Reevaluating the Way We Classify the Diabetic Foot

Restructuring the diabetic foot risk classification system of the International Working Group on the Diabetic Foot

  1. Lawrence A. Lavery, DPM, MPH1,
  2. Edgar J.G. Peters, MD, PHD2,
  3. Jayme R. Williams, DPM1,
  4. Douglas P. Murdoch, DPM1,
  5. Amanda Hudson, DPM1 and
  6. David C. Lavery, MS3
  1. 1Department of Surgery, Texas A&M Health Science Center, Scott and White Hospital, Temple, Texas
  2. 2Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
  3. 3Private Practice, Aurora, Colorado
  1. Address correspondence and reprint requests to Lawrence. A. Lavery, MD, Texas A&M Health Science Center, Scott & White Georgetown Clinic, 703 Highland Spring Ln., Georgetown, Texas 78628. E-mail: llavery{at}swmail.sw.org

Abstract

OBJECTIVE—To separately evaluate peripheral arterial occlusive disease (PAOD) and foot ulcer and amputation history in a diabetic foot risk classification to predict foot complications.

RESEARCH DESIGN AND METHODS—We evaluated 1,666 diabetic patients for 27.2 ± 4.2 months. Patients underwent a detailed foot assessment and were followed at regular intervals. We used a modified version of the International Working Group on the Diabetic Foot's (IWGDF's) risk classification to assess complications during the follow-up period.

RESULTS—There were more ulcerations, infections, amputations, and hospitalizations as risk group increased (χ2 for trend P < 0.001). When risk category 2 (neuropathy and deformity and/or PAOD) was stratified by PAOD, there were more complications in PAOD patients (P < 0.01). When risk group 3 patients (ulceration or amputation history) were separately stratified, there were more complications in subjects with previous amputation (P < 0.01).

CONCLUSIONS—We propose a new risk classification that predicts future foot complications better than that currently used by the IWGDF.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 12 October 2007. DOI: 10.2337/dc07-1302.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted October 5, 2007.
    • Received July 7, 2007.
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  1. Published online before print October 12, 2007, doi: 10.2337/dc07-1302 Diabetes Care January 2008 vol. 31 no. 1 154-156
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