Walters, David Paul; (1992) The prevalence of diabetic foot disease. Doctoral thesis (M.D), UCL (University College London).

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Abstract

During a surveillance programme all the known diabetics (1150) were identified from a general population of 97,034 representing all patients registered with 10 general practices. A control group of 751 non-diabetic subjects were also drawn from the same general population. A single observer reviewed 1077 (93.6%) of the diabetics and 480 (69%) of the controls. Peripheral vascular disease was detected using doppler ankle/brachial pressure index in 20.6% (95% CI 18.2-23.0) of diabetics and 9.6% (95% CI 7.0-11.2) of controls. There was no significant difference between the prevalence in non-insulin dependent and insulin dependent diabetics after adjusting for age. The prevalence in either type of diabetes was however significantly greater than in controls. Multiple logistic regression analysis revealed that age, cerebrovascular disease, coronary artery disease, mean systolic blood pressure, blood glucose, proteinuria and serum cholesterol were significantly and independently associated with the presence of peripheral vascular disease in diabetics. Body mass index was inversely associated. For controls only age and smoking were found to be significant variables. Neuropathy determined by clinical evaluation and sensory vibration thresholds was found in 16.8% (95% CI 14.6-19.0) of diabetics and 2.9% (95% CI 1.4-4.3) of controls (p<0.001). There was however no significant difference between insulin dependent and non-insulin dependent diabetics after accounting for age. Alcohol intake, age, height, HbA1, foot deformity and the presence of any retinopathy were significantly associated with neuropathy in diabetics and only male sex, age and foot deformity in controls. Past or present foot ulceration occurred in 7.4% (95% CI 5.8-9.0) of diabetics and 2.5% (95% CI 1.1-3.9) of controls (p<0.001). Amputation was found in 1.4% (95% CI 0.7-2.1) of diabetics but in no controls. Using logistic regression analysis ulceration was significantly associated with duration of diabetes, foot deformity, absent light touch, impaired pain perception, an absent dorsalis pedis pulse and the presence of any retinopathy. For controls only absent light touch was significant. Using a stepwise multiple regression only age and duration of diabetes were significantly associated with the presence of amputation.

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