Tropical diabetic hand syndrome: risk factors in an adult diabetes population.

OBJECTIVES: To determine risk factors for the tropical diabetic hand syndrome, a condition associated with significant morbidity and mortality in Africa. METHODS: This was a case-control study of a Tanzanian diabetes population presenting with the syndrome during February 1998 to March 2000. A case patient was defined as any patient with diabetes presenting with hand cellulitis, ulceration, or gangrene. Control patients were randomly selected patients with diabetes who had no hand symptoms. RESULTS: Thirty-one case patients and 96 control patients were identified. The median age of case patients was 52 years (range, 28--76 y); 58% were male; 4 patients (16%) died. Precipitating events included papule (n = 6), insect bites (n = 6), boils (n = 5), burns (n = 2), or trauma (n = 3). Case and control patients were similar for presence of micro- and macrovascular disease and occupation. On logistic regression analysis, independent risk factors were body mass index of 20 or less (odds ratio [OR] = 18.0; 95% confidence interval [CI] = 4.3--97.0; P < 0.001), peripheral neuropathy (OR = 23.0; 95% CI = 5.3--124.0; P < 0.001), or type I diabetes, (OR = 6.7; 95% CI = 2.0--24.0, P < 0.01). CONCLUSION: The major risk factors for the tropical diabetic hand syndrome are intrinsically related to the underlying disease. Thus, prevention of hand infections may require aggressive glucose control, and education on hand care and the importance of seeing a doctor promptly at the onset of symptoms.     

The role of Sudoscan feet asymmetry in the diabetic foot

The aim of this study was to investigate the role of Sudoscan asymmetry parameters in the diabetic foot.Patients and methodsIn this study we included 165 participants: 84 type 2 diabetes patients divided into three HbA1c matched groups – group 1: newly diagnosed diabetics (n = 31), group 2: people with longer diabetes duration and established neuropathy (n = 33), group 3: patients with diabetic foot ulcer (n = 20), and a control group of 81 people with prediabetes. All subjects underwent peripheral sudomotor evaluation using Sudoscan device (Impeto Medical, Paris).ResultsPatients with diabetic foot had significantly higher Sudoscan feet asymmetry (19.6%) compared to those with only diabetic neuropathy (7.9%), compared to the group with newly diagnosed diabetes (7.44%), and compared to controls (2.5%). This test has shown a good discriminative value (with a threshold of 9.5%) for diabetic foot with area under the ROC curve of 0.955 (p = 0.001). Additionally, in a regression model feet asymmetry proved its predictive value for participants with diabetic foot.ConclusionIn this study Sudoscan feet asymmetry proved to be a novel discriminator and predictor for diabetic foot patients. It might be considered as a marker for early damage in the neuropathy evaluation protocol.     

Parallels between Russell's viper (Daboia russelii) and hump-nosed viper (Hypnale species) bites in the central hills of Sri Lanka amidst the heavy burden of unidentified snake bites

ObjectiveTo describe the epidemiology of snake bite in the region and attempt to compare proven Russell's viper with hump-nosed viper bites.MethodsAll snake bite admissions to the Toxicology Unit of Teaching Hospital Peradeniya over three year from 2006 were included.ResultsOf the 776 snakebites, 665(86%) were unidentified and non-envenomed. Hump-nosed viper and Russell's viper accounted for 55(7%) and 40(5%) bites respectively, of them, incriminated snakes were found in 36(65%) and 19(48%) cases. The cobra bites-5, krait bites-0. The median ages: Russell's viper bites-41(range 16-66), hump-nosed viper bites-42(range 15-75). The gender incidence, time of bite (>58% daytime) were similar. In hump-nosed viper bite; upper limb involved in 13(36%), happened at home garden in 22(61%), none in paddy fields. In Russell's viper bite; 6(33%) occurred in paddy fields. Dry bites were similar at 5%. In hump-nosed viper bite: local effects 94%, coagulopathy 3%, acute renal failure 3% and one patient died. In Russell's viper bite; local effects 84%, coagulopathy 53%, neurotoxicity 21%. Abdominal pain occurred only in Russell's viper bites 10(53%).ConclusionsOverwhelming numbers of unidentified, non-envenomed snakebites are common in the central hills. Some distinctive differences were observed between Russell's viper and hump-nosed viper bites.     

Assessment of sensory neuropathy in diabetic patients without diabetic foot problems

OBJECTIVES: To study the incidence and extent of peripheral sensory neuropathy in diabetic patients without diabetic foot problems (DFPs) with <5, 5-10 and >10 years duration of diabetes using three different modalities of testing: Pin-Prick Testing, 5.07 Semmes-Weinstein Monofilament Testing (SWMT) and Rapid-Current Perception Threshold (R-CPT) measurements using the Neurometer. METHODS: Our study population consisted of 60 patients (120 feet) treated for diabetes mellitus in the Division of Endocrinology at the National University Hospital. No patient had any DFPs. Twenty-two, 21 and 17 patients had duration of diabetes of <5, 5-10 and >10 years, respectively. All patients were tested for sensory neuropathy using Pin-Prick Testing using a standardized protocol, SWMT and the Neurometer. RESULTS: There was a significantly higher incidence of sensory neuropathy detected by both the Pin-Prick Test and the Neurometer as compared to the SWMT. Also, in all three modalities, there was a significant increase in incidence of sensory neuropathy detected in diabetics with >5 years duration of diabetes. In addition, the Pin-Prick Test showed an increase in extent of sensory neuropathy with a longer duration of diabetes. CONCLUSIONS: The Pin-Prick Test was found to be a simple, cheap and useful diagnostic tool for detection of sensory neuropathy in diabetics without DFPs. In addition, it could accurately delineate the extent of neuropathy in the lower limb - additional useful information not obtainable with SWMT or Neurometer. Even for patients with <5 years duration of diabetes, the incidence of sensory neuropathy detected was considerable. The incidence of neuropathy detected continued to increase with length of duration of diabetes. Hence, we recommend screening of patients for neuropathy as soon as they are diagnosed with diabetes.     

An integrated mobile foot and retinal screening programme for people with Type 2 diabetes managed in primary care.

AIMS: To undertake a vascular and neurological assessment on the feet of all patients with Type 2 diabetes managed solely in local primary care. METHODS: A mobile screening podiatrist (working with an existing mobile retinal screening programme) screened a selected population of 4022 patients with Type 2 diabetes managed solely in 82 general practices. Doppler pressure assessments of peripheral vasculature, bioesthesiometer and monofilament assessment of peripheral neuropathy. RESULTS: This service was administratively simple to set up and integrated well with the retinal screening service and secondary care foot clinic, and was valued by the practices. Disease prevalences were 1.04% for foot ulceration, 19% for peripheral vascular disease and up to 29% for peripheral neuropathy. CONCLUSIONS: This programme screens all patients with known diabetes managed solely in primary care within a district and describes foot morbidity and allows risk stratification. This pattern of service could be a useful template for discussing the diabetes National Service Framework with primary care groups.     

The legitimacy of rattlesnake bites in central Arizona

Previous authors have classified poisonous snake bites as being legitimate or illegitimate, depending on whether the victim was taking unnecessary risks with a snake before being bitten. We reviewed medical records of 86 consecutive rattlesnake bite victims cared for at a single medical center to determine legitimacy of snake bites. A bite was considered illegitimate if, before being bitten, the victim recognized an encounter with a snake but did not attempt to move away from the snake. A legitimate bite was said to have occurred if a person was bitten before an encounter with a snake was recognized or was bitten while attempting to move away from a snake. The study group was made up of 75 male (87.2%) and 11 female (12.8%) victims. Seventy-four percent were 18 to 50 years old, and 15% had been bitten previously. Only 43.4% of all bites were considered legitimate, and pet (captive) snakes accounted for almost one third of all illegitimate bites. The ingestion of alcoholic beverages was associated with 56.5% of illegitimate bites versus 16.7% of legitimate bites (P less than .001). While 74.4% of bites were to upper extremities, only 27% of upper extremity bites were legitimate. All bites to the lower extremity were legitimate (P less than .001). Of 14 individuals bitten by pet snakes, all were men and 64.3% were under the influence of alcohol at the time of the bite.(ABSTRACT TRUNCATED AT 250 WORDS)     

Peripheral Neuropathy as a Presenting Feature of Type 2 Diabetes: A Case-Controlled Study

The characteristics and outcome of 68 newly diagnosed Type 2 diabetic patients who presented with clinically evident peripheral neuropathy were compared with matched controls who had no neuropathy at diagnosis. All subjects (34 male) whose median age was 68 (range 47–89) yr were identified from a computerized diabetes register and presented in 1982–1990. The groups were compared at diagnosis for haemoglobin A₁, body mass index, blood pressure, smoking, and alcohol consumption, and for co-existent coronary and peripheral vascular disease. Mortality and morbidity were recorded to March 1991. Significantly more patients with neuropathy had co-existent peripheral vascular disease: 24(35%) compared to 6(9%) controls (p = 0.0021). Twenty (30%) of those with neuropathy and no controls had retinopathy at diagnosis, which was sight-threatening in 10. Seven (10%) with neuropathy but no controls presented with foot ulcers, one requiring limited amputation. Two more patients with neuropathy and one control subsequently developed foot ulcers resulting in one or more amputation in each group. Twenty-one (31%) of those with neuropathy and 14 (21%) controls died (p = 0.2109). In conclusion more diabetic patients with clinically evident peripheral neuropathy at diagnosis have peripheral vascular disease than matched patients without neuropathy. It is likely that macrovascular disease either exacerbates or causes the neuropathy in this group of patients. They are at high risk of developing foot ulceration and high priority should be given to foot care in planning their management.     

The epidemiology of animal bite injuries in Uganda and projections of the burden of rabies

OBJECTIVES: Rabies is a global problem, although it is often under-reported in developing countries. We aimed at describing the profile of patients presenting to health centres with animal bite injuries in Uganda, and use a predictive model to estimate the mortality of rabies at a national level. METHODS: We conducted a passive surveillance study in Uganda based in a random sample of health centres supplied with rabies vaccine to determine the characteristics of bite injury patients and establish the age and sex profiles of patients, the site of bites and their severity, wound management techniques and details of the vaccination course given. We also applied a decision tree model to the data to estimate the rabies mortality from the bite injury data using an established protocol. RESULTS: We found that most patients are bitten by dogs, and that a considerable proportion of these are young children, who are at greater risk of developing rabies in the absence of treatment due to the location of the bites they receive. From conservative parameter estimates, we estimate that in the absence of post-exposure prophylaxis (PET), 592 (95% CI 345-920) deaths would occur, and that if one dose of PET is sufficient for protection following a rabid animal bite, 20 (95% CI 5-50) deaths would occur annually. If a complete course of PET is required for protection following a rabid animal bite, up to 210 (95% CI 115-359) deaths would occur, as 41% of patients did not complete their course of PET. CONCLUSIONS: Active animal bite surveillance studies are required to improve our mortality estimates and determine the true burden of rabies in the Ugandan population. We emphasize the need for small-scale active case detection studies and improved data on the recognition of rabies in dogs as inputs for improving national-level estimates of rabies mortality.     

The quality and relevance of peripheral neuropathy data on a diabetic clinical information system.

Routinely collected peripheral neuropathy data entered on a diabetic clinical information system since 1979 have been audited for completeness, consistency, accuracy (inter-observer variation), validity by comparison with biothesiometry, and relevance by life table analysis for foot ulceration. Peripheral neuropathy was defined by a neuropathy disability score > or = 4. The data were 98% complete. Forty-nine of 3405 (1.4%) had inconsistent records. Agreement between observers for clinical examination was significant (p < 0.05) for aggregate neuropathy score and its individual components except the knee jerk: Kappa score for observer variation for neuropathy score 0.56 (95% confidence interval 0.36-0.76). There was good agreement between neuropathy defined as aggregate score > or = 4, and as combined vibration perception thresholds for both feet > 60 V: Kappa statistic 0.62 (95% confidence interval 0.44-0.80). The chance of developing a foot problem in 3 years increased from 3% for patients with a score of zero to 45% for people with a score of between 9 and 12. We conclude that the calculation of a clinical neuropathy score is a simple, valid and relevant method for diabetes care both in hospital and the community. When combined with palpation of peripheral pulses most patients at risk of foot ulceration can be identified allowing targeting of preventive chiropody and orthotic resources.     

Blindness following a diabetic foot infection: a variant to the ‘eye–foot syndrome’?

AIMS: The 'eye-foot syndrome' was initially described by Walsh et al. to highlight the important association of foot lesions in patients with diabetic retinopathy. We present a case of a 58-year-old patient with Type 2 diabetes mellitus who developed blindness following endogenous staphylococcal endophthalmitis from an infected foot ulcer. RESULTS: Our case describes the link between the eye and the foot but is somewhat different to the association as described by Walsh et al. Endogenous endophthalmitis is rare with diabetic patients being especially at risk, and we report the first case of endogenous staphylococcal endophthalmitis related to a diabetic foot lesion. CONCLUSIONS: Our case illustrates several important issues in the management of diabetic patients admitted to hospital with infection; the need to thoroughly examine the feet to ascertain any foot lesions and any underlying peripheral vascular disease or peripheral neuropathy, to treat aggressively any infected foot lesions to prevent serious complications of septicaemia and to consider rare conditions like endogenous endophthalmitis in any diabetic patient presenting with acute visual impairment and septicaemia.     

足部震动觉检查诊断糖尿病周围神经病变的价值

目的:探讨足部震动觉检查在糖尿病周围神经病变诊断中的应用价值。方法:根据入选标准选择2型糖尿病患者120例,所有对象均进行神经电生理检查及足部震动觉检查,比较两种诊断方法的结果有无显著差异。结果:两种检测方法所得结果之间存在正关联性(Φ=0.740,P0.01)和良好的一致性(κ=0.739,P0.01)。足部震动觉检查与神经电生理诊断方法检测结果之间的差异无显著性(75%∶73.3%,P0.05)。足部震动觉检查的灵敏度为94.32%,特异度为78.13%,Youden指数为0.7245,说明该方法的诊断效率较高。结论:足部震动觉检查无创伤,简便,效果好在糖尿病周围神经病变的诊断中有很好的应用前景。     

Alternative Medicine: Potential Dangers for the Diabetic Foot

Two patients with non-insulin-dependent diabetes mellitus and previously undiagnosed peripheral neuropathy consulted separate practitioners in alternative medicine with symptoms of painful cold feet. They both received the traditional Chinese therapy of moxibustion and subsequently developed painless ulceration at the sites of treatment on the feet and legs. These cases re-emphasize the dangers of trauma to the neuropathic limb in patients with diabetes.     

The location of the infecting tick bite and the severity of the course of tick-borne encephalitis

Analysis of 846 epidemiological charts of unvaccinated tick-borne encephalitis patients in the period of 1956-1985 established that in 21% cases the disease resulted from multiple bites of the ticks, in 67.3% it occurred from single bites. In 11.7% of the patients, the bite was denied. Single infecting bites were mostly those of the head and neck (39.2% cases), especially frequent among children (84.9%). The upper part of the body and hands were bitten less frequently (16.7 and 12.5%, respectively). Other sites of the bite were reported in 6-10%. The most complicated pattern of tick-borne encephalitis is observed in case of multiple bites: two-fold increase in mortality rates compared to single bites (23.2 vs. 10.7%) and higher percent of focal forms (72.7 vs. 56.5%). In case of the single bites a certain correlation is observed between the site of the bite and the outcome of the disease: fatal outcomes are most frequent in case of the bites in the axilla, arms (14-16%), head and neck (11.2%), and less frequent in case of the bites in the lower limbs (5.9%) and groin (0). The nature of the infecting bite determines, to a great extent, the pathogenesis and outcome of the disease. The prevention of multiple bites would help considerably to reduce mortality rates.     

The association between baseline characteristics and the outcome of foot lesions in a UK population with diabetes.

AIMS: To explore the relationships between time to healing of diabetic foot ulcers and baseline characteristics of both patients and their ulcers. METHODS: All patients were included who were referred to a specialist clinic over a 4-year period. Age, gender, type and duration of diabetes, ulcer site, ulcer duration and baseline characteristics were recorded. Postcode was used to derive an index of social deprivation. Patients were followed up to 1 year. The primary outcome measure was time to healing. Those who died or had an ulcer-related amputation were censored at the time of death or amputation and classified as unhealed. RESULTS: Mean age of 449 participants (63.7% male) was 66.7 years; 42.7% had evidence of peripheral arterial disease, and 80% had peripheral neuropathy. Median ulcer duration at presentation was 29 days; 60.5% ulcers had an area of < 1 cm(2) and 68.3% of all ulcers healed without amputation during the follow-up period. Univariate analysis revealed dose-response relationships between time to healing and increasing duration of diabetes, increasing ulcer area, ulcer site and peripheral arterial disease. No associations were found with age, gender, diabetes type, deprivation index, peripheral neuropathy or infection. The relationship between healing time and ulcer area, peripheral arterial disease and diabetes duration remained significant on multivariate analysis. CONCLUSIONS: The dominant factors influencing healing are cross-sectional area at presentation and the degree of peripheral arterial disease. Further work is needed to define how those at greatest risk may be identified and best managed.     

Peripheral neuropathy does not invariably coexist with autonomic neuropathy in diabetes mellitus

Background: Peripheral somatic and autonomic neuropathies are the most common types of diabetic polyneuropathy. Although duration and degree of hyperglycemia are considered to be risk factors for both autonomic and peripheral neuropathy, recent studies have raised the question of a different development and natural history of these neuropathies in diabetes. In addition, a few studies have investigated the relationship between chronic painful and autonomic neuropathy. The aim of this study was to investigate to what extent autonomic and peripheral neuropathy coexist, as well as whether painful neuropathy is more common in diabetic patients with autonomic neuropathy. Methods: Subjects with type 1 (n=52; mean age 31.7 years) and type 2 diabetes (n=53; mean age 54.5 years) were studied. Evaluation of peripheral neuropathy was based on clinical symptoms (neuropathic symptom score), signs (neuropathy disability score), and quantitative sensory testing (vibration perception threshold). Assessment of autonomic neuropathy was based on the battery of standardized cardiovascular autonomic function tests. Results: Prevalence rates of pure autonomic and of pure peripheral neuropathy in patients with type 1diabetes were 28.8 and 13.5%, respectively. The respective rates in patients with type 2 diabetes were 20.7% (P=0.33 vs. type 1 diabetes) and 20.7% (P=0.32). Peripheral and autonomic neuropathy coexisted in 28.8% of type 1 and in 45.3% of type 2 diabetic subjects (P=0.08). Prevalence rates of chronic painful neuropathy in subjects with type 1 diabetes, with and without autonomic neuropathy, were 16.6 and 22.7%, respectively (P=0.85) and in type 2 diabetic subjects 20 and 22.2%, respectively (P=0.58). Multivariate analysis after adjustment for age, sex, blood pressure, duration of diabetes, HBA(1c), and presence of retinopathy or microalbuminuria showed that neither the indices of peripheral nerve function (neuropathic symptom score, neuropathy disability score, vibration perception threshold) nor the presence of peripheral neuropathy or chronic painful neuropathy are associated with the presence of autonomic neuropathy in individuals with either type 1 or type 2 diabetes. Conclusions: Peripheral and autonomic neuropathies do not invariably coexist in diabetes. In addition, chronic painful neuropathy may be present irrespective of the presence of autonomic neuropathy.     

Clinical and epidemiological features of definitive and presumed loxoscelism in São Paulo,Brazil

A retrospective study analysed 359 proven or presume cases of loxoscelism seen at the Hospital Vital Brazil, Instituto Butantan, S?o Paulo, Brazil, between 1985 and 1996. The spider was identified in 14%. The bites occurred predominantly in the urban areas (73%) between September and February. Patients > 14 years were commonest inflicted (92%) and 41% were bitten while getting dressed. Only 11% sought medical care within the first 12 hours post bite. Cutaneous loxoscelism was the commonest form presenting (96%); commonest manifestations were: pain (76%), erythema (72%), edema with enduration (66%), ecchymosis (39%). Skin necrosis occurred in 53% of patients, most frequently seen on trunk, thigh and upper arm, and when patients seek medical care more than 72 hours after bite. Local infection was detected in 12 patients (3%). Hemolysis was confirmed in 4 cases (1.1%). Generalised cutaneous rash, fever and headache were also observed in 48% of the total of patients. None of them had acute renal failure or died. Treatment usually involved antivenom administration (66%), being associated with corticosteroids (47%) or dapsone (30%). Presumptive diagnosis of loxoscelism may be established based on clinical and epidemiological findings. Further investigations are required to prove the value of antivenom and other treatment schedules.     

Magnitude of foot problems in diabetes in the developing world: a study of 1044 patients

Aim To gain insight into the prevalence of peripheral neuropathy, foot care practices, foot at risk and foot ulcers in patients with diabetes mellitus at a tertiary care centre. Methods A prospective case study involving 1044 patients with diabetes mellitus attending the diabetes clinic of a tertiary care centre in north India from January 2007 to May 2008. All subjects underwent a detailed clinical assessment including vibration perception threshold (VPT) and ankle brachial pressure index (ABI), along with metabolic parameters, and were categorized into ulcer, foot at risk and patients with no risk factors. Foot care practices were assessed with a questionnaire. Peripheral neuropathy was defined as VPT score ≥ 25 V. Peripheral vascular disease (PVD) was defined as ABI < 0.9. One hundred and forty‐nine patients with foot at risk were followed up for 9.0 ± 2.3 months (range 5–13 months). Results The prevalence of peripheral neuropathy was 34.9% and of PVD 12.6%. Two thirds of the patients were at risk for foot ulceration; 9% had an ulcer and 20.2% of them required amputation. Correct foot care practices were followed by 214 (20.5%) subjects of the whole study population and by only 135 (19.3%) of the patients with foot at risk. Improvement in glycaemic control in the patients on follow‐up was associated with improvement or stabilization of VPT score. Five (3.4%) patients developed new ulcers on follow‐up. Conclusion The high prevalence of neuropathy and PVD, coexisting with poor adherence to foot care practices predisposes to foot problems in people with diabetes in our study population.     

Severe peripheral neuropathy and elevated plantar pressures causing foot ulceration in pituitary gigantism

We report two patients with treated pituitary gigantism and peripheral neuropathy, one of whom has chronic foot ulceration. Detailed neurophysiologfcal assessment was performed on both patients. The patient with foot ulceration had clinical and neurophysiological evidence of severe neuropathy, whereas the patient without ulceration had only neurophysiological abnormalities. The sweating response to acetylcholine was markedly impaired in the feet of both patients, suggesting pedal autonomic denervation. Neither patient had evidence of diabetes mellitus and detailed investigation failed to reveal an alternative cause of peripheral neuropathy. Optical pedobarography revealed abnormally high pressure (>10 kg/cm²) under the metatarsal heads of both patients, one such area coinciding with the area of ulceration. Thus in pituitary gigantism elevated plantar pressures may contribute to the development of foot ulceration when severe peripheral neuropathy Is present. Furthermore, as in diabetes mellitus, impaired sweating may also increase the risk of ulceration as the resultant dry skin may develop fissures.     

Transmission of Rickettsia orientalis to man by Leptotrombidium akamushi at a scrub typhus endemic area in Akita Prefecture, Japan

During the summer seasons of 1956 through 1970, 93 larval trombiculid mites were removed from 386 individuals who had been bitten by chiggers in Jumonji, Akita Prefecture. All 87 larvae that were available for examination were identified as Leptotrombidium akamushi. Infestation of man occurred predominantly during July and August, but the period extended from June to November. The duration of attachment was approximately 1 to 3 days. Usually only 1 chigger was found on a victim but on occasion as many as 7 were removed at one time. Scrub typhus developed in 45 (11.7%) of the 386 farmers bitten by chiggers. Although patients with scrub typhus may have sustained multiple bites, only one eschar was found. However, 76% of the patients did not recognize a bite either at the site where an eschar subsequently appeared or elsewhere prior to the onset of disease. If it is assumed that workers who did not subsequently become ill were equally unaware of chigger bites, then the probable incidence of disease in chigger victims was 3.1%. The minimum infectivity rate of L. akamushi larvae in Akita Prefecture was estimated to be 2.3%. Based upon the assumption that infection was transmitted as the result of a single bite, the infective rate of chiggers attacking man was calculated to be 2.5%.     

Obstructive sleep apnea and diabetic neuropathy: a novel association in patients with type 2 diabetes

Rationale: Diabetic peripheral neuropathy is common and causes significant morbidity. Obstructive sleep apnea (OSA) is also common in patients with type 2 diabetes. Because OSA is associated with inflammation and oxidative stress, we hypothesized that OSA is associated with peripheral neuropathy in type 2 diabetes. Objectives: To assess the relationship between OSA and peripheral neuropathy in patients with type 2 diabetes. Methods: A cross-sectional study of adults with type 2 diabetes recruited randomly from the diabetes clinic of two UK hospitals. Measurements and Main Results: Peripheral neuropathy was diagnosed using the Michigan Neuropathy Screening Instrument. OSA (apnea-hypopnea index ≥ 5 events/h) was assessed using home-based, multichannel respiratory monitoring. Serum nitrotyrosine was measured by ELISA, lipid peroxide by spectrophotometer, and microvascular function by laser speckle contrast imaging. Two hundred thirty-four patients (mean [SD] age, 57 [12] yr) were analyzed. OSA prevalence was 65% (median apnea-hypopnea index, 7.2; range, 0-93), 40% of which were moderate to severe. Neuropathy prevalence was higher in patients with OSA than those without (60% vs. 27%, P < 0.001). After adjustment for possible confounders, OSA remained independently associated with diabetic neuropathy (odds ratio, 2.82; 95% confidence interval, 1.44-5.52; P = 0.0034). Nitrotyrosine and lipid peroxide levels (n = 102, 74 with OSA) were higher in OSA and correlated with hypoxemia severity. Cutaneous microvascular function (n = 71, 47 with OSA) was impaired in OSA. Conclusions: We describe a novel independent association between diabetic peripheral neuropathy and OSA. We identified increased nitrosative/oxidative stress and impaired microvascular regulation as potential mechanisms. Prospective and interventional studies are needed to assess the impact of OSA and its treatment on peripheral neuropathy development and progression in patients with type 2 diabetes.