RESUMO
OBJECTIVE: To determine footwear choice and peripheral neuropathy prevalence in a population-based sample of people with diabetes in Barbados. DESIGN AND METHODS: A representative sample of the adult population (≥ 25yrs) was selected by multistage sampling. People with a previous diagnosis of diabetes or a single fasting blood glucose ≥ 7 mmol/L or HbA1c ≥ 6.5% completed a questionnaire. Examination for neuropathy included 10g monofilament testing at 4 plantar sites per foot, 128 Hz tuning fork and vibration perception threshold (VPT) biothesiometer testing at the hallux. RESULTS: Of 237 participants (71.8% response rate, 33% male, mean age 63.2 years, range 29.6 95.7 years, mean HbA1c 7.2%) 50.8% had a previous diagnosis of diabetes, 2 had amputations and 4 had foot ulcers. More men (67%) compared to women (29.7%) never wore footwear in the house (p<0.001), but 42.7% of the women vs. 18.2% men wore slippers (open back shoes) when attending the assessment centre. Most (57.7%) had symptoms of neuropathy by the UK symptom score, but only 7.6% by the slipping slipper sign. With 10g monofilament testing at 8 sites 23.6% (95% CI 18.2-29) 17.2%, 12.0% and 9.8% had a loss of sensation at ≥ 1,2,3 and 4 sites respectively. 9.3% (95% CI 5.6-13) had a VPT of ≥ 25V, and 12.7% (95% CI 8.4-17) did not detect the vibration of a tuning fork for at least one foot. CONCLUSIONS: Objectively detected neuropathy ranged from 9.3% to 23.6%, depending on the method, with foot complications risk being exacerbated by footwear choice.
