Methods: Patients> 40 years presenting to the Hurley Medical Center Outpatient Internal Medicine Residency Clinic in Flint, Michigan were enrolled. Demographics, clinical characteristics including medication use, anthropomorphic measurements, fasting lipids, fasting glucose, and Hemoglobin A1C were obtained. Glucose intolerance was defined using the 2021 ADA diagnosis and classification of diabetes mellitus criteria. DSP was defined using the Michigan Neuropathy Screening Instrument Questionnaire Index (MNSIQI). Descriptive statistics were assessed using means and frequencies.

Results: 81 participants (62% female, 57.5 yrs (SD 8.7). 67% Black, 53% Medicaid, 22%< high school education) have enrolled. 40 (49%) had a history of glucose intolerance, 4 (5%) denied a history of glucose intolerance despite a prior diagnosis, and 7 (9%) were diagnosed as glucose intolerant through study labs.(23%) reported a history of neuropathy. Mean MNSIQI score was 2.65 (SD 1.56); 46 (57%) had DSP. 28 (55%) participants with glucose intolerance had DSP. Among participants with a history of glucose intolerance and DSP, 16/21 (76%) were unaware they had DSP. 7/(64%) participants who did not know they had glucose intolerance prior to participation had DSP.

Conclusions: DSP is extremely common and underrecognized in this patient population with low incomes. Improving awareness of glucose intolerance and DSP is imperative to ensure appropriate foot care and reduce the risk of amputation.