title: Prediction of protective sensory loss, neuropathy and foot ulceration in type 2 diabetes.
abstract: OBJECTIVE
  To prospectively determine clinical and biochemical characteristics associated with the development of peripheral neuropathy, loss of protective sensation, and foot ulceration in persons with type 2 diabetes mellitus (DM) over 7 years.
  
  
  METHODS
  Graded monofilament (MF) testing, vibration perception threshold, and neuropathy symptom questionnaires were undertaken in 206 participants with type 2 DM without peripheral vascular disease or history of foot ulceration and 71 healthy participants without DM at baseline and after 7 years. 6 monthly glycosylated hemoglobin (HbA1c) levels and annual serum lipid profiles were measured during follow-up of those with DM. Incident foot ulceration was recorded at follow-up.
  
  
  RESULTS
  Taller stature and higher quartiles of serum triglyceride and HbA1c levels were associated with neuropathy at follow-up (p=0.008). Remission of baseline neuropathy was observed in 7 participants at follow-up. 9 participants with type 2 DM developed foot ulcers by the end of the study, only 1 at low risk. Mean HbA1c levels were higher in those who developed foot ulceration (p<0.0001). 1 participant with neuropathy throughout developed a Charcot foot. Failure to perceive 2 or more 2, 4 and 6 g MF stimuli at baseline predicted loss of protective sensation at follow-up.
  
  
  CONCLUSIONS
  Tall stature and worse metabolic control were associated with progression to neuropathy. Mean HbA1c levels were higher in those who developed foot ulcers. Graded MF testing may enrich recruitment to clinical trials and assignation of high risk for foot ulceration.
authors.affiliation: South Devon Healthcare NHS Foundation Trust , Torquay , UK.
authors.forename: R B
authors.initials: RB
authors.lastname: Paisey
authors.affiliation: South Devon Healthcare NHS Foundation Trust , Torquay , UK.
authors.forename: T
authors.initials: T
authors.lastname: Darby
authors.affiliation: South Devon Healthcare NHS Foundation Trust , Torquay , UK.
authors.forename: A M
authors.initials: AM
authors.lastname: George
authors.affiliation: South Devon Healthcare NHS Foundation Trust , Torquay , UK.
authors.forename: M
authors.initials: M
authors.lastname: Waterson
authors.affiliation: Department of Statistics , University of Plymouth , Plymouth , UK.
authors.forename: P
authors.initials: P
authors.lastname: Hewson
authors.affiliation: The Medical School, University of Nottingham , Nottingham , UK.
authors.forename: C F
authors.initials: CF
authors.lastname: Paisey
authors.affiliation: South Devon Healthcare NHS Foundation Trust , Torquay , UK.
authors.forename: M P
authors.initials: MP
authors.lastname: Thomson
keywords: Dyslipidemia; Glycemic Control; Peripheral Neuropathy; Type 2 Diabetes