Pharmacists are often the first point of contact and can drive early condition awareness, guide on lifestyle modifications, and help optimize medication regimens. Pharmacists can also recommend over-the-counter treatments (e.g., therapeutic dose of Neurotropic B vitamins) for PN symptom relief.