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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(VPT ≥ 25 V on at least one foot <strong>and</strong> VPT ≤ 50 V on both feet) <strong>in</strong> the UK, US <strong>and</strong>Canada. For each 1 unit <strong>in</strong>crease <strong>in</strong> VPT at basel<strong>in</strong>e the risk <strong>of</strong> ulcer <strong>in</strong>creased by5.6% <strong>and</strong> a VPT > 25V carried a sevenfold risk <strong>of</strong> ulceration over 4 years. AbnormalVPT carried a 7% annual risk <strong>of</strong> foot ulcer (Abbott et al, 1998).In a prospective case control study, 213 people with diabetes (both <strong>Type</strong> 1 <strong>and</strong> 2)were evaluated for the usefulness <strong>of</strong> the International Work<strong>in</strong>g Group on the Diabetic<strong>Foot</strong> Classification System (Peters & Lavery, 2001). They were stratified <strong>in</strong>to fourrisk category groups: no neuropathy (Group 0, n=79), neuropathy without PVD ordeformity (Group 1, n=21), neuropathy <strong>and</strong>/or PVD <strong>and</strong>/or deformity (Group 2, n=51)<strong>and</strong> previous history <strong>of</strong> foot ulcer or a lower-extremity amputation (Group 3, n=62),followed for 3 years <strong>and</strong> assessed for the development <strong>of</strong> foot problems. Mean age<strong>and</strong> duration <strong>of</strong> diabetes <strong>in</strong>creased significantly with <strong>in</strong>creas<strong>in</strong>g severity <strong>of</strong> riskclassification. <strong>Foot</strong> ulcers occurred <strong>in</strong> 5.1, 14.3, 18.8, <strong>and</strong> 55.8% <strong>of</strong> people <strong>in</strong> each <strong>of</strong>the four groups respectively (p
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