Multicenter Study of the Incidence of and Predictive Risk Factors for Diabetic Neuropathic Foot Ulceration

Abbott, Caroline A.; Vileikyte, Loretta; Williamson, Sheila; Carrington, Anne L.; Boulton, Andrew J.M.

doi:10.2337/diacare.21.7.1071

Cited by 350 publications

(260 citation statements)

References 19 publications

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“…O LPV, sensível para diagnóstico de neuropatia leve e subclínica (20), já tinha sido apontado por Boulton e cols. (21) (12). Os autores observaram que a cada aumento de 1 volt no LPV o risco da primeira úlcera no pé se elevava em 5,6%.…”

Section: Discussionunclassified

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Análise de fatores associados à ulceração de extremidades em indivíduos diabéticos com neuropatia periférica

Porciúncula

Rolim

Garofolo

et al. 2007

Arq Bras Endocrinol Metab

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Analysis of Factors Associated with Extremity Ulceration in Diabetic Subjects with Peripheral Neuropathy.Peripheral neuropathy is the main risk factor for foot ulceration in diabetic subjects. This study examined the association of peripheral arterial disease (PAD) with foot ulceration in a sample of diabetic subjects with peripheral neuropathy, and also if inflammatory markers would be associated with this event. We evaluated 32 type 2 diabetic individuals with abnormal 10-g monofilament exam, who were stratified in 2 groups according to history or presence of lower extremities ulcer. The group "with ulcer" (n = 18) included the ones that had active or cicatrized ulcer, or some lower-extremity amputation due to ulcer complications. In addition to the neurological examination and monofilament test, they were submitted to biothesiometry, lower extremity vascular assessment with Doppler, and laboratory determinations. No difference between the groups was found concerning sex distribution, mean age, and duration of diabetes diagnosis. The group with ulcer showed higher mean values of height (1.70 ± 0.06 vs. 1.63 ± 0.11 m, p = 0.044), vibration perception threshold measured in medial malleolli (40.9 ± 13.0 vs. 30.6 ± 12.3 V, p = 0.040) than the group without ulcer. The groups did not differ regarding the mean values of the inflammatory markers. Response to patellae reflex was worse in the group with ulcer (p = 0.047), in which a higher proportion of individuals with abnormal toe-brachial index (p = 0.030) was observed as compared to those without ulcer. We concluded that PAD is associated with the presence of ulcer in neuropathic subjects. The assessment of digital arteries flow in lower limbs (in great toe) contributed to detect such association. Association of diabetic foot ulcers and inflammatory markers was not observed, but cannot be excluded due to limitations of sample size. Prospective studies should examine the sensitivity of the toe-brachial index to identify PAD in diabetic individual at risk of ulceration.

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Section: Discussionunclassified

“…Outros estudos confirmaram o ponto de corte do LPV ≥ 25 volt como preditivo para ulceração do pé (10,11). Cada aumento de 1 volt da LPV no nível basal de percepção do indivíduo associou-se a aumento de 5,6% no risco de úlcera (12).…”

Section: Introductionunclassified

Análise de fatores associados à ulceração de extremidades em indivíduos diabéticos com neuropatia periférica

Porciúncula

Rolim

Garofolo

et al. 2007

Arq Bras Endocrinol Metab

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“…Two studies from northern European countries reported the annual incidence of foot ulcers in the general diabetes population to be just over 2% [12,13]. Ulceration is much more common in patients with predisposing risk factors; annual incidence rates in neuropathic individuals vary from 5% to over 7% [18,19]. It is likely that more than 5% of diabetic patients have a history of foot ulcers [11], whereas the cumulative lifetime incidence may be as high as 15% [9].…”

Section: Epidemiologymentioning

confidence: 99%

“…The association between both somatic and autonomic neuropathy and foot ulceration has been recognised for many years [35]. It is only in the last decade that prospective follow-up studies have confirmed this causative role of somatic neuropathy [12,18,19]. Patients with sensory loss appear to show an increase in risk of developing foot ulcers of up to seven-fold, compared with non-neuropathic diabetic individuals.…”

Section: Causal Pathways To Foot Ulcerationmentioning

confidence: 99%

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

2004

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Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences, with both being less common in patients of Indian subcontinent origin living in the UK. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. With respect to the management of acute Charcot neuroarthropathy in diabetes, recent studies suggest that bisphosphonates reduce disease activity as judged not only by differences in skin temperature, but also by assessing markers of bone turnover. The use of the total-contact cast is demonstrated in the treatment of acute Charcot feet and of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that increasing research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.

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“…A avaliação dos pés constitui-se em passo fundamental na identificação dos fatores de risco que podem ser modificados, o que, conseqüen-temente, reduzirá o risco de ulceração e amputação de membros inferiores nas pessoas com diabetes (30) . Autores destacam que a diminuição da sensação protetora, caracterizada pela redução da sensação dolorosa de trauma na pele (3,(32)(33)(34)(35)(36)(37) , bem como a ausência parcial ou total do reflexo Aquileu (14,26,(38)(39) constituem sinais precoces de futuros processos ulcerativos nos pés, significando alto risco para o desenvolvimento de complicações. Ambas as alterações podem ser avaliadas mediante testes que utilizam vários tipos de instrumentos, desde os mais sofisticados aos mais simples.…”

Section: Avaliação Dos Pés E Prevenção De Complicaçõesunclassified

Pé diabético: estratégias para prevenção

Ochoa-Vigo

Pace

2005

Acta paul. enferm.

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Ochoa-Vigo K, Pace AE. Pé diabético: estratégias para prevenção. Acta Paul Enferm 2005; 18(1):100-9.RESUMO: Aproximadamente 50% das amputações não-traumáticas em membros inferiores ocorrem entre pessoas com diabetes. As amputações são precedidas por úlceras, caracterizadas por lesões cutâneas, com perda do epitélio, que podem estender-se até a derme ou chegar a tecidos profundos. As úlceras, geralmente, são acompanhadas de insensibilidade por neuropatia periférica crônica e associadas a pequenos traumas que se originam do uso de calçados inapropriados, dermatoses comuns ou manipulações incorretas dos pés. O objetivo deste estudo é descrever as principais estratégias para avaliar fatores de risco que conduzem ao desenvolvimento de complicações nos membros inferiores entre pessoas com diabetes, bem como considerá-las uma responsabilidade da equipe de assistência primária. É um trabalho de revisão da literatura, com ênfase na avaliação dos pés como medida preventiva fundamental, para identificar, precocemente, as alterações neurológica e vascular periféricas e disfunções biomecânicas. Destaca-se a avaliação dos calçados como fator externo.

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Multicenter Study of the Incidence of and Predictive Risk Factors for Diabetic Neuropathic Foot Ulceration

Cited by 350 publications

References 19 publications

Análise de fatores associados à ulceração de extremidades em indivíduos diabéticos com neuropatia periférica

Análise de fatores associados à ulceração de extremidades em indivíduos diabéticos com neuropatia periférica

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

Pé diabético: estratégias para prevenção

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