Current Diabetes Reports

, 19:86 | Cite as

Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes

  • Caitlin W. Hicks
  • Elizabeth SelvinEmail author
Microvascular Complications—Neuropathy (R Pop-Busui, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Microvascular Complications—Neuropathy


Purpose of Review

Diabetic peripheral neuropathy eventually affects nearly 50% of adults with diabetes during their lifetime and is associated with substantial morbidity including pain, foot ulcers, and lower limb amputation. This review summarizes the epidemiology, risk factors, and management of diabetic peripheral neuropathy and related lower extremity complications.

Recent Findings

The prevalence of peripheral neuropathy is estimated to be between 6 and 51% among adults with diabetes depending on age, duration of diabetes, glucose control, and type 1 versus type 2 diabetes. The clinical manifestations are variable, ranging from asymptomatic to painful neuropathic symptoms. Because of the risk of foot ulcer (25%) and amputation associated with diabetic peripheral neuropathy, aggressive screening and treatment in the form of glycemic control, regular foot exams, and pain management are important. There is an emerging focus on lifestyle interventions including weight loss and physical activity as well.


The American Diabetes Association has issued multiple recommendation statements pertaining to diabetic neuropathies and the care of the diabetic foot. Given that approximately 50% of adults with diabetes will be affected by peripheral neuropathy in their lifetime, more diligent screening and management are important to reduce the complications and health care burden associated with the disease.


Peripheral neuropathy Lower extremity disease Type 1 diabetes Type 2 diabetes Microvascular complications 



We thank Dr. Andrew Boulton for his review of and insights regarding this manuscript.

Funding Information

Dr. Selvin was supported by grants K24 DK106414 and R01 DK089174 from the National Institutes of Health (NIDDK) related to this topic.

Compliance with Ethical Standards

Conflict of Interest

Caitlin W. Hicks declares that she has no conflict of interest. Elizabeth Selvin is a PI of grants from the Foundation for the National Institutes of Health and the National Kidney Foundation, but that is unrelated to this topic.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136–54. This article describes the most recent position statment from the American Diabetes Association about the workup and management of diabetic neuropathy.CrossRefPubMedGoogle Scholar
  2. 2.
    Gregg EW, Gu Q, Williams D, de Rekeneire N, Cheng YJ, Geiss L, et al. Prevalence of lower extremity diseases associated with normal glucose levels, impaired fasting glucose, and diabetes among U.S. adults aged 40 or older. Diabetes Res Clin Pract. 2007;77(3):485–8. Scholar
  3. 3.
    Boulton AJ. Diabetic neuropathy and foot complications. Handb Clin Neurol. 2014;126:97–107. Scholar
  4. 4.
    Boulton AJ. The pathway to foot ulceration in diabetes. Med Clin North Am. 2013;97(5):775–90. Scholar
  5. 5.
    Kumar S, Ashe HA, Parnell LN, Fernando DJ, Tsigos C, Young RJ, et al. The prevalence of foot ulceration and its correlates in type 2 diabetic patients: a population-based study. Diabet Med. 1994;11(5):480–4.CrossRefGoogle Scholar
  6. 6.
    Margolis DJ, Jeffcoate W. Epidemiology of foot ulceration and amputation: can global variation be explained? Med Clin North Am. 2013;97(5):791–805. Scholar
  7. 7.
    Vileikyte L, Leventhal H, Gonzalez JS, Peyrot M, Rubin RR, Ulbrecht JS, et al. Diabetic peripheral neuropathy and depressive symptoms: the association revisited. Diabetes Care. 2005;28(10):2378–83. Scholar
  8. 8.
    Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. Scholar
  9. 9.
    Albers JW, Pop-Busui R. Diabetic neuropathy: mechanisms, emerging treatments, and subtypes. Curr Neurol Neurosci Rep. 2014;14(8):473. Scholar
  10. 10.
    Dyck PJ, Albers JW, Andersen H, Arezzo JC, Biessels GJ, Bril V, et al. Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity. Diabetes Metab Res Rev. 2011;27(7):620–8. Scholar
  11. 11.
    Partanen J, Niskanen L, Lehtinen J, Mervaala E, Siitonen O, Uusitupa M. Natural history of peripheral neuropathy in patients with non-insulin-dependent diabetes mellitus. N Engl J Med. 1995;333(2):89–94. Scholar
  12. 12.
    Jambart S, Ammache Z, Haddad F, Younes A, Hassoun A, Abdalla K, et al. Prevalence of painful diabetic peripheral neuropathy among patients with diabetes mellitus in the Middle East region. J Int Med Res. 2011;39(2):366–377.10.1177/147323001103900204.CrossRefGoogle Scholar
  13. 13.
    Hall GC, Carroll D, Parry D, McQuay HJ. Epidemiology and treatment of neuropathic pain: the UK primary care perspective. Pain. 2006;122(1–2):156–62. Scholar
  14. 14.
    Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology. 1993;43(4):817–24. Scholar
  15. 15.
    Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care. 2006;29(7):1518–22. Scholar
  16. 16.
    Daousi C, MacFarlane IA, Woodward A, Nurmikko TJ, Bundred PE, Benbow SJ. Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. Diabet Med. 2004;21(9):976–82. Scholar
  17. 17.
    Boulton AJ, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28(4):956–62. Scholar
  18. 18.
    Smith BE. Focal and entrapment neuropathies. Handb Clin Neurol. 2014;126:31–43. Scholar
  19. 19.
    Dyck PJ, Windebank AJ. Diabetic and nondiabetic lumbosacral radiculoplexus neuropathies: new insights into pathophysiology and treatment. Muscle Nerve. 2002;25(4):477–91.CrossRefGoogle Scholar
  20. 20.
    Massie R, Mauermann ML, Staff NP, Amrami KK, Mandrekar JN, Dyck PJ, et al. Diabetic cervical radiculoplexus neuropathy: a distinct syndrome expanding the spectrum of diabetic radiculoplexus neuropathies. Brain. 2012;135(Pt 10):3074–88. Scholar
  21. 21.
    Gibbons CH, Freeman R. Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes. Brain. 2015;138(Pt 1):43–52. Scholar
  22. 22.
    • Iqbal Z, Azmi S, Yadav R, Ferdousi M, Kumar M, Cuthbertson DJ, et al. Diabetic peripheral neuropathy: epidemiology, diagnosis, and pharmacotherapy. Clin Ther. 2018;40(6):828–49. This article provides a comprehensive literature review on the treatment of neuropathic pain in diabetic peripheral neuropathy. CrossRefPubMedGoogle Scholar
  23. 23.
    Pirart J. Diabetes mellitus and its degenerative complications: a prospective study of 4,400 patients observed between 1947 and 1973 (3rd and last part) (author’s transl). Diabete Metab. 1977;3(2–4).Google Scholar
  24. 24.
    Tesfaye S, Stevens LK, Stephenson JM, Fuller JH, Plater M, Ionescu-Tirgoviste C, et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia. 1996;39(11):1377–84.CrossRefGoogle Scholar
  25. 25.
    Abbott CA, Malik RA, van Ross ER, Kulkarni J, Boulton AJ. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care. 2011;34(10):2220–4. Scholar
  26. 26.
    Cabezas-Cerrato J. The prevalence of clinical diabetic polyneuropathy in Spain: a study in primary care and hospital clinic groups. Neuropathy Spanish Study Group of the Spanish Diabetes Society (SDS). Diabetologia. 1998;41(11):1263–9.CrossRefGoogle Scholar
  27. 27.
    Martin CL, Albers JW, Pop-Busui R, Group DER. Neuropathy and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care. 2014;37(1):31–8. Scholar
  28. 28.
    Maser RE, Steenkiste AR, Dorman JS, Nielsen VK, Bass EB, Manjoo Q, et al. Epidemiological correlates of diabetic neuropathy. Report from Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes. 1989;38(11):1456–61. Scholar
  29. 29.
    Jaiswal M, Lauer A, Martin CL, Bell RA, Divers J, Dabelea D, et al. Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for Diabetes in Youth follow-up cohort: a pilot study. Diabetes Care. 2013;36(12):3903–8. Scholar
  30. 30.
    Ismail-Beigi F, Craven T, Banerji MA, Basile J, Calles J, Cohen RM, et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet. 2010;376(9739):419–30. Scholar
  31. 31.
    Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129–39. Scholar
  32. 32.
    Pop-Busui R, Lu J, Lopes N, Jones TL, Investigators BD. Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort. J Peripher Nerv Syst. 2009;14(1):1–13. Scholar
  33. 33.
    Tovi J, Svanborg E, Nilsson BY, Engfeldt P. Diabetic neuropathy in elderly type 2 diabetic patients: effects of insulin treatment. Acta Neurol Scand. 1998;98(5):346–53.CrossRefGoogle Scholar
  34. 34.
    Young MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993;36(2):150–4.CrossRefGoogle Scholar
  35. 35.
    Feldman EL, Nave KA, Jensen TS, Bennett DLH. New horizons in diabetic neuropathy: mechanisms, bioenergetics, and pain. Neuron. 2017;93(6):1296–313. Scholar
  36. 36.
    Sajic M. Mitochondrial dynamics in peripheral neuropathies. Antioxid Redox Signal. 2014;21(4):601–20. Scholar
  37. 37.
    Green AQ, Krishnan S, Finucane FM, Rayman G. Altered C-fiber function as an indicator of early peripheral neuropathy in individuals with impaired glucose tolerance. Diabetes Care. 2010;33(1):174–6. Scholar
  38. 38.
    Malik RA, Veves A, Walker D, Siddique I, Lye RH, Schady W, et al. Sural nerve fibre pathology in diabetic patients with mild neuropathy: relationship to pain, quantitative sensory testing and peripheral nerve electrophysiology. Acta Neuropathol. 2001;101(4):367–74.PubMedGoogle Scholar
  39. 39.
    Ang L, Jaiswal M, Martin C, Pop-Busui R. Glucose control and diabetic neuropathy: lessons from recent large clinical trials. Curr Diab Rep. 2014;14(9):528. Scholar
  40. 40.
    Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, Lachin J, Cleary P, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86. Scholar
  41. 41.
    Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995;28(2):103–17.CrossRefGoogle Scholar
  42. 42.
    Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577–89. Scholar
  43. 43.
    Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):854–865.Google Scholar
  44. 44.
    Callaghan BC, Little AA, Feldman EL, Hughes RA. Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane Database Syst Rev. 2012;(6):CD007543.
  45. 45.
    Tesfaye S, Chaturvedi N, Eaton SE, Ward JD, Manes C, Ionescu-Tirgoviste C, et al. Vascular risk factors and diabetic neuropathy. N Engl J Med. 2005;352(4):341–50. Scholar
  46. 46.
    Wiggin TD, Sullivan KA, Pop-Busui R, Amato A, Sima AA, Feldman EL. Elevated triglycerides correlate with progression of diabetic neuropathy. Diabetes. 2009;58(7):1634–40. Scholar
  47. 47.
    Pinto A, Tuttolomondo A, Di Raimondo D, Fernandez P, La Placa S, Di Gati M, et al. Cardiovascular risk profile and morbidity in subjects affected by type 2 diabetes mellitus with and without diabetic foot. Metabolism. 2008;57(5):676–82. Scholar
  48. 48.
    Hanewinckel R, Ikram MA, Van Doorn PA. Peripheral neuropathies. Handb Clin Neurol. 2016;138:263–82. Scholar
  49. 49.
    Albers JW, Brown MB, Sima AA, Greene DA. Frequency of median mononeuropathy in patients with mild diabetic neuropathy in the early diabetes intervention trial (EDIT). Tolrestat Study Group For Edit (Early Diabetes Intervention Trial). Muscle Nerve. 1996;19(2):140–6.<140::AID-MUS3>3.0.CO;2-E.CrossRefPubMedGoogle Scholar
  50. 50.
    O’Hare JA, Abuaisha F, Geoghegan M. Prevalence and forms of neuropathic morbidity in 800 diabetics. Ir J Med Sci. 1994;163(3):132–5.CrossRefGoogle Scholar
  51. 51.
    Vinik AI, Holland MT, Le Beau JM, Liuzzi FJ, Stansberry KB, Colen LB. Diabetic neuropathies. Diabetes Care. 1992;15(12):1926–75. Scholar
  52. 52.
    Vinik A, Mehrabyan A, Colen L, Boulton A. Focal entrapment neuropathies in diabetes. Diabetes Care. 2004;27(7):1783–8. Scholar
  53. 53.
    Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis (dagger). Ann Med. 2017;49(2):106–16. Scholar
  54. 54.
    Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217–28. Scholar
  55. 55.
    Hicks CW, Selvarajah S, Mathioudakis N, Sherman RE, Hines KF, Black JH 3rd, et al. Burden of infected diabetic foot ulcers on hospital admissions and costs. Ann Vasc Surg. 2016;33:149–58. Scholar
  56. 56.
    American Association of Diabetes, Consensus Development Conference on Diabetic Foot Wound Care: 7–8 April 1999, Boston, Massachusetts. Am Diabetes Assoc Diabetes Care. 1999;22(8):1354–60.
  57. 57.
    Brem H, Sheehan P, Rosenberg HJ, Schneider JS, Boulton AJ. Evidence-based protocol for diabetic foot ulcers. Plast Reconstr Surg. 2006;117(7 Suppl):193S–209S; discussion 210S–211S. Scholar
  58. 58.
    Boodoo C, Perry JA, Leung G, Cross KM, Isaranuwatchai W. Cost-effectiveness of telemonitoring screening for diabetic foot ulcer: a mathematical model. CMAJ Open. 2018;6(4):E486-E494. CrossRefGoogle Scholar
  59. 59.
    Lim JZ, Ng NS, Thomas C. Prevention and treatment of diabetic foot ulcers. J R Soc Med. 2017;110(3):104–109.10.1177/0141076816688346.CrossRefGoogle Scholar
  60. 60.
    •• American Association of Diabetes. 11. Microvascular complications and foot care: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S124–38. This article describes the most recent recommendations from the American Diabetes Association about the workup and management of microvascular complications and foot care in adults with diabetes.CrossRefGoogle Scholar
  61. 61.
    Boulton AJ. Lowering the risk of neuropathy, foot ulcers and amputations. Diabet Med. 1998;15(Suppl 4):S57–9.<S57::AID-DIA741>3.0.CO;2-D.CrossRefPubMedGoogle Scholar
  62. 62.
    Boulton AJ, Kempler P, Ametov A, Ziegler D. Whither pathogenetic treatments for diabetic polyneuropathy? Diabetes Metab Res Rev. 2013;29(5):327–33. Scholar
  63. 63.
    Smith AG, Russell J, Feldman EL, Goldstein J, Peltier A, Smith S, et al. Lifestyle intervention for pre-diabetic neuropathy. Diabetes Care. 2006;29(6):1294–9. Scholar
  64. 64.
    Bril V, England J, Franklin GM, Backonja M, Cohen J, Del Toro D, et al. Evidence-based guideline: treatment of painful diabetic neuropathy: report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. PM R. 2011;3(4):345–52, 352 e341–321. Scholar
  65. 65.
    Onakpoya IJ, Thomas ET, Lee JJ, Goldacre B, Heneghan CJ. Benefits and harms of pregabalin in the management of neuropathic pain: a rapid review and meta-analysis of randomised clinical trials. BMJ Open. 2019;9(1):e023600. Scholar
  66. 66.
    Ormseth MJ, Scholz BA, Boomershine CS. Duloxetine in the management of diabetic peripheral neuropathic pain. Patient Prefer Adherence. 2011;5:343–56. Scholar
  67. 67.
    Kvinesdal B, Molin J, Froland A, Gram LF. Imipramine treatment of painful diabetic neuropathy. JAMA. 1984;251(13):1727–30.CrossRefGoogle Scholar
  68. 68.
    Max MB, Culnane M, Schafer SC, Gracely RH, Walther DJ, Smoller B, et al. Amitriptyline relieves diabetic neuropathy pain in patients with normal or depressed mood. Neurology. 1987;37(4):589–96. Scholar
  69. 69.
    Gimbel JS, Richards P, Portenoy RK. Controlled-release oxycodone for pain in diabetic neuropathy: a randomized controlled trial. Neurology. 2003;60(6):927–34. Scholar
  70. 70.
    Harati Y, Gooch C, Swenson M, Edelman S, Greene D, Raskin P, et al. Double-blind randomized trial of tramadol for the treatment of the pain of diabetic neuropathy. Neurology. 1998;50(6):1842–6. Scholar
  71. 71.
    Hojsted J, Sjogren P. Addiction to opioids in chronic pain patients: a literature review. Eur J Pain. 2007;11(5):490–518. Scholar
  72. 72.
    Patil PR, Wolfe J, Said Q, Thomas J, Martin BC. Opioid use in the management of diabetic peripheral neuropathy (DPN) in a large commercially insured population. Clin J Pain. 2015;31(5):414–24. Scholar
  73. 73.
    Zhao Y, Wu N, Chen S, Boulanger L, Police RL, Fraser K. Changes in opioid use and healthcare costs among U.S. patients with diabetic peripheral neuropathic pain treated with duloxetine compared with other therapies. Curr Med Res Opin. 2010;26(9):2147–56. Scholar
  74. 74.
    Wu N, Chen S, Boulanger L, Fraser K, Bledsoe SL, Zhao Y. Duloxetine compliance and its association with healthcare costs among patients with diabetic peripheral neuropathic pain. J Med Econ. 2009;12(3):192–202. Scholar
  75. 75.
    Martell BA, O’Connor PG, Kerns RD, Becker WC, Morales KH, Kosten TR, et al. Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med. 2007;146(2):116–27. Scholar
  76. 76.
    Gordois A, Scuffham P, Shearer A, Oglesby A, Tobian JA. The health care costs of diabetic peripheral neuropathy in the US. Diabetes Care. 2003;26(6):1790–5. Scholar
  77. 77.
    Hicks CW, Selvarajah S, Mathioudakis N, Perler BA, Freischlag JA, Black JH 3rd, et al. Trends and determinants of costs associated with the inpatient care of diabetic foot ulcers. J Vasc Surg. 2014;60(5):1247–1254 e1242. Scholar
  78. 78.
    Van Acker K, Bouhassira D, De Bacquer D, Weiss S, Matthys K, Raemen H, et al. Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics. Diabetes Metab. 2009;35(3):206–13. Scholar
  79. 79.
    Tolle T, Xu X, Sadosky AB. Painful diabetic neuropathy: a cross-sectional survey of health state impairment and treatment patterns. J Diabetes Complications. 2006;20(1):26–33. Scholar
  80. 80.
    McDermott AM, Toelle TR, Rowbotham DJ, Schaefer CP, Dukes EM. The burden of neuropathic pain: results from a cross-sectional survey. Eur J Pain. 2006;10(2):127–35. Scholar
  81. 81.
    Timar B, Timar R, Gaita L, Oancea C, Levai C, Lungeanu D. The impact of diabetic neuropathy on balance and on the risk of falls in patients with type 2 diabetes mellitus: a cross-sectional study. PLoS One. 2016;11(4):e0154654. Scholar
  82. 82.
    Brown SJ, Handsaker JC, Bowling FL, Boulton AJ, Reeves ND. Diabetic peripheral neuropathy compromises balance during daily activities. Diabetes Care. 2015;38(6):1116–22. Scholar
  83. 83.
    Schwartz AV, Vittinghoff E, Sellmeyer DE, Feingold KR, de Rekeneire N, Strotmeyer ES, et al. Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care. 2008;31(3):391–6. Scholar
  84. 84.
    Schneider AL, Williams EK, Brancati FL, Blecker S, Coresh J, Selvin E. Diabetes and risk of fracture-related hospitalization: the Atherosclerosis Risk in Communities Study. Diabetes Care. 2013;36(5):1153–8. Scholar
  85. 85.
    Yang Y, Hu X, Zhang Q, Zou R. Diabetes mellitus and risk of falls in older adults: a systematic review and meta-analysis. Age Ageing. 2016;45(6):761–7. Scholar
  86. 86.
    Janghorbani M, Van Dam RM, Willett WC, Hu FB. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007;166(5):495–505. Scholar
  87. 87.
    Kim JH, Jung MH, Lee JM, Son HS, Cha BY, Chang SA. Diabetic peripheral neuropathy is highly associated with nontraumatic fractures in Korean patients with type 2 diabetes mellitus. Clin Endocrinol (Oxf). 2012;77(1):51–5. Scholar
  88. 88.
    Selvin E, Narayan KM, Huang ES. Chapter 41: Quality of care in people with diabetes. In: Cowie CCCS, Menke A, Cissell MA, Eberhardt MS, Meigs JB, Gregg EW, Knowler WC, Barrett-Connor E, Becker DJ, Brancati FL, Boyko EJ, Herman WH, Howard BV, Narayan KMV, Rewers M, Fradkin JE, editors. Diabetes in America, 3rd ed. NIH Pub No. 17–1468. 3rd ed. Bethesda, MD: National Institutes of Health; 2018.Google Scholar
  89. 89.
    Centers for Disease Control and Prevention (CDC). Age-adjusted percentage of adults aged 18 years or older with diagnosed diabetes receiving a foot exam in the last year, United States, 1994–2010 Last updated 2014. Accessed 03/07/2019.
  90. 90.
    Centers for Medicare and Medicaid Services (CMS). Proposed clinical quality measures for 2014. 2014 Updated 2014. Accessed 03/02/2019.
  91. 91.
    Miller JD, Carter E, Shih J, Giovinco NA, Boulton AJ, Mills JL, et al. How to do a 3-minute diabetic foot exam. J Fam Pract. 2014;63(11):646–56.PubMedGoogle Scholar
  92. 92.
    American Association of Diabetes. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26(12):3333–41. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Vascular Surgery and Endovascular TherapyJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

Personalised recommendations