摘要
Context:Among persons diagnosed as having diabetes mellitus, the prevalence of foot ulcers is 4%to 10%, the annual population-based incidence is 1.0%to 4.1 %, and the lifetime incidence may be as high as 25%. These ulcers frequently b ecome infected, cause great morbidity, engender considerable financial costs, an d are the usual first step to lower extremity amputation. Objective:To systemat ically review the evidence on the efficacy of methods advocated for preventing d iabetic foot ulcers in the primary care setting. Data Sources, Study Selection, and Data Extraction:The EBSCO, MEDLINE, and the National Guideline Clearinghous e databases were searched for articles published between January 1980 and April 2004 using database-specific keywords. Bibliographies of retrieved articles wer e also searched, along with the Cochrane Library and relevant Web sites. We revi ewed the retrieved literature for pertinent information, paying particular atten tion to prospective cohort studies and randomized clinical trials. Data Synthesi s:Prevention of diabetic foot ulcers begins with screening for loss of protecti ve sensation, which is best accomplished in the primary care setting with a brie f history and the Semmes-Weinstein monofilament. Specialist clinics may quantif y neuropathy with biothesiometry, measure plantar foot pressure, and assess lowe r extremity vascular status with Doppler ultrasound and ankle-brachial blood pr essure indices. These measurements, in conjunction with other findings from the history and physical examination, enable clinicians to stratify patients based o n risk and to determine the type of intervention. Educating patients about prope r foot care and periodic foot examinations are effective interventions to preven t ulceration. Other possibly effective clinical interventions include optimizing glycemic control, smoking cessation, intensive podiatric care, debridement of c alluses, and certain types of prophylactic foot surgery. The value of various ty pes of prescription footwear for ulcer prevention is not clear. Conclusions:Sub stantial evidence supports screening all patients with diabetes to identify thos e at risk for foot ulceration. These patients might benefit from certain prophyl actic interventions, including patient education, prescription footwear, intensi ve podiatric care, and evaluation for surgical interventions.
Context:Among persons diagnosed as having diabetes mellitus, the prevalence of foot ulcers is 4%to 10%, the annual population-based incidence is 1.0%to 4.1 %, and the lifetime incidence may be as high as 25%. These ulcers frequently b ecome infected, cause great morbidity, engender considerable financial costs, an d are the usual first step to lower extremity amputation. Objective:To systemat ically review the evidence on the efficacy of methods advocated for preventing d iabetic foot ulcers in the primary care setting. Data Sources, Study Selection, and Data Extraction:The EBSCO, MEDLINE, and the National Guideline Clearinghous e databases were searched for articles published between January 1980 and April 2004 using database-specific keywords. Bibliographies of retrieved articles wer e also searched, along with the Cochrane Library and relevant Web sites. We revi ewed the retrieved literature for pertinent information, paying particular atten tion to prospective cohort studies and randomized clinical trials. Data Synthesi s:Prevention of diabetic foot ulcers begins with screening for loss of protecti ve sensation, which is best accomplished in the primary care setting with a brie f history and the Semmes-Weinstein monofilament. Specialist clinics may quantif y neuropathy with biothesiometry, measure plantar foot pressure, and assess lowe r extremity vascular status with Doppler ultrasound and ankle-brachial blood pr essure indices. These measurements, in conjunction with other findings from the history and physical examination, enable clinicians to stratify patients based o n risk and to determine the type of intervention. Educating patients about prope r foot care and periodic foot examinations are effective interventions to preven t ulceration. Other possibly effective clinical interventions include optimizing glycemic control, smoking cessation, intensive podiatric care, debridement of c alluses, and certain types of prophylactic foot surgery. The value of various ty pes of prescription footwear for ulcer prevention is not clear. Conclusions:Sub stantial evidence supports screening all patients with diabetes to identify thos e at risk for foot ulceration. These patients might benefit from certain prophyl actic interventions, including patient education, prescription footwear, intensi ve podiatric care, and evaluation for surgical interventions.
