Identification of patients at risk for diabetic foot - A comparison of standardized noninvasive testing with routine practice at community diabetes clinics

The aim of the study was the comparison of a simple standardized noninvasiv e examination of neuropathy and angiopathy with routine diagnostic practice in community diabetes clinics For the identification of patients at risk o f foot ulceration. Consecutive patients (n=322), aged 30 years and more, wi th a diabetes duration of more than 5 years,were examined by trained pediat ric nurses in six diabetes clinics over a 1-year period; 44 of these patien ts had active or previous foot ulcerations. We evaluated the differences be tween the routine diagnostic practice (based on the patient's medical histo ry and a physical examination) and noninvasive testing of peripheral neurop athy [vibration perception threshold (VPT) and the Semmes-Weinstein 10-g mo nofilament wire system] and angiopathy [Doppler ankle/brachial index (ABI)] . Using receiver operating characteristic (ROC) analysis, we evaluated the sensitivity and specificity of noninvasive testing methods for identifying patients at risk and selecting the optimal diagnostic cutoff points. Patien ts with severe neuropathy, as determined by noninvasive testing (VPT greate r than or equal to 30 V and/or insensitivity to 10 g monofilament), had bee n diagnosed to have neuropathy in diabetes clinics in 54% of cases. Patient s with angiopathy at risk of developing diabetic foot ulcers (ABI less than or equal to0.8) had been diagnosed, in diabetes clinics, to have periphera l arterial disease in 50% (they reported claudications in 41%, had femoral artery bruits detected in 29% and nonpalpable peripheral pulsations in 12%) . Our findings stress the importance of using standardized simple noninvasi ve testing methods to increase the accuracy of identifying patients at risk for the diabetic foot at the community level. (C) 2001 Elsevier Science In c. All rights reserved.