The prevalence and determinants of foot ulceration in type II diabetic patients in a primary health care setting.
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 fool 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.
de Sonnaville
J J
JJ
Research Centre Primary/Secondary Health Care, Academic Hospital Vrije Universiteit, Amsterdam, Netherlands.
Colly
L P
LP
Wijkel
D
D
Heine
R J
RJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D017719:Diabetic Foot / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000150:complications; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D010523:Peripheral Nervous System Diseases / Q000150:complications; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies