Singh N, Armstrong DG, Lipsky BA, et al.
JAMA. Date of publication 2005 Jan 12;volume 293(2):217-28.
1. JAMA. 2005 Jan 12;293(2):217-28.
Preventing foot ulcers in patients with diabetes.
Singh N(1), Armstrong DG, Lipsky BA.
Author information:
(1)Department of Medicine, Division of Endocrinology,Veterans Affairs Puget Sound
Healthcare System and University of Washington School of Medicine, Seattle 98108,
USA. Nalini.Singh2@med.va.gov
CONTEXT: Among persons diagnosed as having diabetes mellitus, the prevalence of
foot ulcers is 4% to 10%, the annual population-based incidence is 1.0% to 4.1%,
and the lifetime incidence may be as high as 25%. These ulcers frequently become
infected, cause great morbidity, engender considerable financial costs, and are
the usual first step to lower extremity amputation.
OBJECTIVE: To systematically review the evidence on the efficacy of methods
advocated for preventing diabetic foot ulcers in the primary care setting.
DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: The EBSCO, MEDLINE, and the
National Guideline Clearinghouse databases were searched for articles published
between January 1980 and April 2004 using database-specific keywords.
Bibliographies of retrieved articles were also searched, along with the Cochrane
Library and relevant Web sites. We reviewed the retrieved literature for
pertinent information, paying particular attention to prospective cohort studies
and randomized clinical trials.
DATA SYNTHESIS: Prevention of diabetic foot ulcers begins with screening for loss
of protective sensation, which is best accomplished in the primary care setting
with a brief history and the Semmes-Weinstein monofilament. Specialist clinics
may quantify neuropathy with biothesiometry, measure plantar foot pressure, and
assess lower extremity vascular status with Doppler ultrasound and ankle-brachial
blood pressure indices. These measurements, in conjunction with other findings
from the history and physical examination, enable clinicians to stratify patients
based on risk and to determine the type of intervention. Educating patients about
proper foot care and periodic foot examinations are effective interventions to
prevent ulceration. Other possibly effective clinical interventions include
optimizing glycemic control, smoking cessation, intensive podiatric care,
debridement of calluses, and certain types of prophylactic foot surgery. The
value of various types of prescription footwear for ulcer prevention is not
clear.
CONCLUSIONS: Substantial evidence supports screening all patients with diabetes
to identify those at risk for foot ulceration. These patients might benefit from
certain prophylactic interventions, including patient education, prescription
footwear, intensive podiatric care, and evaluation for surgical interventions.
DOI: 10.1001/jama.293.2.217
PMID: 15644549 [Indexed for MEDLINE]
