Reduction in Foot Ulcer Incidence

Abstract

Diabetic foot lesions are one of the most serious causes of morbidity among diabetic people and often require a long hospital stay. Despite intensive therapy, many of these patients will require a lower-extremity amputation (LEA), with a high economic and social cost. The estimated cost due to LEAs in diabetic patients in Spain was 5,289 million pesetas ($39.5 million U.S.) (1). Area 7 in Madrid has the lowest LEA incidence of all Caucasian populations (2), with a progressive decline since 1989, reaching a ≥50% decrease in 1997. Preventive strategies are mainly focused on early peripheral neuropathy detection, diagnosed by a neuropathy disability score (NDS) ≥6. Diabetic people diagnosed with neuropathy are then included in a continuous prophylactic foot care program (FP). This program has been available in our area since 1993. Our study assessed the effectiveness of the FP in reducing the foot ulcer incidence in diabetic patients included in this program between 1993 and 1996 and in the follow-up completed in December 1999.We designed a prospective clinic-based study in which all diabetic patients who attended the outpatient clinic of the endocrinology service and who were diagnosed as having peripheral neuropathy based on an NDS ≥6 were included in a screening and prophylactic FP. The NDS is included in the standards of medical care for diabetic people from area 7 in Madrid (population of 565,000). The number of people with diagnosed diabetes is estimated to be ∼ 19,000.The design of the screening program has been described previously elsewhere (3). In short, we recruited diabetic patients with an NDS ≥6 who were considered to be suffering from peripheral neuropathy according to standard criteria (4). All of these diabetic patients were tested for peripheral vascular disease (PVD) and morphological plantar deformities; for visual and motor capacity that enabled them to …