title: Stratification of foot ulcer risk in patients with diabetes: a population-based study.
abstract: This trial assessed whether a simple clinical tool can be used to stratify patients with diabetes, according to risk of developing foot ulceration. This was a prospective, observational follow-up study of 3526 patients with diabetes (91% type 2 diabetes) attending for routine diabetes care. Mean age was 64.7 (range 15-101) years and duration of diabetes was 8.8 (+/-1.5 SD) years. Patients were categorised into 'low' (64%), 'moderate' (23%) or 'high' (13%) risk of developing foot ulcers by trained staff using five clinical criteria during routine patient care. During follow-up (1.7 years), 166 (4.7%) patients developed an ulcer. Foot ulceration was 83 times more common in high risk and six times more in moderate risk, compared with low-risk patients. The negative predictive value of a 'low-risk score' was 99.6% (99.5-99.7%; 95% confidence interval). This clinical tool accurately predicted foot ulceration in routine practice and could be used direct scarce podiatry resources towards those at greatest need.
authors.affiliation: Diabetes Department, Ninewells Hospital, Dundee, UK. graham.leese@tuht.scot.nhs.uk
authors.forename: G P
authors.initials: GP
authors.lastname: Leese
authors.forename: F
authors.initials: F
authors.lastname: Reid
authors.forename: V
authors.initials: V
authors.lastname: Green
authors.forename: R
authors.initials: R
authors.lastname: McAlpine
authors.forename: S
authors.initials: S
authors.lastname: Cunningham
authors.forename: A M
authors.initials: AM
authors.lastname: Emslie-Smith
authors.forename: A D
authors.initials: AD
authors.lastname: Morris
authors.forename: B
authors.initials: B
authors.lastname: McMurray
authors.forename: A C
authors.initials: AC
authors.lastname: Connacher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017719:Diabetic Foot / Q000209:etiology*; D004812:Epidemiologic Methods; D005528:Foot / Q000098:blood supply; D005531:Foot Deformities, Acquired / Q000150:complications; D006801:Humans; D008875:Middle Aged; D011674:Pulse; D012677:Sensation