Sedentary time is an independent factor in the development of foot ulcers in people with diabetic peripheral neuropathy, according to a new study published in the journal Diabetes Research and Clinical Practice.
Peripheral neuropathy — nerve damage affecting the limbs, especially the legs and feet — is a common complication of diabetes, and increases the risk of developing foot ulcers, or wounds that don’t easily heal. Not everyone with peripheral neuropathy develops foot ulcers, but having diminished feeling in your feet can make it easier to injure them, or to exacerbate an existing injury so that it doesn’t heal effectively. At the same time, many people with peripheral neuropathy also have reduced blood flow in their feet due to peripheral arterial disease (also known as peripheral vascular disease), which also disproportionately affects people with diabetes. This reduced blood flow can make it very difficult for foot ulcers to heal.
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For the latest study, researchers looked at 175 people with diabetic peripheral neuropathy who took part in a larger study called SAMBA, which included annual medical evaluations. This evaluation included many different survey questions about health-related behaviors, including physical activity and sedentary behavior. Participants’ nerve and vascular function was evaluated, and they were examined for foot ulcers and asked about any past diagnosis of foot ulcers. The average age of participants was 72.6, and 165 of them had type 2 diabetes, while 10 had type 1 diabetes. The main outcome the researchers were interested in was a new diagnosis of a foot ulcer.
During the course of the study’s seven years of follow-up, 62 out of the 175 participants with diabetic peripheral neuropathy (35.5%) developed a foot ulcer. There were four new foot ulcers during the first year (affecting 6.5% of participants), 12 during the second year (19.4%), 10 during the third year (16.1%), eight during the fourth year (12.0%), 12 during the fifth year (19.4%), six during the sixth year (9.7%), and 10 during the seventh year (16.1%). Participants’ right foot accounted for 42 ulcers overall, while the left foot saw a total of 22 ulcers. There were 10 cases in which an amputation was required — nine minor amputations (such as those of a single toe or part of the foot) and one below-the-knee amputation, for an overall amputation incidence of 5.7% among the participants.
Reported sedentary time was significantly higher in participants who developed a foot ulcer — an average of 12.8 hours per day, compared with 9.4 hours per day in those who didn’t develop a foot ulcer. While other factors were found to influence the risk of developing a foot ulcer — including certain measures of nerve and blood vessel function, as well as foot deformities and skin dryness — sedentary time was one of the strongest predictors of who would develop a foot ulcer among the study participants.
“These data point to the determinant role of sedentary behavior on the development” of foot ulcers in people with diabetic peripheral neuropathy, the researchers concluded. “The monitoring of [sedentary] time with strategies aimed at reducing it should be included in the standard care of diabetic patients.”