Personalized risk stratification in diabetic foot disease

Background

The current understanding of diabetic foot disease is based on a biomedical model of predominantly non-modifiable risk factors, including neuropathy, vascular disease, foot deformity, and ulcer history. Hence, ulcer risk stratification systems only incorporate these traditional risk factors, not taking important, modifiable biomechanical and patient-behaviour parameters, or any personalised, gender or cultural differences into account.

While some of these parameters are proven as independent risk factors for ulceration, there are no risk stratification systems incorporating these. The consequence is a significant variation in ulcer risk within current risk strata, and stratification systems that are not specific, not novel, and not intervention oriented. These systems do not guide personalised medicine, nor stimulate efficient use of resources for screening and treatment. In this DIALECT project we aim to assess groups of people at risk of ulceration and amputation for modifiable, behavioural, and other personalised factors to improve risk stratification and create starting points for personalised treatment approaches in ulcer and amputation prevention.

Approach

This project focuses on register-based data obtained from examinations of the lower extremity, physical functioning, biomechanics, and mobility in individuals with type 1 and type 2 diabetes. The project comprises of three longitudinal population-based studies, wherein data on clinical, laboratory, and behavioral factors pertaining to diabetic foot complications, will be extracted from local (database from Steno Diabetes Center Copenhagen) and national Danish registers. Using a variety of statistical methods, the doctoral candidate will determine risk factors for ulcer development, its recurrence and amputation. A personalized risk prediction model for ulcer incidence and amputation will be developed and validated. External validation may be done using the Sci-Diabetes database, accessed via the Glasgow Safe Haven patient record system. This project aims to build a comprehensive understanding of the risk factors for diabetic foot ulcers and lower-extremity amputations. Additionally, it aims to identify an approach using which research results may be implementable in clinical settings.

Our research team

Steno Diabetes Center Copenhagen (SDCC) is a diabetes center within the public authority of the Capital Region of Copenhagen. SDCC is the largest diabetes clinic in Scandinavia and treats each year more than 11,000 people with diabetes from the Capital Region. SDCC is organised in four departments (Patient Care, Clinical Research, Health Promotion, and Education) that work closely together around the unifying focus of translational research, care, and prevention.

The doctoral candidate will be part of the Complications Research group which is embedded within the department of Clinical and Translational Research and the candidate will learn from, and collaborate with a multidisciplinary team of clinicians, epidemiologists, and statisticians. The doctoral candidate will also work together with another doctoral candidate from DIALECT at SDCC who focuses on patient involvement and shared decision-making.

Steno Diabetes Center Copenhagen

Steno Diabetes Center Copenhagen (SDCC) is a diabetes center within the public authority of the Capital Region of Copenhagen. SDCC is the largest diabetes clinic in Scandinavia and treats each year more than 11,000 people with diabetes from the Capital Region. The ambition of SDCC is to improve the entire field of diabetes in the Capital Region, but also to contribute with inspiration and new knowledge nationally and internationally.