posted on 2021-09-21, 17:55authored byEdward J. Boyko
Roger Pecoraro made important contribution
to diabetic foot research and is primarily responsible for instilling in me an
interest in these complications. Our collaboration in the final years of his
life led to the development of the Seattle Diabetic Foot Study. At the time it
began, the Seattle Diabetic Foot Study was perhaps unique in being a
prospective study of diabetic foot ulcer conducted in a non-specialty primary
care population of patients with diabetes and without foot ulcer. Important
findings from this research include the demonstration that neurovascular
measurements, diabetes characteristics, past history of ulcer or amputation,
body weight, and poor vision all significantly and independently predict foot
ulcer risk. A prediction model from this research that included only readily
available clinical information showed excellent ability to discriminate between
patients who did and did not develop ulcer during follow-up (area under ROC
curve=0.81 at one year). Identification of limb-specific amputation risk
factors showed considerable overlap with those risk factors identified for foot
ulcer, but suggested arterial perfusion as playing a more important role. Risk
of foot ulcer in relation to peak plantar pressure estimated at the site of the
pressure measurement showed a significant association over the metatarsal
heads, but not other foot locations, suggesting that the association between
pressure and this outcome may differ by foot location. The Seattle Diabetic
Foot Study has helped to expand our knowledge base on risk factors and
potential causes of foot complications. Translating this information into
preventive interventions remains a continuing challenge.
Funding
Funded by VA Rehabilitation, Research, and Development Program. The study sponsor/funder was not involved in the design of the study; the collection, analysis, and interpretation of data; or writing the report; and did not impose any restrictions regarding the publication of the report. The views expressed in this paper do not necessarily reflect those of the U.S. Department of Veterans Affairs.