Combining diabetic foot and retinopathy screening: A step in the right direction? - a feasibility study
Jane Ea Lewis1, Keith Morris1, Thomas Powell2
1Cardiff Metropolitan University, Cardiff, UK.
Insights
Integrating diabetic foot screening into diabetic retinopathy appointments is feasible and well-received. This approach effectively identifies early peripheral artery disease and sensory neuropathy in diabetic patients.
Area of Science:
- Cardiology
- Ophthalmology
- Diabetology
Background:
- Peripheral artery disease (PAD) is a prevalent cardiovascular condition, disproportionately affecting individuals with diabetes.
- PAD significantly increases the risk of severe lower extremity complications, cardiovascular events, and mortality.
- Diabetic retinopathy screening is a routine appointment for many diabetic patients.
Purpose of the Study:
- To assess the feasibility and acceptability of integrating diabetic foot screening into routine diabetic retinopathy screening appointments.
- To explore the potential for early detection of peripheral artery disease and neuropathy within this integrated model.
Main Methods:
- A cross-sectional study involving foot screening during the interval of diabetic retinopathy assessment.
- Lower limb arterial assessment included Ankle Brachial Index (ABI), pulse volume waveform, and protective light touch sensation.
- Statistical analysis using binary logistical regression identified predictors of PAD.
Main Results:
- 88% of invited participants (n=321) met inclusion criteria.
- A significant proportion (26.4%) had asymptomatic peripheral artery disease, and 3% had peripheral sensory neuropathy.
- Age, existing coronary heart disease, and gender were identified as predictors of PAD.
Conclusions:
- Integrating foot examination into eye screening appointments is feasible and positively received by patients and staff.
- This integrated approach facilitates the early identification of undiagnosed peripheral artery disease and sensory neuropathy.
- The findings highlight the value of incorporating foot surveillance into routine eye screening for diabetic populations.
Objectives:
Peripheral artery disease is a major cardiovascular disease affecting more than 200 million people globally and up to 4 times more frequent in the diabetic population. It can lead to lower extremity amputations or revascularisation and is associated with an increased risk of myocardial infarction, stroke and early mortality. This novel cross-sectional study aimed to explore the feasibility and acceptability of incorporating diabetic foot screening at routine diabetic retinopathy screening appointments.
Methods:
Participants underwent foot screening during the interval between pupil dilatation and retinal photography as part of the eye screening procedure. Lower limb arterial assessment included ankle brachial index, pulse volume waveform and protective light touch sensation.
Results:
Of 364 participants invited, 88% (n = 321) met the inclusion criteria. About 26.4% (n = 86) had asymptomatic peripheral artery disease and 3% (n = 10) had peripheral sensory neuropathy. Binary logistical regression analysis identified age (p < 0.005), existing coronary heart disease (p < 0.005) and gender (p = 0.03) as predictors of peripheral artery disease.
Conclusion:
Incorporating foot examination during eye screening appointments is feasible and was well received by participants and staff alike. Undiagnosed early peripheral artery disease was evident in a third of the study population emphasising the benefit of introducing foot surveillance into eye screening appointments for the early identification of lower limb arterial disease and peripheral sensory neuropathy.
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