{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T06:32:01Z","timestamp":1762324321477,"version":"3.37.3"},"reference-count":48,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2018,10,22]],"date-time":"2018-10-22T00:00:00Z","timestamp":1540166400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"National Institute of Health Research (NIHR) Health Technology Assessment (HTA)","award":["HTA 10\/57\/08"],"award-info":[{"award-number":["HTA 10\/57\/08"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet. Med."],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Diabetes guidelines recommend screening for the risk of foot ulceration but vary substantially in the underlying evidence base. Our purpose was to derive and validate a prognostic model of independent risk factors for foot ulceration in diabetes using all available individual patient data from cohort studies conducted worldwide.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a systematic review and meta\u2010analysis of individual patient data from 10 cohort studies of risk factors in the prediction of foot ulceration in diabetes. Predictors were selected for plausibility, availability and low heterogeneity. Logistic regression produced adjusted odds ratios (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>s) for foot ulceration by ulceration history, monofilament insensitivity, any absent pedal pulse, age, sex and diabetes duration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 10 studies contained data from 16\u00a0385 participants. A history of foot ulceration produced the largest <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> [6.59 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.49 to 17.45)], insensitivity to a 10\u00a0g monofilament [3.18 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.65 to 3.82)] and any absent pedal pulse [1.97 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.62 to 2.39)] were consistently, independently predictive. Combining three predictors produced sensitivities between 90.0% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 69.9% to 97.2%) and 95.3% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 84.5% to 98.7%); the corresponding specificities were between 12.1% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 8.2% to 17.3%) and 63.9% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 61.1% to 66.6%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This prognostic model of only three risk factors, a history of foot ulceration, an inability to feel a 10\u00a0g monofilament and the absence of any pedal pulse, compares favourably with more complex approaches to foot risk assessment recommended in clinical diabetes guidelines.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.13797","type":"journal-article","created":{"date-parts":[[2018,8,13]],"date-time":"2018-08-13T14:55:07Z","timestamp":1534172107000},"page":"1480-1493","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["The development and validation of a multivariable prognostic model to predict foot ulceration in diabetes using a systematic review and individual patient data meta\u2010analyses"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0473-9959","authenticated-orcid":false,"given":"F.","family":"Crawford","sequence":"first","affiliation":[{"name":"Research and Development NHS Fife Queen Margaret Hospital Dunfermline Scotland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3011-7416","authenticated-orcid":false,"given":"G.","family":"Cezard","sequence":"additional","affiliation":[{"name":"Population and Health Research Group (PHRG) School of Geography and Sustainable Development (SGSD) Irvine Building University of St Andrews St Andrews UK"},{"name":"The Centre for Population Health Sciences Usher Institute for Population Health Sciences and Informatics University of Edinburgh Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7742-1757","authenticated-orcid":false,"given":"F. M.","family":"Chappell","sequence":"additional","affiliation":[{"name":"The Centre for Clinical Brain Sciences the University of Edinburgh Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the PODUS Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,10,22]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"key":"e_1_2_11_3_1","unstructured":"KerrM.Footcare for People with Diabetes. The Economic Case for Change. NHS Diabetes. Available atDiabetes@leicester.prontaprint.comLast accessed 20 August 2018."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1900\/RDS.2016.13.158"},{"key":"e_1_2_11_5_1","unstructured":"National Intitute of Health and Crae Excellence.Diabetic Foot Problems: Prevention and Management. NG19. Available athttps:\/\/www.nice.org.uk\/guidance\/NG19Last accessed 27 June 2018."},{"key":"e_1_2_11_6_1","unstructured":"Scottish Intercollegiate Guidelines Network.Management of Diabetes: A National Clinical Guideline. SIGN 116 & 154. Available athttp:\/\/www.sign.ac.uk\/assets\/qrg116.pdfLast accessed 27 June 2018."},{"key":"e_1_2_11_7_1","unstructured":"International Diabetes Federation (IDF).International Consensus on the Diabetic Foot. Amsterdam: International Diabetes Federation (IDF) 2015. Available athttp:\/\/iwgdf.org\/Last accessed 27 June 2018."},{"key":"e_1_2_11_8_1","unstructured":"National Health and Medical Research Council.National Evidence Based Guidelines: Prevention Identification and Management of Foot Complications in Diabetes 2004. 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