OUTCOME ON DIABETIC FOOT COMPLICATIONS IN RELATION TO CLINICAL EXAMINATION AND QUANTITATIVE SENSORY TESTING - A CASE-CONTROL STUDY

A total of 405 diabetic patients who first attended St Thomas' Diabete s Clinic between 1982 and 1985 had a detailed standardized computerize d first visit record, including a structured foot examination and toe vibration perception thresholds (VPT, Biothesiometer), were reviewed i n 1995. None of the patients had a history of foot ulceration at first visit. Twenty-five patients (6.2 %) developed foot ulcers (n = 11, 2. 7 %) or had an amputation (n = 14, 3.5 %) over a mean 12-year period. Twenty of these patients were then individually matched with 3 non-ulc er patients. Statistically significant odds ratios (OR) were found for a baseline abnormal age-adjusted toe VPT (OR 4.38, CI 1.11-17.26; p = 0.01); abnormal clinical examination (at least 1 abnormality out of: ankle jerks, tuning fork or cotton wool sensation; OR 2.3, CI 1.00-5.2 0; p < 0.01); and HbA(1) (OR 1.30, CI 1.01-1.66; P < 0.02) in patients who subsequently developed lower extremity complications. The sensiti vity of VPT (70 %) was better than that for clinical testing (55 %) in predicting long-term complications, although all tests showed similar specificity (70-72 %). The risk of events also doubled for every 10 y ears of diabetes (OR 2.10, CI 1.11-4.30; p = 0.02). We conclude that a ge-corrected VPT measurements, which are objective and simple to perfo rm, are better predictors of future foot complications than semi-quant itative tests in diabetes clinics. We encourage their use in the campa ign to reduce the morbidity of diabetic peripheral neuropathy. (C) 199 8 John Wiley & Sons, Ltd.