title: Diabetic neuropathy status and the concerns in underserved rural communities: challenges and opportunities for diabetes educators.
abstract: The purpose of this study was to investigate the prevalence of diabetic peripheral neuropathy (DPN) and to identify at risk populations in medically underserved rural communities.
  
  
  
  A cross-sectional study was conducted in 816 type 2 diabetic patients from 5 rural Arkansas counties who attended a diabetes education program from 2005 to 2009. The data was collected through a survey questionnaire and from medical records. Univariate and multivariate analyses were conducted.
  
  
  
  Of the 816 patients studied, 9.6% had a DPN diagnosis, and 43% reported peripheral neuropathy symptoms (PNS). Among the patients with PNS, 79% had not been diagnosed with DPN. Multivariate analyses found that being female, being white, having less than a college education, having a longer duration of diabetes, having a history of smoking, having a professional foot examination, and performing self foot examinations are associated with a higher risk for having DPN or PNS.
  
  
  
  The study found that the prevalence of patients with PNS was high, and that DPN was alarmingly underdiagnosed in these underserved rural communities. The high prevalence of PNS and underdiagnosis of DPN could influence the development of severe foot complications like diabetic foot ulcer, and even possibly increase the risk of lower extremity amputation in these underserved communities. The at risk population identified by this study would be a resource to help diabetes educators develop targeted education and intervention programs in underserved rural communities.
authors.affiliation: The Department of Physical Therapy, University of Central Arkansas, Conway, Arkansas (Dr Wang)
authors.forename: Wen
authors.initials: W
authors.lastname: Wang
authors.affiliation: The Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Balamurugan)
authors.forename: Appathurai
authors.initials: A
authors.lastname: Balamurugan
authors.affiliation: The Arkansas Department of Health, Diabetes Prevention and Control Program, Little Rock, Arkansas (Ms Biddle)
authors.forename: Joyce
authors.initials: J
authors.lastname: Biddle
authors.affiliation: St. Vincent Infirmary, St. Vincent Health System, Little Rock, Arkansas (Ms Rollins)
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Rollins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001131:Arkansas / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D017719:Diabetic Foot / Q000453:epidemiology / Q000517:prevention & control; D003929:Diabetic Neuropathies / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment; D010353:Patient Education as Topic; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health