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

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Evidence Table: Section 9AuthorGlycaemic control and peripheral neuropathyLevel of EvidenceLevel Study TypeEvidenceQualityRatingMagnitudeRatingRelevanceRatingAzad N (1999)(Adults – US)II RCT High Medium + HighDyck PJ (1999)(Adults – US)III-2 Cohort High High + HighGaster B (1998) I Systematic Review High High + HighHotta N (1993)(Adults – Japan)II RCT Medium High + LowKlein R (1995)(Adults – US)III-2 Cohort High High + HighKlein R (1996)(Adults – US)III-2 Cohort High High + HighOhkubo Y (1995)(Adults – Japan)II RCT Medium High + LowTovi J (1998)(Adults – Sweden)II RCT Medium Low HighUKPDS 33 (1998)(Adults – UK)II RCT High High + Highvan de Poll-Franse LV(2002)III-2 Cohort High High + High(Adults – The Netherlands)For magnitude rating:+indicates positive effect of glycaemic control 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 9.72
Section 10: Diabetes Foot ProblemsIssueDoes appropriate footwear reduce ulceration and amputation?RecommendationsPeople with diabetes should be encouraged to wear properly fitted, cushioned footwear andpadded socks.People with diabetes with high risk feet require special attention to footwear.Evidence Statements• Therapeutic footwear reduces the risk of ulcer recurrenceEvidence Level I• Therapeutic footwear combined with podiatry care reduces the risk of amputation inhigh risk individualsEvidence Level II• Plantar foot pressures are influenced by footwearEvidence Level III-2• Callus formation can be reduced by certain footwearEvidence Level II• Padded socks reduce plantar pressureEvidence Level III-273
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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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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
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Page 36 and 37: Also in the Seattle study, 67 peopl
Page 38 and 39: Summary - Ulcer as a Risk Factor fo
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Page 46 and 47: Evidence Table: Section 5Detection
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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
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Page 62 and 63: Mazzuca et al (1986) studies 532 pe
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Page 66 and 67: Evidence Table: Section 8AuthorEffe
Page 68 and 69: Background - Glycaemic Control and
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Page 74 and 75: Background - Footwear to Reduce Ulc
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Page 78 and 79: Comparisons of in-shoe foot pressur
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Page 84 and 85: Background - Foot Clinics and Multi
Page 86 and 87: A prospective non randomised contro
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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
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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
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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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