Introduction

For a diabetic patient, there is a significantly greater risk ofdeveloping ulcers, infections, and amputations in comparisonto non-diabetics. The probability for the occurrence of acomplication is predicted under a voluminous sum of differentclinical and social risk factors. Risk factors including systemicpathology, local vascular disease, and social and family historyhave been linked to diabetic foot complications. However,only risk stratification models based on local pathology havebeen validated. While a risk spectrum based on systemicdisease has been proposed, it has never been validated. Thesystemic risk spectrum has the following five constructs:macrovascular disease, microvascular disease, functionalmicrovascular disease, metabolic syndrome, and family history.[Harkless, 2004]

The goal of this study is to validate the constructs and overallrisk spectrum score to help develop a model that predicts thedevelopment of foot related complications of Type II diabetesmellitus. This can potentially help focus efforts on thosepatients in need of he greatest preventive care to optimizetheir health and decrease the cost to the health system

Materials and methodsThis retrospective study was based on medical chart review. Ofall Type II diabetic patients over the age of 18 who were seenat the Western University of Health Sciences Foot & AnkleCenter between January 2011 and April 2014. The patientdemographics were recorded at the initial encounter and themedical and surgical history, diabetes pharmaceuticalmanagement, and any foot related complications wererecorded at each visit. at the Center was recorded. Theprevalence of all history and complications was determined.The presence of each category of the risk spectrum wasidentified and the risk spectrum sum was calculated.

Using SPSS statistical software the following tests wereperformed:• Correlations for each construct of the risk spectrum and the

development of any complication• Log regression model for the sum of the risk spectrum and

the development of any complication • Linear regression model for the sum of the risk spectrum

and the total number of complications developed

AcknowledgmentsI would like to thank Dr. Labovitz for his mentorship and guidancethroughout this project. I would like to thank Dr. Shofler assistingin the calculation of the data.

Results

Discussions:

Using a linear regression model, we determined that there is a weak positive correlation, albeit significant, between the sum of the constructs and the total number of complications. A log regression model determined a significant relationship with a stronger correlation for the sum of the risk spectrum constructs predictive of developing any complication. The goodness-to-fit tests show the model is predictive of the development of any complications. The predictive models show only 2.3% of the variance is due to the sum of the spectrum when predicting any complication occurring and only 1.9% of the variance for the total number of complications developed. The risk spectrum score predicts a 16.3% increased chance of developing another complication and with each increase of the score a patient is a 1.35 times more likely to develop a complication.

Briesaun Williams1, Jonathan Labovitz, DPM2, David Shofler, DPM2

1. Western University of Health Sciences, Graduate College of Biomedical Sciences, Pomona, CA

2. Western University of Health Sciences, College of Podiatry, Pomona, CA

Literature cited1, Harkless L and Holmes C. Linking Risk Factors: The Role of

History in Predicting Outcome. The Diabetic Foot 2004; 7(3): 114-122.

2. Peters EJG, Lavery LA. Effectiveness of the DIabetic Foot Risk Classification System of the International Working Group on the Diabetic Foot. 2001, 24:1142 1447.

3. Reiber GE, Pecoraro RE, Koepsell TD (1992) Risk factors for amputation in patients with diabetes mellitus. A case-control study. Annals of Internal Medicine. 117(2): 97–105

4. Armstrong DG, Lavery LA, Harkless LB, Van Houtum WH (1997) Amputation and reamputation of the diabetic foot. Journal of the American Podiatric Medical Association 87: 255–59

5. Flores AR. Risk Factors for Amputation in Diabetic Patients: A Case-control Study. Archives of Medical Research. January 14 1998; Volume 29, No.2.

6. Marso SP, Hiatt WR. Peripheral Arterial Disease in Patients with Diabetes. Journal American College of Cardiology 2006, 47(5):

Further informationDue to the high percentage of other possible variables, it is possible to lookinto other factors that were not observed in this study as other directcorrelations.

Diabetic Risk Spectrum and Its Prevalence of Complication

Construct Pathology

Macrovascular disease Peripheral arterial disease, Heart disease, CVA, CAD,

Microvascular disease Neuropathy, Retinopathy, Nephropathy, Renal disease

Functional microvascular disease Gastroparesis, Impotence

Metabolic syndrome disease HTN, Obesity,

Family history disease Family history DM, Family history amputation

The Systemic Risk Spectrum