Brief reportPrevalence of lower extremity diseases associated with normal glucose levels, impaired fasting glucose, and diabetes among U.S. adults aged 40 or older☆
Introduction
Peripheral arterial disease (PAD) and peripheral neuropathy (PN) are disabling lower extremity disease (LED) complications of diabetes that can lead to non-healing ulcers and amputation [1], [2], [3]. However, both conditions can occur before the diagnosis of diabetes [4], [5], [6], [7], [8], [9] and the degree to which this occurs has implications for how aggressively diabetes and LED screening should be conducted to initiate care to prevent serious complications [10], [11], [12]. We previously reported the prevalence of lower extremity disease in the U.S. population, showing that PAD and PN were each about twice as common among the diabetic population as the non-diabetic population [13]. However, we lacked data to examine the degree to which intermediate steps toward the diagnosis of diabetes, including impaired fasting glucose and undiagnosed diabetes, were associated with LED. In this report, we report findings from the recently available 6 years of the continuous National Health and Nutrition Examination Survey (NHANES) (1999–2004) providing the first opportunity to compare the prevalence of specific LEDs among U.S. adults aged ≥40 years with normal glucose, impaired fasting glucose, and undiagnosed and diagnosed diabetes.
Section snippets
Research design and methods
The NHANES is a continuous, nationally representative cross-sectional survey of the U.S. civilian non-institutionalized population [14], [15], [16]. Nine thousand nine hundred and seventy adults aged ≥40 years agreed to participate in the NHANES surveys, 9145 (92%) of them attended a physical exam, and half were randomly assigned to a morning fasting glucose examination. Of 3896 persons who had the fasting glucose examination, 3607 (93%) underwent a lower extremity disease examination, serving
Results
The mean age of the population was 56.7 years and ranged from 54.6 among persons with normal glucose to 59.9 and 61.6 among those with diagnosed and undiagnosed diabetes (not shown).
The prevalence of PN was lowest among persons with normal glucose levels (10.5%, 95% CI, 8.9–12.1%), similar among those with IFG, 58% higher among those with undiagnosed diabetes (16.6%, 9.6–23.7%), almost twice as high among those with diagnosed diabetes (19.4%, 15.5–23.2%), and higher among persons with diabetes
Discussion
In this nationally representative study of American adults aged 40 years or older, persons with established diabetes had about twice the risk for PN and PAD as those without diabetes and, among those with diabetes, about 1 in 12 have PAD, 1 in 5 have PN, and 1 in 4 have some type of LED. Unexpectedly, however, the prevalence of each LED was as high among persons with previously undiagnosed diabetes as those with diagnosed diabetes.
PAD and PN are each associated with extensive morbidity but are
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The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.