THE PREVALENCE AND DETERMINANTS OF FOOT ULCERATION IN TYPE-II DIABETIC-PATIENTS IN A PRIMARY HEALTH-CARE SETTING

The purpose of the study was to assess the prevalence of foot (pre-)ul cers and their determinants in type II diabetic patients in a primary health care setting. Six hundred and nine patients (246 men, mean age 64.8 (range, 40-94) years, diabetes duration, 4.3 (0-44.9) years) from 22 general practices attended a regional shared care project in Amste rdam. At first visit all patients were examined by a podiatrist. Amput ations, active foot ulcers (Wagner stage 1 or 2) and pre-ulcers (Wagne r stage 0, hard skin with or without macerating changes) were recorded in 0 (0%), 11 (1.8%) and 79 (12.9%) patients, respectively. In multiv ariate logistic regression analysis, after adjustment for age and gend er, diabetes duration, cigarette smoking, peripheral vascular disease (assessed by calculating ankle/brachial index) sensory neuropathy (by Semmes-Weinstein monofilament 5.07), dry feet and severe hammer toes w ere independently and significantly associated (pre-)ulceration, In co nclusion, one of every seven type II diabetic patients in primary heal th care has a foot (pre-)ulcer. Patients at risk for foot ulceration c an be identified by inspection and the use of simple instruments. (C) 1997 Elsevier Science Ireland Ltd.