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Optimizing foot screening in type 1 diabetes: Evaluation of risk-adapted screening intervals (OPTI-ONE)
Christian Selmer Buhl1, Søren Tang Knudsen2, Christoffer Sand Amtoft1
1Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, Aarhus, Denmark.
Aims:
To assess the cumulative risk of diabetic foot complications in a real-world type 1 diabetes (T1DM) population to examine whether observed risk patterns support risk-adapted screening intervals.
Methods:
This observational cohort study included T1DM patients in the Central Denmark Region (2020-2025). Patients were stratified into low, high, or very high risk using modified IWGDF criteria. Cumulative risks of a composite endpoint (ulcers, amputations, or Charcot foot) were estimated, accounting for death as a competing event and stratifying by albuminuria and advanced retinopathy.
Results:
Among 7329 individuals with T1DM, 2074 (28.3%) were low-risk, 3562 (48.6%) high-risk, 437 (6.0%) very high-risk, and 1256 (17.1%) had unknown status. Over a mean follow-up of 3.26 years, the three-year cumulative risk was 0.55% (95% CI: 0.35-0.83) for low-risk, 3.45% (2.84-4.15) for high-risk, and 20.86% (16.67-25.38) for very high-risk patients. Among low-risk patients without albuminuria or advanced retinopathy, the risk was 0.37% (0.15-0.77).
Conclusions:
Low-risk T1DM patients exhibit a very low incidence of foot complications. These findings support consideration of extended, risk-adapted screening intervals, such as every three years, in this subgroup, with the potential to optimize healthcare resource utilization. While these data support the feasibility of such an approach, further studies are warranted to validate the safety of extended screening intervals in clinical practice.