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Research paper thumbnail of The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort: Original article

Diabetic Medicine, 2002

Aims To determine the incidence of, and clinically relevant risk factors for, new foot ulceration... more Aims To determine the incidence of, and clinically relevant risk factors for, new foot ulceration in a large cohort of diabetic patients in the community healthcare setting.Methods Diabetic patients (n = 9710) underwent foot screening in six districts of North-west England in various healthcare settings. All were assessed at baseline for demographic information, medical and social history, neuropathy symptom score, neuropathy disability score, cutaneous pressure perception (insensitivity to the 10 g monofilament), foot deformities, and peripheral pulses. Two years later, patients were followed up via postal questionnaire to determine the incidence of new foot ulcers. Cox’s proportional hazards regression analysis was used to determine the independent, relative risk of baseline variables for new foot ulceration.Results New foot ulcers occurred in 291/6613 patients who completed and returned their 2-year follow-up questionnaire (2.2% average annual incidence). The following factors were independently related to new foot ulcer risk: ulcer present at baseline (relative risk (95% confidence interval)) 5.32 (3.71–7.64), past history of ulcer 3.05 (2.16–4.31), abnormal neuropathy disability score (≥ 6/10) 2.32 (1.61–3.35), any previous podiatry attendance 2.19 (1.50–3.20), insensitivity to the 10 g monofilament 1.80 (1.36–2.39), reduced pulses 1.80 (1.40–2.32), foot deformities 1.57 (1.22–2.02), abnormal ankle reflexes 1.55 (1.01–2.36) and age 0.99 (0.98–1.00).Conclusions More than 2% of community-based diabetic patients develop new foot ulcers each year. The neuropathy disability score, 10 g monofilament and palpation of foot pulses are recommended as screening tools in general practice.

Research paper thumbnail of Multicenter study of the incidence of and predictive risk factors for diabetic neuropathic foot ulceration

Diabetes Care, 1998

OBJECTIVE -To investigate longitudinally prognostic factors for foot ulceration in a large popula... more OBJECTIVE -To investigate longitudinally prognostic factors for foot ulceration in a large population of diabetic patients with established neuropathy.

Research paper thumbnail of Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril on human diabetic neuropathy: randomised double-blind controlled trial

Lancet, 1998

The effect of three angiotensin-converting enzyme (ACE) inhibitors on ciliary beat frequency was ... more The effect of three angiotensin-converting enzyme (ACE) inhibitors on ciliary beat frequency was monitored with a view to investigating whether ciliotoxicity could account for the high incidence of cough associated with the use of those agents. An additional objective was to investigate whether intranasal administration of those ACE inhibitors was safe. It was found that captopril and enalapril maleate reduced ciliary beat frequency in a dose-dependent manner. The effect of captopril was reversible while that of enalapril maleate was not. Lisinopril was non-ciliotoxic at four concentrations up to 113 mM.

Research paper thumbnail of The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort: Original article

Diabetic Medicine, 2002

Aims To determine the incidence of, and clinically relevant risk factors for, new foot ulceration... more Aims To determine the incidence of, and clinically relevant risk factors for, new foot ulceration in a large cohort of diabetic patients in the community healthcare setting.Methods Diabetic patients (n = 9710) underwent foot screening in six districts of North-west England in various healthcare settings. All were assessed at baseline for demographic information, medical and social history, neuropathy symptom score, neuropathy disability score, cutaneous pressure perception (insensitivity to the 10 g monofilament), foot deformities, and peripheral pulses. Two years later, patients were followed up via postal questionnaire to determine the incidence of new foot ulcers. Cox’s proportional hazards regression analysis was used to determine the independent, relative risk of baseline variables for new foot ulceration.Results New foot ulcers occurred in 291/6613 patients who completed and returned their 2-year follow-up questionnaire (2.2% average annual incidence). The following factors were independently related to new foot ulcer risk: ulcer present at baseline (relative risk (95% confidence interval)) 5.32 (3.71–7.64), past history of ulcer 3.05 (2.16–4.31), abnormal neuropathy disability score (≥ 6/10) 2.32 (1.61–3.35), any previous podiatry attendance 2.19 (1.50–3.20), insensitivity to the 10 g monofilament 1.80 (1.36–2.39), reduced pulses 1.80 (1.40–2.32), foot deformities 1.57 (1.22–2.02), abnormal ankle reflexes 1.55 (1.01–2.36) and age 0.99 (0.98–1.00).Conclusions More than 2% of community-based diabetic patients develop new foot ulcers each year. The neuropathy disability score, 10 g monofilament and palpation of foot pulses are recommended as screening tools in general practice.

Research paper thumbnail of Multicenter study of the incidence of and predictive risk factors for diabetic neuropathic foot ulceration

Diabetes Care, 1998

OBJECTIVE -To investigate longitudinally prognostic factors for foot ulceration in a large popula... more OBJECTIVE -To investigate longitudinally prognostic factors for foot ulceration in a large population of diabetic patients with established neuropathy.

Research paper thumbnail of Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril on human diabetic neuropathy: randomised double-blind controlled trial

Lancet, 1998

The effect of three angiotensin-converting enzyme (ACE) inhibitors on ciliary beat frequency was ... more The effect of three angiotensin-converting enzyme (ACE) inhibitors on ciliary beat frequency was monitored with a view to investigating whether ciliotoxicity could account for the high incidence of cough associated with the use of those agents. An additional objective was to investigate whether intranasal administration of those ACE inhibitors was safe. It was found that captopril and enalapril maleate reduced ciliary beat frequency in a dose-dependent manner. The effect of captopril was reversible while that of enalapril maleate was not. Lisinopril was non-ciliotoxic at four concentrations up to 113 mM.