Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes
Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes
proportion of subjects with a duration of diabetes >25 years (25 v 5%, p 25V, the testsensitivity for developing a first ulcer was 83% with a specificity of 62% withlikelihood ratio for a positive test of 2.2 (CI 1.8-2.5) and for a negative test of 0.27 (CI0.14-0.48). In these 469 subjects with both Type 1 and Type 2 diabetes withoutprevious ulceration, a vibration perception threshold (VPT) > 25V was associatedwith a 7.99 (CI 3.65-17.5; p < 0.01) times increased risk of ulceration compared withpeople who had a VPT < 15V. Recurrent ulceration only occurred in those with VPT> 25V, who had a cumulative 4-year ulcer incidence of 19.8% or 8.3% per year(Young et al, 1994).In a prospective study of 352 people with Type 2 diabetes, foot lesions were assessedusing the Seattle Wound Classification system. Monofilament testing and thermalsensitivity testing were used to identify neuropathy. In this predominantly AfricanAmerican female group (76%) with a mean age 60 years, using multivariatemodelling, neuropathy predicted both minor wounds and ulceration (OR 5.23 [CI2.26-12.13], p≤0.001) (Litzelman et al, 1997a).Abbott et al (1998) prospectively investigated the incidence of foot ulcer over oneyear in 1,033 people with Type 1 or Type 2 diabetes with established neuropathy14
(VPT ≥ 25 V on at least one foot and VPT ≤ 50 V on both feet) in the UK, US andCanada. For each 1 unit increase in VPT at baseline the risk of ulcer increased by5.6% and a VPT > 25V carried a sevenfold risk of ulceration over 4 years. AbnormalVPT carried a 7% annual risk of foot ulcer (Abbott et al, 1998).In a prospective case control study, 213 people with diabetes (both Type 1 and 2)were evaluated for the usefulness of the International Working Group on the DiabeticFoot Classification System (Peters & Lavery, 2001). They were stratified into fourrisk category groups: no neuropathy (Group 0, n=79), neuropathy without PVD ordeformity (Group 1, n=21), neuropathy and/or PVD and/or deformity (Group 2, n=51)and previous history of foot ulcer or a lower-extremity amputation (Group 3, n=62),followed for 3 years and assessed for the development of foot problems. Mean ageand duration of diabetes increased significantly with increasing severity of riskclassification. Foot ulcers occurred in 5.1, 14.3, 18.8, and 55.8% of people in each ofthe four groups respectively (p
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proportion <strong>of</strong> subjects with a duration <strong>of</strong> diabetes >25 years (25 v 5%, p 25V, the testsensitivity for develop<strong>in</strong>g a first ulcer was 83% with a specificity <strong>of</strong> 62% withlikelihood ratio for a positive test <strong>of</strong> 2.2 (CI 1.8-2.5) <strong>and</strong> for a negative test <strong>of</strong> 0.27 (CI0.14-0.48). In these 469 subjects with both <strong>Type</strong> 1 <strong>and</strong> <strong>Type</strong> 2 diabetes withoutprevious ulceration, a vibration perception threshold (VPT) > 25V was associatedwith a 7.99 (CI 3.65-17.5; p < 0.01) times <strong>in</strong>creased risk <strong>of</strong> ulceration compared withpeople who had a VPT < 15V. Recurrent ulceration only occurred <strong>in</strong> those with VPT> 25V, who had a cumulative 4-year ulcer <strong>in</strong>cidence <strong>of</strong> 19.8% or 8.3% per year(Young et al, 1994).In a prospective study <strong>of</strong> 352 people with <strong>Type</strong> 2 diabetes, foot lesions were assessedus<strong>in</strong>g the Seattle Wound Classification system. Mon<strong>of</strong>ilament test<strong>in</strong>g <strong>and</strong> thermalsensitivity test<strong>in</strong>g were used to identify neuropathy. In this predom<strong>in</strong>antly AfricanAmerican female group (76%) with a mean age 60 years, us<strong>in</strong>g multivariatemodell<strong>in</strong>g, neuropathy predicted both m<strong>in</strong>or wounds <strong>and</strong> ulceration (OR 5.23 [CI2.26-12.13], p≤0.001) (Litzelman et al, 1997a).Abbott et al (1998) prospectively <strong>in</strong>vestigated the <strong>in</strong>cidence <strong>of</strong> foot ulcer over oneyear <strong>in</strong> 1,033 people with <strong>Type</strong> 1 or <strong>Type</strong> 2 diabetes with established neuropathy14
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