Screening of diabetic neuropathy and ulcer risk in Primary Health Care using a mobile application

Abstract

Introduction: Diabetes mellitus (DM) is a chronic condition that can cause damage to multiple organs, leading to the development of complications and increased morbidity and mortality. Diabetic polyneuropathy (DPN) is currently the most prevalent chronic complication of DM, making it essential to implement strategies for the early detection of DPN and the risk of developing diabetic foot — a complication characterized by a wound (ulcer) in the lower limbs aggravated by infection, which may also include any neurological, orthopedic, or vascular alteration affecting this region of the body. Approximately 85% of amputations in individuals with diabetes could be prevented through measures such as early detection, prevention, and intervention in ulcers. Objective: To detect, through the use of a screening tool — the SISPED® application (Diabetic Foot System) — the presence of DPN, to stage the risk for ulcer development, and to evaluate the usability of the application. Methods: A prospective, analytical, and longitudinal study was conducted with individuals with DM aged over 18 years who underwent foot assessment using the SISPED® tool. Descriptive analysis was performed using frequency tables for categorical variables and measures of central tendency and dispersion for continuous variables. The chi-square test or Fisher’s exact test was used to compare proportions. The Mann–Whitney test was applied for comparison of continuous variables between two groups, and the Kruskal–Wallis test for comparisons among four groups. A p-value <0.05 was considered statistically significant. Results: A total of 203 individuals had their feet evaluated. There was a predominance of females aged between 50 and 79 years, with approximately 11 years since DM diagnosis, a mean glycated hemoglobin (HbA1c) level of 8%, use of oral medications, and associated hypertension. The prevalence of neuropathy was 31%. Age, DM duration greater than 10 years, and the Neuropathy Symptom Score (NSS) and Neuropathy Impairment Score (NIS) were significantly associated with the presence of DPN. The presence of vasculopathy and altered plantar sensitivity were associated with a higher risk of ulcer development. The usability of the SISPED® application, assessed using the System Usability Scale (SUS®), was rated as moderate by the medical students who applied the instrument. Conclusions: the study showed a high prevalence of PND and a high prevalence of moderate and high risks for the development of ulcers. The usability found among medical students was considered moderate.