Baba Mendel, Davis Wendy A, Norman Paul E, Davis Timothy M E
School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Podiatric Medicine Unit, University of Western Australia, Crawley, Perth, Western Australia, Australia.
School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia.
J Diabetes Complications. 2015 Apr;29(3):356-61. doi: 10.1016/j.jdiacomp.2015.01.008. Epub 2015 Jan 19.
To assess temporal changes in foot ulceration and its risk factors in community-based people with type 2 diabetes.
Baseline data from the longitudinal observational Fremantle Diabetes Study collected from 1993 to 1996 (Phase I) and 2008 to 2011 (Phase II) were analyzed. Generalized linear modeling was used to examine changes in foot ulcer prevalence and its associates between phases. Multiple logistic regression was used to determine associates of prevalent foot ulceration in individual and pooled phases.
There were 16 foot ulcers among 1296 patients in Phase I (1.2%) and 23 in 1509 Phase II patients (1.5%; P=0.86 after age, sex and race/ethnicity adjustment). Glycemic and non-glycemic cardiovascular risk factors were better in Phase II, but diabetes duration was longer, peripheral sensory neuropathy (PSN) was more prevalent and more patients were Aboriginal (P<0.001) than in Phase I. In multivariable analysis of both phases and pooled data, diabetes duration and peripheral sensory neuropathy (PSN) were independent associates of foot ulceration (P≤0.026). Prior hospitalization for ulcer, intermittent claudication, any absent pedal pulse and Aboriginality were also significant in the pooled model (P≤0.009).
Strong associations between foot ulcer and diabetes duration, PSN, symptomatic and clinically-detectable peripheral vascular disease were observed. Aboriginality also proved an independent risk factor. Since all these risk factors apart from intermittent claudication and impalpable foot pulses were more prevalent in Phase II, improved community- and hospital-based foot care between phases are likely to have attenuated the risk of foot ulcers in Phase II patients.
评估社区2型糖尿病患者足部溃疡及其危险因素的时间变化。
分析了1993年至1996年（第一阶段）和2008年至2011年（第二阶段）收集的纵向观察性弗里曼特尔糖尿病研究的基线数据。采用广义线性模型检查各阶段足部溃疡患病率及其相关因素的变化。采用多因素logistic回归确定各阶段和合并阶段足部溃疡的相关因素。
第一阶段1296例患者中有16例足部溃疡（1.2%），第二阶段1509例患者中有23例（1.5%；年龄、性别和种族/民族调整后P=0.86）。第二阶段血糖和非血糖心血管危险因素有所改善，但糖尿病病程更长，周围感觉神经病变（PSN）更普遍，且原住民患者比第一阶段更多（P<0.001）。在两个阶段和合并数据的多变量分析中，糖尿病病程和周围感觉神经病变（PSN）是足部溃疡的独立相关因素（P≤0.026）。溃疡既往住院史、间歇性跛行、任何足部脉搏缺失和原住民身份在合并模型中也具有显著性（P≤0.009）。
观察到足部溃疡与糖尿病病程、PSN、有症状和临床可检测的周围血管疾病之间存在密切关联。原住民身份也被证明是一个独立的危险因素。由于除间歇性跛行和足部脉搏触诊不清外，所有这些危险因素在第二阶段更为普遍，因此两个阶段之间社区和医院足部护理的改善可能降低了第二阶段患者足部溃疡的风险。
