{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:32:21Z","timestamp":1788222741901,"version":"build-2803163510"},"reference-count":15,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2018,12,13]],"date-time":"2018-12-13T00:00:00Z","timestamp":1544659200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet. Med."],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To determine how routinely collected data can inform a risk model to predict <jats:italic>de novo<\/jats:italic> foot ulcer presentation in the primary care setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were available on 15 727 individuals without foot ulcers and 1125 individuals with new foot ulcers over a 12\u2010year follow\u2010up in <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content> primary care. We examined known risk factors and added putative risk factors in our logistic model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>People with foot ulcers were 4.2 years older (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 3.1\u20135.2) than those without, and had higher HbA<jats:sub>1c<\/jats:sub> % (mean 7.9 \u00b1 1.9 vs 7.5 \u00b1 1.7) \/ HbA<jats:sub>1c<\/jats:sub> mmol\/mol (63 \u00b1 21 vs 59 \u00b1 19) (p&lt;0.0001) concentration [+0.45 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.33\u20130.56), creatinine level [+6.9 \u03bcmol\/L (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 4.1\u20139.8)] and Townsend score [+0.055 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.033\u20130.077)]. Absence of monofilament sensation was more common in people with foot ulcers (28% vs 21%; <jats:italic>P<\/jats:italic>&lt;0.0001), as was absence of foot pulses (6.4% vs 4.8%; <jats:italic>P<\/jats:italic>=0.017). There was no difference between people with or without foot ulcers in smoking status, gender, history of stroke or foot deformity, although foot deformity was extremely rare (0.4% in people with foot ulcers, 0.6% in people without foot ulcers). Combining risk factors in a single logistic regression model gave modest predictive power, with an area under the receiver\u2010operating characteristic curve of 0.65 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.62\u20130.67). The prevalence of ulceration in the bottom decile of risk was 1.8% and in the top decile it was 13.4% (compared with an overall prevalence of 6.5%); thus, the presence of all six risk factors gave a relative risk of 7.4 for development of a foot ulcer over 12 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We have made some progress towards defining a variable set that can be used to create a foot ulcer prediction model. More accurate determination of foot deformity\/pedal circulation in primary care may improve the predictive value of such a future risk model, as will identification of additional risk variables.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.13837","type":"journal-article","created":{"date-parts":[[2018,10,15]],"date-time":"2018-10-15T14:14:32Z","timestamp":1539612872000},"page":"1412-1416","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Developing a foot ulcer risk model: what is needed to do this in a real\u2010world primary care setting?"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9537-4050","authenticated-orcid":false,"given":"A.","family":"Heald","sequence":"first","affiliation":[{"name":"School of Medicine and Manchester Academic Health Sciences Centre University of Manchester Manchester"},{"name":"Department of Diabetes and Endocrinology Salford Royal Hospital Salford"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Lunt","sequence":"additional","affiliation":[{"name":"School of Medicine and Manchester Academic Health Sciences Centre University of Manchester Manchester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. K.","family":"Rutter","sequence":"additional","affiliation":[{"name":"Faculty of Biology, Medicine and Health University of Manchester Manchester"},{"name":"Manchester University NHS Foundation Trust Manchester Academic Health Science Centre Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. G.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Faculty of Biology, Medicine and Health University of Manchester Manchester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4506-8223","authenticated-orcid":false,"given":"G.","family":"Cortes","sequence":"additional","affiliation":[{"name":"Medical Department High Speciality Regional Hospital of Ixtapaluca Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Department of Diabetes Kings College Hospital London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Jude","sequence":"additional","affiliation":[{"name":"Tameside Hospital NHS Foundation Trust Ashton\u2010under\u2010Lyme"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Boulton","sequence":"additional","affiliation":[{"name":"Manchester University NHS Foundation Trust Manchester Academic Health Science Centre Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Dunn","sequence":"additional","affiliation":[{"name":"East Cheshire Trust Cheshire UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,13]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/88.11.1436"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67698-2"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-2145"},{"key":"e_1_2_9_5_1","unstructured":"National Diabetes Audit. Available athttp:\/\/content.digital.nhs.uk\/nda. Last accessed 28 March 2018."},{"key":"e_1_2_9_6_1","unstructured":"https:\/\/www.diabetes.org.uk. Last accessed 28 March 2018."},{"key":"e_1_2_9_7_1","unstructured":"National Institute for Health and Care Excellence.Guideline NG19. August 2015: Diabetic foot problems: prevention and management. Available athttps:\/\/www.nice.org.uk\/guidance\/ng19\/. Last accessed 28 March 2018."},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta19570"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2017.02.034"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-017-4522-x"},{"key":"e_1_2_9_11_1","unstructured":"TownsendP PhillimoreP BeattieA.Health and deprivation: inequality and the North.Routledge;1988."},{"key":"e_1_2_9_12_1","unstructured":"NHS Digital Read Codes"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc05-2031"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.150653"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ede.0000222409.00878.37"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-10-346"}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fdme.13837","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.13837","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dme.13837","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.13837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T02:28:35Z","timestamp":1694140115000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.13837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,13]]},"references-count":15,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1111\/dme.13837"],"URL":"https:\/\/doi.org\/10.1111\/dme.13837","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,13]]},"assertion":[{"value":"2018-10-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}