Diabetic foot ulcer predicted by readily available clinical information

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Diabetic foot ulcer can be predicted by readily available clinical information.

According to recent research published in the journal Diabetes Care, “The ability of readily available clinical information to predict the occurrence of diabetic foot ulcer has not been extensively studied.”

E.J. Boyko and colleagues working with the University of Washington conducted “a prospective study of the individual and combined effects of commonly available clinical information in the prediction of diabetic foot ulcer occurrence. We followed 1,285 diabetic veterans without foot ulcer for this outcome with annual clinical evaluations and quarterly mailed questionnaires to identify foot problems.”

They continued, “At baseline we assessed age; race; weight; current smoking; diabetes duration and treatment; HbA[1c] (A1C); visual acuity; history of laser photocoagulation and amputation; foot shape; claudication; foot insensitivity to the 10-g monofilament, foot callus, pedal edema; hallux limitus, tinea pedis and onychomycosis. Cox proportional hazards modeling was used with backwards stepwise elimination to develop a prediction model for the first foot ulcer occurrence after the baseline examination.”

The results showed, “At baseline, subjects were 62.4 years of age on average and 98% male. Mean follow-up duration was 3.38 years, during which time 216 foot ulcers occurred, for an incidence of 5.0/100 person-years. Significant predictors (p(<=)0.05) of foot ulcer in the final model (hazard ratio, 95% CI) included A1C (1.10, 1.06-1.15), impaired vision (1.48, 1.00-2.18), prior foot ulcer (2.18, 1.50-2.95) prior amputation (2.57, 1.60-4.12), monofilament insensitivity) (2.03, 1.50-2.76), tinea pedis (0. 73, 0.54-0.98), and onychomycosis (1.58, 1.16-2.16). Area under the receiver operating characteristic curve was 0.81 at 1 year and 0.76 at 5 years.”

The researchers concluded, “Readily available clinical information has substantial predictive power for the development of diabetic foot ulcer and may help in accurately targeting persons at high risk of this outcome for preventive interventions.”

Boyko and colleagues published their study in Diabetes Care (Prediction of diabetic foot ulcer occurrence using commonly available clinical information - The Seattle diabetic foot study. Diabetes Care, 2006;29(6):1202-1207).

For additional information, contact E.J. Boyko, VA Puget Sound S152E, 1660 S Columbian Way, Seattle, WA 98108, USA.

The publisher’s contact information for the journal Diabetes Care is: American Diabetes Association, 1701 N Beauregard St., Alexandria, VA 22311-1717, USA.

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