Complication rate among people with diabetes at low risk of foot ulceration in Fife, UK: an analysis of routinely collected data

Heggie, Robert; Chappell, Francesca M; Crawford, Fay; Martin, Angela; Gupta, Saket; Hawkins, Neil; Horne, Margaret; Leese, Graham; Lewsey, James

doi:10.1111/dme.14339

Cited by 3 publications

(5 citation statements)

References 21 publications

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“…This approach was previously used to personalise monitoring frequency for retinopathy based on prediction models [41,42]. A recent observational study of 10,421 people with diabetes showed that only 5.1% of those classified as low risk had progressed to moderate risk in 2 years [43]. If people with diabetes change risk status infrequently, then regular foot screening is less likely to be of clinical value and personalised screening intervals could be valuable.…”

Section: Discussionmentioning

confidence: 99%

Prognostic models for predicting the risk of foot ulcer or amputation in people with type 2 diabetes: a systematic review and external validation study

et al. 2021

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Aims/hypothesis Approximately 25% of people with type 2 diabetes experience a foot ulcer and their risk of amputation is 10–20 times higher than that of people without type 2 diabetes. Prognostic models can aid in targeted monitoring but an overview of their performance is lacking. This study aimed to systematically review prognostic models for the risk of foot ulcer or amputation and quantify their predictive performance in an independent cohort. Methods A systematic review identified studies developing prognostic models for foot ulcer or amputation over minimal 1 year follow-up applicable to people with type 2 diabetes. After data extraction and risk of bias assessment (both in duplicate), selected models were externally validated in a prospective cohort with a 5 year follow-up in terms of discrimination (C statistics) and calibration (calibration plots). Results We identified 21 studies with 34 models predicting polyneuropathy, foot ulcer or amputation. Eleven models were validated in 7624 participants, of whom 485 developed an ulcer and 70 underwent amputation. The models for foot ulcer showed C statistics (95% CI) ranging from 0.54 (0.54, 0.54) to 0.81 (0.75, 0.86) and models for amputation showed C statistics (95% CI) ranging from 0.63 (0.55, 0.71) to 0.86 (0.78, 0.94). Most models underestimated the ulcer or amputation risk in the highest risk quintiles. Three models performed well to predict a combined endpoint of amputation and foot ulcer (C statistics >0.75). Conclusions/interpretation Thirty-four prognostic models for the risk of foot ulcer or amputation were identified. Although the performance of the models varied considerably, three models performed well to predict foot ulcer or amputation and may be applicable to clinical practice. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Prognostic models for predicting the risk of foot ulcer or amputation in people with type 2 diabetes: a systematic review and external validation study

et al. 2021

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“…Furthermore, an analysis of routinely collected foot risk assessment data conducted by the wider research group found only 5% of people at low risk of foot ulceration changed their risk score during a 2-year period. 36 This suggests that biennial, as opposed to annual foot risk assessment for those at low risk of foot ulceration may be adequate. 36 If this simplified CPR was used biennially to assess risk of foot ulceration, the burden on diabetes services across primary care, community and hospital settings could be greatly reduced.…”

Section: Discussionmentioning

confidence: 99%

“… 36 This suggests that biennial, as opposed to annual foot risk assessment for those at low risk of foot ulceration may be adequate. 36 If this simplified CPR was used biennially to assess risk of foot ulceration, the burden on diabetes services across primary care, community and hospital settings could be greatly reduced.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies

Chappell

Crawford

Horne

et al. 2021

BMJ Open Diab Res Care

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IntroductionThe aim of the study was to develop and validate a clinical prediction rule (CPR) for foot ulceration in people with diabetes.Research design and methodsDevelopment of a CPR using individual participant data from four international cohort studies identified by systematic review, with validation in a fifth study. Development cohorts were from primary and secondary care foot clinics in Europe and the USA (n=8255, adults over 18 years old, with diabetes, ulcer free at recruitment). Using data from monofilament testing, presence/absence of pulses, and participant history of previous ulcer and/or amputation, we developed a simple CPR to predict who will develop a foot ulcer within 2 years of initial assessment and validated it in a fifth study (n=3324). The CPR’s performance was assessed with C-statistics, calibration slopes, calibration-in-the-large, and a net benefit analysis.ResultsCPR scores of 0, 1, 2, 3, and 4 had a risk of ulcer within 2 years of 2.4% (95% CI 1.5% to 3.9%), 6.0% (95% CI 3.5% to 9.5%), 14.0% (95% CI 8.5% to 21.3%), 29.2% (95% CI 19.2% to 41.0%), and 51.1% (95% CI 37.9% to 64.1%), respectively. In the validation dataset, calibration-in-the-large was −0.374 (95% CI −0.561 to −0.187) and calibration slope 1.139 (95% CI 0.994 to 1.283). The C-statistic was 0.829 (95% CI 0.790 to 0.868). The net benefit analysis suggested that people with a CPR score of 1 or more (risk of ulceration 6.0% or more) should be referred for treatment.ConclusionThe clinical prediction rule is simple, using routinely obtained data, and could help prevent foot ulcers by redirecting care to patients with scores of 1 or above. It has been validated in a community setting, and requires further validation in secondary care settings.

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“…shown the risk of death is considerably higher than that of developing a foot ulcer for people with diabetes and people with diabetes who experience foot ulcers have also been found to have a greater risk of death than those who do not. 8,9 An author of this manuscript previously published the results of a cohort study conducted between 2006 and 2008 which aimed to quantify the predictive value of elements of clinical history, diagnostic test results and symptoms and signs for foot ulceration in the general diabetes population recruited in a community healthcare setting. 10 People registered with the NHS Tayside podiatry service in Scotland gave consent for their health data to be collected and analysed (n = 1193) and were followed up for an average period of 11 months between 2007 and 2008.…”

Section: More Recently Analyses Of Patients' Routinely Collected Data...mentioning

confidence: 99%

“…More recently, analyses of patients' routinely collected data have shown the risk of death is considerably higher than that of developing a foot ulcer for people with diabetes and people with diabetes who experience foot ulcers have also been found to have a greater risk of death than those who do not. 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

The 10‐year follow‐up of a community‐based cohort of people with diabetes: The incidence of foot ulceration and death

Mohammed,

Crawford,

Cezard

et al. 2023

Endocrino Diabet & Metabol

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BackgroundIdentifying people with diabetes who are likely to experience a foot ulcer is an important part of preventative care. Many cohort studies report predictive models for foot ulcerations and for people with diabetes, but reports of long‐term outcomes are scarce.AimWe aimed to develop a predictive model for foot ulceration in diabetes using a range of potential risk factors with a follow‐up of 10 years after recruitment. A new foot ulceration was the outcome of interest and death was the secondary outcome of interest.DesignA 10‐year follow‐up cohort study.Methods1193 people with a diagnosis of diabetes who took part in a study in 2006–2007 were invited to participate in a 10‐year follow‐up. We developed a prognostic model for the incidence of incident foot ulcerations using a survival analysis, Cox proportional hazards model. We also utilised survival analysis Kaplan–Meier curves, and relevant tests, to assess the association between the predictor variables for foot ulceration and death.ResultsAt 10‐year follow‐up, 41% of the original study population had died and more than 18% had developed a foot ulcer. The predictive factors for foot ulceration were an inability to feel a 10 g monofilament or vibration from a tuning fork, previous foot ulceration and duration of diabetes.ConclusionsThe prognostic model shows an increased risk of ulceration for those with previous history of foot ulcerations, insensitivity to a 10 g monofilament, a tuning fork and duration of diabetes. The incidence of foot ulceration at 10‐year follow‐up was 18%; however, the risk of death for this community‐based population was far greater than the risk of foot ulceration.

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Complication rate among people with diabetes at low risk of foot ulceration in Fife, UK: an analysis of routinely collected data

Cited by 3 publications

References 21 publications

Prognostic models for predicting the risk of foot ulcer or amputation in people with type 2 diabetes: a systematic review and external validation study

Prognostic models for predicting the risk of foot ulcer or amputation in people with type 2 diabetes: a systematic review and external validation study

Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies

The 10‐year follow‐up of a community‐based cohort of people with diabetes: The incidence of foot ulceration and death

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