Evaluación longitudinal de la exploración del pie en una cohorte de pacientes con diabetes mellitus tipo 2

Introduction: Diabetic foot is a frequent health problem and it represents an important cause of morbidity and mortality. Objectives: To analyze the evolution of foot examination in diabetic people and to determinate risk factors associated with diabetic foot. Material and methods: We performed an observational prospective study. Patients with type 2 diabetes between the years 2003-2008 and from a primary health care center were included. Measurements: sociodemographic, clinical data and test results. Descriptive analysis and logistic regression to relate the variables with development of diabetic foot were used. Results: 161 patients were included, with a mean age of 66 years old. 87% of them had hypertension, 88% dyslipidemia, 20% had history of cardiovascular disease and 11% of peripheral arterial disease. 9% had retinopathy, 21% symptomatic neuropathy and 0.6% a history of ulcer or amputation. Successive annual assessments showed reduction of pedal pulse palpation (77.4% normal at 1st evaluation and 62.8% at 4th evaluation, p < 0.0001). Sensation in the feet kept stable (81.2-85,9%). Proportion of patients with foot-at-risk increased from 30 to 42% (p < 0.001), % of those with normal foot did not change (from 39.5 to 42.3%) and % of those with pathologic diabetic foot changed from 30.6% at first evaluation to 23.1% in the last one (p < 0.01), Mean HbA1c levels remained about 7.4% through the four years of follow-up. Multivariate analysis shows find a significant relationship of diabetic foot to advanced age, higher HbA1c levels at the beginning, presence of nephropathy at first evaluation, basal alteration of pedal pulses, and a low number of sensitive points in the monofilament evaluation. Conclusions: At study end, we observe a diminution of the proportion of healthy feet, basically because of absence/deterioration of artery pulses. The patient with higher risk would be an old patient, with nephropathy, high levels of HbA1c and alterations in clinical evaluation (sensitivity and/or distant pulses).