Diabetic foot ulcer development risk classifications’ validation: A multicentre prospective cohort study

Monteiro‐Soares, Matilde; Ribas, Rosineide Marques; Silva, C. Pereira da; Bral, T.; Mota, Augusto César de Andrade; Torres, Sylvia; Morgado, A V; Couceiro, Ricardo; Ribeiro, Ruy M.; Dias, Vanessa; Moreira, Maria Elisabeth Lopes; Mourão, Paulo Henrique Orlandi; Oliveira, Maria João; Madureira, Manuela; Paixão-Dias, V M; Dinis-Ribeiro, Mário

doi:10.1016/j.diabres.2017.02.034

Cited by 22 publications

(47 citation statements)

References 12 publications

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“…The central importance of foot risk assessment in health checks for people with diabetes is acknowledged by healthcare systems across the world. Our analyses, based on data collected internationally, indicate that only three risk factors, a history of foot ulceration, the inability to feel a 10 g monofilament and the absence of at least one pedal pulse, are required to distinguish between those who will ulcerate and those who will not with a high degree of accuracy comparable with other, more complex, prognostic models [39]. The simplicity of our model has advantages for clinical practice because it is intuitively correct to suppose that the fewer tests and elements from the patient history that healthcare professionals are required to consider, the more likely risk assessment procedures will be performed.…”

Section: Discussionmentioning

confidence: 99%

The development and validation of a multivariable prognostic model to predict foot ulceration in diabetes using a systematic review and individual patient data meta‐analyses

2018

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Section: Discussionmentioning

confidence: 99%

The development and validation of a multivariable prognostic model to predict foot ulceration in diabetes using a systematic review and individual patient data meta‐analyses

2018

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“…Skin is one of the important target organs affected by diabetes mellitus, therefore, diabetes induces multifactorial complications in skin including intractable foot ulcer [2,3]. Although both micro-and macroangiopathy are believed to contribute to the development and delayed healing of diabetic wounds, the pathogenesis of diabetic skin ulcer is complex and still incompletely understood [4,5].…”

Section: Introductionmentioning

confidence: 99%

Glucagon-like peptide-1 analogue liraglutide facilitates wound healing by activating PI3K/Akt pathway in keratinocytes

Nagae

Uchi

Morino-Koga

et al. 2018

Diabetes Research and Clinical Practice

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Diabetes induces various skin troubles including foot ulcer. This type of skin ulcer is refractory but the pathogenesis is not so certain. Recent study show that glucagon-like peptide-1 (GLP-1) analogues reduce foot complications with diabetes (Pé rez et al., 2015), however, the role of GLP-1/GLP-1R axis is not fully understood, and clear evidence of GLP-1 to facilitate wound closure is still lacking. In this study, we investigated whether a potent GLP-1R agonist liraglutide affects wound healing process. Methods: The expression of GLP-1R in HaCaT cells were indentified by quantitative reversetranscription polymerase chain reaction (qRT-PCR) and immunoblotting analysis. To assess the effect on wound closure in keratinocytes, we performed in vitro scratch assay using the IncuCyte system (Essen BioSciences, Ann Arborm MI). We applied ointment containing liraglutide on full-thickness wounds in the dorsum of female balb/c mice (n = 6) until healing. To investigate the effect on PI3K/Akt pathway, we used IncuCyte system in HaCaT treated with PI3K inhibitor and Akt inhibitor. Results: Keratinocytes expressed GLP-1R and liraglutide induced their migration. Liraglutide facilitated the wound healing in mice. Liraglutide upregulated keratinocyte migration via PI3K/Akt activation. Conclusions: Our study suggests that liraglutide may be a potential target drug to improve skin ulcer with diabetes through its specific receptor GLP-1.

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“…Readily available clinical information has substantial predictive power for the development of diabetic foot ulcers and may help in accurately targeting people at high risk of this outcome for preventive interventions. In 2006, Boyko et al .…”

Section: Discussionmentioning

confidence: 99%

“…Readily available clinical information has substantial predictive power for the development of diabetic foot ulcers [7,8,10] and may help in accurately targeting people at high risk of this outcome for preventive interventions. In 2006, Boyko et al [12] found HbA 1c , impaired vision, prior foot ulcer, prior amputation, monofilament insensitivity, tinea pedis and onychomycosis to be predictive factors for future foot ulceration.…”

Section: Discussionmentioning

confidence: 99%

“…The recently published PODUS study [7] has shown that risk assessment procedures recommended by NICE can be simplified. This was discussed by Monteiro-Soares et al [8], who concluded that, although all the existing classifications were valid in a high-risk clinical context and had a very high capacity to categorize as low risk those individuals with diabetes who will not develop a foot ulcer, further research is needed in the primary care setting in this area.…”

Section: Introductionmentioning

confidence: 99%

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Developing a foot ulcer risk model: what is needed to do this in a real‐world primary care setting?

et al. 2018

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Aim To determine how routinely collected data can inform a risk model to predict de novo foot ulcer presentation in the primary care setting. Methods Data were available on 15 727 individuals without foot ulcers and 1125 individuals with new foot ulcers over a 12‐year follow‐up in UK primary care. We examined known risk factors and added putative risk factors in our logistic model. Results People with foot ulcers were 4.2 years older (95% CI 3.1–5.2) than those without, and had higher HbA1c % (mean 7.9 ± 1.9 vs 7.5 ± 1.7) / HbA1c mmol/mol (63 ± 21 vs 59 ± 19) (p<0.0001) concentration [+0.45 (95% CI 0.33–0.56), creatinine level [+6.9 μmol/L (95% CI 4.1–9.8)] and Townsend score [+0.055 (95% CI 0.033–0.077)]. Absence of monofilament sensation was more common in people with foot ulcers (28% vs 21%; P<0.0001), as was absence of foot pulses (6.4% vs 4.8%; P=0.017). There was no difference between people with or without foot ulcers in smoking status, gender, history of stroke or foot deformity, although foot deformity was extremely rare (0.4% in people with foot ulcers, 0.6% in people without foot ulcers). Combining risk factors in a single logistic regression model gave modest predictive power, with an area under the receiver‐operating characteristic curve of 0.65 (95% CI 0.62–0.67). The prevalence of ulceration in the bottom decile of risk was 1.8% and in the top decile it was 13.4% (compared with an overall prevalence of 6.5%); thus, the presence of all six risk factors gave a relative risk of 7.4 for development of a foot ulcer over 12 years. Conclusion We have made some progress towards defining a variable set that can be used to create a foot ulcer prediction model. More accurate determination of foot deformity/pedal circulation in primary care may improve the predictive value of such a future risk model, as will identification of additional risk variables.

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Diabetic foot ulcer development risk classifications’ validation: A multicentre prospective cohort study

Cited by 22 publications

References 12 publications

The development and validation of a multivariable prognostic model to predict foot ulceration in diabetes using a systematic review and individual patient data meta‐analyses

The development and validation of a multivariable prognostic model to predict foot ulceration in diabetes using a systematic review and individual patient data meta‐analyses

Glucagon-like peptide-1 analogue liraglutide facilitates wound healing by activating PI3K/Akt pathway in keratinocytes

Developing a foot ulcer risk model: what is needed to do this in a real‐world primary care setting?

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