This trial assessed whether a simple clinical tool can be used to stratify patients with diabetes, according to risk of developing foot ulceration. This was a prospective, observational follow-up study of 3526 patients with diabetes (91% type 2 diabetes) attending for routine diabetes care. Mean age was 64.7 (range 15-101) years and duration of diabetes was 8.8 (+/-1.5 SD) years. Patients were categorised into 'low' (64%), 'moderate' (23%) or 'high' (13%) risk of developing foot ulcers by trained staff using five clinical criteria during routine patient care. During follow-up (1.7 years), 166 (4.7%) patients developed an ulcer. Foot ulceration was 83 times more common in high risk and six times more in moderate risk, compared with low-risk patients. The negative predictive value of a 'low-risk score' was 99.6% (99.5-99.7%; 95% confidence interval). This clinical tool accurately predicted foot ulceration in routine practice and could be used direct scarce podiatry resources towards those at greatest need.

These population-based U.K. amputation data are similar to amputation rates in the U.S. Amputation rates appear to have decreased significantly since 1980-1982. The impact of diabetes education and prevention programs that target the processes leading to amputation can now be evaluated.

ObjectiveTo study the association between socioeconomic deprivation and prevalence of diabetic retinopathy (DR).DesignPopulation-based, cross-sectional observational study and retrospective longitudinal analysis over 12 years.SettingPrimary care, East of Scotland.MethodsOutcome data from DR screening examinations (digital retinal photography) were collected from the Scottish regional diabetes electronic record from inception of database to December 2012. The overall Scottish Index of Multiple Deprivation (SIMD) 2012 score for each patient was obtained using their residential postcode. Multiple binary logistic regression was used to analyse the relationship between overall SIMD score and prevalence of DR, adjusting for other variables: age, gender, glycated haemoglobin, cholesterol levels and duration of disease.Primary outcomeAny retinopathy (R1 and above) in either eye.ResultsA total of 1861 patients with type 1 diabetes mellitus (DM) and 18 197 patients with type 2 DM were included in the study. Prevalence of DR in type 1 and type 2 DM were 56.3% and 25.5%, respectively. Increased prevalence of DR in type 1 DM was associated with higher overall SIMD score (p=0.002), with an OR for the most deprived relative to the least deprived of 2.40 (95% CI 1.36 to 4.27). In type 2 DM, the overall SIMD score was not significantly associated with increased prevalence of DR, with an OR for the most deprived relative to the least deprived of 0.85 (95% CI 0.71 to 1.02, p=0.07).ConclusionsSocioeconomic deprivation is associated with increased prevalence of DR in patients with type 1 DM and this occurs earlier. This highlights the need for targeted interventions to address inequalities in eye healthcare.

OBJECTIVE -To compare the mortality of people who were diagnosed with type 2 diabetes over 65 years of age with that of nondiabetic individuals. RESEARCH DESIGN AND METHODS-Using a population-based diabetes information system for an observational cohort study in Tayside, Scotland, people who were diagnosed with type 2 diabetes over the age of 65 years between 1993 and 2002 were identified. Nondiabetic comparators, matched for age and sex, were identified from the nondiabetic population. The two cohorts were followed up for mortality and cardiovascular mortality according to death certification records.RESULTS -There were 3,594 people with type 2 diabetes (48% male) and 7,188 matched comparators identified in the study. Over a mean follow-up period of 4.6 Ϯ 2.9 years for 3,594 people with type 2 diabetes and 7,188 comparators, 909 (25.3%) patients in the diabetic cohort and 1,651 (23.0%) in the nondiabetic cohort died. The adjusted relative risk for mortality in the diabetic cohort compared with the nondiabetic cohort was 1.06 (95% CI 0.94 -1.19) for men and 1.29 (1.15-1.45) for women. Cardiovascular deaths accounted for 49.4% of the deaths in people with and 45.2% in those without diabetes (adjusted relative risk 1.01 [0.93-1.10]).CONCLUSIONS -Men diagnosed with type 2 diabetes over the age of 65 years have no excess mortality compared with their nondiabetic counterparts, a finding that was not replicated for women. Diabetes Care 27:2797-2799, 2004D iabetes is known to reduce life expectancy in older people (1). However, older people with diabetes are a heterogeneous group, including newly diagnosed people and those whose diagnosis may have occurred up to 20 years previously (2-4). Some research suggests that the effect on mortality of a diagnosis of diabetes becomes progressively less as age at diagnosis increases (5). A group of older people whose diabetes was detected by screening had an increased risk of mortality (6), and even patients who were diagnosed with diabetes over the age of 80 years had a reduced life expectancy of ϳ1 year (7). However, two European studies found no difference in mortality between men diagnosed with diabetes over the age of 75 years and nondiabetic men (8,9). We compared all-cause and cardiovascular mortality in cohorts of people diagnosed with type 2 diabetes at an older age with that in nondiabetic individuals. RESEARCH DESIGN AND METHODS -The DARTS/MEMO (Diabetes Audit and Research in TaysideScotland/Medicines Monitoring Unit) Collaboration (9) works on the record linkage of health care data to facilitate epidemiological and health services research in the population of Tayside, Scotland (estimated population of 389,800 in 1998). Record linkage is enabled by the widespread use of a unique health care identifier (community health index number) that is allocated to people when they register with a general practitioner in Scotland. This study was conducted in a defined population of general practitioner-registered people who were known to be residents of Tayside during the entire ...

This study provides baseline figures for rates of diabetic complications for Type 1 and Type 2 diabetes, and confirms the increased burden of macrovascular disease in Type 2 diabetes.