Development and assessment of a simple scoring system for the risk of developing diabetic foot

Identification of risk factors for diabetic foot and creation of risk classifications based on these factors are important for prevention of diabetic foot. We have created a simple screening score system based on information obtained during routine medical checkups to identify patients at high risk of developing diabetic foot and examined the efficacy of this system. We compared 108 patients in the diabetic foot ulcer group with 108 age and sex-matched controls who were hospitalized at Saiseikai Central Hospital in Tokyo. The risk scores of 316 diabetic outpatients whose feet were examined from April 2011 to September 2012 were calculated. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of the risk score to diagnose high-risk patients in categories ≥1 of the risk classification of the International Working Group on the Diabetic Foot (IWGDF). Differences between the ulcer and control groups were observed for 5 items: (1) diabetes duration, (2) average corrected bilateral visual acuity, (3) estimated glomerular filtration rate, (4) marital status, and (5) occupation. Multiple logistic analysis was performed using these items as independent variables, and the scoring system was created from the odds ratios. The scoring system cutoff value (≥7) was 56.9 % sensitive and 95.2 % specific for patients in IWGDF category ≥1 when applied in 316 outpatient foot examinations, and its ROC area under the curve was 0.865 (95 % CI, 0.83–0.91). High-risk diabetes patients were effectively identified by evaluating risk factors that included social characteristics and clinical examination findings. © 2014, The Japan Diabetes Society.