Prevalence of peripheral neuropathy, diabetic foot and level of glycemic control in refugees and migrants residing in Greece

Introduction

Data regarding access to diabetic neuropathy (DN) and diabetic foot (DF) examination, as well as the prevalence of these conditions in refugees and migrants (R&M) with diabetes mellitus (DM) residing in European countries are currently lacking. The study’s primary objective was the estimation of DN and DF prevalence among diabetic R&M residing in Greece. Associations between DN diagnosis, demographic characteristics, glycemic control (HbA1c value), housing status and level of access to the National Healthcare System (ESY) were secondarily explored.

Materials and methods

R&M with DM were screened for DN/DF at the Doctors of the World’s central polyclinic in Athens. For DN diagnosis, calculation of the Neuropathy Disability and Neuropathy Symptoms scores for each patient was followed by examination with 10 g Semmes-Weinstein monofilament. Demographic characteristics were also collected. Logistic regression was used for DN correlation with various variables. For HbA1c value association with the variables “Social Security Number (AMKA) possession” (representing access to ESY) and "unstable housing", Shapiro-Wilk regularity and Mann-Whitney tests were used. P < 0.05 was selected as the cutoff for statistical significance.

Results

From 67 patients examined, 47.8 % (n = 32) and 7.5 % (n = 5) were diagnosed with DN and DF respectively, while none had been previously screened for DN in Greece. In the single-factor analysis, age, years of diabetes and AMKA were significantly associated with DN. In the multivariate analysis, only age remained statistically significant. A statistically significant decrease in HbA1c values was observed in AMKA holders. Lower HbA1c values were observed in those with stable housing, but the association was not statistically significant.

Conclusion

A significant percentage of our study participants were diagnosed with DN and DF. Significantly lower HbA1c values were observed in patients with AMKA, thus underlining the importance of improving access to healthcare services for marginalized populations in Greece.