Effectiveness of the Diabetic Foot Risk Classification System of the International Working Group on the Diabetic Foot

Abstract

OBJECTIVE—To evaluate the effectiveness of a diabetic foot risk classification system by the International Working Group on the Diabetic Foot to predict clinical outcomes. RESEARCH DESIGN AND METHODS—A total of 225 diabetic patients were initially evaluated as part of a prospective case-control study at the University of Texas Health Science Center at San Antonio. Complete records were available for 213 patients for follow-up evaluation after 29 months. Upon enrollment, subjects were stratified into four risk groups based on the presence of risk factors according to the consensus of the International Working Group on the Diabetic Foot. Group 0 consisted of subjects without neuropathy, group 1 consisted of patients with neuropathy but without deformity or peripheral vascular disease (PVD), group 2 consisted of subjects with neuropathy and deformity or PVD, and group 3 consisted of patients with a history of foot ulceration or a lower-extremity amputation. RESULTS—Upon enrollment, patients in higher-risk groups had longer duration of diabetes, worse glycemic control, vascular and neuropathic variables, and more systemic complications of diabetes. During 3 years of follow-up, ulceration occurred in 5.1, 14.3, 18.8, and 55.8% of the patients in groups 0, 1, 2, and 3, respectively (linear-by-linear association, P < 0.001). All amputations were found in Groups 2 and 3 (3.1 and 20.9%, P < 0.001). CONCLUSIONS—The foot risk classification of the International Working Group on the Diabetic Foot predicts ulceration and amputation and can function as a tool to prevent lower-extremity complications of diabetes.

Risk stratification systems for diabetic foot ulcers: a systematic review

“…No validity testing of the ADA system has ever been performed, while the SIGN and UTFRS systems have been validated once [18,21]. The IWGDF system suffered modifications twice and its validation was performed accordingly [19,20]. The Boyko et al system was the only one externally validated [24,25].…”

“…The IWGDF system This stratification system was created through consensus involving 45 expert clinicians and researchers from 23 countries [9,19]. Although there is an 8 year interval between them, both papers by Apelqvist and colleagues [9,14] are very similar.…”

Building a scalable diabetic limb preservation program: four steps to success

“…This examination has been codified as part of the American Diabetes Association Comprehensive Diabetic Foot Examination [25]. It was further pared down to a basic ‘three-minute foot exam’ for family physicians, nurses, and technicians [11,26–28]. Once risk levels are determined, more appropriate recommendations can be made regarding shoe-gear, insoles, orthoses, and follow-up intervals.…”

Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial

“…A reduced incidence of new foot ulcers has been shown when foot care education was included as part of an integrated package of diabetes care delivered to selected and relatively disadvantaged groups in the USA [12,13], but has not been confirmed in other studies [14][15][16][17][18][19].…”

“…those who have had an ulcer before [19,20]. In a Swedish cohort study of 558 people managed between 1983 and 1990 ulcers recurred in 34, 61 and 70% at 1, 3 and 5 years, and major amputation in 3, 10 and 12% [21].…”