1st Department of Propaedeutic and Internal Medicine, Athens University Medical School, Athens, Greece.
Curr Diab Rep. 2011 Aug;11(4):294-301. doi: 10.1007/s11892-011-0192-0.
Diabetic foot ulcers affect almost 5% of the patients with diabetes and carry a huge physical, emotional, and financial burden. Almost 80% of amputations in patients with diabetes are preceded by a foot ulcer. The need for simple screening methods for prevention of foot ulcers and amputations is indisputable. Simple tests such as monofilament, tuning fork, vibration perception threshold determination, ankle reflexes, and pinprick sensation alone or in combination have been studied prospectively and can be used for identification of patients at risk. Newer tests examining sudomotor dysfunction and skin dryness have been introduced in recent years. In cross-sectional studies sudomotor dysfunction assessed by either sympathetic skin response or NEUROPAD™ (Miro Verbandstoffe GmbH, Wiehl-Drabenderhöhe, Germany) testing has been consistently associated with foot ulceration. In addition, NEUROPAD™ testing is simple, reproducible, and widely available and has a high sensitivity for the diagnosis of clinical or subclinical diabetic polyneuropathy. Prospective studies are required to establish whether sudomotor dysfunction can predict foot ulcers and if simple methods assessing sudomotor dysfunction (eg, NEUROPAD™ testing) can be included in the screening tests for the prevention of this complication.
糖尿病足溃疡影响了近 5%的糖尿病患者，给他们带来了巨大的身体、情感和经济负担。近 80%的糖尿病患者截肢前都有足部溃疡。毫无疑问，我们需要简单的筛查方法来预防足部溃疡和截肢。单纯的测试，如单丝、音叉、振动感觉阈值测定、踝反射和刺痛觉，单独或联合使用，已经进行了前瞻性研究，可以用于识别有风险的患者。近年来，已经引入了一些新的测试来检查出汗功能障碍和皮肤干燥。在横断面研究中，通过交感皮肤反应或 NEUROPAD（Miro Verbandstoffe GmbH，Wiehl-Drabenderhöhe，德国）测试评估的出汗功能障碍与足部溃疡一直存在关联。此外，NEUROPAD 测试简单、可重复、广泛可用，对诊断临床或亚临床糖尿病性多发性神经病具有较高的敏感性。需要前瞻性研究来确定出汗功能障碍是否可以预测足部溃疡，以及评估出汗功能障碍的简单方法（如 NEUROPAD 测试）是否可以纳入预防这种并发症的筛查测试中。
