F Crawford1, G Cezard2,3, F M Chappell4. 1. Research and Development, NHS Fife, Queen Margaret Hospital, Dunfermline, Scotland. 2. Population and Health Research Group (PHRG), School of Geography and Sustainable Development (SGSD), Irvine Building, University of St Andrews, St Andrews, UK. 3. The Centre for Population Health Sciences, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK. 4. The Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, UK.
Abstract
AIMS: Diabetes guidelines recommend screening for the risk of foot ulceration but vary substantially in the underlying evidence base. Our purpose was to derive and validate a prognostic model of independent risk factors for foot ulceration in diabetes using all available individual patient data from cohort studies conducted worldwide. METHODS: We conducted a systematic review and meta-analysis of individual patient data from 10 cohort studies of risk factors in the prediction of foot ulceration in diabetes. Predictors were selected for plausibility, availability and low heterogeneity. Logistic regression produced adjusted odds ratios (ORs) for foot ulceration by ulceration history, monofilament insensitivity, any absent pedal pulse, age, sex and diabetes duration. RESULTS: The 10 studies contained data from 16 385 participants. A history of foot ulceration produced the largest OR [6.59 (95% CI 2.49 to 17.45)], insensitivity to a 10 g monofilament [3.18 (95% CI 2.65 to 3.82)] and any absent pedal pulse [1.97 (95% CI 1.62 to 2.39)] were consistently, independently predictive. Combining three predictors produced sensitivities between 90.0% (95% CI 69.9% to 97.2%) and 95.3% (95% CI 84.5% to 98.7%); the corresponding specificities were between 12.1% (95% CI 8.2% to 17.3%) and 63.9% (95% CI 61.1% to 66.6%). CONCLUSIONS: This prognostic model of only three risk factors, a history of foot ulceration, an inability to feel a 10 g monofilament and the absence of any pedal pulse, compares favourably with more complex approaches to foot risk assessment recommended in clinical diabetes guidelines.
AIMS: Diabetes guidelines recommend screening for the risk of foot ulceration but vary substantially in the underlying evidence base. Our purpose was to derive and validate a prognostic model of independent risk factors for foot ulceration in diabetes using all available individual patient data from cohort studies conducted worldwide. METHODS: We conducted a systematic review and meta-analysis of individual patient data from 10 cohort studies of risk factors in the prediction of foot ulceration in diabetes. Predictors were selected for plausibility, availability and low heterogeneity. Logistic regression produced adjusted odds ratios (ORs) for foot ulceration by ulceration history, monofilament insensitivity, any absent pedal pulse, age, sex and diabetes duration. RESULTS: The 10 studies contained data from 16 385 participants. A history of foot ulceration produced the largest OR [6.59 (95% CI 2.49 to 17.45)], insensitivity to a 10 g monofilament [3.18 (95% CI 2.65 to 3.82)] and any absent pedal pulse [1.97 (95% CI 1.62 to 2.39)] were consistently, independently predictive. Combining three predictors produced sensitivities between 90.0% (95% CI 69.9% to 97.2%) and 95.3% (95% CI 84.5% to 98.7%); the corresponding specificities were between 12.1% (95% CI 8.2% to 17.3%) and 63.9% (95% CI 61.1% to 66.6%). CONCLUSIONS: This prognostic model of only three risk factors, a history of foot ulceration, an inability to feel a 10 g monofilament and the absence of any pedal pulse, compares favourably with more complex approaches to foot risk assessment recommended in clinical diabetes guidelines.
Authors: Francesca M Chappell; Fay Crawford; Margaret Horne; Graham P Leese; Angela Martin; David Weller; Andrew J M Boulton; Caroline Abbott; Matilde Monteiro-Soares; Aristidis Veves; Richard D Riley Journal: BMJ Open Diabetes Res Care Date: 2021-05
Authors: Fay Crawford; Donald J Nicolson; Aparna E Amanna; Angela Martin; Saket Gupta; Graham P Leese; Robert Heggie; Francesca M Chappell; Heather H McIntosh Journal: Diabetologia Date: 2019-11-27 Impact factor: 10.122
Authors: Joline W J Beulens; Josan S Yauw; Petra J M Elders; Talitha Feenstra; Ron Herings; Roderick C Slieker; Karel G M Moons; Giel Nijpels; Amber A van der Heijden Journal: Diabetologia Date: 2021-04-27 Impact factor: 10.122