Prevalence and Risk Factors for Neuropathy in a Canadian First Nation Community

Abstract

Objective To determine the prevalence of and risk factors for diabetic neuropathy in a Canadian First Nation population.

Research Design and Methods A community-based screening study of 483 adults. Measures included: glucose, A1c, cholesterol, triglycerides, homocysteine, hypertension, waist circumference, height, weight and foot examinations. Neuropathy was defined as loss of protective sensation determined through application of a 10-g monofilament.

Results Twenty-two percent of participants had a previous diagnosis of diabetes and 14% had new diabetes or IFG. Prevalence of neuropathy increased by glucose level: 5% among those with normal glucose levels; 8% among those with new IFG and diabetes; and 15% among those with established diabetes (p<.01). Those with neuropathy were more likely to have foot deformities (p<.01) and callus (p<.001) than those without neuropathy. Among those with dysglycemia (≥6.1mmol/l), the mean number of foot problems for those with insensate feet was 3 compared to 0.3 among those with sensation (p<.001). In multivariate logistic regression female gender, low education, A_1c, smoking and homocysteine were independently associated with neuropathy, controlling for age.

Conclusions Neuropathy prevalence is high given the young age of our participants (mean 40 years), and was present among the undiagnosed. The high number and type of foot problems places this population at increased risk for ulceration; the low level of foot care in the community increases the risk. Homocysteine is a risk factor that may be related to lifestyle and requires further investigation.