A multi-centre study on the prevalence of lower extremity ulcers and amputations among diabetic out-patients in the Lombardy Region

A total of 33,544 diabetic out-patients were listed in 22 diabetic clinics in the Lombardy area. Among these, 6400 were randomly selected and 5813 wer e then studied (2982 men and 2831 women) age 63.3+/-11.6. A standardized qu estionnaire was filled out, and clinical examination of the lower extremiti es including peripheral pulses, tendon reflexes, and vibration perception w ere performed. The prevalence of amputation was 1.2% (1.6% in men vs 0.9% i n women, p<0.002). The prevalence of ulcers was 6.0% (6.3% in men vs 5.7% i n women, NS), Prevalence of amputation and ulcers significantly increased w ith advancing age and with the duration of diabetes in both sexes. Higher p revalence of amputation and ulcers was recorded in type 1 and insulin-treat ed type 2 patients. Ulcers and amputations were significantly associated wi th signs of peripheral neuropathy (absence of vibratory sensibility) and ma cro and microvascular disease (history of claudication, absence of peripher al pulses, retinopathy and nephropathy), The independent role of skin lesio ns and prelesions was assessed only for ulcers, These findings confirm that lower extremity lesions are a major problem in diabetic out-patients. Phys ical examination of lower extremities and simple measures of peripheral neu ropathy and vascular diseases should be used to identify high-risk subjects for intensive intervention. Diab. Nutr. Metab. 11: 179-187, 1998. (C) 1998 , Editrice Kurtis.