Aims: Gangrene and amputation are among most feared complications of diabetes mellitus. Early detection of patients at high risk for foot ulceration can prevent foot complications. Regular foot screening (medical history, foot examination and classification into risk groups) was introduced at the out-patient diabetes clinic in Ljubljana in November 1996. We aimed to explore the relationships between the observed variables, check the appropriateness of the risk status classification and of the post-screening decisions.
Methods: The data of 11.594 patients, obtained in 18 years, were analysed by multiple correspondence analysis (MCA). Most of the observed variables were categorical.
Results: The majority of the screened population was free of foot complications. We demonstrated an increasing frequency and severity of foot problems with an increasing age, as well as the association between the loss of protective sensation and the history of foot ulceration, foot deformity and callus formation, the history of foot ulcer or amputation and acute foot ulceration. A new finding was that the location of foot deformity points was closer to female than male gender, indicating the possible role of fashionable high-heel footwear. The appropriateness of therapeutic decisions was confirmed: the points representing absent foot pulses and referral to vascular specialist were close together, as well as points representing foot deformity and special footwear prescription or callus formation and referral to pedicurist.
Conclusions: MCA was applied to the data on foot pathology in the population attending the out-patient diabetes clinic. The method proved to be a useful statistical tool for analysing the data of screening procedures.
Namen: Gangrena in amputacija sodita med najhujše zaplete sladkorne bolezni. Zaplete na nogah lahko preprečimo z zgodnjim odkrivanjem ogroženih bolnikov. V Diabetološki ambulanti Ljubljana izvajamo presejalni test za diabetično stopalo od novembra 1996. Test obsega anamnezo, klinični pregled in klasifikacijo glede na ogroženost. Želeli smo raziskati povezanost med opazovanimi spremenljivkami, preveriti pravilnost klasifikacije bolnikov in ustreznost odločitev po pregledu.
Metode: Podatke 11.594 bolnikov, dobljene v 18 letih, smo analizirali z multiplo korespondenčno analizo (MCA). Večina opazovanih spremenljivk je bila kategoričnih.
Rezultati: Večina opazovane populacije ni imela zapletov na nogah. Dokazali smo, da pogostnost in izraženost težav z nogami narašča s starostjo ter da obstajajo povezave med izgubo zaščitne občutljivosti in razjedo v anamnezi, med deformacijo nog in tvorbo kalusa, med ulkusom ali amputacijo v anamnezi in akutno razjedo. Nova ugotovitev je lokacija točke, ki označuje deformacijo stopala, bliže ženskemu kot moškemu spolu, kar kaže na možen vpliv modnih čevljev z visokimi petami. Potrdili smo ustreznost terapevtskih odločitev: točke, ki označujejo odsotne stopalne pulze, in tiste, ki označujejo napotitev k angiologu, so bile blizu skupaj, prav tako deformacija nog in predpis posebne obutve ali tvorba kalusa in napotitev k pedikerju.
Zaključek: MCA smo uporabili za analizo podatkov o patologiji stopal pri populaciji bolnikov iz naše diabetološke ambulante. Metoda se je izkazala kot uporabno statistično orodje za analizo podatkov o presejalnih testih.
Keywords: diabetic foot; screening; statistics.