Independent Physiological Predictors of Foot Lesions in Patients With NIDDM

摘要: OBJECTIVE To identify and quantify independent physiological risk factors for foot lesions in diabetic patients. RESEARCH DESIGN AND METHODS There were 352 patients enrolled a 1-year randomized controlled trial aimed at reducing risks lower-extremity pathology through patient education system interventions. Inclusion criteria as follows: being age 40 years or over, above ideal body weight, having been diagnosed with NIDDM. Participants predominantly African-American (76%), elderly (mean 60 of age), indigent (77% annual income < $10,000), women (81%) who had diabetes 10 years. Prospective multivariate modeling used baseline clinical signs (e.g., blood pressure, dermatological characteristics, neuropathic measures) laboratory values lipid profiles measures glycemic control) to predict rated using the Seattle Wound Classification. RESULTS When controlling intervention effects, only neuropathy (monofilament testing [odds ratio {OR} 2.75, 95% CI 1.55–4.88] thermal sensitivity [2.18, 1.13–4.21]) predicted wounds classified 1.2 (minor injury), but investigation least 1.3 (nonulcerated lesions) indicated (13.41), 3.19–56.26), monofilament abnormalities (5.23, 2.26–12.13), low HDL (1.63, 1.11–2.39) predictors. Although fungal dermatitis, dry cracked skin, edema, ingrown nails, microalbuminuria, fasting glucose, hemoglobin A1c candidates one both multivariable models ( P 0.3), they not significant predictors. CONCLUSIONS Lesions may be preventable aggressive screening peripheral abnormal lipids. Also, these results provide empirical support commonly held belief that prospectively future wounds.