G. Segalini et al., A multi-centre study on the prevalence of lower extremity ulcers and amputations among diabetic out-patients in the Lombardy Region, DIABET NUTR, 11(3), 1998, pp. 179-187
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.