Affiliation:
1. School of Mathematics and Statistics University of St Andrews St Andrews UK
2. School of Health and Social Care University of Essex Colchester UK
3. British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care University of Cambridge Cambridge UK
4. Victor Phillip Dahdaleh Heart and Lung Research Institute University of Cambridge Cambridge UK
Abstract
AbstractBackgroundIdentifying people with diabetes who are likely to experience a foot ulcer is an important part of preventative care. Many cohort studies report predictive models for foot ulcerations and for people with diabetes, but reports of long‐term outcomes are scarce.AimWe aimed to develop a predictive model for foot ulceration in diabetes using a range of potential risk factors with a follow‐up of 10 years after recruitment. A new foot ulceration was the outcome of interest and death was the secondary outcome of interest.DesignA 10‐year follow‐up cohort study.Methods1193 people with a diagnosis of diabetes who took part in a study in 2006–2007 were invited to participate in a 10‐year follow‐up. We developed a prognostic model for the incidence of incident foot ulcerations using a survival analysis, Cox proportional hazards model. We also utilised survival analysis Kaplan–Meier curves, and relevant tests, to assess the association between the predictor variables for foot ulceration and death.ResultsAt 10‐year follow‐up, 41% of the original study population had died and more than 18% had developed a foot ulcer. The predictive factors for foot ulceration were an inability to feel a 10 g monofilament or vibration from a tuning fork, previous foot ulceration and duration of diabetes.ConclusionsThe prognostic model shows an increased risk of ulceration for those with previous history of foot ulcerations, insensitivity to a 10 g monofilament, a tuning fork and duration of diabetes. The incidence of foot ulceration at 10‐year follow‐up was 18%; however, the risk of death for this community‐based population was far greater than the risk of foot ulceration.
Funder
Health Technology Assessment Programme
Subject
Endocrinology, Diabetes and Metabolism
Reference21 articles.
1. International Diabetes Federation IDF Diabetes Atlas.10th edn. Brussels Belgium.2021. Accessed October 29 2023.https://www.diabetesatlas.org
2. The cost of diabetic foot ulcers and amputations to the National Health Service in England
3. NICE NG19.Diabetic Foot Problems Prevention and Management. Accessed October 29 2023.https://www.nice.org.uk/guidance/ng19
4. International Working Group of the Diabetic Foot (IWGDF). Accessed October 29 2023.https://iwgdfguidelines.org/
5. Prognostic models for predicting the risk of foot ulcer or amputation in people with type 2 diabetes: a systematic review and external validation study