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

More documents

Recommendations

Info

Section 2: Diabetes Foot ProblemsIssueIs peripheral vascular disease a risk factor for ulceration or amputation?RecommendationPeople with diabetes should be assessed regularly for peripheral vascular disease.Evidence Statements• Peripheral vascular disease is a risk factor for amputationEvidence Level III-2• Studies on the relationship between peripheral vascular disease and foot ulcers havegiven variable resultsEvidence Level III-220
Background - Peripheral Vascular Disease as a Risk FactorPeripheral vascular disease (PVD) is common in people with Type 2 diabetes beingpresent in 8% at the time of diagnosis and in 45% of people who have had diabetes for20 years (Hiatt & Sussman, 1994). The prevalence of PVD at diagnosis of diabetesand the risk of developing PVD over time increase with increasing age (Davis et al,1997).PVD is considered to be the most important factor related to outcome of a diabeticfoot ulcer (International Working Group on the Diabetic Foot, 1999) and is a majorcontributor to the high rates of amputation in people with diabetes as well aspredicting increased risk of cardiovascular mortality (Orchard & Strandness, 1993).Vascular assessment in the general practice setting is, by necessity, based on historyand clinical examination. More sophisticated bedside investigations are available andhave been shown to predict ulceration and amputation. The ankle-arm index (AAI) orankle-brachial index (ABI), is a ratio of blood pressure measured in the arm and in theankle by a hand-held ultrasound doppler. A ratio of less than 0.50 indicates severePVD. Calcification of pedal arteries, which is common in people with diabetes, resultsin a falsely high blood pressure reading in the feet and consequently a falsely highratio. In addition, the repeatability of the AAI/ABI measure has a coefficient ofvariation of 10 to 15% and therefore requires duplicate readings. In view of theequipment and time required to perform the examination, AAI/ABI may be used in aspecialist practice but has limited application in a busy general practice.Transcutaneous oximetry (TcPO 2 ) is a measurement of partial pressure of oxygen atthe skin surface. Levels less that 50mmHg are associated with PVD and a reducedhealing ability (McNeely et al, 1995).Invasive techniques such as angiography are more specific in demonstrating PVD butare also associated with significant morbidity. In a study of 104 people with diabetes,both a score based on the results of an angiogram (OR 2.32 [CI 1.40-3.84]) and theABI (OR 1.84 [CI 1.10-3.06]) were predictive of major amputation (Faglia et al,1998).Evidence - Peripheral Vascular Disease as a Risk FactorPeripheral vascular disease is a risk factor for amputationIn the prospective Seattle Diabetic Foot Study of 776 veterans with diabetes, PVD hasbeen shown to be an independent risk factor for amputation (RR 3.0, CI 1.3-7.1)(Adler et al, 1999). In a multivariate model relative to a reference hazard ratio (HR) of1 for an individual with neither PVD (as indicated by absent or diminished pulses) norneuropathy, individuals with PVD in either leg but without neuropathy had an HR foramputation of 20.5 compared with an HR of 9.3 for neuropathy alone and HR 19.0when both PVD and neuropathy were present. When different measures of PVD wereused in a multivariate hazards model, AAI ≤0.8 in either lower extremity, TcPO 2 ≤50mmHg in either foot and absence/diminished peripheral pulses gave a similar HR for21
Page 1: National Evidence Based Guidelinesf
Page 4: Research OfficersMs Linda SmithPodi
Page 7 and 8: 2.2 Issues for Foot Problems in Typ
Page 9: • Aim to achieve the best possibl
Page 12 and 13: Background - Peripheral Neuropathy
Page 14 and 15: proportion of subjects with a durat
Page 16 and 17: and an OR 1.1-7.8. This study also
Page 18 and 19: Summary - Peripheral Neuropathy as
Page 22 and 23: predicting risk of amputation, 2.9
Page 24 and 25: Summary - Peripheral Vascular Disea
Page 26 and 27: Section 3: Diabetes Foot ProblemsIs
Page 28 and 29: Evidence - Foot Deformity and Previ
Page 30 and 31: people with both LJM and neuropathy
Page 32 and 33: Summary - Foot Deformity and Previo
Page 36 and 37: Also in the Seattle study, 67 peopl
Page 38 and 39: Summary - Ulcer as a Risk Factor fo
Page 42 and 43: The other frequently reported metho
Page 44 and 45: side; and 82% having the same resul
Page 46 and 47: Evidence Table: Section 5Detection
Page 48 and 49: Background - Clinical Detection of
Page 50 and 51: pulse was bilaterally absent in 1.8
Page 52 and 53: Evidence Table: Section 6AuthorClin
Page 54 and 55: Background - Frequency of Foot Exam
Page 56 and 57: Summary - Frequency of Foot Examina
Page 60 and 61: Behaviour assessment scores, measur
Page 62 and 63: Mazzuca et al (1986) studies 532 pe
Page 64 and 65: with before the programme, after 1-
Page 66 and 67: Evidence Table: Section 8AuthorEffe
Page 68 and 69: Background - Glycaemic Control and
Page 70 and 71:
In a previous Japanese randomised s
Page 72 and 73:
Evidence Table: Section 9AuthorGlyc
Page 74 and 75:
Background - Footwear to Reduce Ulc
Page 76 and 77:
period. In addition people without
Page 78 and 79:
Comparisons of in-shoe foot pressur
Page 80 and 81:
The rate of plantar callus formatio
Page 82 and 83:
Evidence Table: Section 10AuthorFoo
Page 84 and 85:
Background - Foot Clinics and Multi
Page 86 and 87:
A prospective non randomised contro
Page 88 and 89:
Summary - Foot Clinics and Multi-di
Page 90 and 91:
Section 12: Diabetes Foot ProblemsI
Page 92 and 93:
and/or osteomyelitis; III - fore-fo
Page 94 and 95:
Summary - Economic consequences•
Page 96 and 97:
Section 13: Diabetes Foot ProblemsI
Page 98 and 99:
Some ethnic groups are associated w
Page 100 and 101:
Evidence Table: Section 13AuthorSoc
Page 102 and 103:
Calle-Pascual AL, Duran A, Diaz A,
Page 104 and 105:
Jannink MJ, van Dijk H, de Vries J,
Page 106 and 107:
Moss SE, Klein R, Klein BE. The 14-
Page 108 and 109:
Soulier SM, Godsey C, Asay ED, Perr
Page 110 and 111:
Diabetes Foot Problems: General Ref
Page 112 and 113:
McNeely MJ, Boyko EJ, Ahroni JH, St
Page 114 and 115:
Diabetes Foot Problems: Other Refer
Page 116 and 117:
Caputo GM, Cavanagh PR, Ulbrecht JS
Page 118 and 119:
Garbalosa JC, Cavanagh PR, Wu G, Ul
Page 120 and 121:
Lavery LA, Armstrong DG, Wunderlich
Page 122 and 123:
Payne C. Regional variations of dia
Page 124 and 125:
Tovi J, Svanborg E, Nilsson BY, Eng
Page 126 and 127:
Criteria used to determine the suit
Page 128 and 129:
QUESTIONS KEY WORDS NO.ARTICLESIDEN
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
show all

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

Create successful ePaper yourself

Delete template?

Save as template?