title: High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study.
abstract: OBJECTIVE
  Large clinical studies describing the typical clinical presentation of diabetic foot ulcers are limited and most studies were performed in single centres with the possibility of selection of specific subgroups. The aim of this study was to investigate the characteristics of diabetic patients with a foot ulcer in 14 European hospitals in ten countries.
  
  
  METHODS
  The study population included 1,229 consecutive patients presenting with a new foot ulcer between 1 September 2003 and 1 October 2004. Standardised data on patient characteristics, as well as foot and ulcer characteristics, were obtained. Foot disease was categorised into four stages according to the presence or absence of peripheral arterial disease (PAD) and infection: A: PAD -, infection -; B: PAD -, infection +; C: PAD +, infection -; D: PAD +, infection +.
  
  
  RESULTS
  PAD was diagnosed in 49% of the subjects, infection in 58%. The majority of ulcers (52%) were located on the non-plantar surface of the foot. With regard to severity, 24% had stage A, 27% had stage B, 18% had stage C and 31% had stage D foot disease. Patients in the latter group had a distinct profile: they were older, had more non-plantar ulcers, greater tissue loss and more serious comorbidity.
  
  
  CONCLUSIONS
  According to our results in this European cohort, the severity of diabetic foot ulcers at presentation is greater than previously reported, as one-third had both PAD and infection. Non-plantar foot ulcers were more common than plantar ulcers, especially in patients with severe disease, and serious comorbidity increased significantly with increasing severity of foot disease. Further research is needed to obtain insight into the clinical outcome of these patients.
authors.affiliation: Department of Internal Medicine, University Hospital Maastricht, P. Debeyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands. Leonne.Prompers@intmed.unimaas.nl
authors.forename: L
authors.initials: L
authors.lastname: Prompers
authors.forename: M
authors.initials: M
authors.lastname: Huijberts
authors.forename: J
authors.initials: J
authors.lastname: Apelqvist
authors.forename: E
authors.initials: E
authors.lastname: Jude
authors.forename: A
authors.initials: A
authors.lastname: Piaggesi
authors.forename: K
authors.initials: K
authors.lastname: Bakker
authors.forename: M
authors.initials: M
authors.lastname: Edmonds
authors.forename: P
authors.initials: P
authors.lastname: Holstein
authors.forename: A
authors.initials: A
authors.lastname: Jirkovska
authors.forename: D
authors.initials: D
authors.lastname: Mauricio
authors.forename: G
authors.initials: G
authors.lastname: Ragnarson Tennvall
authors.forename: H
authors.initials: H
authors.lastname: Reike
authors.forename: M
authors.initials: M
authors.lastname: Spraul
authors.forename: L
authors.initials: L
authors.lastname: Uccioli
authors.forename: V
authors.initials: V
authors.lastname: Urbancic
authors.forename: K
authors.initials: K
authors.lastname: Van Acker
authors.forename: J
authors.initials: J
authors.lastname: van Baal
authors.forename: F
authors.initials: F
authors.lastname: van Merode
authors.forename: N
authors.initials: N
authors.lastname: Schaper
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D017719:Diabetic Foot / Q000453:epidemiology* / Q000473:pathology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005534:Foot Diseases / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000453:epidemiology* / Q000473:pathology; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index