Outcome on diabetic foot complications in relation to clinical examination and quantitative sensory testing: a case-control study
✍ Scribed by Coppini, D.V.; Young, P.J.; Weng, C.; Macleod, A.F.; Sönksen, P.H.
- Publisher
- John Wiley and Sons
- Year
- 1998
- Tongue
- English
- Weight
- 104 KB
- Volume
- 15
- Category
- Article
- ISSN
- 0742-3071
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✦ Synopsis
A total of 405 diabetic patients who first attended St Thomas' Diabetes Clinic between 1982 and 1985 had a detailed standardized computerized first visit record, including a structured foot examination and toe vibration perception thresholds (VPT, Biothesiometer), were reviewed in 1995. None of the patients had a history of foot ulceration at first visit. Twenty-five patients (6.2 %) developed foot ulcers (n = 11, 2.7 %) or had an amputation (n = 14, 3.5 %) over a mean 12-year period. Twenty of these patients were then individually matched with 3 non-ulcer patients. Statistically significant odds ratios (OR) were found for a baseline abnormal age-adjusted toe VPT (OR 4.38, CI 1.11-17.26; p = 0.01); abnormal clinical examination (at least 1 abnormality out of: ankle jerks, tuning fork or cotton wool sensation; OR 2.3, CI 1.00-5.20; p Ͻ 0.01); and HbA 1 (OR 1.30, CI 1.01-1.66; P Ͻ 0.02) in patients who subsequently developed lower extremity complications. The sensitivity of VPT (70 %) was better than that for clinical testing (55 %) in predicting long-term complications, although all tests showed similar specificity (70-72 %). The risk of events also doubled for every 10 years of diabetes (OR 2.10, CI 1.11-4.30; p = 0.02). We conclude that age-corrected VPT measurements, which are objective and simple to perform, are better predictors of future foot complications than semi-quantitative tests in diabetes clinics. We encourage their use in the campaign to reduce the morbidity of diabetic peripheral neuropathy.