Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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Evidence Table: Section 13AuthorSocioeconomic ConsiderationsLevel of EvidenceLevel Study TypeEvidenceQualityRatingMagnitudeRatingRelevanceRatingKarter AJ (2002)(Adults – US)III-2 Cohort High High + MediumLavery LA (2003b)(Adults – US)III-2 Cohort High High + MediumWeng C (2000)(Adults – UK)III-2 Cohort High High + MediumYoung BA (2003)(Adults – US)III-2 Cohort High High + MediumFor magnitude rating:+indicates negative effect (or impact) of lower socioeconomic status on diabetic foot disease. High = clinically important &statistically significant; Medium = small clinical importance & statistically significant; Low = no statistically significant effect.Criteria for Quality and Relevance ratings are detailed in Appendix 9.100
Diabetes Foot Problems: Evidence ReferencesAbbott CA, Vileikyte L, Williamson S, Carrington AL, Boulton AJ. Multicenter study of the incidenceof and predictive risk factors for diabetic neuropathic foot ulceration. Diabtetes Care 1998;21:1071-5.Abbott CA, Carrington AL, Ache H, Bath S, Every LC, Griffiths J, Hann AW, Hussein A, Jackson N,Johnson KE, Ryder CH, Torkington R, Van Ross ERE, Whalley AM, Widdows P, Williamson S,Boulton AJM. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, newdiabetic foot ulceration in a community-based patients cohort. Diabet Med 2002;19:377-84.Abouaesha F, van Schie CH, Griffths GD, Young RJ, Boulton AJ. Plantar tissue thickness is related topeak plantar pressure in the high-risk diabetic foot. Diabetes Care 2001;24:1270-4.Adler AI, Boyko EJ, Ahroni JH, Smith DG. Lower-extremity amputation in diabetes. The independenteffects of peripheral vascular disease, sensory neuropathy, and foot ulcers. Diabetes Care1999;22:1029-35.American Diabetes Association. Preventive foot care in diabetes. Diabetes Care 2004;27 (Suppl1):S63-4.Apelqvist J, Larsson J, Agardh CD. The influence of external precipitating factors and peripheralneuropathy on the development and outcome of diabetic foot ulcers. J Diabetes Complications1990;4:21-5.Armstrong DG, Lavery LA, Vela SA, Quebedeaux TL, Fleischli JG. Choosing a practical screeninginstrument to indentify patients at risk for diabetic foot ulceration. Arch Intern Med 1998;158:289-92.Armstrong DG, Nguyen HC, Lavery LA, van Schie CH, Boulton AJ, Harkless LB. Off-loading thediabetic foot wound: a randomised clinical trial. Diabetes Care 2001;24:1019-22.Azad N, Emanuele NV, Abraira C, Henderson WG, Colwell J, Levin SR, Nuttall FQ, Comstock JP,Sawin CT, Silbert C, Rubino FA. The effects of intensive glycemic control on neuropathy in the VAcooperative study on type II diabetes mellitus (VA CSDM). J Diabetes Complications 1999;13:307-13.Barth R, Campbell LV, Allen S, Jupp JJ, Chisholm DJ. Intensive education improves knowledge,compliance, and foot problems in Type 2 diabetes. Diabet Med 1991;8:111-7.Benotmane A, Mohammedi F, Ayad F, Kadi K, Medjbeur S, Azzouz A. Management of diabetic footlesions in hospital: costs and benefits. Diabetes Metab 2001;27:688-94.Bloomgarden ZT, Karmally W, Metzger MJ, Brothers M, Nechemias C, Bookman J, Faierman D,Ginsberg-Fellner F, Rayfield E, Brown WV. Randomized controlled trial of diabetic patient education:improved knowledge without improved metabolic status. Diabetes Care 1987;10:263-72.Boulton AJ, Kubrusly DB, Bowker JH, Gadia MT, Quintero L, Becker DM, Skyler JS, Sosenko JM.Impaired vibratory perception and diabetic foot ulceration. Diabet Med 1986;3:335-7.Boyko EJ, Ahroni JH, Davignon D, Stensel V, Prigeon RL, Smith DG. Diagnositic utility of the historyand physical examination for peripheral vascular disease among patients with diabetes mellitus. J ClinEpidemiol 1997;50:659-68.Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Davignon DR, Smith DG. A prospective study of riskfactors for diabetic foot ulcers. Diabetes Care 1999;22:1036-42.Brown MJ, Bird SJ, Watling S, Kaleta H, Hayes L, Eckert S, Foyt HL. Natural progression of diabeticperipheral neuropathy in the Zenarestat study population. Diabetes Care 2004;27:1153-9.Busch K, Chantelau E. Effectiveness of a new brand of stock 'diabetic' shoes to protect anainst diabeticfoot ulcer relapse. A prospective cohort study. Diabet Med 2003;20:665-9.101
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National Evidence Based Guidelinesf
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Research OfficersMs Linda SmithPodi
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2.2 Issues for Foot Problems in Typ
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• Aim to achieve the best possibl
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Background - Peripheral Neuropathy
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proportion of subjects with a durat
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and an OR 1.1-7.8. This study also
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Summary - Peripheral Neuropathy as
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Section 2: Diabetes Foot ProblemsIs
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predicting risk of amputation, 2.9
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Summary - Peripheral Vascular Disea
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Evidence - Foot Deformity and Previ
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people with both LJM and neuropathy
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Summary - Foot Deformity and Previo
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Also in the Seattle study, 67 peopl
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Summary - Ulcer as a Risk Factor fo
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The other frequently reported metho
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side; and 82% having the same resul
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Evidence Table: Section 5Detection
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Background - Clinical Detection of
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Page 124 and 125: Tovi J, Svanborg E, Nilsson BY, Eng
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Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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