Identificar el pie de riesgo en pacientes con diabetes. Un espacio de mejora en atención primaria / Identify the risk foot in patients with diabetes. A space for improvement in primary care

Objetivos: Identificar los factores condicionantes del pie de riesgo (PR) comparando 2 métodos de evaluación (cualitativo y cuantitativo) para neuropatía, arteriopatía y deformidades del pie. Concordancia entre alteraciones detectadas y registradas en el historial clínico (HC). Material y métodos: Estudio observacional. Ámbito: 2 centros de atención primaria del Instituto Catalán Salud. Población: Quinientos treinta y dos pacientes con diabetes, ambos sexos >18 años con registros del PR y consentimiento informado. Mediciones: Neuropatía: valoración síntomas (NSS) y signos discapacidad (NDS). Arteriopatía: índice tobillo brazo (ITB), cuestionario Edimburgo, pulsos pedios. Deformidades pie: pedigrafía. Valores de referencia cuantitativos: Neuropatía definida: NDS>6 puntos o 3-5 y NSS>5 puntos. ITB: valor normalidad (0,90-1,30). Resultados: Mujeres: 46,42%; edad media: 67,29 años (DE: 7,69). Ciento cincuenta y tres pacientes sin complicaciones neurovasculares. Cualitativo: Sin diferenciar manifestaciones clínicas: 252 pacientes presentaron neuropatía; 99 pacientes presentaron ITB alterado; 28 pacientes presentaron complicaciones y 101 pacientes cuestionario Edimburgo alterado. Cuantitativo: Diferenciando manifestaciones clínicas: del grupo neuropatía, 110 pacientes solo presentaron síntomas; 46 pacientes presentaron neuropatía definida y 96 pacientes puntuación NDS y NSS, sin criterios neuropatía definida. ITB alterado: 52, solo ITB>1,30; 47, solo ITB<0,90; 12, asociaron neuropatía e ITB>1,30 y 16 con ITB<0,90. Cuestionario Edimburgo: 47 pacientes presentaron clínica atípica y 54, típica. Concordancia entre alteraciones neurovasculares cuantitativas y registradas r=0,32 para neuropatía y r=0,21 en arteriopatía. El punto de presión sobre el 5.° metatarso se asoció a neuropatía cuantitativa: OR: 2,32 (1,188-4,546); p=0,01.Conclusión: La evaluación, identificando manifestaciones clínicas, mejora la identificación del PR aunque necesitamos más investigación (AU)

Goals: Identify conditioning factors of the foot risk (FR) by comparing two evaluation methods (qualitative and quantitative) for neuropathy, arteriopathy, foot deformities. Concordance between detected the alterations and registered in clinical history (CH). Material and methods: It is an observational study. Ambit: in two primary care centers of the Catalan Health Institute. Population: Five hundred thirty-two patients with diabetes, both >18 years with FR records and informed consent. Measurements: Neuropathy: symptom assessment (NSS) and signs of disability (NDS). Arteriopathy: Index ABI. Edinburgh Questionnaire, fart pulses. Foot deformities: Pedigraphy. Quantitative reference: Values Defined neuropathy: NDS>6 points or 3-5 and NSS>5 points. ITB: Normal value (.90-1.30). Results: Women, 46.42%. Middle ages, 67.29 years (SD 7.69). One hundred fifty-three patients did not present neurovascular alterations. Qualitative: Without differentiating clinical manifestations: 252, patients presented neuropathy; 99, altered ITB; 28, two complications and 101, Edinburgh Quiz: altered. Quantitative: Differentiating clinical manifestations: among the neuropathy group; 110, patients only presented symptoms; 46, definite neuropathy. In 96, NDS and NSS scores without defined neuropathy criteria. Altered ABI: 52, only ABI>1.30; 47, ABI<.90; 12, associated neuropathy and ABI>1.30 and 16, with ABI<.90. Edinburgh questionnaire: 47, presented atypical symptoms and 26, typical. Agreement, between quantitative and recorded neurovascular alterations r=.32 for neuropathy and r=.21 in arteriopathy. The pressure point on the 5th metatarsal, was associated with quantitative neuropathy: OR: 2.32 (1.188–4.546), P=.01. Conclusion: The evaluation, identifying clinical manifestations, improves the identification of FR, although we need more research (AU)

[Identify the risk foot in patients with diabetes. A space for improvement in primary care]. / Identificar el pie de riesgo en pacientes con diabetes. Un espacio de mejora en atención primaria.

GOALS: Identify conditioning factors of the foot risk (FR) by comparing two evaluation methods (qualitative and quantitative) for neuropathy, arteriopathy, foot deformities. Concordance between detected the alterations and registered in clinical history (CH). MATERIAL AND METHODS: It is an observational study. Ambit: in two primary care centers of the Catalan Health Institute. POPULATION: Five hundred thirty-two patients with diabetes, both >18 years with FR records and informed consent. MEASUREMENTS: Neuropathy: symptom assessment (NSS) and signs of disability (NDS). Arteriopathy: Index ABI. Edinburgh Questionnaire, fart pulses. Foot deformities: Pedigraphy. Quantitative reference: Values Defined neuropathy: NDS>6 points or 3-5 and NSS>5 points. ITB: Normal value (.90-1.30). RESULTS: Women, 46.42%. Middle ages, 67.29 years (SD 7.69). One hundred fifty-three patients did not present neurovascular alterations. QUALITATIVE: Without differentiating clinical manifestations: 252, patients presented neuropathy; 99, altered ITB; 28, two complications and 101, Edinburgh Quiz: altered. QUANTITATIVE: Differentiating clinical manifestations: among the neuropathy group; 110, patients only presented symptoms; 46, definite neuropathy. In 96, NDS and NSS scores without defined neuropathy criteria. ALTERED ABI: 52, only ABI>1.30; 47, ABI<.90; 12, associated neuropathy and ABI>1.30 and 16, with ABI<.90. Edinburgh questionnaire: 47, presented atypical symptoms and 26, typical. Agreement, between quantitative and recorded neurovascular alterations r=.32 for neuropathy and r=.21 in arteriopathy. The pressure point on the 5th metatarsal, was associated with quantitative neuropathy: OR: 2.32 (1.188-4.546), P=.01. CONCLUSION: The evaluation, identifying clinical manifestations, improves the identification of FR, although we need more research.