Major adverse foot events and functional mobility deficits associated with diabetic neuropathy and nephropathy

Abstract

Aim: The purpose is to determine the risk ratios (RR) for both major adverse foot events (MAFEs) and the presence of moderate and severe functional mobility deficits in participants with diabetic peripheral neuropathy across the stages of chronic kidney disease (CKD).

Methods: We studied 284 participants with diabetes mellitus, peripheral neuropathy, and CKD. MAFEs including foot fracture, ulcerations, Charcot neuropathic arthropathy (CN), osteomyelitis, and minor foot amputations were collected from foot x-ray reports in the medical records of 152 participants; functional mobility deficits were assessed in 132 participants using the modified physical performance test (mPPT). Moderate mobility deficit was categorized as mPPT scores 22-29 and severe mobility deficit as < 22. Unadjusted and adjusted (age, body weight, race, HbA1c) RR were calculated across each stage of CKD, with stage 1 CKD used as the reference group.

Results: The RR for neuropathic foot fracture, CN, and diabetic foot ulceration remained consistent across CKD stages. The RR of minor amputation is greater in CKD stages 4 and 5. The RR of moderate or severe mobility deficit is greater in CKD stages 3 and 5 and in CKD stages 3, 4, and 5, respectively. An inverse association was observed between MAFE prevalence and mPPT scores across CKD stages.

Conclusion: Major adverse foot events and functional mobility deficits are prevalent in individuals with DPN and diabetic kidney disease. The risks for minor foot amputation and functional mobility deficits increase as early as stage 3 CKD and increase further in stages 4 and 5.

Keywords

Diabetes mellitus / chronic kidney disease / risk for diabetic foot complications / major amputation

References

[1] AbbottCA,vanRoss ER,BoultonAJ.Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K.Diabetes Care2011;34:2220-4 PMCID:PMC3177727

[2] JupiterDC,BuckleyCJ.The impact of foot ulceration and amputation on mortality in diabetic patients. I: From ulceration to death, a systematic review.Int Wound J2016;13:892-903 PMCID:PMC7950078

[3] GazzarusoC,PujiaA,GiustinaA.Predictors of healing, ulcer recurrence and persistence, amputation and mortality in type 2 diabetic patients with diabetic foot: a 10-year retrospective cohort study.Endocrine2021;71:59-68

[4] SchmidtBM.Updates on diabetic foot and charcot osteopathic arthropathy.Curr Diab Rep2018;18:74

[5] RathnayakeA,MalabuUH.Lower extremity amputations and long-term outcomes in diabetic foot ulcers: a systematic review.World J Diabetes2020;11:391-9 PMCID:PMC7503503

[6] BenbowSJ,MacFarlaneIA.Diabetic peripheral neuropathy and quality of life.QJM1998;91:733-7

[7] SelbyNM.An updated overview of diabetic nephropathy: diagnosis, prognosis, treatment goals and latest guidelines.Diabetes Obes Metab2020;22 Suppl 1:3-15

[8] HoogeveenEK.The epidemiology of diabetic kidney disease.Kidney Dial2022;2:433-42

[9] LeveyAS,SchmidCH.CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)A new equation to estimate glomerular filtration rate.Ann Intern Med2009;150:604-12 PMCID:PMC2763564

[10] DiMarco M,MianoN.Cardiovascular risk and renal injury profile in subjects with type 2 diabetes and non-albuminuric diabetic kidney disease.Cardiovasc Diabetol2023;22:344 PMCID:PMC10720121

[11] FatmaS.Classification of functionality of people with diabetic peripheral neuropathy based on international classification of functioning, disability, and health core set (ICF-CS) of diabetes mellitus.J Diabetes Metab Disord2020;19:213-21. PMCID:PMC7270312

[12] CoffeyJT,ZhouH.Valuing health-related quality of life in diabetes.Diabetes Care2002;25:2238-43

[13] JonesMA,BullockGS,VeselyBD.Biomarkers of chronic kidney disease-mineral bone disorder (CKD-MBD) in the diabetic foot: a medical record review.Diabetes Res Clin Pract2022;194:110160

[14] DiamondJE,DelittoA.Reliability of a diabetic foot evaluation.Phys Ther1989;69:797-802

[15] ArmstrongDG,VelaSA,FleischliJG.Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration.Arch Intern Med1998;158:289-92

[16] ReubenDB,KimpauS.The predictive validity of self-report and performance-based measures of function and health.J Gerontol1992;47:M106-10

[17] ReubenDB.An objective measure of physical function of elderly outpatients. The physical performance test.J Am Geriatr Soc1990;38:1105-12

[18] BrownM,BinderEF.Physical and performance measures for the identification of mild to moderate frailty.J Gerontol A Biol Sci Med Sci2000;55:M350-5

[19] TuttleLJ,BittelAJ.Early-onset physical frailty in adults with diabesity and peripheral neuropathy.Can J Diabetes2018;42:478-83 PMCID:PMC5991981

[20] KingMB,WhippleR.Reliability and responsiveness of two physical performance measures examined in the context of a functional training intervention.Physical Therapy2000;80:8-16

[21] HostHH,BrownM.Reliability of the modified physical performance test in older adults.Physical Therapy1996;76:S23-4

[22] AboyansV,AbrahamP.American Heart Association Council on Peripheral Vascular DiseaseCouncil on Epidemiology and PreventionCouncil on Clinical CardiologyCouncil on Cardiovascular NursingCouncil on Cardiovascular Radiology and Interventionand Council on Cardiovascular Surgery and AnesthesiaMeasurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association.Circulation2012;126:2890-909

[23] MargolisDJ,FeldmanHI.Association between renal failure and foot ulcer or lower-extremity amputation in patients with diabetes.Diabetes Care2008;31:1331-6 PMCID:PMC2453658

[24] EggersPW,PughJ.Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population.Kidney Int1999;56:1524-33

[25] UgoyaSO,UgoyaTA,PuepetFH.Clinically diagnosed diabetic neuropathy: frequency, types and severity.J Natl Med Assoc2006;98:1763-6. PMCID:PMC2569794

[26] KovesdyCP,Petruski-IvlevaN.Chronic kidney disease progression among patients with type 2 diabetes identified in US administrative claims: a population cohort study.Clin Kidney J2021;14:1657-64 PMCID:PMC8162850