Risk score effective for predicting foot ulceration in diabetics
MedWire News: A UK scoring system developed for patients with diabetes is effective for predicting 4-year foot ulceration risk, suggest findings published in a brief report.
"In patients who are at low-risk, it may be that less frequent screening (every 3-4 years) may be appropriate if the patient is well informed to seek help if there are foot abnormalities present," write David Price (ABM University, Swansea, UK), and colleagues.
Current guidelines suggest annual foot screening for patients with diabetes, stratifying them as low-, increased-, or high-risk for foot ulceration, to try and reduce the high number of traumatic lower limb amputations caused by diabetic foot ulcers. Assessment of risk includes measurement of vibration sense and the degree of movement in the foot, as well as the presence of sensory neuropathy and general abnormalities.
In this study, Price and co-workers assessed the efficacy of such stratification for prediction of foot ulceration in 1153 diabetic individuals, with a mean age of 66.5 years, who were followed-up for 4.0 years. They found that 0.17% (1/586), 3.30% (10/305), and 11.9% (28/236) of those considered at low-, increased-, and high-risk had developed new foot ulceration since baseline.
Individuals in the low-risk group were younger, had a shorter duration of diabetes, had lower creatinine levels and incidence of microalbuminuria/proteinuria, and were less likely to use ACE (angiotensin-converting enzyme) inhibitors than those in the higher risk groups. They also had higher diastolic blood pressure and total cholesterol levels.
The researchers found that, after adjusting for these factors, the patients in the increased- and high-risk groups had a significant 4-year prospective risk for foot ulceration of 11.9 and 30.7, respectively, compared with patients in the low-risk group.
"A long-term prospective large-scale study is warranted to examine this further," conclude Price et al in the journal Diabetes Research and Clinical Practice.
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By Helen Albert