Prospective cohort study

46 subjects w/DM and foot ulcers, 322 controls at general medicine clinic

225 age-matched subjects w/DM followed at one large diabetes center: 76 cases w/existing foot ulceration or history of foot ulceration, 149 controls from other clinics, not a random sample

356 American Indians w/DM followed in primary care setting

Monofilament, N/A biothesiometer, Achilles tendon reflexes

Biothesiometer N/A

5.07 monofilament 32 months

Absence of Achilles tendon reflexes (adjusted abnormal 5.07 monofilament test TcP02 <30 mmHg) Loss of protective sensation (VPT > 25 V) History of amputation Elevated plantar pressure

>65 N per cm2 >1 subjective symptom of neuropathy Hallux rigidus, hallus valgus, toe deformity Poor diabetes control Duration of diabetes

>10 year Male sex

Insensitivity to 5.07 monofilament

6.48 (2.37-18.06) 18.42 (3.83-88.47) 57.87 (5.08-658.96)

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