Sämann A, Tajiyeva O, Müller N, Tschauner T, Hoyer H, Wolf G, Müller U A
Department of Internal Medicine III, Friedrich-Schiller-University Jena, Germany.
Diabet Med. 2008 May;25(5):557-63. doi: 10.1111/j.1464-5491.2008.02435.x. Epub 2008 Mar 14.
The diabetic foot syndrome (DFS) is an important complication of diabetes mellitus resulting in amputations, disability and reduced quality of life. DFS is preventable. The aim was to investigate the prevalence of the DFS at the primary care level in Germany.
This was a cross-sectional study of the prevalence of DFS, associated factors and glycaemic control at the primary care level in Germany. We examined an unselected sample of participants with known diabetes who were insured by Deutsche BKK, a large healthcare insurer.
Three hundred and forty-one general practitioners examined 4778 participants with diabetes mellitus: 366 (7.7%) participants (mean age 49 +/- 16 years) had Type 1 and 4412 participants (mean age 66 +/- 10 years) had Type 2 diabetes. DFS was diagnosed in 138 patients, resulting in a prevalence of 3.6%[95% confidence interval (CI) 1.9, 6.0] in Type 1 and 2.8% (95% CI 2.3, 3.4) in Type 2 diabetes. DFS was independently associated with age, duration of diabetes, height, current smoking and insulin therapy. There was no significant effect of glycaemic control on the risk of DFS. The prevalence of other abnormal foot findings was: peripheral neuropathy 9.7%, peripheral arterial disease 14.8% (absent dorsalis pedis), 12.4% (absent tibialis posterior), acute diabetic foot ulcer 0.8%, amputations of lower extremities 1.5%, and amputations limited to toes 0.5%.
The prevalence of the DFS at the primary care level in Germany is 2.9%. Almost 50% of patients with DFS had major or minor amputations. Common risk factors such as hyperkeratosis and poor glycaemic control can be modified. Effective therapeutic approaches in addition to methods for primary and secondary prevention of DFS should be used more widely.
糖尿病足综合征（DFS）是糖尿病的一种重要并发症，可导致截肢、残疾并降低生活质量。DFS是可预防的。本研究旨在调查德国基层医疗中DFS的患病率。
这是一项关于德国基层医疗中DFS患病率、相关因素及血糖控制情况的横断面研究。我们对德国大型医疗保险公司Deutsche BKK承保的已知糖尿病患者进行了非选择性抽样检查。
341名全科医生检查了4778例糖尿病患者：366例（7.7%）患者（平均年龄49±16岁）患有1型糖尿病，4412例患者（平均年龄66±10岁）患有2型糖尿病。138例患者被诊断为DFS，1型糖尿病患者的患病率为3.6%[95%置信区间（CI）1.9，6.0]，2型糖尿病患者的患病率为2.8%（95%CI 2.3，3.4）。DFS与年龄、糖尿病病程、身高、当前吸烟状况及胰岛素治疗独立相关。血糖控制对DFS风险无显著影响。其他足部异常表现的患病率为：周围神经病变9.7%，周围动脉疾病14.8%（足背动脉搏动消失），12.4%（胫后动脉搏动消失），急性糖尿病足溃疡0.8%，下肢截肢1.5%，局限于脚趾的截肢0.5%。
德国基层医疗中DFS的患病率为2.9%。近50%的DFS患者进行了大截肢或小截肢。诸如角化过度和血糖控制不佳等常见危险因素是可以改变的。除了DFS的一级和二级预防方法外，有效的治疗方法应得到更广泛的应用。
