State of the science in diabetic foot: subjective screening vs. objective diabetic neuropathy examination in primary care

Abstract

Among the conditioning factors of Diabetic Foot (DF), neuropathy is considered the main factor, arteriopathy the aggravating factor, and foot deformities the triggering factor. The preventive interventions for DF and its complications are distributed by levels of care. At the higher level, hospital care focuses on reducing DF amputations. At the lower level, Primary Care (PC) and Podiatry, focused on preventing DF. PC is considered the ideal place to identify the conditioning factors of DF. In this area, prevention follows the recommendations of the International Working Group on Diabetic Foot (IWGDF) by screening neuropathy focused on the sensitive or insensitive foot. The American Diabetes Association (ADA) a recommends person-centered assessment of neuropathy by clinical examination of symptoms and signs testing sensory, motor, and autonomic neuropathy. This controversy lead us to investigate which methodology (screening or clinical examination) could be more accurate in identifying the conditioning factors of DF in a group of people recruited in the TERMOPIEDI study. Neuropathy was assessed following the definition of diabetic neuropathy, the Young MJ diagnostic criteria, and the Toronto Council diagnostic category. These results allowed us to know the applicability of this procedure in PC within nursing competencies, detecting a greater number of patients with neuropathy compared to the screening method. People with neuropathy presented higher plantar temperature, concluding that neuropathy interferes with foot thermoregulation.