Clinical Diabetes Center, Elisabeth Hospital Essen, Essen, Germany.
Medical Faculty, Institute for Health Services Research and Health Economics, Heinrich-Heine-University, Düsseldorf, Germany.
Diabet Med. 2024 Apr;41(4):e15241. doi: 10.1111/dme.15241. Epub 2023 Oct 30.
To determine both the risk of first ever ulcer (FEU) and its time to onset in a population which had loss of protective sensation (LOPS) in the foot either with or without loss of protective pain (LOPP).
People with diabetes and LOPS without history of FEU presenting in a specialist clinic were included. LOPP was diagnosed by reduced vibration perception and pain perception by using a pinprick simulator. Participants were followed by routine foot checks, phone interview or by letter until the occurrence of a FEU, death or the end of observation period. Survival functions in LOPP strata were compared by log rank test. The hazard ratio (HR) of an FEU in people with compared to people without LOPP was estimated using Cox regression. Time to first ulcer was estimated using the framework of an accelerated failure time (AFT) model.
One hundred and thirty participants were followed up for a median of 48.3 months. Pain perception was lost in 55.4%. Eighteen people with LOPP developed a FEU (25.0%) as opposed to six (10.3%) of those with no LOPP (p = 0.02). Age-sex-adjusted HR for FEU was 3.0 (p = 0.02) for people with compared to people without LOPP. Age-sex-adjusted time to FEU for people with LOPP was approximately half (p = 0.03) than people without LOPP.
It is suggested that estimation of LOPP is included in routine practice because of its high predictive value for a FEU.
在足部既存在保护性感觉丧失（LOPS）又存在保护性疼痛丧失（LOPP）或仅存在 LOPS 的人群中，确定首次溃疡（FEU）的风险及其发病时间。
纳入在专科诊所就诊且有糖尿病且既往无 FEU 病史但存在 LOPS 的人群。LOPP 通过使用针刺痛觉模拟器检测到的振动感觉减退和疼痛感觉减退来诊断。通过常规足部检查、电话访谈或信件对参与者进行随访，直到发生 FEU、死亡或观察期结束。使用对数秩检验比较 LOPP 各层的生存函数。使用 Cox 回归估计有 LOPP 与无 LOPP 的人发生 FEU 的风险比（HR）。使用加速失效时间（AFT）模型的框架来估计首次溃疡的时间。
130 名参与者的中位随访时间为 48.3 个月。55.4%的人失去了痛觉。18 名有 LOPP 的人发生了 FEU（25.0%），而无 LOPP 的人有 6 人（10.3%）（p=0.02）。年龄性别校正后，与无 LOPP 的人相比，有 LOPP 的人发生 FEU 的 HR 为 3.0（p=0.02）。有 LOPP 的人发生 FEU 的时间大约是无 LOPP 的人的一半（p=0.03）。
建议在常规实践中纳入 LOPP 的评估，因为它对 FEU 具有较高的预测价值。
