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 Table of Contents  
LETTER TO EDITOR
Year : 2017  |  Volume : 1  |  Issue : 3  |  Page : 83-84

Managing painful diabetic neuropathy in Libya: An updated profile of benghazi diabetes centre


1 Centre for Pain Research, Leeds, UK; Department of Physiology, Faculty of Medicine, University of Benghazi, Benghazi, Libya; MENA Research Group, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
2 Centre for Pain Research; MENA Research Group, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK

Date of Web Publication26-Dec-2017

Correspondence Address:
Sabri Garoushi
Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, City Campus, LS1 3HE, Leeds

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_31_17

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How to cite this article:
Garoushi S, Johnson MI, Tashani OA. Managing painful diabetic neuropathy in Libya: An updated profile of benghazi diabetes centre. Libyan J Med Sci 2017;1:83-4

How to cite this URL:
Garoushi S, Johnson MI, Tashani OA. Managing painful diabetic neuropathy in Libya: An updated profile of benghazi diabetes centre. Libyan J Med Sci [serial online] 2017 [cited 2021 May 10];1:83-4. Available from: https://www.ljmsonline.com/text.asp?2017/1/3/83/221498



Diabetes mellitus is one of the most common diseases worldwide according to the World Health Organization (WHO). The WHO estimated that 422 million people worldwide have diabetes, leading to approximately 1.5 million deaths per year.[1] Expectedly, more than 80% of diabetic deaths occur in low- and middle-income countries. More worryingly, it is predicted that diabetic death will double by 2030.

According to the International Federation of Diabetes, the number of people with diabetes in Libya in 2015 is 354,000.[2] This projection highlights the seriousness of undertaking the necessary preventive measures and improving the management of the disease in Libya to lessen the burden of diabetes and its complications in this country whose population is nearly 6 million.[3]

Diabetes is one of the diseases known to have many complications which may lead to disability and death; these complications include severe hypoglycemia, diabetic ketoacidosis, hyperosmolar nonketotic coma, microvascular and macrovascular complications. The most common complications of diabetes among Libyans are neuropathies (45.7%).[4],[5] Not all neuropathies will lead to neuropathic pain, but there is evidence that neuropathic pain is very prevalent among diabetic patients.[5]

As a part of a research program on the prevalence and assessment of painful diabetic neuropathy (PDN) in Libya, the principal investigator (SG) went to Benghazi Diabetes Centre (BDC) to validate the Arabic version of neuropathic pain screening tool. The purpose of this letter is to give an updated profile about BDC and discuss challenges and opportunities in managing PDN in Libya.

BDC, which is the main center in Eastern Libya, deals in an outpatients' clinic format with diabetics. The center was historically established as the largest diabetes registry in Libya in 1969.[5] However, about a decade ago, a study found that there were shortcomings in the care provided in this center including a large number of patients were not checked for complications of diabetes.[6]

Nowadays, at the time of civil war in the city, BDC is still working with full capacity. The center is very busy throughout the week (Saturday–Thursday), closing only on Fridays. The center has been operational for 48 years. The center divided the follow-up days into two categories: Saturday, Monday, and Wednesday for women only and Sunday, Tuesday, and Thursday for men only. This was probably implemented because of cultural and religious sensitivities in this Muslim country where segregation between the sexes is the norm in most cases. The number of patients seen every day is between 300 and 500. The average number of health-care professionals is 25 with 5 main physicians to follow up the patients. The main services delivered are reviewing patients' medication and checking fasting blood glucose level on the day of the visit. In addition, doctors usually check for any possible complications of diabetes and refer patients for further follow-up by specialists. There are follow up clinics in BDC for Eye care, dietitian, Dental care and endocrine clinic but not diabetic neuropathy whether painful or not apart from a limited provision on Foot care to prevent developing a gangrenous foot. This is very distressing to both doctors and patients in the case of PDN as patients with pain have neither an effective pain relief treatment prescribed or assessed nor a specialized pain service to be referred to.

Knowledge of health professionals in BDC about pain, and specifically neuropathic pain management, has to be consolidated through Continuous Professional Development program as most physicians in the clinic struggle to manage acute or chronic cases of pain. Unexpectedly, patients were not very oriented or even concerned about PDN despite the fact that it is a very common complication of diabetes, can affect up to 30% of the patients,[5] and is the most common cause of neuropathic pain.[7] A closer observation of patients during the principal investigator's 3 weeks of data collection in BDC revealed that patients, generally, were more concerned about retinopathy and male patients frequently raised the issue of erectile dysfunction. Male patients with erectile dysfunction cannot ask their treating physician about any help with such complication as the majority of physicians are female and this issue is very sensitive culturally.

All of these observations give a clear idea about the unresolved issue of pain management of diabetic patients as no guidelines or protocols are developed in BDC to deal with PDN.

The authors highly recommend that the issue of acute and chronic pain needs to be prioritized by the health authorities in Libya. As an essential part of pain management, development of screening tool such as Leeds Assessment of Neuropathic Pain Symptoms and Signs or a similar tool will help to screen and assess PDN. In conclusion, the BDC health professionals are doing a great job and have to be commended and supported, but further efforts are urgently needed to tackle the undiagnosed or undertreated common complications.

Financial support and sponsorship

The first author is funded by the State of Libya.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Global Status Report on Non-Communicable Diseases 2017. Geneva: World Health Organization; 2017.  Back to cited text no. 1
    
2.
IDF, I. D. F. Diabetes in Libya; 2017. Available from: http://www.idf.org/membership/mena/libya. [Last accessed on 2017 Feb 20].  Back to cited text no. 2
    
3.
Bank TW. 2015; Available from: http://www.worldbank.org/en/region/mena. [Last accessed on 2017 Aug 01].  Back to cited text no. 3
    
4.
Kadiki OA, Roaed RB. Epidemiological and clinical patterns of diabetes mellitus in Benghazi, Libyan Arab Jamahiriya. East Mediterr Health J 1999;5:6-13.  Back to cited text no. 4
[PUBMED]    
5.
Roaeid R, Kadiki O. Prevalence of long-term complications among Type 2 diabetic patients in Benghazi, Libya. J Diabetol 2011;3:1-8.  Back to cited text no. 5
    
6.
Aslam A, Singh J, Rajbhandari S. Pathogenesis of painful diabetic neuropathy. Pain Res Treat 2014;2014:412041.  Back to cited text no. 6
[PUBMED]    
7.
Roaeid RB, Kablan AA. Profile of diabetes health care at Benghazi Diabetes Centre, Libyan Arab Jamahiriya. East Mediterr Health J 2007;13:168-76.  Back to cited text no. 7
[PUBMED]    



This article has been cited by
1 A cross-sectional study to estimate the point prevalence of painful diabetic neuropathy in Eastern Libya
Sabri Garoushi,Mark I. Johnson,Osama A. Tashani
BMC Public Health. 2019; 19(1)
[Pubmed] | [DOI]



 

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