Elsevier

Diabetes & Metabolism

Volume 29, Issue 3, June 2003, Pages 261-268
Diabetes & Metabolism

Original article
Screening diabetic patients at risk for foot ulceration. A multi-centre hospital-based study in France

https://doi.org/10.1016/S1262-3636(07)70035-6Get rights and content

Summary

Background

To determine the prevalence of risk factors for diabetic foot ulceration in diabetic patients free of active pedal ulceration in a hospital setting.

Methods

In sixteen French diabetology centres, a survey was conducted on a given day in all diabetic people attending the units, both as in- or out-patients.

Results

664 patients were evaluated: 105 had an active foot ulcer and were excluded from the analysis as were four other patients due to lack of reliable data. From the 555 assessable patients, 40 (7.2%) had a history of foot ulcer or lower-limb amputation. Sensory neuropathy with loss of protective sensation, as measured by the 5.07 (10 g) Semmes-Weinstein monofilament testing, was present in 27.1% of patients, whereas 17% had a peripheral arterial disease mainly based on the clinical examination. On addition, foot deformities were found in 117 patients (21.1%). According to the classification system of the International Working Group on the Diabetic Foot, 72.8% of patients were at low-risk for pedal ulceration (grade 0) and 17,5% were in the higher-risk groups (grade 2 & 3). If patients with isolated peripheral arterial disease were considered as a separate risk group (as was those with isolated neuropathy), percentage of low-risk patients decreased to 65.6%. There was a clear trend between the increasing severity of the staging and age, duration of diabetes, prevalence of nephropathy and retinopathy.

Conclusions

Prevalence of risk factors for foot ulceration is rather high in a hospital-based diabetic population, emphasising the need for implementing screening and preventive strategies to decrease the burden of diabetic foot problems and to improve the quality of life for people with diabetes.

Résumé

Dépistage des patients diabétiques à risque de lésion du pied: résultats d'une étude multicentrique française

Objectif

Déterminer la prévalence des facteurs de risque d'ulcération du pied chez les diabétiques sans lésion ouverte du pied, vus dans un contexte hospitalier.

Méthode

Une enquête a été réalisée un jour donné auprès de tous les diabétiques vus en hospitalisation ou en consultation dans seize centres de diabétologie français.

Résultats

Sur 664 patients examinés, 105 (15,8%) présentaient une ulcération et ont été exclus de l'analyse ainsi que 4 autres en raison de données ininterprétables. Quarante des 555 patients évaluables (7,2%) avaient un antécédent d'ulcère ou d'amputation. Une neuropathie sensitive avec perte de la sensation de protection jugée par le test au monofilament de 10 g, était notée chez 27,1% des patients; une artériopathie des membres inférieurs, jugée essentiellement sur des critères cliniques, était présente chez 17% et des déformations du pied chez 21,1%. D'après la classification du Groupe d'Etude International sur le Pied Diabétique, 72,8% de la population étudiée était considéré comme à faible risque d'ulcération (classe 0), alors que 17,5% étaient à haut risque (classes 2 et 3). En faisant de l'artériopathie isolée une classe de risque séparée, le pourcentage des patients à risque faible diminuait à 65,4%. Il existait une association nette entre sévérité de la classe de risque d'une part et âge, durée du diabète, prévalence de la néphropathie et de la rétinopathie, d'autre part.

Conclusion

La prévalence des facteurs de risque podologique apparaît élevée dans une population diabétique hospitalière, justifiant la nécessité de la mise en pratique d'une politique réelle de dépistage et de prévention.

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