Abstract
Objectives
The lower limb complications of diabetes contribute significantly to patient morbidity
and health-care costs in Canada. Despite practice guidelines, awareness of and screening
for modifiable early pathologies has been inconsistent. Our study objective was to
determine the prevalence and types of early foot pathology in a large, Canadian, community
care–based diabetes population.
Methods
This study was a retrospective, observational analysis of the LMC Diabetes & Endocrinology
foot care program launched in 2017. We examined foot pathologies associated with vascular,
nerve, nail and dermatologic complications, as well as foot deformities. Individuals
≥18 years of age with diabetes, assessed by an LMC chiropodist in Ontario between
February 2018 and April 2019, were included in the analysis.
Results
Of the 5,084 individuals assessed, 470 with type 1 diabetes and 3,903 with type 2
diabetes met the study criteria. Mean age, body mass index and diabetes duration were
61.5 years, 31.3 kg/m2 and 13.9 years, respectively. Reduced pedal pulses, sensory neuropathy and onychomycosis
were reported in 8.9%, 16.7% and 14.5% of those in the type 1 diabetes group, and
in 19.4%, 26.6% and 28.7% of those in the type 2 group, respectively. Hyperkeratosis
was present in 51% and foot deformities were present in 44.5% among both groups. Foot
ulcer prevalence was 1.7%, and pedal pulses, sensory neuropathy, hyperkeratosis and
onychauxis, adjusted for age, sex, body mass index and diabetes duration, were each
significantly associated with ulceration.
Conclusions
In a large foot screening program of community-based adults with diabetes, modifiable
early foot pathologies were prevalent and provided further evidence of the value of
consistent screening to alleviate the morbidity and economic burden of lower limb
complications.
Résumé
Objectifs
Au Canada, les complications du diabète qui touchent le membre inférieur contribuent
de façon significative à la morbidité du patient et aux coûts des soins de santé.
En dépit des lignes directrices de la pratique, la sensibilisation aux pathologies
de stade précoce modifiables et leur dépistage fluctuaient. L’objectif de notre étude
était de déterminer la prévalence et les types de pathologies du pied de stade précoce
au sein d’une vaste population diabétique qui recevaient des soins en milieu communautaire
au Canada.
Méthodes
Il s’agissait d’une étude observationnelle rétrospective du programme de soins des
pieds de LMC Diabète et endocrinologie lancé en 2017. Nous avons examiné les pathologies
du pied associées aux complications vasculaires, nerveuses, unguéales et dermatologiques,
et les déformations du pied. Nous avons inclus à l’étude les individus diabétiques
≥ 18 ans évalués par un podiatre de LMC en Ontario entre février 2018 et avril 2019.
Résultats
Parmi les 5084 individus évalués, 470 individus atteints du diabète de type 1 et 3903
individus atteints du diabète de type 2 répondaient aux critères. L’âge, l’indice
de masse corporelle et la durée du diabète étaient en moyenne et de façon respective
de 61,5 ans, de 31,3 kg/m2 et de 13,9 ans. On a signalé la diminution des pouls pédieux, la neuropathie sensorielle
et l’onychomycose de façon respective chez 8,9 %, 16,7 % et 14,5 % des individus du
groupe de diabète de type 1 et chez 19,4 %, 26,6 % et 28,7 % des individus du groupe
de diabète de type 2. Dans les 2 groupes, on a noté la présence de l’hyperkératose
chez 51 % des individus et de déformations du pied chez 44,5 % des individus. La prévalence
de l’ulcère du pied était de 1,7 %, et les pouls pédieux, la neuropathie sensorielle,
l’hyperkératose et l’onychauxis ajustés selon l’âge, le sexe, l’indice de masse corporelle
et la durée du diabète étaient chacun associés de façon significative à l’ulcération.
Conclusions
Dans un vaste programme de dépistage du pied d’adultes diabétiques en milieu communautaire,
la prévalence des pathologies du pied modifiables de stade précoce a permis de confirmer
l’importance du dépistage régulier pour alléger la morbidité et le fardeau économique
des complications du membre inférieur.
Keywords
Mots clés
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Article info
Publication history
Published online: December 02, 2020
Accepted:
November 25,
2020
Received:
September 2,
2020
Identification
Copyright
© 2020 Canadian Diabetes Association.
