Prevalence of Diabetic Neuropathy and Foot Ulceration: Identification of Potential Risk Factors -- A Population-Based Study

Ch. Manes, MD, N. Papazoglou, MD, E. Sossidou, K. Soulis, MD, D. Milarakis, A. Satsoglou and A. Sakallerou


Wounds. 2002;14(1) 

In This Article

Abstract and Introduction

Population-based studies reflecting the true prevalence of a disease need to include a large sample size and to obtain a high response rate in order to truly represent the disease in the community. The aim of this population study was to evaluate the prevalence of peripheral diabetic neuropathy (DN), foot ulceration (FU), and the potential risk factors. Eight-hundred and twenty-one diabetic patients that included 304 men and 781 type 2 patients (80% of the known diabetic population in a county, aged 18-70 years) were studied. Mean age of the patients and known diabetes duration were 59.5 ± 7.46 and 7.6 ± 6.9 years, respectively. Neuropathy was defined clinically by a standardized examination as the presence of abnormalities of at least two of the following criteria: symptoms, sensory, and motor signs (using score techniques). Vibration perception thresholds (VPT) were estimated in all the patients. The prevalence of neuropathy was 33.5 percent (95% confidence limits 30.3-36.7%), prevalence of FU was 4.75 percent (95% confidence limits 3.3-6.2%), and prevalence of peripheral vascular disease (PVD) was 12.7 percent (95% confidence limits 10.7-14.7%). Patients with foot ulcers had more severe neuropathy (NDS 11.6 ± 5.26) and higher VPT (40 ±13.3) than those without foot ulcers (NDS 6.92 ± 2.83, VPT 30 ± 13.8) (p < 0.05). Age, height, fasting glucose, diabetes duration, but not gender were found to be significant risk factors in univariate analyses for DN. Further investigation by multiple logistic regression analysis of the above variables showed that all of them remained significant risk factors for DN (p < 0.05). DN and PVD remained risk factors for FU (p < 0.05). We concluded that a large proportion of the diabetic population are neuropathic and, therefore, at risk of foot ulceration. Strategies to reduce the risk of neuropathy should be developed and should involve all the diabetic population in both rural and urban areas.

There is substantial evidence that diabetic neuropathy (DN) leading to foot ulceration (FU) is associated with increased morbidity and increased risk of mortality. Previous estimates of the prevalence of diabetic peripheral neuropathy vary widely due to the different diagnostic criteria employed and study populations involved.[1,2]

Since a definition of DN was obtained in the San Antonio Conference[3] and a more clinical approach to the diagnosis was suggested later by the Neurodiab subcommittee of the European Association, there have been only a few population-based studies that have examined the prevalence of this disorder and foot ulceration.[3] However, such studies are important when a large population sample size is captured and a high response rate is obtained. These types of studies can give valuable information regarding the actual prevalence of the disease in the whole community. Furthermore, the studies that have been published so far have reported different prevalence rates and also different risk factors for DN and FUs.[4,5,6,7,8,9,10]

The aim of the present study was to estimate the prevalence of diabetic chronic sensorimotor neuropathy and foot ulceration in a geographically well-defined diabetic population and to evaluate the potential risk factors.


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