RISK-FACTORS FOR DIABETIC PERIPHERAL SENSORY NEUROPATHY - RESULTS OF THE SEATTLE PROSPECTIVE DIABETIC FOOT STUDY

OBJECTIVE - To identify risk factors for diabetic lower-extremity peri pheral sensory neuropathy prospectively in a cohort of U.S. veterans w ith diabetes. RESEARCH DESIGN AND METHODS - General medicine clinic ou tpatients with diabetes were followed prospectively for the developmen t of insensitivity to the 5.07 monofilament on the loot. RESULTS - Of 775 subjects, 388 (50%) had neuropathy at baseline. Of the 387 subject s without neuropathy at baseline, 288 were followed up, and of these, 58 (20%) developed neuropathy. Multivariate logistic regression modeli ng of prevalent neuropathy controlling for sex and race revealed indep endent and significant associations with age, duration of diabetes, gl ycohemoglobin level. height, history of lower-extremity ulceration, ca llus, 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, hei ght, history of ulcer, and CAGE screening instrument alcohol score; cu rrent smoking and albumin level were inversely associated with risk. C ONCLUSIONS - 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 alc ohol ingestion, Neuropathy was less common in current smokers than sub jects not currently smoking.