Peripheral neuropathy significantly increases the risk of persistent lower extremity ulcers in individuals with diabetes in the United States: a cross-sectional study based on National Health and Nutrition Examination Survey data

Background Lower extremity ulcers are a major health concern in the diabetic population as they can result in chronic wounds, infection, and amputation. Previous studies have shown that one of the major consequences of peripheral neuropathy (PN) is an increased risk of lower extremity ulcers, which can lead to significant morbidity and mortality in individuals with diabetes. However, the specific role of PN in increasing the risk of persistent lower extremity ulcers (PLEU) in this population has not been well elucidated. We aimed to examine and establish a connection between PN and PLEU in individuals with diabetes in the United States. Methods A cross-sectional study was conducted using the National Health and Nutrition Examination Survey data from 1999 to 2004 for participants aged ≥40 years with a diagnosis of diabetes. PLEU was defined based on questionnaires assessing the presence of non-healing ulcers in the lower extremities for >4 weeks in patients with diabetes. PN was defined as numbness, loss of sensation, painful sensations, tingling in one’s feet in the last 3 months or ≥1 area of no sensation based on monofilament testing. Logistic regression analysis was performed to assess the relationship between PN and PLEU. Results In total, 1,671 participants were included (1,018 and 653 participants with and without PN, respectively). The overall prevalence of PLEU was 9% (151/1,671), whereas it was 12.5% (127/1,018) and 3.7% (24/653) in PN and non-PN participants, respectively. We found that PN was associated with a 274% greater incidence of PLEU (odds ratio [OR]=3.74, 95% confidence interval [CI]=2.39–5.85, p<0.001) compared with participants without PN. After adjusting for potential confounders, PN was associated with a 209% higher incidence of PLEU (OR=3.09, 95% CI=1.95–4.92, p<0.001) compared with participants without PN. The results remained stable based on our subgroup analyses and propensity score matching. Conclusion PN is significantly associated with PLEU in patients with diabetes in the United States.