Risk Factors for Diabetic Peripheral Sensory Neuropathy: Results of the Seattle Prospective Diabetic Foot Study
- Amanda I Adler, MD, PHD,
- Edward J Boyko, MD, MPH,
- Jessie H Ahroni, ARNP, PHD,
- Victoria Stensel,
- Ruby C Forsberg and
- Douglas G Smith, MD
- Northwest Health Services Research and Development Program, Veterans Administration Puget Sound Health Care System Seattle, Washington
- Medical Service, Veterans Administration Puget Sound Health Care System Seattle, Washington
- Department of Medicine, University of Washington Seattle, Washington
- Department of Orthopedic Surgery, University of Washington Seattle, Washington
- Address correspondence and reprint requests to Amanda I. Adler, MD, PhD, Oxford University, Radcliffe Infirmary Diabetes Research Laboratories, Woodstock Rd., 0X2 6HE Oxford, U.K. E-mail: .
OBJECTIVE To identify risk factors for diabetic lower-extremity peripheral sensory neuropathy prospectively in a cohort of U.S. veterans with diabetes.
RESEARCH DESIGN AND METHODS General medicine clinic outpatients with diabetes were followed prospectively for the development of insensitivity to the 5.07 monofilament on the foot.
RESULTS Of 775 subjects, 388 (50%) had neuropathy at baseline. Of the 387 subjects without neuropathy at baseline, 288 were followed up, and of these, 58 (20%) developed neuropathy. Multivariate logistic regression modeling of prevalent neuropathy controlling for sex and race revealed independent and significant associations with age, duration of diabetes, glycohemoglobin level, height, history of lower-extremity ulceration, callus, and edema; an independent and inverse correlation was noted with ankle-arm index. Risk factors for incident neuropathy in multivariate logistic regression included age, baseline glycohemoglobin level, height, history of ulcer, and CAGE screening instrument alcohol score; current smoking and albumin level were inversely associated with risk.
CONCLUSIONS Poorer glycemic control increases the risk of neuropathy and is amenable to intervention. Height and age directly increase risk of neuropathy and may help identify patients at risk. A proportion of neuropathy in diabetic veterans is probably due to or worsened by alcohol ingestion. Neuropathy was less common in current smokers than subjects not currently smoking.
- Received November 21, 1996.
- Revision received March 19, 1997.
- Accepted March 19, 1997.
- Copyright © 1997 by the American Diabetes Association