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The study aims to assess foot complications among patients with diabetes in Canada, using patient data collected during diabetes foot assessments performed by the LMC Chiropody Team between February 27, 2018 and April 17, 2019.
Among patients with diabetes, one of the major causes of increased morbidity and mortality include lower-extremity complications. Patients who have peripheral neuropathy and peripheral arterial disease are at risk of developing foot ulcers and infection, which can lead to lower-extremity amputations. Adults with diabetes in Canada are 20 times more likely to be hospitalized for a nontraumatic lower limb amputation than adults without diabetes. Thus, the prevention, education and early treatment of diabetes foot complications are an important component of caring for patients living with diabetes.
In addition to neuropathy and peripheral arterial disease, risk factors for developing foot ulcers include increased levels of glycated hemoglobin, onychomycosis, microvascular complications, previous foot ulcer or amputation, structural deformity, and limited joint mobility. To the best of our knowledge, the prevalence of foot complications, such as onychomycosis, and the association of diabetes foot complications with glycemic control and other diabetes risk factors, has not been assessed before in a large sample of Canadian patients. To better understand foot complications among patients with diabetes in Canada, the investigators will retrospectively examine patient data collected during diabetes foot assessments performed by the LMC Chiropody Team. The LMC Chiropody Team is part of LMC Diabetes & Endocrinology, which is one of the largest endocrine practice groups globally.
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| Measure | Description | Time Frame |
|---|---|---|
| Prevalence of diabetes foot complications: foot ulcer | Proportion of patients diagnosed with a foot ulcer | 24-hours |
| Prevalence of diabetes foot complications: onychocryptosis | Proportion of patients with onychocryptosis | 24-hours |
| Prevalence of diabetes foot complications: onychomycosis | Proportion of patients with onychomycosis | 24-hours |
| Prevalence of diabetes foot complications: onychauxis | Proportion of patients with onychauxis | 24-hours |
| Prevalence of diabetes foot complications: hyperkeratosis | Proportion of patients with hyperkeratosis | 24-hours |
| Prevalence of diabetes foot complications: foot deformities | Proportion of patients with foot deformities | 24-hours |
| Prevalence of diabetes foot complications: neuropathy risk | Risk for neuropathy will be measured using the modified Toronto Clinical Neuropathy Score (mTCNS) | 24-hours |
| Measure | Description | Time Frame |
|---|---|---|
| Diabetes foot assessment risk group | Diabetes foot assessment risk group will be determined according to International Diabetes Federation (IDF) recommendations. Proportion of patients with low, moderate, high and very high risk will be reported. | 24-hours |
| Association between foot risk variables and the presence of a foot ulcer |
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Inclusion Criteria:
Exclusion Criteria:
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Patients with diabetes at LMC Diabetes & Endocrinology, who were provided with an initial diabetes foot assessment supported by funding from Bausch Canada. The diabetes foot assessments were performed by the LMC Chiropody Team at seven of the Ontario LMC clinics between February 27, 2018 and April 17, 2019.
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| Name | Affiliation | Role |
|---|---|---|
| Ronnie Aronson, MD | LMC Healthcare | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| LMC Healthcare | Toronto | Canada |
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Risk factors that are associated with foot ulcers in our patient cohort with diabetes will be reported. |
| 24-hours |
| ID | Term |
|---|---|
| D003924 | Diabetes Mellitus, Type 2 |
| D003922 | Diabetes Mellitus, Type 1 |
| D005530 | Foot Deformities |
| D009264 | Nails, Malformed |
| D003929 | Diabetic Neuropathies |
| D053546 | Keratoderma, Palmoplantar, Epidermolytic |
| D014009 | Onychomycosis |
| D017719 | Diabetic Foot |
| D003920 | Diabetes Mellitus |
| ID | Term |
|---|---|
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| D009140 | Musculoskeletal Diseases |
| D020763 | Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
| D009422 | Nervous System Diseases |
| D048909 | Diabetes Complications |
| D015776 | Keratoderma, Palmoplantar, Diffuse |
| D007645 | Keratoderma, Palmoplantar |
| D012873 | Skin Diseases, Genetic |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D007642 | Keratosis |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D014005 | Tinea |
| D003881 | Dermatomycoses |
| D009181 | Mycoses |
| D001423 | Bacterial Infections and Mycoses |
| D007239 | Infections |
| D012874 | Skin Diseases, Infectious |
| D009260 | Nail Diseases |
| D003925 | Diabetic Angiopathies |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D016523 | Foot Ulcer |
| D007871 | Leg Ulcer |
| D012883 | Skin Ulcer |
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