Does Screening Prevent Diabetic Foot Complications?

TOPLINE:

National foot screening programmes for patients with diabetes began in 2004 in England and 2006 in Scotland. The number and quality of studies to support such programmes for the prevention of lower limb complications is low. Current evidence suggests that the impact of diabetic foot screening on important clinical outcomes is variable.

METHODOLOGY:

• A literature review performed to identify trials and observational studies designed to determine whether population-based foot screening in people with diabetes reduces lower limb complications, as assessed by development of foot ulceration, minor and major lower limb amputations, hospitalisation, or death.
• Only five studies published since 2012 were identified that addressed the issue, including one randomised controlled trial (RCT) of 62 participants and four much larger observational studies (range: 2899 to 61,292 participants) of moderate-to-low quality and with significant risk for bias.

TAKEAWAY:

• Only the RCT examined the effect of foot screening on ulceration, with a positive result (control group [7/29] vs screened group [0/30]; a 24% reduction).
• Minor amputation, examined in two studies, was reduced in one observational study (0.64% in control group to 0.18% in screened group; a 72% reduction), but no differences were seen in the RCT.
• Major amputations were reduced in three observational studies, by 96% (control group [0.52%] vs screened group [0.02%]), 51%, and 17%, respectively, but no effect was seen in the RCT.
• Hospitalisation, assessed in two studies, was reduced by 33% in one study by patients who attended regular foot screening (odds ratio, 0.67), but was doubled in another (21% before screening to 42% after).
• None of the studies examined the impact of foot screening on mortality in patients with diabetes.

IN PRACTICE:

“Given the incorporation of foot screening into routine clinical practice in many countries including England and Scotland, a formal randomised controlled trial is no longer possible. Nonetheless, the effectiveness of screening programme could be addressed using prospectively collected data captured within national databases to emulate a target trial and ensure that the current screening programme is cost-effective and of benefit to the patients,” the authors wrote.

SOURCE:

Conducted by Aleksandra Staniszewska, of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK, and colleagues, the study was published online September 18, 2024, in the Journal of Diabetes and Its Complications.

LIMITATIONS:

Only five studies were identified, all prone to significant bias. In the RCT, significant potential for selection bias and only univariate analyses performed. The largest of the observational studies was done in patients undergoing haemodialysis, limiting generalisation. Contradictory results for hospitalisation likely due to contrasting healthcare systems.

DISCLOSURES:

The study did not receive any funding. The authors declared no conflicts of interest.