Diabetes is a growing epidemic with complications ranging from debilitating to deadly. Preventing diabetes complications like peripheral neuropathy requires strict glucose control, but this is often impossible for low-income and minoritized Americans who are forced to choose between their health and other basic needs. While diabetes is more widespread in these communities, it is far less studied, which means there is less known about the prevalence of neuropathy of the disease in these populations.
For the past two years, the Flint Neuropathy Study has been investigating diabetes and neuropathy among primary care patients at Hurley Medical Center (HMC), which serves a predominantly low-income community in Flint, Michigan. The study’s primary investigator (PI), Melissa Elafros, MD, PhD, explained that the first goal of this collaboration was to determine the incidence of neuropathy among the people in the city. The accepted prevalence for the U.S. population is about 13%. Yet, researchers in Flint found that 73% of their patient population suffers from neuropathy. Quite a jump from the national rate.
Even more cause for alarm was that 75% of the patients with neuropathy were unaware they had it. This is particularly concerning because, as people with neuropathy lose sensation, they are more likely to experience foot trauma by stepping on something sharp or sustaining an injury. This leads to infection, pain, and even eventually amputation, which significantly impacts quality of life. Diagnosing neuropathy early offers a valuable opportunity to educate patients, for example about appropriate foot care, so they can reduce the risk of injury and manage neuropathic pain.
“Already we have identified an enormous burden of undiagnosed neuropathy,” explained Dr. Elafros. “What we don’t know, however, is if this is unique to patients seen at this clinic or if this is representative of a larger problem in Flint and communities like Flint.”
A new grant from the NIH’s National Institute of Diabetic and Digestive and Kidney Disease (NIDDK) will allow Dr. Elafros and her team to see if this problem extends beyond HMC by partnering with providers at McLaren Flint nine miles away. Of course, in any study, more participants mean better data, but adding McLaren Flint will allow Dr. Elafros to begin to investigate why there is a high prevalence of neuropathy, and why so much of it is undiagnosed.
“Then our next steps will be to figure out why neuropathy is not being diagnosed among primary care patients and how to address this,” said Dr. Elafros.
Once these topics are better understood, Dr. Elafros and her team will develop a pilot intervention targeting barriers to neuropathy diagnosis and management in primary care.
“In the ideal world, every patient with neuropathy would have access to a neurologist,” said Dr. Elafros. “But that is not feasible and, for many patients with neuropathy, it’s not necessary. The goal of the Flint Neuropathy Study is to optimize neuropathy management in the primary care setting. Our team is excited for this expansion to McLaren Flint as it will bring us one step closer to reaching our goal.”
