Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot

OBJECTIVE - TO evaluate the effectiveness of a diabetic foot risk classific ation system by the International Working Group on the Diabetic Foot to pre dict clinical outcomes. RESEARCH DESIGN AND METHODS - A total of 225 diabetic patients were initial ly a evaluated as part of a prospective case-control study at the Universit y of Texas Health Science Center at San Antonio. Complete records were avai lable for 213 patients for follow-up evaluation after 29 months. Upon enrol lment, subjects were stratified into four risk, groups based oil the presen ce of risk factors according to the consensus of the International Working Group on the Diabetic FOOL. Group 0 consisted of subjects without neuropath y, group I consisted of patients with neuropathy but without deformity or p eripheral vascular disease (PVD), group 2 consisted of subjects with neurop athy and deformity or PVD, and group 3 consisted of patients with a history of foot ulceration or a lower-extremity, amputation. RESULTS - Upon enrollment, patients in higher-risk groups had longer durati on of diabetes, worse glycemic control, vascular and neuropathic variables, and more systemic complications of diabetes. During 3 years of follow-up, ulceration occurred in 5.1, 14.3, 18.8, and 55.8% of the patients in groups 0, 1, 2, and 3, respectively (linear-by-linear association, P < 0.001). Al l amputations were found in Groups 2 and 3 (3.1 and 20.9%, P < 0.001). CONCLUSIONS - The foot risk classification of the International Working Gro up on the Diabetic Foot predicts ulceration and amputation and can function as a tool to prevent lower-extremity complications of diabetes.