Stratification of foot risk predicts the incidence of new foot disease, but do we yet know that the adoption of routine screening reduces it?

Jeffcoate, William

doi:10.1007/s00125-011-2075-y

Cited by 29 publications

(30 citation statements)

References 12 publications

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“…Despite these modifications and using all the different definitions proposed, these two variables were highly associated with DFU development (P!0.001). This corroborates our systematic review results: DPN and PVD clinical collection methods seem relatively unimportant (4,15). Although several authors have described the foot pulse palpation to have low sensitivity (16,17), the SWM application procedure does not have consensus (18,19) and the tuning fork has low reliability (19); several studies have shown that these simple methods can be implemented for both community (2,8,15,19,20) and high risk (3, 4) setting diabetic foot screening, independently of the variables collection method.…”

Section: Discussionsupporting

confidence: 86%

Validation and comparison of currently available stratification systems for patients with diabetes by risk of foot ulcer development

Monteiro‐Soares

Carneiro

Sampaio

et al. 2012

European Journal of Endocrinology

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Aims/hypothesis: There are five systems to stratify the risk for the development of a diabetic foot ulcer (DFU). This study aimed to prospectively validate all of them in the same cohort of participants to allow their direct comparison. Methods: A retrospective cohort study was conducted on all patients with diabetes but without an active DFU attending our podiatry section (nZ364) from January 2008 to December 2010. Participants' characteristics and all variables composing the stratification systems were assessed at baseline. Follow-up was performed for 1 year or until DFU occurred. Results: Participants had a mean age of 64 years; 99.7% had type 2 diabetes and 48.6% were male. Median follow-up was 12 months (1-12) during which 33 subjects (9.1%) developed a DFU. Age, diabetes duration, foot deformity, peripheral vascular disease, diabetic peripheral neuropathy, previous DFU, and previous lower extremity amputation were associated with DFU occurrence. All systems presented greater DFU occurrence frequency as the risk group was higher (c 2 , P!0.001) and showed good diagnostic accuracy values, especially negative predictive value (R95%) and area under the receiver operating curve (R0.73). The lowest performance concerned positive predictive value (%29.5%). Conclusions/interpretation: All the currently available stratification systems show high accuracy to detect which patients will develop a DFU with no significant differences among them. Therefore, for diabetic foot screening and resource allocation, it would be desirable to have a single unified system, combining the available systems, prospectively validated in a multicenter context and testing the inclusion of novel predictive variables' pertinence.

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Section: Discussionsupporting

confidence: 86%

Validation and comparison of currently available stratification systems for patients with diabetes by risk of foot ulcer development

Monteiro‐Soares

Carneiro

Sampaio

et al. 2012

European Journal of Endocrinology

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“…18 Clinically effective and cost-effective health care requires the careful measurement of health outcomes, and the need for an evidence-based approach to foot care services in diabetes has been documented. 19,20 Two systematic reviews highlight the gaps in the knowledge about the best way to identify those at risk.…”

Section: Chapter 1 Backgroundmentioning

confidence: 99%

A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS)

Crawford

Cézard

Chappell

et al. 2015

Health Technol Assess

158

196

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BackgroundAnnual foot risk assessment of people with diabetes is recommended in national and international clinical guidelines. At present, these are consensus based and use only a proportion of the available evidence.ObjectivesWe undertook a systematic review of individual patient data (IPD) to identify the most highly prognostic factors for foot ulceration (i.e. symptoms, signs, diagnostic tests) in people with diabetes.Data sourcesStudies were identified from searches of MEDLINE and EMBASE.Review methodsThe electronic search strategies for MEDLINE and EMBASE databases created during an aggregate systematic review of predictive factors for foot ulceration in diabetes were updated and rerun to January 2013. One reviewer applied the IPD review eligibility criteria to the full-text articles of the studies identified in our literature search and also to all studies excluded from our aggregate systematic review to ensure that we did not miss eligible IPD. A second reviewer applied the eligibility criteria to a 10% random sample of the abstract search yield to check that no relevant material was missed. This review includes exposure variables (risk factors) only from individuals who were free of foot ulceration at the time of study entry and who had a diagnosis of diabetes mellitus (either type 1 or type 2). The outcome variable was incident ulceration.ResultsOur search identified 16 cohort studies and we obtained anonymised IPD for 10. These data were collected from more than 16,000 people with diabetes worldwide and reanalysed by us. One data set was kept for independent validation. The data sets contributing IPD covered a range of temporal, geographical and clinical settings. We therefore selected random-effects meta-analysis, which assumes not that all the estimates from each study are estimates of the same underlying true value, but rather that the estimates belong to the same distribution. We selected candidate variables for meta-analysis using specific criteria. After univariate meta-analyses, the most clinically important predictors were identified by an international steering committee for inclusion in the primary, multivariable meta-analysis. Age, sex, duration of diabetes, monofilaments and pulses were considered most prognostically important. Meta-analyses based on data from the entire IPD population found that an inability to feel a 10-g monofilament [odds ratio (OR) 3.184, 95% confidence interval (CI) 2.654 to 3.82], at least one absent pedal pulse (OR 1.968, 95% CI 1.624 to 2.386), a longer duration of a diagnosis of diabetes (OR 1.024, 95% CI 1.011 to 1.036) and a previous history of ulceration (OR 6.589, 95% CI 2.488 to 17.45) were all predictive of risk. Female sex was protective (OR 0.743, 95% CI 0.598 to 0.922).LimitationsIt was not possible to perform a meta-analysis using a one-step approach because we were unable to procure copies of one of the data sets and instead accessed data via Safe Haven.ConclusionsThe findings from this review identify risk assessment procedures that can reliably inform national and international diabetes clinical guideline foot risk assessment procedures. The evidence from a large sample of patients in worldwide settings show that the use of a 10-g monofilament or one absent pedal pulse will identify those at moderate or intermediate risk of foot ulceration, and a history of foot ulcers or lower-extremity amputation is sufficient to identify those at high risk. We propose the development of a clinical prediction rule (CPR) from our existing model using the following predictor variables: insensitivity to a 10-g monofilament, absent pedal pulses and a history of ulceration or lower-extremities amputations. This CPR could replace the many tests, signs and symptoms that patients currently have measured using equipment that is either costly or difficult to use.Study registrationThis study is registered as PROSPERO CRD42011001841.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Det anses som viktig med individuell opplaering (Jeffcoate WJ, 2011). For den enkelte pasient er tiltaket daglig å undersøke føttene.…”

Section: Verdier Og Preferanserunclassified

Kronisk pankreatitt – utredning og behandling

Engjom¹,

Waage²,

Hoem³

et al. 2018

Tidsskriftet

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Nasjonal faglig retningslinje for diabetes erstatter IS-1674: «Nasjonal faglig retningslinje for forebygging, diagnostikk og behandling av diabetes» fra 2009. Bakgrunnen for revisjonen er endringer i folkehelselovgivningen, ny kommunehelselov, Føringer i samhandlingsreformen, og strategier for innvandrers helse og for ikke-smittsomme sykdommer. Disse har vaert førende for revideringsarbeidet. Samtidig har det kommet ny kunnskap om etiologi, forebygging og behandling av diabetes.I forbindelse med implementering av retningslinjen er det laget en folder med de viktigste anbefalingene i retningslinjen (PDF). MålgrupperHovedmålgruppen for retningslinjen er fastleger og annet helsepersonell ansatt i kommunale helse-og omsorgstjenester, og beslutningstakere i helse-og omsorgsadministrasjon både kommunalt og regionalt. Revisjonen har lagt vekt på å beskrive henvisnings-og samhandlingsrutiner med spesialisthelsetjenesten for å styrke fastlegers kompetanse og trygghet i å håndtere stadig flere pasienter med diabetes og annen kronisk sykdom. Denne avgrensningen fører også til at hovedvekten av anbefalingene gjelder personer med diabetes type 2 over 18 år.For å understøtte Samhandlingsreformens mål om et sømløst tjenesteforløp, er spesialisthelsetjenesten også målgruppe for retningslinjen. Personer med diabetes vil ofte alternere mellom primaer-og spesialisthelsetjenesten etter sykdommens forløp og grad av komplikasjoner, og retningslinjen inneholder derfor også informasjon om ansvarsfordeling mellom tjenestene og noen utvalgte prosedyrer for behandling på sykehus. Arbeidsgrupper og habilitetRundt 60 klinikere og brukerrepresentanter har deltatt i revisjonsarbeidet. Valget av representanter ble basert på en invitasjon til alle regionale helseforetak, Legeforeningen, Norsk Sykepleierforbund, Kommunenes Sentralforbund og Diabetesforbundet. Kjønn, alder, klinisk erfaring, forskningserfaring, geografisk tilhørighet og om de arbeider i primaer-eller spesialisthelsetjenesten ble tatt i betraktning ved utvelgelse., Det nasjonale fagrådet for diabetes ble oppfordret til å komme med forslag til representanter og fagområder som skulle prioriteres. Etter at fagområdene var bestemt, ble det gjort ytterligere søk etter representanter som har utpekt seg på sine felt gjennom forskning og foredragsvirksomhet.Under følger en oversikt over arbeidsgruppene, klinikere og brukerrepresentanter som har vaert involvert i arbeidet. Hver arbeidsgruppe har hatt en gruppeleder med overordnet ansvar for fremdrift og ledelse av gruppemøtene i samråd med Helsedirektoratet. Gruppelederen har også fungert som fagredaktør, og har i samarbeid med Helsedirektoratet hatt det redaksjonelle ansvaret med å formidle gruppens vurderinger over i et elektronisk format. DF= Representant fra DiabetesforbundetDiagnostikk av diabetes, risikovurdering og oppfølging av personer med høy risiko for å utvikle diabetes Alle deltakerne i arbeidsgruppene har avgitt skriftlig erklaering hvor de har redegjort for mulige faglige eller økonomiske interessekonflikter knyttet til dett...

show abstract

Stratification of foot risk predicts the incidence of new foot disease, but do we yet know that the adoption of routine screening reduces it?

Cited by 29 publications

References 12 publications

Validation and comparison of currently available stratification systems for patients with diabetes by risk of foot ulcer development

Validation and comparison of currently available stratification systems for patients with diabetes by risk of foot ulcer development

A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS)

Kronisk pankreatitt – utredning og behandling

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