title: Outcome on diabetic foot complications in relation to clinical examination and quantitative sensory testing: a case-control study.
abstract: A total of 405 diabetic patients who first attended St Thomas' Diabetes Clinic between 1982 and 1985 had a detailed standardized computerized first visit record, including a structured foot examination and toe vibration perception thresholds (VPT, Biothesiometer), were reviewed in 1995. None of the patients had a history of foot ulceration at first visit. Twenty-five patients (6.2%) developed foot ulcers (n = 11, 2.7%) or had an amputation (n = 14, 3.5%) over a mean 12-year period. Twenty of these patients were then individually matched with 3 non-ulcer patients. Statistically significant odds ratios (OR) were found for a baseline abnormal age-adjusted toe VPT (OR 4.38, CI 1.11-17.26; p = 0.01); abnormal clinical examination (at least 1 abnormality out of: ankle jerks, tuning fork or cotton wool sensation; OR 2.3, CI 1.00-5.20; p < 0.01); and HbA1 (OR 1.30, CI 1.01-1.66; P < 0.02) in patients who subsequently developed lower extremity complications. The sensitivity of VPT (70%) was better than that for clinical testing (55 %) in predicting long-term complications, although all tests showed similar specificity (70-72%). The risk of events also doubled for every 10 years of diabetes (OR 2.10, CI 1.11-4.30; p = 0.02). We conclude that age-corrected VPT measurements, which are objective and simple to perform, are better predictors of future foot complications than semi-quantitative tests in diabetes clinics. We encourage their use in the campaign to reduce the morbidity of diabetic peripheral neuropathy.
authors.affiliation: Division of Medicine, St Thomas' Hospital, London, UK. d.coppini@umds.ac.uk
authors.forename: D V
authors.initials: DV
authors.lastname: Coppini
authors.forename: P J
authors.initials: PJ
authors.lastname: Young
authors.forename: C
authors.initials: C
authors.lastname: Weng
authors.forename: A F
authors.initials: AF
authors.lastname: Macleod
authors.forename: P H
authors.initials: PH
authors.lastname: Sönksen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D000671:Amputation, Surgical; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D017719:Diabetic Foot / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000150:complications; D003930:Diabetic Retinopathy / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D016523:Foot Ulcer / Q000209:etiology / Q000601:surgery; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D016017:Odds Ratio; D011507:Proteinuria / Q000150:complications; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012684:Sensory Thresholds / Q000502:physiology*; D012907:Smoking / Q000009:adverse effects; D014110:Touch; D014732:Vibration
chemical_list: D006442:Glycated Hemoglobin