제2형 당뇨병 노인에서 당뇨병성 말초신경병증과 균형장애, 낙상위험성, 우울

Abstract

This study was conducted to examine the prevalence of diabetic peripheral neuropathy in elderly patients with type 2 diabetes mellitus, to identify the relationship between diabetic peripheral neuropathy and balance impairment, risk of falls, and depression. Data were collected from 130 elderly patients with type 2 diabetes mellitus, who visited the department of endocrinology as outpatients in a university hospital located in Jeju City, from May 23 to September 11, 2017 using the structured questionnaire and the physical examination. The tools used in this study included a structured questionnaire for the subjects' general and disease related characteristics, the Michigan Neuropathy Screening Instrument questionnaire for diabetic peripheral neuropathy, the unipedal stance test for balance impairment, the simple screening test for the risk of falls, and the Geriatric Depression Scale (GDS) Short Form Korea Version for depression. The collected data were analyzed using descriptive statistics, chi-square test, and independent t-test. The following are the results of this study: 1) The age of the subjects was 71.8±4.2 years old, and the gender of the subjects was male 59.2%, female 40.8%, and those HbA1c level was 7.62±1.28%, and the duration of diabetes mellitus (DM) was 15.7±10.9 years. The number of subjects with diabetic peripheral neuropathy was 41 (31.5%) and scored 4.71±2.28 points on average in the MNSI; 26 (63.4%) of them were taking drugs for diabetic peripheral neuropathy. The number of those without diabetic peripheral neuropathy was 89 (68.5%) and scored 1.75±1.77 points on average in the MNSI; 27 (30.3%) of those without peripheral neuropathy were suspected of having diabetic peripheral neuropathy. Major diabetic peripheral neuropathy symptoms reported by the subjects were found in the following order: numbness (50.0%), nocturnal exacerbation (40.0%), burning (28.5%), prickling (28.5%), hypersensitivity (20.8%), hypoethesia (0.8%). 2) In the subjects' general and disease related characteristics, there were significant differences with diabetic peripheral neuropathy in gender (χ²=4.819, p=.028), smoking history (χ²=8.319, p=.004), exercise (χ²=6.980, p=.008), duration of DM (t=-6.333, p<.001), DM treatment (χ²=9.721, p=.008), diabetic retinopathy (χ²=19.423, p<.001), and HbA1c (t=-2.045, p=.043). 3) While there were significant differences in the existence of balance impairment depending on diabetic peripheral neuropathy (χ²=4.941, p<.028), the MNSI score did not show significant differences depending on balance impairment (t=-1.963, p=.052). 4) There were significant differences in the existence of the risk of falls depending on diabetic peripheral neuropathy (χ²=9.402, p<.002), and the MNSIscore also showed significant differences depending on the risk of falls (t=-3.555, p=.001). 5) While there were no significant differences in the existence of depression depending on diabetic peripheral neuropathy (χ²=0.044, p=.834), the MNSI score showed significant differences depending on depression (t=-2.449, p=.016), and the depression group's MNSI score was significantly higher than the non-depression group's. Based on the findings above, it would be needed to diagnose peripheral neuropathy early for elderly patients with a long duration of diabetes mellitus, assess symptoms periodically, and provide an active nursing intervention to alleviate symptoms and prevent disease from worsening. More importantly, comprehensively assessing balance impairment, the risk of falls, and depression, which are related to diabetic peripheral neuropathy, and providing a suitable intervention to prevent or ease them would improve not only diabetic elderly patient's mental and physical health but also their quality of life.