title: Older subjects with diabetes and prediabetes are frequently unaware of having distal sensorimotor polyneuropathy: the KORA F4 study.
abstract: OBJECTIVE
  Distal sensorimotor polyneuropathy (DSPN) is a severe complication of type 2 diabetes. This study aimed to assess the prevalence of unawareness of DSPN in prediabetes and diabetes in a sample of the older population of Augsburg, Germany.
  
  
  METHODS
  Glucose tolerance status was determined in 61- to 82-year-old participants of the population-based KORA F4 Study (2006-2008) (n = 1,100). Clinical DSPN was defined as the presence of bilaterally impaired foot-vibration perception and/or bilaterally impaired foot-pressure sensation. DSPN case subjects were considered unaware of their condition when answering "no" to the question, "Has a physician ever told you that you are suffering from nerve damage, neuropathy, polyneuropathy, or diabetic foot?"
  
  
  RESULTS
  Clinical DSPN was prevalent in 154 (14%) participants, 140 of whom were unaware of their disorder. At a prevalence of 23.9% (95% CI 12.6-38.8), participants with combined impaired fasting glucose and impaired glucose tolerance had the highest prevalence of DSPN. Of these, 10 of 11 (91%) were unaware of having clinical DSPN. Participants with known diabetes had an equally high prevalence of DSPN [22.0% (16.2-28.9)], with 30 of the 39 (77%) DSPN case subjects unaware of having the disorder. Among subjects with known diabetes who reported to have had their feet examined by a physician, 18 of 25 (72%) clinical DSPN case subjects emerged unaware of having DSPN.
  
  
  CONCLUSIONS
  Our findings showed a high prevalence of unawareness of having clinical DSPN among the prediabetic and diabetic groups and an insufficient frequency of professional foot examinations, suggesting inadequate attention to diabetic foot prevention practice.
authors.affiliation: Leibniz Center for Diabetes Research, Heinrich Heine University Dusseldorf, Dusseldorf, Germany.
authors.forename: Brenda W C
authors.initials: BW
authors.lastname: Bongaerts
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rathmann
authors.forename: Margit
authors.initials: M
authors.lastname: Heier
authors.forename: Bernd
authors.initials: B
authors.lastname: Kowall
authors.forename: Christian
authors.initials: C
authors.lastname: Herder
authors.forename: Doris
authors.initials: D
authors.lastname: Stöckl
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
authors.forename: Dan
authors.initials: D
authors.lastname: Ziegler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology*; D011115:Polyneuropathies / Q000453:epidemiology*; D011236:Prediabetic State / Q000453:epidemiology*; D015995:Prevalence