TY - JOUR
T1 - Variability in activity may precede diabetic foot ulceration
AU - Armstrong, David G.
AU - Lavery, Lawrence A.
AU - Holtz-Neiderer, Katherine
AU - Mohler, Martha J.
AU - Wendel, Christopher S.
AU - Nixon, Brent P.
AU - Boulton, Andrew J.M.
PY - 2004/8
Y1 - 2004/8
N2 - OBJECTIVE - To evaluate the role of activity in the development of neuropathic foot ulceration in individuals with diabetes. RESEARCH DESIGN AND METHODS - We evaluated the first 100 consecutive individuals with diabetes (95.0% male, aged 68.5 ± 10.0 years with concomitant neuropathy, deformity, and/or a history of lower-extremity ulceration/partial foot amputation) enrolled in an ongoing prospective longitudinal activity study. Subjects used a high-capacity continuous computerized activity monitor. Data were collected continuously over a minimum of 25 weeks (or until ulceration) with daily activity units expressed as means ± SD. RESULTS - Eight subjects ulcerated during the evaluation period of 37.1 ± 12.3 weeks. The average daily activity was significantly lower in individuals who ulcerated compared with individuals who did not ulcerate (809.0 ± 612.2 vs. 1,394.5 ± 868.5, P = 0.03). Furthermore, there was a large difference in variability between groups. The coefficient of variation was significantly greater in the ulceration group compared with the no ulceration group (96.4 ± 50.3 vs. 44.7 ± 15.4%, P = 0.0001). In the 2 weeks preceding the ulcerative event, the coefficient of variation increased even further (115.4 ± 43.0%, P = 0.02), but there was no significant difference in average daily activity during that period (P = 0.5). CONCLUSIONS - The results of this study suggest that individuals with diabetes who develop ulceration may actually have a lower overall activity than their counterparts with no ulceration, but the quality of that activity may be more variable. Perhaps modulating the "peaks and valleys" of activity in this population through some form of feedback might prove to reduce risk for ulceration in this very-high-risk population.
AB - OBJECTIVE - To evaluate the role of activity in the development of neuropathic foot ulceration in individuals with diabetes. RESEARCH DESIGN AND METHODS - We evaluated the first 100 consecutive individuals with diabetes (95.0% male, aged 68.5 ± 10.0 years with concomitant neuropathy, deformity, and/or a history of lower-extremity ulceration/partial foot amputation) enrolled in an ongoing prospective longitudinal activity study. Subjects used a high-capacity continuous computerized activity monitor. Data were collected continuously over a minimum of 25 weeks (or until ulceration) with daily activity units expressed as means ± SD. RESULTS - Eight subjects ulcerated during the evaluation period of 37.1 ± 12.3 weeks. The average daily activity was significantly lower in individuals who ulcerated compared with individuals who did not ulcerate (809.0 ± 612.2 vs. 1,394.5 ± 868.5, P = 0.03). Furthermore, there was a large difference in variability between groups. The coefficient of variation was significantly greater in the ulceration group compared with the no ulceration group (96.4 ± 50.3 vs. 44.7 ± 15.4%, P = 0.0001). In the 2 weeks preceding the ulcerative event, the coefficient of variation increased even further (115.4 ± 43.0%, P = 0.02), but there was no significant difference in average daily activity during that period (P = 0.5). CONCLUSIONS - The results of this study suggest that individuals with diabetes who develop ulceration may actually have a lower overall activity than their counterparts with no ulceration, but the quality of that activity may be more variable. Perhaps modulating the "peaks and valleys" of activity in this population through some form of feedback might prove to reduce risk for ulceration in this very-high-risk population.
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U2 - 10.2337/diacare.27.8.1980
DO - 10.2337/diacare.27.8.1980
M3 - Article
C2 - 15277427
AN - SCOPUS:3342944929
SN - 1935-5548
VL - 27
SP - 1980
EP - 1984
JO - Diabetes Care
JF - Diabetes Care
IS - 8
ER -