The Prevalence of Foot Ulceration and its Correlates in Type 2 Diabetic Patients: a Population‐based Study

Abstract

The prevalence of peripheral neuropathy, peripheral vascular disease, and foot ulceration in Type 2 diabetic patients in the community were determined in a community-based study. Eight hundred and eleven subjects (404 male, 407 female, mean age 65.4 (range 34-90) years, diabetes duration 7.4 (0-50) years) from 37 general practices in three UK cities were studied. Neuropathy was diagnosed clinically using modified neuropathy disability scores which were ascertained using structured interviews and clinical examinations by one observer in each city. Peripheral vascular disease was diagnosed if a history of revascularization was present or > or = 2 foot pulses were absent. History of current or previous foot ulceration was recorded. The prevalence of neuropathy was 41.6% (95% confidence limits 38.3-44.9%) and the prevalence of PVD, 11% (9.1-13.7%). Forty-eight percent of neuropathic patients reported significant neuropathic symptoms. Forty-three patients (5.3% (3.8-6.8%)) had current or past foot ulcers; 20 of these were pure neuropathic ulcers, 13 neuroischaemic, 5 pure vascular, and 5 were unclassified. Multiple logistic regression showed history of amputation, neuropathy disability score, and peripheral vascular disease to be significantly associated with foot ulceration after adjusting for age and diabetes duration. A substantial proportion of Type 2 diabetic patients, often elderly patients who do not attend hospitals, suffered from peripheral neuropathy and peripheral vascular disease. These patients are at risk of foot ulceration and may benefit from preventive footcare.

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

“…A selection of recent epidemiological data [11,12,13,14,15,16,17] on ulceration and amputation is listed in Table 1. 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].…”

Pé diabético: estratégias para prevenção

“…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.…”

“…No entanto, sabe-se que a redução das complicações nos pés, que conduzem à amputação, não depende unicamente dos recursos hospitalares, mas sim, da disponibilidade de medidas preventivas efetivas sobre os cuidados com os pés, bem como da oferta de programas educativos a toda a comunidade (33) . Esses dados são relevantes ao se considerar que a maioria das pessoas com diabetes é tratada pelo clíni-co geral da rede pública da comunidade (unidades básicas e unidades distritais de saúde), onde o aprazamento das consultas médicas pode variar de três meses a um ano.…”

A survey of lower limb amputation rate in patients with diabetes at Shahid Modarres Hospital, Tehran, Iran, during 5 years

“…3 One of the major complications of diabetes melitus is diabetic foot ulcer, which can be caused by different mechanisms such as diabetic neuropathy and vasculopathy or both and is seen in 3.5% of diabetic patients. [3][4][5][6][7] Diabetic foot ulcers can lead to lower limb amputation if diagnosed late or managed inadequately. This problem is seen in 1.2% to 13.7% of patients with diabetes and is the most common cause of amputation all over the world, while easily preventable.…”