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

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Evidence Table: Section 5Detection of Loss of Protective Foot SensationAuthorLevel of EvidenceLevel Study TypeEvidenceQualityRatingMagnitudeRatingRelevanceRatingArmstrong DG (1998)(Adults – US)III-2 Case-control Medium High + HighBoyko EJ (1999)(Adults – US)III-2 Cohort High High + HighKlenerman L (1996)(Adults – UK)III-2 Cross-sectional High High + HighMayfield JA (2000)III-2Systematic review ofCohort studiesMedium High + HighMcGill M (1999)(Adults – Australia)III-2 Cross-sectional Medium High + HighMcNeely MJ (1995)(Adults – US)III-2 Case-control High High + HighPham H (2000)(Adults – US)III-2 Cohort High High + HighRith-Najarian S (1992)(Adults – Red LakeIII-2 Cohort High High + LowChippewa Indians)For magnitude rating:+Semmes-Weinstein monofilament predicts foot ulceration. 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 9.46
Section 6: Diabetes Foot ProblemsIssueHow should peripheral vascular disease be assessed clinically?RecommendationPeople with diabetes should be assessed for peripheral vascular disease by:− enquiring about symptoms of intermittent claudication− palpation of pedal pulsesEvidence Statements• Intermittent claudication is indicative of peripheral vascular diseaseEvidence Level III-2• The absence of intermittent claudication does not exclude peripheral vascular diseaseEvidence Level III-2• Palpable foot pulses in people with diabetes make significant peripheral vasculardisease unlikelyEvidence Level III-2• The absence of foot pulses increases the likelihood of amputationEvidence Level III-247
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 20 and 21: Section 2: Diabetes Foot ProblemsIs
Page 22 and 23: predicting risk of amputation, 2.9
Page 24 and 25: Summary - Peripheral Vascular Disea
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 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•
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Section 13: Diabetes Foot ProblemsI
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Some ethnic groups are associated w
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Evidence Table: Section 13AuthorSoc
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Calle-Pascual AL, Duran A, Diaz A,
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Jannink MJ, van Dijk H, de Vries J,
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Moss SE, Klein R, Klein BE. The 14-
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Soulier SM, Godsey C, Asay ED, Perr
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Diabetes Foot Problems: General Ref
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McNeely MJ, Boyko EJ, Ahroni JH, St
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Diabetes Foot Problems: Other Refer
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Caputo GM, Cavanagh PR, Ulbrecht JS
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Garbalosa JC, Cavanagh PR, Wu G, Ul
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Lavery LA, Armstrong DG, Wunderlich
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Payne C. Regional variations of dia
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Tovi J, Svanborg E, Nilsson BY, Eng
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Criteria used to determine the suit
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QUESTIONS KEY WORDS NO.ARTICLESIDEN
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Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

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