Foot Ulcer Risk Is Lower in South-Asian and African-Caribbean Compared With European Diabetic Patients in the U.K.

Abstract

OBJECTIVE—To determine 1) foot ulcer rates for European, South-Asian, and African-Caribbean diabetic patients in the U.K and 2) the contribution of neuropathy and peripheral arterial disease (PAD) differences to altered ulcer risk between the groups. RESEARCH DESIGN AND METHODS—In this U.K. population–based study, we screened 15,692 type 1 and type 2 diabetic patients in the community health care setting for foot ulcers, foot deformities, neuropathy, and PAD plus other characteristics. In total, 13,409 were European (85.5%), 1,866 were South Asian (11.9%), and 371 were African Caribbean (2.4%). RESULTS—The age-adjusted prevalence of diabetic foot ulcers (past or present) for Europeans, South Asians, and African Caribbeans was 5.5, 1.8, and 2.7%, respectively (P < 0.0001). Asians and African Caribbeans had less neuropathy, PAD, and foot deformities than Europeans (P = 0.003). The unadjusted risk of ulcer (odds ratio [OR]) for Asians versus Europeans was 0.29 (95% CI 0.20–0.41) (P < 0.0001). PAD, neuropathy, foot deformities, and insulin use attenuated the age-adjusted OR from 0.32 to 0.52 (0.35–0.76) (P < 0.0001). African-Caribbean versus European ulcer risk in males was attenuated from 0.60 to 0.71 by vibration sensation. CONCLUSIONS—South Asians with diabetes in the U.K. have about one-third the risk of foot ulcers of Europeans. The lower levels of PAD, neuropathy, insulin usage, and foot deformities of the Asians account for approximately half of this reduced foot ulcer risk. Lower neuropathy is the main contributor to the reduced African-Caribbean ulcer rate, particularly in men. The reasons for these ethnic differences warrant further investigation.

Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study

“…to patients with moderate to severe neuropathy. Indeed, in previous studies from our group we reported that 43% of a clinic-based diabetes cohort had VPT >25 [36], and 44% of a community cohort had NDS >3 [37], suggesting that these results apply to a substantial proportion of patients with diabetes.…”

Association Between Renal Failure and Foot Ulcer or Lower-Extremity Amputation in Patients With Diabetes

“…We were able to conduct several sensitivity analyses and found that our inability to determine race/ethnicity was not likely to have influenced our measurement of eGFR. Further, Abbott et al (22) did note various rates of foot complications and PAD and DFU in ethnic groups. However, these authors concluded that variable rates of PAD and neuropathy at least partially explained the different rates of LEA and DFU in these ethnic groups.…”

The diabetic foot: grand overview, epidemiology and pathogenesis

“…In Western countries, foot ulcers are more common in male patients [22], and in mixed populations, foot ulceration is more common among those of European origin when compared to Asians and African-Caribbeans [31]. However, the greatest single risk factor for foot ulceration is a past history of either ulceration or amputation [6].…”