A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study.

Boyko, Edward J.; Ahroni, Jessie H.; Stensel, Victoria L; Forsberg, Ruby C.; Davignon, Denise R.; Smith, Douglas G.

doi:10.2337/diacare.22.7.1036

Cited by 579 publications

(523 citation statements)

References 1 publication

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“…Patients with diabetes have an amputation rate that is many times higher than that of patients without diabetes, and previous studies have found that the primary risk factors for amputation include age, (male) sex, smoking, the presence of peripheral vascular disease, and BP [18]. Our model contains a single Weibull equation to estimate the absolute risk of a first amputation of a digit or limb (ICD-9 codes ≥5.845-≤5.848, or 250.6) or a fatal peripheral vascular event (ICD-9 codes 997.2, 997.6, 250.6 or 440.2).…”

Section: Methodsmentioning

confidence: 99%

A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68)

et al. 2004

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Aims/hypothesis. The aim of this study was to develop a simulation model for Type 2 diabetes that can be used to estimate the likely occurrence of major diabetes-related complications over a lifetime, in order to calculate health economic outcomes such as qualityadjusted life expectancy. Methods. Equations for forecasting the occurrence of seven diabetes-related complications and death were estimated using data on 3642 patients from the United Kingdom Prospective Diabetes Study (UKPDS). After examining the internal validity, the UKPDS Outcomes Model was used to simulate the mean difference in expected quality-adjusted life years between the UKPDS regimens of intensive and conventional blood glucose control. Results. The model's forecasts fell within the 95% confidence interval for the occurrence of observed events during the UKPDS follow-up period. When the model was used to simulate event history over patients' lifetimes, those treated with a regimen of conventional glucose control could expect 16.35 undiscounted quality-adjusted life years, and those receiving treatment with intensive glucose control could expect 16.62 quality-adjusted life years, a difference of 0.27 (95% CI: −0.48 to 1.03). Conclusions/interpretations. The UKPDS OutcomesModel is able to simulate event histories that closely match observed outcomes in the UKPDS and that can be extrapolated over patients' lifetimes. Its validity in estimating outcomes in other groups of patients, however, remains to be evaluated. The model allows simulation of a range of long-term outcomes, which should assist in informing future economic evaluations of interventions in Type 2 diabetes. The centres of the UKPDS are listed at the end of the paper Conflict of interest. Several authors (as indicated above) are employed by the University of Oxford. This paper describes and places in the public domain a simulation model that we have called the UKPDS Outcomes Model. All of the information necessary to reproduce the UKPDS Outcomes Model is provided in this article, but it is conceivable that a future user with a commercial interest in the UKPDS Outcomes Model might prefer to use the software already created by University programmers. Depending on the nature of the proposed use of the UKPDS Outcomes Model, the University of Oxford might charge a fee in this case.

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Section: Methodsmentioning

confidence: 99%

A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68)

et al. 2004

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“…It might be of clinical importance that the use of rocker bottom shoes does not result in decreased pressure under the first and fifth ray, which are the locations where ulceration most often occurs in patients with cavovarus deformity (12).…”

Section: Vas Scoresmentioning

confidence: 99%

The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet

2003

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OBJECTIVE -The aim of this study was to investigate the effect of shoe design on the plantar pressure dynamics of patients with diabetic neuropathy during walking.RESEARCH DESIGN AND METHODS -Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured.RESULTS -Shoes with a rocker bottom principle reduced pressure 35-65% underneath the heel and the central metatarsal heads. Increased contact area did not result in significant pressure reductions underneath the forefoot. Pressure dynamics underneath the heel and medial forefoot (first metatarsal head and hallux) on average showed no significant differences among the different shoes with a cushioning insole.CONCLUSIONS -The most effective way to offload the forefoot of patients with neuropathic feet is through the use of the rocker sole principle. In general, the effect of an insole depends on the design characteristics of a shoe. Predicting the effect of therapeutic footwear on an individual scale, however, remains difficult. Therefore, in-shoe pressure measurements seem to be necessary to evaluate a therapeutic shoe prescription in certain individual cases. Diabetes Care 26:441-445, 2003B auman et al. (1) were among the first researchers who published their study on the relationship between high-pressure areas and plantar ulceration in the insensitive foot. They appreciated the effect of both a total contact cast and certain orthopedic shoes on the healing process of neuropathic ulcers. They investigated the effect of shoe sole design on plantar pressure reduction using small pressure sensors taped to specific areas underneath the sole of the foot.Using similar equipment 25 years later, Nawoczenski et al. (2) showed that certain pivotal and curved rocker bottom shoes were able to effectively reduce forefoot pressure in normal subjects. Many studies have followed since then (rev. in 3). However, despite all the pioneering work, different disciplines dealing with the neuropathic foot often still disagree about which therapeutic shoe modalities to prescribe. In the Netherlands, also, this is a continuing topic of dispute. Although some strongly propagate the use of custom made (orthopedic) shoes with a stiff sole and rocker bar to prevent recurrence of a neuropathic ulcer, others recommend the use of an extra depth shoe. It has been argued that these less heavy, more cosmetically attractive shoes would be at least as effective in preventing recurrence of neuropathic ulcers.According to Spencer, "There is a need to measure the effectiveness of the range of pressure relieving interventions for the prevention and treatment of diabetic foot ulcers as there is a small amount of poor quality research in this area" (3). The present study was performed to investigate the relation between shoe design and pressure reduction in the context of the above discussion. Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured usin...

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“…The pathway to DFU development is multifactorial, involving several risk factors, including the diagnosis of diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD), prior DFU and amputation, age, history of diabetic retinopathy suboptimal diabetes control, nephropathy, and end-stage renal disease (ESRD) [4–6]…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the 10 g monofilament has been found to have a similar diagnostic rate when compared to the 128 Hz tuning fork (32.6 vs 31.4%, respectively). Furthermore, the efficacy of the 10 g monofilament has been established in multiple studies [3,6]. PAD was defined as monophasic Doppler ultrasound readings, an ankle brachial pressure index (ABPI) of <0.9 or the existence of symptomatic vascular disease [4,24].…”

Section: Introductionmentioning

confidence: 99%

Diabetic foot ulcer outcomes from a podiatry led tertiary service in Kuwait

Messenger

Masoetsa

Hussain

et al. 2018

Diabetic Foot & Ankle

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Objective: This single-centred study aims to evaluate the incidence, risk factors and treatment outcomes of a podiatry led, evidence-based diabetic foot ulcer (DFU) clinic. Research design and methods: Data from the DFU database and patient electronic health records were retrospectively collected from patients with new DFUs who were referred for treatment to the Department of Podiatry, Dasman Diabetes Institute, Kuwait, from 1 October 2014, to 31 December 2016. Patients were followed-up until healing occurred or until 6 months after the study end date, whichever came first. Results: All data were analysed using IBM SPSS version 24 software. Data were collected from 230 patients with 335 DFUs. Most DFUs (67%) were present for <3 months from the time of the first podiatry appointment. A total of 56% of DFUs were classified as neuropathic. Most (72%) DFUs healed, with a median healing time of 52.0 days. Chronic kidney disease (p = 0.001), retinopathy (p = 0.03), smoking (p = 0.02), ulcer location (p = 0.03), peripheral arterial disease (PAD) (p = 0.004) and osteomyelitis (p = 0.05) were found to have a meaningful association with DFU outcome. The number of days to heal was associated with ulcer classification (p = 0.005), bacterial infection (p = 0.002), osteomyelitis (p = < 0.001) and PAD (p = < 0.001). Conclusions: The incidence of new DFUs in our tertiary clinic is 3.4%. The incidence of diabetic foot ulceration, days to heal, healing rate and the risk factors influencing healing are in accordance with other multidisciplinary facilities with podiatry input.

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A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study.

Abstract: Certain foot deformities, reduced skin oxygenation and foot perfusion, poor vision, greater body mass, and both sensory and autonomic neuropathy independently influence foot ulcer risk, thereby providing support for a multifactorial etiology for diabetic foot ulceration.

Cited by 579 publications

References 1 publication

A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68)

A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68)

The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet

Diabetic foot ulcer outcomes from a podiatry led tertiary service in Kuwait

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