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Prevalence and Risk Evaluation of Diabetic Complications of the Foot Among Adults With Type 1 and Type 2 Diabetes in a Large Canadian Population (PEDAL Study)

Published:December 02, 2020DOI:https://doi.org/10.1016/j.jcjd.2020.11.011

      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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