The development and validation of a multivariable prognostic model to predict foot ulceration in diabetes using a systematic review and individual patient data meta-analyses

• Type: Article in International Scientific Journal
• Date: 2018

Authors

Crawford, F (Author) Other; Cezard, G (Author) Other; Chappell, FM (Author) Other; Young, MJ (Author) Other; Abbott, CA (Author) Other; Boulton, AJM (Author) Other; Boyko, EJ (Author) Other; Seelig, A (Author) Other; Kastenbauer, T (Author) Other; Leese, GP (Author) Other; Monami, M (Author) Other; Matilde Soares (Author) FMUP; Rith Najarian, SJ (Author) Other; Veves, A (Author) Other; Stansby, GP (Author) Other; Sheikh, A (Author) Other; Coates, N (Author) Other; Jeffcoate, WJ (Author) Other; Leech, N (Author) Other; Fahey, T (Author) Other

Journal

Title: Diabetic Medicine

Vol. 35

Pages: 1480-1493

ISSN: 0742-3071

Publisher: Wiley-Blackwell

Indexing

Scopus - 16 Citations

Other information

Authenticus ID: P-00S-CNK

DOI: 10.1111/dme.13797

Abstract (EN): Aims: Diabetes guidelines recommend screening for the risk of foot ulceration but vary substantially in the underlying evidence base. Our purpose was to derive and validate a prognostic model of independent risk factors for foot ulceration in diabetes using all available individual patient data from cohort studies conducted worldwide. Methods: We conducted a systematic review and meta-analysis of individual patient data from 10 cohort studies of risk factors in the prediction of foot ulceration in diabetes. Predictors were selected for plausibility, availability and low heterogeneity. Logistic regression produced adjusted odds ratios (ORs) for foot ulceration by ulceration history, monofilament insensitivity, any absent pedal pulse, age, sex and diabetes duration. Results: The 10 studies contained data from 16 385 participants. A history of foot ulceration produced the largest OR [6.59 (95% CI 2.49 to 17.45)], insensitivity to a 10 g monofilament [3.18 (95% CI 2.65 to 3.82)] and any absent pedal pulse [1.97 (95% CI 1.62 to 2.39)] were consistently, independently predictive. Combining three predictors produced sensitivities between 90.0% (95% CI 69.9% to 97.2%) and 95.3% (95% CI 84.5% to 98.7%); the corresponding specificities were between 12.1% (95% CI 8.2% to 17.3%) and 63.9% (95% CI 61.1% to 66.6%). Conclusions: This prognostic model of only three risk factors, a history of foot ulceration, an inability to feel a 10 g monofilament and the absence of any pedal pulse, compares favourably with more complex approaches to foot risk assessment recommended in clinical diabetes guidelines. © 2018 Crown copyright. Diabetes Medicine © 2018 Diabetes UK.

Language: English

Type (Professor's evaluation): Dissemination