Skip to main content
Top
Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

Useful screening tools for preventing foot problems of diabetics in rural areas: a cross-sectional study

Authors: Chia-Hao Chang, Yun-Shing Peng, Chang-Cheng Chang, Mei-Yen Chen

Published in: BMC Public Health | Issue 1/2013

Login to get access

Abstract

Background

Preventing diabetic foot problems (DFP) and their associated consequences is a critical in rural regions. The objective is to present an association of non-invasive DFP assessment tools and physiological indicators for early detection among rural cases of diabetes in Taiwan.

Methods

Secondary data analysis of 387 participants previously diagnosed with type 2 diabetes was used. The Michigan Neuropathy Screening Instrument (MNSI), Ankle Brachial Index (ABI), optimal scaling combination (OSC) of MNSI, and age were used to examine peripheral neurovascular function. The King’s College classification (KC) and Texas risk classification (TRC) were used to understand diabetic foot complications.

Results

The findings indicated that MNSI was negatively correlated with ABI, but positively with diabetes duration, age, KC, TRC, fasting blood glucose, low density of lipoprotein cholesterol, body mass index and waist circumference. The area under the receiver operating characteristic curves for assessing the risk of ABI based on OSC was larger than for MNSI, KC, and TRC.

Conclusion

It is shown that using OSC, MNSI, and ABI as community screening tools is useful in detecting early neurovasculopathy. In addition, where an ABI machine is unavailable, primary healthcare providers that perform MNSI or OSC may be cost-effective. The study was approved by the institutional review board of the ethical committee (No 98-2224-B).
Appendix
Available only for authorised users
Literature
2.
go back to reference Apelqvist J, Larsson J: What is the most effective way to reduce incidence of amputation in the diabetic foot?. Diabetes/Metabolism Research and Review. 2000, 16: 75-83. 10.1002/1520-7560(200009/10)16:1+<::AID-DMRR139>3.0.CO;2-8.CrossRef Apelqvist J, Larsson J: What is the most effective way to reduce incidence of amputation in the diabetic foot?. Diabetes/Metabolism Research and Review. 2000, 16: 75-83. 10.1002/1520-7560(200009/10)16:1+<::AID-DMRR139>3.0.CO;2-8.CrossRef
3.
go back to reference Bentley J, Foster A: Multidisciplinary management of the diabetic foot ulcer. British Journal of Community Nursing. 2007, 12: 6-10.CrossRef Bentley J, Foster A: Multidisciplinary management of the diabetic foot ulcer. British Journal of Community Nursing. 2007, 12: 6-10.CrossRef
4.
go back to reference Williams DT, Harding KG, Price P: An evaluation of the efficacy of methods used in screening for lower-limb arterial disease in diabetes. Diabetes Care. 2005, 28: 2206-2210. 10.2337/diacare.28.9.2206.CrossRefPubMed Williams DT, Harding KG, Price P: An evaluation of the efficacy of methods used in screening for lower-limb arterial disease in diabetes. Diabetes Care. 2005, 28: 2206-2210. 10.2337/diacare.28.9.2206.CrossRefPubMed
5.
go back to reference Faglia E, Clerici G, Clerissi J: Long-term prognosis of diabetic patients with critical limb ischemia: a population-based cohort study. Diabetes Care. 2009, 32: 822-827. 10.2337/dc08-1223.CrossRefPubMedPubMedCentral Faglia E, Clerici G, Clerissi J: Long-term prognosis of diabetic patients with critical limb ischemia: a population-based cohort study. Diabetes Care. 2009, 32: 822-827. 10.2337/dc08-1223.CrossRefPubMedPubMedCentral
6.
go back to reference Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, Landsman AS, Lavery LA, Moore C, Schuberth JM, Wukick DK, Andersen C, Vanore JV: Diabetic foot disorders: a clinical practice guideline. Foot Ankle Surgeon. 2006, 45: S1-S66. 10.1016/S1067-2516(07)60001-5.CrossRef Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, Landsman AS, Lavery LA, Moore C, Schuberth JM, Wukick DK, Andersen C, Vanore JV: Diabetic foot disorders: a clinical practice guideline. Foot Ankle Surgeon. 2006, 45: S1-S66. 10.1016/S1067-2516(07)60001-5.CrossRef
7.
go back to reference Brem H, Sheehan P, Rosenberg HJ, Schneider JS, Boulton AJ: Evidence-based protocol for diabetic foot ulcers. Plastic and Reconstructive Surgery. 2006, 117: 193S-209S. 10.1097/01.prs.0000225459.93750.29.CrossRefPubMed Brem H, Sheehan P, Rosenberg HJ, Schneider JS, Boulton AJ: Evidence-based protocol for diabetic foot ulcers. Plastic and Reconstructive Surgery. 2006, 117: 193S-209S. 10.1097/01.prs.0000225459.93750.29.CrossRefPubMed
8.
go back to reference Nather A, Chionh SB, Tay PL, Aziz Z, Teng JW, Rajeswari K, Erasmus A, Nambiar A: Foot screening for diabetics. Ann Acad Med Singapore. 2010, 39: 472-475.PubMed Nather A, Chionh SB, Tay PL, Aziz Z, Teng JW, Rajeswari K, Erasmus A, Nambiar A: Foot screening for diabetics. Ann Acad Med Singapore. 2010, 39: 472-475.PubMed
9.
go back to reference Dunning T: Nursing care of older people with diabetes. 2008, Australia: Blackwell Publishing, 164-167. Dunning T: Nursing care of older people with diabetes. 2008, Australia: Blackwell Publishing, 164-167.
10.
go back to reference Dros J, Wewerinke A, Bindels PJ, Weert HCV: Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy: a Systematic Review. Annals of Family Medicine. 2009, 7: 555-558. 10.1370/afm.1016.CrossRefPubMedPubMedCentral Dros J, Wewerinke A, Bindels PJ, Weert HCV: Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy: a Systematic Review. Annals of Family Medicine. 2009, 7: 555-558. 10.1370/afm.1016.CrossRefPubMedPubMedCentral
11.
go back to reference Feng Y, Schlösser FJ, Sumpio BE: The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy. Journal of Vascular Surgery. 2009, 50: 675-682. 10.1016/j.jvs.2009.05.017.CrossRefPubMed Feng Y, Schlösser FJ, Sumpio BE: The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy. Journal of Vascular Surgery. 2009, 50: 675-682. 10.1016/j.jvs.2009.05.017.CrossRefPubMed
12.
go back to reference Moghtaderi A, Bakhshipour A, Rashidi H: Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy. Clin Neurol Neurosurg. 2006, 108: 477-481. 10.1016/j.clineuro.2005.08.003.CrossRefPubMed Moghtaderi A, Bakhshipour A, Rashidi H: Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy. Clin Neurol Neurosurg. 2006, 108: 477-481. 10.1016/j.clineuro.2005.08.003.CrossRefPubMed
13.
go back to reference Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes on behalf of the TASC II Working Group: Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007, 33: 1-70. 10.1016/j.ejvs.2006.11.008.CrossRef Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes on behalf of the TASC II Working Group: Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007, 33: 1-70. 10.1016/j.ejvs.2006.11.008.CrossRef
14.
go back to reference Frykberg RG, Lavery LA, Pham H, Harvey C, Harkless L, Veves A: Role of neuropathy and high foot pressures in diabetic foot ulceration. Diabetes Care. 1998, 21: 1714-1719. 10.2337/diacare.21.10.1714.CrossRefPubMed Frykberg RG, Lavery LA, Pham H, Harvey C, Harkless L, Veves A: Role of neuropathy and high foot pressures in diabetic foot ulceration. Diabetes Care. 1998, 21: 1714-1719. 10.2337/diacare.21.10.1714.CrossRefPubMed
15.
go back to reference Jorneskog G, Brismar K, Fagrell B: Skin capillary circulation is more impaired in the toes of diabetic than non-diabetic patients with peripheral vascular disease. Diabet Med. 1995, 12: 36-41.CrossRefPubMed Jorneskog G, Brismar K, Fagrell B: Skin capillary circulation is more impaired in the toes of diabetic than non-diabetic patients with peripheral vascular disease. Diabet Med. 1995, 12: 36-41.CrossRefPubMed
16.
go back to reference Boyko EJ, Ahroni JH, Davignon D, Stensel V, Prigeon RL, Smith DG: Diagnostic utility of the history and physical examination for peripheral vascular disease among patients with diabetes mellitus. J Clin Epidemiol. 1997, 50: 659-68. 10.1016/S0895-4356(97)00005-X.CrossRefPubMed Boyko EJ, Ahroni JH, Davignon D, Stensel V, Prigeon RL, Smith DG: Diagnostic utility of the history and physical examination for peripheral vascular disease among patients with diabetes mellitus. J Clin Epidemiol. 1997, 50: 659-68. 10.1016/S0895-4356(97)00005-X.CrossRefPubMed
17.
go back to reference Pinzur MS, Slovenkai MP, Trepman E, Shields NN: Guidelines for diabetic foot care: recommendations endorsed by the Diabetes Committee of the American Orthopaedic Foot and Ankle Society. Foot Ankle Int. 2005, 26: 113-119.PubMed Pinzur MS, Slovenkai MP, Trepman E, Shields NN: Guidelines for diabetic foot care: recommendations endorsed by the Diabetes Committee of the American Orthopaedic Foot and Ankle Society. Foot Ankle Int. 2005, 26: 113-119.PubMed
18.
go back to reference Erasmus A: In Diabetic Foot Problems. Classification systems. Edited by: Nather A. 2008, Singapore: World Scientific, 87-106. Erasmus A: In Diabetic Foot Problems. Classification systems. Edited by: Nather A. 2008, Singapore: World Scientific, 87-106.
19.
go back to reference Edmonds ME, Foster AVM: Managing the diabetic foot. 2005, London: Blackwell ScienceCrossRef Edmonds ME, Foster AVM: Managing the diabetic foot. 2005, London: Blackwell ScienceCrossRef
20.
go back to reference Armstrong DG, Lavery LA, Harkless LB: Validation of a diabetic wound classification system. Diabetes Care. 1998, 21: 855-859. 10.2337/diacare.21.5.855.CrossRefPubMed Armstrong DG, Lavery LA, Harkless LB: Validation of a diabetic wound classification system. Diabetes Care. 1998, 21: 855-859. 10.2337/diacare.21.5.855.CrossRefPubMed
21.
go back to reference Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJ: A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care. 2001, 24: 84-88. 10.2337/diacare.24.1.84.CrossRefPubMed Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJ: A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care. 2001, 24: 84-88. 10.2337/diacare.24.1.84.CrossRefPubMed
22.
go back to reference McDermott MM, Greenland P, Liu K, Guralnik JM, Celic L, Criqui MH, Chan C, Martin GJ, Schneider J, Pearce WH, Taylor LM, Clark E: The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med. 2002, 136: 873-883. 10.7326/0003-4819-136-12-200206180-00008.CrossRefPubMed McDermott MM, Greenland P, Liu K, Guralnik JM, Celic L, Criqui MH, Chan C, Martin GJ, Schneider J, Pearce WH, Taylor LM, Clark E: The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med. 2002, 136: 873-883. 10.7326/0003-4819-136-12-200206180-00008.CrossRefPubMed
23.
go back to reference Potier L, Abi Khalil C, Mohammedi K, Roussel R: Use and utility of ankle brachial index in patients with diabetes. Eur J Vasc Endovasc Surg. 2011, 41: 110-116. 10.1016/j.ejvs.2010.09.020.CrossRefPubMed Potier L, Abi Khalil C, Mohammedi K, Roussel R: Use and utility of ankle brachial index in patients with diabetes. Eur J Vasc Endovasc Surg. 2011, 41: 110-116. 10.1016/j.ejvs.2010.09.020.CrossRefPubMed
24.
go back to reference Alzamora M, Fores R, Baena-Diez J, Pera G, Toran P, Sorribes M, Vicheto M, Reina MD, Sancho A, Albaladejo C, Llussà J, the PERART/ARTPER study group: The Peripheral Arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population. BMC Public Health. 2010, 10: 38-48. 10.1186/1471-2458-10-38.CrossRefPubMedPubMedCentral Alzamora M, Fores R, Baena-Diez J, Pera G, Toran P, Sorribes M, Vicheto M, Reina MD, Sancho A, Albaladejo C, Llussà J, the PERART/ARTPER study group: The Peripheral Arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population. BMC Public Health. 2010, 10: 38-48. 10.1186/1471-2458-10-38.CrossRefPubMedPubMedCentral
26.
go back to reference Davidson MB: How our current medical care system fails people with diabetes: Lack of timely, appropriate clinical decisions. Diabetes Care. 2009, 32: 370-372.CrossRefPubMedPubMedCentral Davidson MB: How our current medical care system fails people with diabetes: Lack of timely, appropriate clinical decisions. Diabetes Care. 2009, 32: 370-372.CrossRefPubMedPubMedCentral
27.
go back to reference Boulton AJM: Late sequelae of diabetic neuropathy. Diabetic neuropathy. Edited by: Boulton AJM. 1997, Lancashire: Marius Press, 63-76. Boulton AJM: Late sequelae of diabetic neuropathy. Diabetic neuropathy. Edited by: Boulton AJM. 1997, Lancashire: Marius Press, 63-76.
28.
go back to reference Moghtaderi A, Bakhshipour A, Rashidi H: Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy. Clinical Neurology and Neurosurgery. 2006, 108: 477-481. 10.1016/j.clineuro.2005.08.003.CrossRefPubMed Moghtaderi A, Bakhshipour A, Rashidi H: Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy. Clinical Neurology and Neurosurgery. 2006, 108: 477-481. 10.1016/j.clineuro.2005.08.003.CrossRefPubMed
29.
go back to reference Booth J, Young MJ: Differences in the performance of commercially available 10-g monofilaments. Diabetes Care. 2000, 23: 984-988. 10.2337/diacare.23.7.984.CrossRefPubMed Booth J, Young MJ: Differences in the performance of commercially available 10-g monofilaments. Diabetes Care. 2000, 23: 984-988. 10.2337/diacare.23.7.984.CrossRefPubMed
30.
go back to reference DeLong ER, DeLong DM, Clarke-Pearson DL: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988, 44: 837-845. 10.2307/2531595.CrossRefPubMed DeLong ER, DeLong DM, Clarke-Pearson DL: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988, 44: 837-845. 10.2307/2531595.CrossRefPubMed
31.
go back to reference Paisey RB, Arredondo G, Villalobos A, Lozano O, Guevara L, Kelly S: Association of differing dietary, metabolic, and clinical risk factors with microvascular complications of diabetes: a prevalence study of 503 Mexican type II diabetic subjects. Diabetes Care. 1984, 5: 421-427.CrossRef Paisey RB, Arredondo G, Villalobos A, Lozano O, Guevara L, Kelly S: Association of differing dietary, metabolic, and clinical risk factors with microvascular complications of diabetes: a prevalence study of 503 Mexican type II diabetic subjects. Diabetes Care. 1984, 5: 421-427.CrossRef
32.
go back to reference Tesfaye S, Chaturvedi N, Eaton SEM, Ward JD, Manes C, Ionescu-Tirgoviste C, Witte DR, Fuller JH, EURODIAB Prospective Complications Study Group: Vascular Risk Factors and Diabetic Neuropathy. Engl J Med. 2005, 352: 341-350. 10.1056/NEJMoa032782.CrossRef Tesfaye S, Chaturvedi N, Eaton SEM, Ward JD, Manes C, Ionescu-Tirgoviste C, Witte DR, Fuller JH, EURODIAB Prospective Complications Study Group: Vascular Risk Factors and Diabetic Neuropathy. Engl J Med. 2005, 352: 341-350. 10.1056/NEJMoa032782.CrossRef
33.
go back to reference Kärvestedt L, Mårtensson E, Grill V, Elofsson S, Wendt G, Hamsten A, Brismar K: Peripheral Sensory Neuropathy Associates With Micro- or Macroangiopathy. Diabetes Care. 2009, 32: 317-322.CrossRefPubMedPubMedCentral Kärvestedt L, Mårtensson E, Grill V, Elofsson S, Wendt G, Hamsten A, Brismar K: Peripheral Sensory Neuropathy Associates With Micro- or Macroangiopathy. Diabetes Care. 2009, 32: 317-322.CrossRefPubMedPubMedCentral
34.
Metadata
Title
Useful screening tools for preventing foot problems of diabetics in rural areas: a cross-sectional study
Authors
Chia-Hao Chang
Yun-Shing Peng
Chang-Cheng Chang
Mei-Yen Chen
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-612

Other articles of this Issue 1/2013

BMC Public Health 1/2013 Go to the issue