Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study

Research Question: Previous cross-sectional studies have shown an association between sudomotor dysfunction and diabetic foot ulceration (DFU). The aim of this prospective multicenter study was to determine the role of dryness of foot skin and of established neurological modalities in the prediction...

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Main Authors: Georgios S. Panagoulias, Ioanna Eleftheriadou, Nikolaos Papanas, Christos Manes, Zdravko Kamenov, Dragan Tesic, Stavros Bousboulas, Anastasios Tentolouris, Edward B. Jude, Nikolaos Tentolouris
Format: Article
Language:English
Published: Frontiers Media S.A. 2020-09-01
Series:Frontiers in Endocrinology
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Online Access:https://www.frontiersin.org/article/10.3389/fendo.2020.00625/full
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spelling doaj-4c84a531ee48442c9091956524beab872020-11-25T03:25:55ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922020-09-011110.3389/fendo.2020.00625554275Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational StudyGeorgios S. Panagoulias0Ioanna Eleftheriadou1Nikolaos Papanas2Christos Manes3Zdravko Kamenov4Dragan Tesic5Stavros Bousboulas6Anastasios Tentolouris7Edward B. Jude8Nikolaos Tentolouris9First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, GreeceFirst Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, GreeceSecond Department of Internal Medicine, Diabetes Center, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupoli, GreeceDiabetes Center, Papageorgiou General Hospital, Thessaloniki, GreeceDiabetes Outpatient Clinic, University Hospital Alexandrovska, Medical University—Sofia, Sofia, BulgariaClinic for Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center of Vojvodina, Medical Faculty, University Novi Sad, Novi Sad, SerbiaDiabetes Outpatient Clinic, “St. Panteleimon” General State Hospital, Nikaia, GreeceFirst Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, GreeceTameside Hospital NHS Foundation Trust and University of Manchester, Ashton-under-Lyne, United KingdomFirst Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, GreeceResearch Question: Previous cross-sectional studies have shown an association between sudomotor dysfunction and diabetic foot ulceration (DFU). The aim of this prospective multicenter study was to determine the role of dryness of foot skin and of established neurological modalities in the prediction of risk for foot ulceration in a cohort of individuals with diabetes mellitus (DM).Design: The study was conducted from 2012 to 2017. A total of 308 subjects with DM without history of DFU or critical limb ischemia completed the study. Diabetic neuropathy was assessed using the neuropathy symptom score (NSS) and neuropathy disability score (NDS). In a subset of participants, vibration perception threshold (VPT) was evaluated. Dryness of foot skin was assessed by the visual indicator plaster method (IPM). The diagnostic performance of the above neurological modalities for prediction of DFU was tested by receiver operating characteristic curve (ROC) analysis.Results: During the 6-year follow-up, 55 patients (annual ulceration incidence 2.97%) developed DFU. Multivariate Cox-regression analysis after controlling for the effect of age, gender, and DM duration demonstrated that the risk (hazard ratio, 95% confidence intervals) of DFU increased significantly with either abnormal IPM (3.319, 1.460–7.545, p = 0.004) or high (≥6) NDS (2.782, 1.546–5.007, p = 0.001) or high (≥25 volts) VPT (2.587, 1.277–5.242, p = 0.008). ROC analysis showed that all neurological modalities could discriminate participants who developed DFU (p < 0.001). IPM testing showed high sensitivity (0.86) and low specificity (0.49), while high vs. low NDS and VPT showed low sensitivity (0.40 and 0.39, respectively) and high specificity (0.87 and 0.89, respectively) for identification of patients at risk for DFU.Conclusion: Dryness of foot skin assessed by the IPM predicts the development of DFU. IPM testing has high sensitivity, whereas high NDS and VPT have high specificity in identifying subjects at risk for DFU. The IPM can be included in the screening methods for identification of the foot at risk.https://www.frontiersin.org/article/10.3389/fendo.2020.00625/fulldiabetesfoot ulcerindicator plaster methodneuropadriskneuropathy disability score
collection DOAJ
language English
format Article
sources DOAJ
author Georgios S. Panagoulias
Ioanna Eleftheriadou
Nikolaos Papanas
Christos Manes
Zdravko Kamenov
Dragan Tesic
Stavros Bousboulas
Anastasios Tentolouris
Edward B. Jude
Nikolaos Tentolouris
spellingShingle Georgios S. Panagoulias
Ioanna Eleftheriadou
Nikolaos Papanas
Christos Manes
Zdravko Kamenov
Dragan Tesic
Stavros Bousboulas
Anastasios Tentolouris
Edward B. Jude
Nikolaos Tentolouris
Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study
Frontiers in Endocrinology
diabetes
foot ulcer
indicator plaster method
neuropad
risk
neuropathy disability score
author_facet Georgios S. Panagoulias
Ioanna Eleftheriadou
Nikolaos Papanas
Christos Manes
Zdravko Kamenov
Dragan Tesic
Stavros Bousboulas
Anastasios Tentolouris
Edward B. Jude
Nikolaos Tentolouris
author_sort Georgios S. Panagoulias
title Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study
title_short Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study
title_full Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study
title_fullStr Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study
title_full_unstemmed Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study
title_sort dryness of foot skin assessed by the visual indicator test and risk of diabetic foot ulceration: a prospective observational study
publisher Frontiers Media S.A.
series Frontiers in Endocrinology
issn 1664-2392
publishDate 2020-09-01
description Research Question: Previous cross-sectional studies have shown an association between sudomotor dysfunction and diabetic foot ulceration (DFU). The aim of this prospective multicenter study was to determine the role of dryness of foot skin and of established neurological modalities in the prediction of risk for foot ulceration in a cohort of individuals with diabetes mellitus (DM).Design: The study was conducted from 2012 to 2017. A total of 308 subjects with DM without history of DFU or critical limb ischemia completed the study. Diabetic neuropathy was assessed using the neuropathy symptom score (NSS) and neuropathy disability score (NDS). In a subset of participants, vibration perception threshold (VPT) was evaluated. Dryness of foot skin was assessed by the visual indicator plaster method (IPM). The diagnostic performance of the above neurological modalities for prediction of DFU was tested by receiver operating characteristic curve (ROC) analysis.Results: During the 6-year follow-up, 55 patients (annual ulceration incidence 2.97%) developed DFU. Multivariate Cox-regression analysis after controlling for the effect of age, gender, and DM duration demonstrated that the risk (hazard ratio, 95% confidence intervals) of DFU increased significantly with either abnormal IPM (3.319, 1.460–7.545, p = 0.004) or high (≥6) NDS (2.782, 1.546–5.007, p = 0.001) or high (≥25 volts) VPT (2.587, 1.277–5.242, p = 0.008). ROC analysis showed that all neurological modalities could discriminate participants who developed DFU (p < 0.001). IPM testing showed high sensitivity (0.86) and low specificity (0.49), while high vs. low NDS and VPT showed low sensitivity (0.40 and 0.39, respectively) and high specificity (0.87 and 0.89, respectively) for identification of patients at risk for DFU.Conclusion: Dryness of foot skin assessed by the IPM predicts the development of DFU. IPM testing has high sensitivity, whereas high NDS and VPT have high specificity in identifying subjects at risk for DFU. The IPM can be included in the screening methods for identification of the foot at risk.
topic diabetes
foot ulcer
indicator plaster method
neuropad
risk
neuropathy disability score
url https://www.frontiersin.org/article/10.3389/fendo.2020.00625/full
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