Racial Disparities in Diabetes Prevalence and Peripheral Neuropathy Characteristics: A Single-Center Retrospective Review of Native Hawaiians and Other Pacific Islanders in Hawaiʻi

Background: Peripheral neuropathy is a painful complication of type 2 diabetes where nerve damage can lead to muscle weakness, balance impairment, and autonomic instability which are established risk factors for falls. Native Hawaiian and Pacific Islander (NHPI) communities have a disproportionate burden of type 2 diabetes yet remain underrepresented in neuropathy research. Current screening guidelines rely on sensory-focused tests such as monofilament and vibration testing to detect early nerve damage, reflecting the assumption that neuropathy presents as sensory loss before motor weakness or autonomic symptoms like dizziness and fainting. A prior retrospective chart review of 274 patients at Hawaii Pacific Neuroscience found that NHPI patients presented with significantly less documented sensory loss but greater muscle weakness and autonomic dizziness compared to White and Asian patients, even after adjusting for age, body mass index (BMI), and diabetes status. This pattern suggested that standard sensory-first screenings may underrecognize neuropathic symptoms in NHPI patients and may contribute to undetected fall risk in this population.

Methods: This study extends the previous work by examining whether racial and ethnic differences in neuropathic presentation translate into measurable differences in fall transition risk. Fall transition is defined as any documented shift from non-faller to faller status in the medical record and represents a critical clinical moment where once a patient experiences their first fall, their risk of recurrent falls increases. A retrospective cohort of 187 patients was drawn from Hawaii Pacific Neuroscience (2013-2026). All patients had peripheral neuropathy confirmed via nerve conduction studies and ICD-10 coding. A logistic regression model was fit to examine fall transition status as a function of race and ethnicity, BMI, diabetes status, and age, with White patients as the reference group.

Results: Neither NHPI or Asian race and ethnicity was significantly associated with fall transition after adjustment. NHPI patients had lower adjusted odds of fall transition compared to White patients (OR = 0.74, 95% CI [0.35, 1.57], p = .432), while Asian patients had higher adjusted odds (OR = 1.77, 95% CI [0.70, 4.44], p = .220), though neither result reached statistical significance. Higher Diabetes status showed a trending positive association with fall transition (OR = 1.81, 95% CI [0.77,4.20], p = .169) that warrants further investigation.

Conclusion: These findings do not yet demonstrate a significant racial or ethnic disparity in documented fall transition risk after accounting for metabolic and demographic factors. However, the trending association between diabetes status and fall transition, combined with previous finding of greater motor and autonomic burden in NHPI patients, suggests that the relationship between neuropathy phenotype and fall risk in this population warrants continued investigation. Limitations include incomplete glycemic control data (HbA1c), likely underreporting of falls in routine clinical documentation, and a small sample size. Prospective studies with standardized fall ascertainment and complete metabolic data are needed to clarify whether neuropathic presentation is observed in NHPI patients contributes to real world fall and injury risk.