Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot

International Working Group on the Diabetic Foot

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OBJECTIVE: To evaluate the effectiveness of a diabetic foot risk classification system by the International Working Group on the Diabetic Foot to predict clinical outcomes.

RESEARCH DESIGN AND METHODS: A total of 225 diabetic patients were initially evaluated as part of a prospective case-control study at the University of Texas Health Science Center at San Antonio. Complete records were available for 213 patients for follow-up evaluation after 29 months. Upon enrollment, subjects were stratified into four risk groups based on the presence of risk factors according to the consensus of the International Working Group on the Diabetic Foot. Group 0 consisted of subjects without neuropathy, group 1 consisted of patients with neuropathy but without deformity or peripheral vascular disease (PVD), group 2 consisted of subjects with neuropathy and deformity or PVD, and group 3 consisted of patients with a history of foot ulceration or a lower-extremity amputation.

RESULTS: Upon enrollment, patients in higher-risk groups had longer duration of diabetes, worse glycemic control, vascular and neuropathic variables, and more systemic complications of diabetes. During 3 years of follow-up, ulceration occurred in 5.1, 14.3, 18.8, and 55.8% of the patients in groups 0, 1, 2, and 3, respectively (linear-by-linear association, P < 0.001). All amputations were found in Groups 2 and 3 (3.1 and 20.9%, P < 0.001).

CONCLUSIONS: The foot risk classification of the International Working Group on the Diabetic Foot predicts ulceration and amputation and can function as a tool to prevent lower-extremity complications of diabetes.

Original languageEnglish
Pages (from-to)1442-7
Number of pages6
JournalDiabetes Care
Issue number8
Publication statusPublished - Aug 2001


  • Blood Pressure
  • Body Mass Index
  • Case-Control Studies
  • Diabetes Mellitus, Type 1/blood
  • Diabetes Mellitus, Type 2/blood
  • Diabetic Angiopathies/classification
  • Diabetic Foot/epidemiology
  • Diabetic Neuropathies/classification
  • Female
  • Follow-Up Studies
  • Foot Deformities/classification
  • Glycated Hemoglobin A/analysis
  • Humans
  • Male
  • Middle Aged
  • Risk Assessment
  • Risk Factors
  • Texas
  • Time Factors

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