A utilização do monofilamento de 10 gramas como preditor de ulceração em indivíduos com diabetes mellitus: uma revisão sistemática

Abstract

Introduction: The Diabetic Foot Ulcer (DFU), a rupture of the skin of the foot involving at least the epidermis and part of the dermis, resulting from the nervous impairment caused by Diabetic Neuropathy (DN), stands out as an amalgam of pathophysiological, socioeconomic and educational factors. In this context, the identification of feet with sensitivity abnormalities that could develop ulceration, through the 10-gram Monofilament Test (10gMT), is a clinically relevant and cost-effective tool that has a significant impact on reducing the onset of UPD. Objectives: To identify observational studies that examined the relationship between the use of the 10-gram Monofilament Test, as a predictor of the incidence of ulceration in people with Diabetes Mellitus (DM), with an emphasis on population characteristics, socioeconomics and the methodological aspects of the 10gMT. Objectives: To identify observational studies that have examined the relationship between the use of the 10-gram Monofilament Test (10gMT) as a predictor of the incidence of ulceration in people with Diabetes Mellitus (DM), with emphasis on population characteristics, socioeconomic and methodological aspects of the 10gMT. Methods: This is a systematic review of the literature, following the PRISMA guidelines. The search was carried out in three electronic databases: Medline/Pubmed, Scopus and Embase, until October 31, 2023. The methodological quality of cohort studies was analyzed using the Newcastle-Ottawa Scale (NOS) tool recommended by Cochrane. Results: Of the 1179 articles extracted, 10 studies were included in the systematic review, after applying the eligibility criteria. The studies came from North America and Europe, countries with a high Human Development Index (HDI), were single-center, had a variable population sample and study duration. The average total duration of the studies was 2.8 years. The average total number of points investigated in the 10gMT methodology was 5.2 points. The percentages of abnormalities in the 10gMT, ranged from 4.8 to 75.6%, with a total average percentage of 25.06%. Only two studies used only the 10gMT to identify plantar sensitivity abnormalities. The average total percentage incidence of UPD was approximately 13%. Conclusions: The study analyzed and systematized data that may or may not corroborate the relationship between the use of the 10gMT and the incidence of UPD, a topic that has been little addressed in the national literature but which has been published extensively internationally. The 10gMT proved to be a good strategy for detecting loss of plantar protective sensitivity, being a low-cost, easily reproducible option that detects abnormalities when used alone or together. It also predicts that the foot is severely compromised and at imminent risk of ulceration.