CINTESIS researcher Matilde Monteiro Soares won an honorable mention of the Pedro Eurico Lisbon Lilly Award / Portuguese Society of Diabetology (SPD). The award, delivered during the Congress of the SPD, contemplates the work developed by the scientist in the field of Diabetic Foot.
In the article entitled “Diabetic foot ulcer development risk classifications’ validation: A multicentre prospective cohort study,” published in the journal “Diabetes Research and Clinical Practice”, Matilde Monteiro Soares analyzed the current risk classifications for developing diabetic foot ulcers with the objective of assessing their predictive value, as well as the variables included, and comparing their validity in primary health care and in hospitals.
For this purpose, an unprecedented prospective multicenter study was conducted, including diabetic individuals without (active) diabetic foot ulcers, analyzed at a tertiary hospital (Vila Nova de Gaia Hospital Center – CHVNG in Portuguese) during the Multidisciplinary Diabetic Foot Consultation, and two Family Health Units (Aqua Flaviae and Santo André de Canidelo).
Among the variables that were analyzed and that were essential for a correct stratification of the patients’ risk were vision or physical problems, foot deformity, onychomycosis (“athlete’s foot”), peripheral artery disease, peripheral diabetic neuropathy, altered sensitivity, history ulcer or amputation of the lower extremity, etc. The data were collected and recorded by health professionals, namely GPs, nurses and podiatrists.
The 446 subjects included in the study (223 from the hospital and 223 from the primary care units), were, on average, 65 years old, the body mass index was 29 kg / m2 and the duration of the diagnosis was 13 years. About 50% were men. The overwhelming majority (99%) had type 2 diabetes, of which 69% used only oral antidiabetics to control glycaemia.
According to Matilde Monteiro Soares, at the end of one year 7% of the individuals with diabetes developed diabetic foot ulcers, 1.6% suffered an amputation (minor or major) and 4% died. Most of the events occurred in people followed in a hospital setting, who also had the longest duration of diabetes and more complications due to the disease.
The study is also authored by another CINTESIS researcher, Mário Dinis Ribeiro, and it is the first prospective study to validate all risk classifications used in diabetic foot in people without active ulcer.
“This study showed that the different existing classifications (including those used by our National Health System) are comparable and robust to adequately identify subjects at risk of developing a diabetic foot ulcer. All variables included in the classifications, except tinea pedis and footwear, were associated with a higher risk of developing diabetic foot ulcers at one year. The longer duration of diabetes, the use of insulin and the presence of more than one symptom of diabetic peripheral neuropathy (DPN) and pain at rest also revealed a statistically significant association with the outcome,” explains the author of the study.
The CINTESIS researcher suggests that the risk classification also includes the duration of diabetes, since it has been shown to be associated with the development of diabetic foot ulcers, and recommends strengthening patient education for self-care (such as hydration, nails care and footwear), especially among the elderly.
Matilde Monteiro Soares also recommends to pay greater attention to aesthetic issues when prescribing footwear, given that women are more resistant to their use. In the future, studies should be developed to evaluate the validity of these classifications as well as the impact of adherence to self-care in the prevention of the diabetic foot ulcer in the long term.