Peripheral Neuropathy Tied to Mortality in Adults Without Diabetes

Researchers report today in the Annals of Internal Medicine that peripheral neuropathy is common in adults in the United States and is linked to an increased risk of death, even in the absence of diabetes.

In an email, senior author Elizabeth Selvin, PhD, MPH, professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, said, "Doctors don't typically screen for peripheral neuropathy in persons without diabetes."

"Our findings show that peripheral neuropathy, as measured by decreased sensation in the feet, is common even in people who do not have diabetes," Selvin said.

Patients with diabetes usually have annual foot exams that include a peripheral neuropathy screening, but this isn't the case for most adults who don't have diabetes.

According to Hicks, who is the director of research at the university's diabetic foot and wound service, the study raises the question of whether physicians should pay more attention to peripheral neuropathy in people without diabetes.

Hicks and colleagues looked at data from 7116 adults aged 40 and up who took part in the National Health and Nutrition Examination Survey between 1999 and 2004 to see if there were any links between peripheral neuropathy and all-cause and cardiovascular mortality.

Participants in the study underwent monofilament testing for peripheral neuropathy.

Peripheral neuropathy affected 13.5% of the participants, including 27% of adults with diabetes and 11.6% of adults without diabetes.

When compared to participants without peripheral neuropathy, those with peripheral neuropathy were older, more likely to be male, and had lower levels of education.

Adults with diabetes and peripheral neuropathy had a mortality rate of 57.6 per 1000 person-years, compared to 34.3 in adults with peripheral neuropathy but no diabetes, 27.1 in adults with diabetes but no peripheral neuropathy, and 13.0 in adults without diabetes or peripheral neuropathy.

Peripheral neuropathy was found to be significantly associated with all-cause mortality and cardiovascular mortality in diabetic participants after controlling for age, sex, race, or ethnicity, as well as risk factors such as cardiovascular disease.

Peripheral neuropathy was found to be associated with all-cause mortality in people without diabetes, but not with cardiovascular mortality.

In a sensitivity analysis that focused on adults with normoglycemia, the link between peripheral neuropathy and all-cause mortality remained.

According to Elsa S. Strotmeyer, PhD, MPH, associate professor of epidemiology at the University of Pittsburgh in Pittsburgh, Pennsylvania, "the study confirms findings from prior studies that examined the prevalence of peripheral sensation loss in populations of older adults with and without diabetes."

"The clinical significance of peripheral numbness in older adults without diabetes is underappreciated," she said.

"It's not surprising that is linked to mortality because these conditions are linked to increased mortality in older adults, and loss of peripheral sensation in the foot may also be linked to fall injuries, and mortality from fall injuries has increased dramatically in older adults over the past several decades."

Read the original article "In Adults Without Diabetes, Peripheral Neuropathy Is Linked to Mortality" at https://www.medscape.com/viewarticle/942168