In a recent blog, David G. Armstrong, DPM, MD, PhD, discussed an article he co-wrote in the journal Diabetes Care.1 Unfortunately, I did not see this article when it was originally published but came across it while reading his diabetic foot care blog.

The article discusses the importance of stratifying our patients with diabetes into categories depending on their risk factors. During podiatry school and in residency, I recall the emphasis on learning classification systems for fractures, injuries and especially wounds when it comes to describing the wounds and classifying them. It would have been useful to learn a risk assessment for patients with diabetes that would help provide continuity of care for our patients but also help the patients better understand what their risks are and further guide other clinicians.

We can discuss the risks with patients but they often see these as abstract unless these risks are associated with a number, the same way we can check people’s blood pressure and show them a visible number. The patient understands this.

As I read this information, I thought, wouldn’t it be nice if every clinician used this risk assessment guide so it could immediately guide other medical professionals when treating these patients? It would also help patients immediately know where they stand with their diabetes and risk of complications. You can find the risk assessment table at .1

You should complete the risk classification for every patient with diabetes annually and change it as needed. Include this assessment in your notes and charting, especially if you are connected to an electronic medical records system with multiple specialty groups. It is an easy way for the other clinicians to understand these risk factors immediately. The goal would be to include this in the chart of every patient with diabetes. This will also be a good referral source from primary care physicians if they recognize that they should assess this information in every patient with diabetes.

I intend this blog post to show the importance for every clinician of classifying patients with diabetes into a risk category. The same way patients should know their daily blood sugar levels and HbA1C, they should also know what their risk classification is for diabetes.

I encourage others to start using this risk classification system. I would like to hear the thoughts of others on this topic. Feel free to comment below.


1. Boulton AJM, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment. Diabetes Care. 2008; 31(8):1679-85.

Originally posted on Podiatry Today