A program for screening patients at a high risk for lower extremity ulcers and amputations

A screening of patients with diabetes mellitus (DM) at a high risk for trophic foot ulcers and amputation has been made in Saint Petersburg since 2001. This study was undertaken to analyze the results of this screening. A total of 3807 patients with DM (96% with type 2 and 4% with type 1) were examined. The history of DM was 9.6 ±8.1 years; the body mass index, 30.4±8.2 kg/m²; mean age, 66.5±10.9 years. Passport data, the year of detection of DM, its type, anthropometric indices, history data on ulcerative defect of the foot and/or amputation were recorded. Arterial pulsation in both feet, sensitivity to 10-g monofilament; the presence of foot or toe deformities were assessed. The risk was determined in accordance with the modified recommendations of the International Agreement on the Diabetic Foot. Low, intermediate, and high, and very high risks were detected in 43.1, 37.3, 14.6%, and 5% of the examinees, respectively. The groups did not differ in age, but the patients at a very high risk had a long history of DM as compared with those at a low risk (14.9 ±9.1 versus 8.4 ± 7.7years; p <0.05). Foot deformity, severe polyneuropathy, lower extremity angiopathy were identified in 46, 11.5, and 10.6% of the patients, respectively. Foot and toe deformities were more frequently detected in type 1 DM. The substantially long persistence of DM was a cause of the high incidence of polyneuropathy, angiopathy, and a history of pyonecrotic processes in patients with type 1 DM. The proportion of patients at high and very high risks was almost 20%, which indicates that Diabetic Foot rooms should be set up. In the examinees, foot and toe deformities are the most common risk factors, which is largely due to the age of the population. The results of screening suggest that it is necessary to set up additional Diabetic Foot rooms, their work being aimed at foot care, and, in terms of the great spread of food deformity, to review the orthopedic provision system for diabetic patients.

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