Warren M1, Cornwall M1
1Northern Arizona University, Department of Physical Therapy and Athletic Training, Flagstaff, United States
Background: Regular foot screening in those with diabetes is one method to prevent neuropathic foot ulcers and associated complications. Early detection of peripheral neuropathy signs in individuals with diabetes is essential for the prevention of foot ulceration and amputation. The frequency, as well as factors related to whether a healthcare professional performs a foot screening are not known.
Purpose: To explore the peripheral neuropathy risk factors that were associated with a healthcare professional checking feet in individuals with diabetes. A secondary purpose was to explore the association of walking limitation with a healthcare professional checking feet in individuals with diabetes.
Methods: The cross sectional study used data from the 2013-2016 National Health and Nutrition Examination Survey (NHANES), an annual population-based questionnaire and examination from a nationally representative sample of about 5,000 community-dwelling people in the US. The sample included NHANES data from individuals who participated in both the questionnaire and examination with a self-reported physician diagnosis of diabetes or taking medications for diabetes. The dependent variable was assessed from the question, “During the past 12 months, about how many times has a doctor or other health professional checked your feet for any sores or irritations?” This was categorized as checking feet (FT_CHK): yes (> 1 times) or no (0 times). Peripheral neuropathy risk factors in NHANES included duration of diabetes ( 3, 4-10, and 10+ years); hemoglobin A1C (AIC; normal, borderline, abnormal); smoking (never, ever, current); and high cholesterol and high blood pressure (self-report or measured), and signs of microvascular (i.e., retinopathy, kidney disease) and macrovascular (i.e., coronary heart disease, stroke) involvement (all yes or no). The risk factors were also dichotomized to normal/abnormal and summed to a risk score (0-9). Walking limitation was defined as self-reported significant walking limitation or use of a walking aide (yes or no). Other (e.g., age, body mass index) variables were also extracted. Logistic regression assessed the association between FT_CHK and risk factors, as well as walking limitations, adjusting for age and accounting for NHANES design.
Results: 4,941 individuals were included. Of these, most (76.1%) had FT_CHK in the past 12 months. On average, the individuals were (mean ± standard error) 61.7 ± 0.4 years old and 65.1% obese (BMI > 30 kg/m2). Age-adjusted odds ratio (AOR) were significant for FT_CHK with the following peripheral neuropathy risk factors: AIC (abnormal vs. normal AOR=2.7, 95% confidence interval [CI]:1.2-5.5), retinopathy (AOR=2.8, 95%CI:1.1-7.0), and kidney disease AOR=2.4, 95%CI:1.04-5.4). Individuals had 4.1 ± 0.1 risk factors. The score was significantly associated with FT_CHK (AOR=1.4, 95%CI:1.1-1.8); for every additional risk factor, there was 40% higher odds of FT_CHK. There was no association between walking limitation and FT_CHK (p=0.22).
Conclusion(s): Individuals with an abnormal A1C, or signs and symptoms of retinopathy and kidney disease in addition to a diagnosis of diabetes had higher odds of FT_CHK for sores or irritations.
Implications: The results of this study indicate that healthcare professionals in the US are performing foot screenings to individuals with significant risk factors for the development of a peripheral neuropathy and possible consequences.
Keywords: Peripheral neuropathy, function, neuropathic ulcers
Funding acknowledgements: Work was unfunded
Purpose: To explore the peripheral neuropathy risk factors that were associated with a healthcare professional checking feet in individuals with diabetes. A secondary purpose was to explore the association of walking limitation with a healthcare professional checking feet in individuals with diabetes.
Methods: The cross sectional study used data from the 2013-2016 National Health and Nutrition Examination Survey (NHANES), an annual population-based questionnaire and examination from a nationally representative sample of about 5,000 community-dwelling people in the US. The sample included NHANES data from individuals who participated in both the questionnaire and examination with a self-reported physician diagnosis of diabetes or taking medications for diabetes. The dependent variable was assessed from the question, “During the past 12 months, about how many times has a doctor or other health professional checked your feet for any sores or irritations?” This was categorized as checking feet (FT_CHK): yes (> 1 times) or no (0 times). Peripheral neuropathy risk factors in NHANES included duration of diabetes ( 3, 4-10, and 10+ years); hemoglobin A1C (AIC; normal, borderline, abnormal); smoking (never, ever, current); and high cholesterol and high blood pressure (self-report or measured), and signs of microvascular (i.e., retinopathy, kidney disease) and macrovascular (i.e., coronary heart disease, stroke) involvement (all yes or no). The risk factors were also dichotomized to normal/abnormal and summed to a risk score (0-9). Walking limitation was defined as self-reported significant walking limitation or use of a walking aide (yes or no). Other (e.g., age, body mass index) variables were also extracted. Logistic regression assessed the association between FT_CHK and risk factors, as well as walking limitations, adjusting for age and accounting for NHANES design.
Results: 4,941 individuals were included. Of these, most (76.1%) had FT_CHK in the past 12 months. On average, the individuals were (mean ± standard error) 61.7 ± 0.4 years old and 65.1% obese (BMI > 30 kg/m2). Age-adjusted odds ratio (AOR) were significant for FT_CHK with the following peripheral neuropathy risk factors: AIC (abnormal vs. normal AOR=2.7, 95% confidence interval [CI]:1.2-5.5), retinopathy (AOR=2.8, 95%CI:1.1-7.0), and kidney disease AOR=2.4, 95%CI:1.04-5.4). Individuals had 4.1 ± 0.1 risk factors. The score was significantly associated with FT_CHK (AOR=1.4, 95%CI:1.1-1.8); for every additional risk factor, there was 40% higher odds of FT_CHK. There was no association between walking limitation and FT_CHK (p=0.22).
Conclusion(s): Individuals with an abnormal A1C, or signs and symptoms of retinopathy and kidney disease in addition to a diagnosis of diabetes had higher odds of FT_CHK for sores or irritations.
Implications: The results of this study indicate that healthcare professionals in the US are performing foot screenings to individuals with significant risk factors for the development of a peripheral neuropathy and possible consequences.
Keywords: Peripheral neuropathy, function, neuropathic ulcers
Funding acknowledgements: Work was unfunded
Topic: Health promotion & wellbeing/healthy ageing; Health promotion & wellbeing/healthy ageing; Older people
Ethics approval required: No
Institution: Northern Arizona University
Ethics committee: Institutional Review Board
Reason not required: IRB determined it was not human subjects research since it was secondary data analysis of de-identified, publicaly available data,
All authors, affiliations and abstracts have been published as submitted.
