A multi-centre study on the prevalence of lower extremity ulcers and amputations among diabetic out-patients in the Lombardy Region

A total of 33,544 diabetic out-patients were listed in 22 diabetic clinics in the Lombardy area. Among these, 6400 were randomly selected and 5813 were then studied (2982 men and 2831 women) age 63.3+/-11.6. A standardized questionnaire was filled out, and clinical examination of the lower extremities including peripheral pulses, tendon reflexes, and vibration perception were performed. The prevalence of amputation was 1.2% (1.6% in men vs 0.9% in women, p<0.002). The prevalence of ulcers was 6.0% (6.3% in men vs 5.7% in women, NS), Prevalence of amputation and ulcers significantly increased with advancing age and with the duration of diabetes in both sexes. Higher prevalence of amputation and ulcers was recorded in type 1 and insulin-treated type 2 patients. Ulcers and amputations were significantly associated with signs of peripheral neuropathy (absence of vibratory sensibility) and macro and microvascular disease (history of claudication, absence of peripheral pulses, retinopathy and nephropathy), The independent role of skin lesions and prelesions was assessed only for ulcers, These findings confirm that lower extremity lesions are a major problem in diabetic out-patients. Physical examination of lower extremities and simple measures of peripheral neuropathy and vascular diseases should be used to identify high-risk subjects for intensive intervention. Diab. Nutr. Metab. 11: 179-187, 1998. (C) 1998, Editrice Kurtis.