Diabetic foot ulcer incidence bucks the trend
medwireNews: Study findings suggest that the current annual incidence of diabetic foot may be lower than previously reported in the 1990s, despite the prevalence of diabetes nearly doubling in that time.
“This observation could reflect the efficacy of screening practices and an increased awareness of foot problems in individuals with diabetes,” the research team suggests.
Among 81,793 individuals with diabetes registered in the Netherlands Institute for Health Services Research (NIVEL) Primary Care Database between 2010 and 2013, complete foot examinations were documented in 56.3% of individuals over 195,806 person–years of follow-up, with at least one component of this examination documented for 64.2%.
Active foot ulceration was recorded for 412 patients, giving a 4-year overall prevalence of 0.5%, 0.78% among patients who had at least one component of their foot examination documented, and 2.85% among patients with ulcer status explicitly stated.
The team also calculated annual incidence rates for 383 of the patients who had new active foot ulcers, after excluding 29 with prevalent ulcers, and found corresponding rates of 0.22%, 0.34%, and 1.08%.
Despite these relatively low prevalence and incidence rates, lead researcher Robert Stoekenbroek (University of Amsterdam, the Netherlands) and colleagues note that at least 20% of all patients had at least one abnormality on foot examination. Neuropathy was the most common problem, seen in 11.1% of patients, followed by absent pedal pulsations in 9.4%, and callus/pressure marks in 6.5%.
“This finding signifies the importance of screening, as these individuals have a markedly increased risk of developing foot ulcers,” they say, adding that “screening would be expected to reduce ulcer incidence by enabling earlier preventive intervention among individuals with an increased ulcer risk.”
Such interventions might include shoe modifications, targeted education on foot care, and pedicures, they suggest in Diabetologia.
Indeed, the researchers indicate that the efficacy of such screening practices may explain why their rates are lower than previously reported annual rates of 1.8% and 2.1% in two Dutch studies in the 1990s and similar rates, of between 2.0% and 2.6%, from other international population-based studies from the same time period.
Acknowledging that a limited number of studies prevents definitive conclusions on time trends, the team nevertheless believe “that it is unlikely that the large increase in the prevalence of diabetes and the changes in diabetes care have been accompanied by an increased occurrence of foot ulcers among the diabetes population in the Netherlands.”
By Lucy Piper
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