Cumulative risk of diabetic foot complications in risk groups of type 1 and type 2 diabetes: Real-world evidence from a 22-year follow-up study

The International Working Group on the Diabetic Foot (IWGDF) recommends annual foot screening for low-risk individuals of diabetic foot ulcers (DFUs), with screening frequency increasing with an increased risk.1 These screening intervals are largely based on expert opinion, owing to limited supporting evidence.1 Annual screening intervals for diabetic retinopathy, once similarly recommended, were revised, and extended for low-risk individuals upon evaluation of progression risks.2

It is relevant to consider if foot screening intervals for individuals at very low-risk (IWGDF risk category = 0)1 of diabetic foot complications (DFCs) may be extended beyond a year. A prerequisite for this guideline revision would be ascertaining the risk of DFCs. Hence, we aimed to estimate the cumulative risk (CR) of DFCs in risk groups of type 1 (T1D) and type 2 diabetes (T2D), using a simple risk-stratification rule. Based on the IWGDF 4-level risk-stratification system,1 our study combines categories 1–2 into a single ‘high-risk’ group and uses two clinically-relevant risk factors.