Baba M, Foley L, Davis W A, Davis T M E
School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle; Podiatric Medicine Unit, University of Western Australia, Crawley, Perth, Western Australia, Australia.
Diabet Med. 2014 Nov;31(11):1439-45. doi: 10.1111/dme.12521. Epub 2014 Jul 7.
To determine self-awareness of diabetes-related foot problems and its associates in a community-based cohort of people with Type 2 diabetes.
A survey concerning diabetic foot problems was administered to 358 consecutive patients with Type 2 diabetes [mean ± SD age 67.4 ± 10.8 years, 56.1% males, median (interquartile range) diabetes duration 9.0 (3.9-16.8) years] attending for detailed clinical, biochemical and questionnaire assessment as part of the longitudinal observational Fremantle Diabetes Study Phase II.
Compared with the 213 patients (59.5%) who considered their feet to be normal, the 145 (40.5%) who considered their feet to be abnormal were older, had longer diabetes duration and were more likely to have sensory neuropathic symptoms and self-reported poor circulation (P < 0.001). In those who considered their feet to be normal, 67.9% had peripheral sensory neuropathy (score >2/8 on the Michigan Neuropathy Screening Instrument clinical portion), 9.9% had an ankle-brachial index < 0.9, 6.1% had both peripheral sensory neuropathy and an ankle-brachial index < 0.90, and 86.9% had one or more features on inspection, such as deformity, dry skin, callus and fissures that could facilitate more serious complications, despite the majority having had at least one foot examination by a healthcare professional in the previous year.
Self-assessment of diabetes-related foot problems by patients in the Fremantle Diabetes Study Phase II was unreliable. The present data suggest that self-perceived foot health should be assessed together with foot examination findings. Intensive education and monitoring may be necessary in those who consider their feet to be normal but who have neurovascular, structural and/or other precursors of serious foot pathology.
在一个基于社区的2型糖尿病患者队列中，确定糖尿病相关足部问题的自我认知及其相关因素。
对358例连续的2型糖尿病患者[平均±标准差年龄67.4±10.8岁，男性占56.1%，糖尿病病程中位数（四分位间距）为9.0（3.9 - 16.8）年]进行了一项关于糖尿病足部问题的调查，这些患者作为纵向观察性弗里曼特尔糖尿病研究第二阶段的一部分，前来接受详细的临床、生化和问卷调查评估。
与认为自己足部正常的213例患者（59.5%）相比，认为自己足部异常的145例患者（40.5%）年龄更大，糖尿病病程更长，更有可能出现感觉神经病变症状且自我报告循环不良（P < 0.001）。在认为自己足部正常的患者中，67.9%有周围感觉神经病变（密歇根神经病变筛查工具临床部分评分>2/8），9.9%踝肱指数<0.9，6.1%既有周围感觉神经病变且踝肱指数<0.90，86.9%在检查时有一项或多项特征，如畸形、皮肤干燥、胼胝和裂隙，这些可能会促使出现更严重的并发症，尽管大多数患者在前一年至少接受过一次医疗保健专业人员的足部检查。
弗里曼特尔糖尿病研究第二阶段患者对糖尿病相关足部问题的自我评估不可靠。目前的数据表明，应将自我感知的足部健康与足部检查结果一起评估。对于那些认为自己足部正常但有神经血管、结构和/或严重足部病变其他先兆的患者，可能需要强化教育和监测。
