Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, UK.
QJM. 2011 May;104(5):403-10. doi: 10.1093/qjmed/hcq227. Epub 2010 Dec 23.
Annual foot checks are recommended in patients with diabetes mellitus (DM) to identify those at risk of foot ulceration. Systematic reviews have found few studies evaluating the predictive value of tests in community-based diabetic populations.
To quantify the predictive value of clinical risk factors in relation to foot ulceration in a community population.
A cohort of 1192 people with diabetes receiving care in community settings was recruited and a screening procedure, covering symptoms, signs and diagnostic tests was conducted at baseline. At an average 1-year follow-up patients who developed a foot ulcer were identified by an independent blind assessor. Multivariable analysis was performed to identify clinical predictors of foot ulceration.
The incidence of foot ulceration was 1.93% [95% confidence interval (CI) 1.27-2.89). Three time-independent clinical predictors with five factors were selected: previous amputation [odds ratio (OR) 14.7, 95% CI 3.1-69.5), use of insulin before 3 months with inability to distinguish between cool and cold temperatures (OR 2.97, 95% CI 1.9-4.5) and failure to obtain at least one blood pressure reading for the calculation of ankle-brachial index with the failure to feel touch with a 10-g monofilament (OR 1.7, 95% CI 1.3-2.2).
Recommendations for annual diabetic foot check in low-risk, community-based patients should be reviewed as absolute events of ulceration are low. The accuracy of foot risk assessment tools to predict ulceration requires evaluation in randomized controlled trials with concurrent economic evaluations.
建议糖尿病（DM）患者每年进行足部检查，以识别有足部溃疡风险的患者。系统评价发现，很少有研究评估社区糖尿病人群中测试的预测价值。
定量评估社区人群中临床危险因素与足部溃疡之间的预测价值。
招募了 1192 名在社区环境中接受治疗的糖尿病患者，并在基线时进行了包括症状、体征和诊断测试的筛查程序。在平均 1 年的随访中，由独立的盲法评估员确定发生足部溃疡的患者。采用多变量分析确定足部溃疡的临床预测因素。
足部溃疡的发生率为 1.93%（95%CI 1.27-2.89）。选择了三个独立于时间的具有五个因素的临床预测因素：既往截肢[比值比（OR）14.7，95%CI 3.1-69.5]、在 3 个月前使用胰岛素且无法区分冷和冷温度（OR 2.97，95%CI 1.9-4.5）和未能获得至少一个血压读数以计算踝肱指数，并且未能感觉到 10 克单丝的触感（OR 1.7，95%CI 1.3-2.2）。
应该重新审查对低风险、社区为基础的患者进行年度糖尿病足部检查的建议，因为溃疡的绝对发生率较低。足部风险评估工具预测溃疡的准确性需要在具有同时进行经济评估的随机对照试验中进行评估。
