The prevalence and determinants of foot ulceration in type II diabetic patients in a primary health care setting

• Published in: Diabetes research and clinical practice Vol. 35; no. 2; pp. 149 - 156
• Main Authors: de Sonnaville, J.J.J., Colly, L.P., Wijkel, D., Heine, R.J.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.03.1997; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; Associated diseases and complications; Biological and medical sciences; Cohort Studies; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; Diabetic foot; Diabetic Foot - diagnosis; Diabetic Foot - epidemiology; Diabetic Foot - physiopathology; Diabetic Neuropathies - complications; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Netherlands - epidemiology; Neuropathy; Odds Ratio; Peripheral Nervous System Diseases - complications; Prevalence; Primary health care; Primary Health Care - statistics & numerical data; Prospective Studies; Type II diabetes mellitus; Vascular disease; Netherlands; Vascular disease; Type II diabetes mellitus; Neuropathy; Primary health care; Diabetic foot; Endocrinopathy; Human; Nervous system diseases; Prevalence; Risk factor; Disease of the foot; Complication; Peripheral nerve disease; Peripheral neuropathy; Non insulin dependent diabetes; Public health
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/S0168-8227(97)01380-6

The purpose of the study was to assess the prevalence of foot (pre-)ulcers and their determinants in type II diabetic patients in a primary health care setting. Six hundred and nine patients (246 men, mean age 64.8 (range, 40–94) years, diabetes duration, 4.3 (0–44.9) years) from 22 general practices attended a regional shared care project in Amsterdam. At first visit all patients were examined by a podiatrist. Amputations, active foot ulcers (Wagner stage 1 or 2) and pre-ulcers (Wagner stage 0, hard skin with or without macerating changes) were recorded in 0 (0%), 11 (1.8%) and 79 (12.9%) patients, respectively. In multivariate logistic regression analysis, after adjustment for age and gender, diabetes duration, cigarette smoking, peripheral vascular disease (assessed by calculating ankle/brachial index), sensory neuropathy (by Semmes-Weinstein monofilament 5.07), dry feet and severe hammer toes were independently and significantly associated (pre-)ulceration. In conclusion, one of every seven type II diabetic patients in primary health care has a foot (pre-)ulcer. Patients at risk for foot ulceration can be identified by inspection and the use of simple instruments.