Pressure time integral as a discriminant for group membership in the progression of diabetes

Diabetic neuropathy is one of the most common complications associated with progression of diabetes. Several approaches have been used in an attempt to predict the onset of neuropathy, peak pressure notwithstanding. Yet, prediction of this complication remains elusive. We sought to broaden the approach of discrete (peak) pressure values by evaluating the effects of the pressure-time integral (PTI) at specific plantar surface foot regions (rearfoot, midfoot, forefoot). Four groups: healthy (H), pre-diabetic (PD), diabetic without neuropathy (D), and diabetic with neuropathy (DN) walked while wearing pressure-measuring insoles. Results identified a significant region x group interaction for PTI. Follow-up simple main effects demonstrated significant PTI differences at the forefoot region for all groups. Excluding H, results further suggested that PTI may be used to identify group membership, as demonstrated by an increase in PTI across all foot regions for PD, D and DN.