Does Every Person With Type 1 Diabetes Really Need a Foot Exam Every Year?

For people with type 1 diabetes, routine foot screening has long followed a familiar rule: get a foot exam every year. However, does everyone face the same risk of developing serious foot complications? The OPTI-ONE study suggests the answer may be no. Researchers examined whether foot screening intervals could reflect individual risk rather than follow a fixed schedule. Their findings raise an important question for diabetes care: Could some patients safely undergo less frequent screening while higher-risk individuals receive closer attention?

Table of Contents

1. What the OPTI-ONE study reveals about diabetic foot risk
2. Which patients need more frequent foot screening?
3. Could low-risk patients safely have foot exams every three years?
4. How personalized foot screening could improve type 1 diabetes care
5. Conclusion
6. Frequently Asked Questions

What the OPTI-ONE Study Reveals About Diabetic Foot Risk

Researchers in Denmark conducted the OPTI-ONE observational cohort study to assess foot complications in 7,329 people with type 1 diabetes. The study followed patients from 2020 through 2025, with an average follow-up of 3.26 years.

Participants were categorized using modified International Working Group on the Diabetic Foot (IWGDF) criteria. Researchers then examined the risk of foot ulcers, amputations, or Charcot foot, a condition that weakens foot bones and joints.

The results revealed striking differences between risk groups.

Among participants, 28.3% were classified as low-risk, 48.6% as high-risk, and 6.0% as very high-risk. Another 17.1% had an unknown risk classification.

Over three years, the cumulative risk of foot complications was:

• Low-risk patients: 0.55%
• High-risk patients: 3.45%
• Very high-risk patients: 20.86%

Importantly, low-risk participants without albuminuria or advanced retinopathy had an even lower three-year risk of 0.37%.

Albuminuria indicates excess protein in the urine, which can signal kidney damage. Meanwhile, advanced retinopathy reflects significant diabetes-related damage to the eyes.

These findings suggest that diabetes-related complications outside the feet may help identify patients requiring closer surveillance.

Furthermore, the difference between low-risk and very high-risk groups highlights why a uniform screening schedule may not reflect individual needs.

Nevertheless, the study measured complication risk rather than directly comparing different screening schedules. Therefore, its results cannot establish that less frequent examinations are equally safe.

Which Patients Need More Frequent Foot Screening?

Not everyone with type 1 diabetes faces the same likelihood of developing foot ulcers or other complications.

Several clinical factors increase risk, particularly peripheral neuropathy, poor circulation, previous foot ulcers, and structural foot changes.

Peripheral neuropathy damages nerves and reduces sensation. Consequently, patients may not notice small injuries, blisters, or pressure-related wounds.

Peripheral artery disease also increases risk because reduced blood flow makes wounds harder to heal.

Additionally, a history of amputation or foot ulceration identifies patients who require ongoing preventive care.

The OPTI-ONE findings reinforce the importance of identifying these risks before deciding how often examinations should occur.

Current Recommendations for Diabetic Foot Screening

The American Diabetes Association's 2026 Standards of Care continue to recommend comprehensive foot evaluations at least annually.

However, higher-risk patients need more frequent assessment.

Current guidance describes the following risk-based examination intervals:

• Very low risk: Annually when protective sensation and circulation are preserved.
• Low risk: Every 6 to 12 months when sensory loss or peripheral artery disease is present.
• Moderate risk: Every 3 to 6 months when multiple risk factors coexist.
• High risk: Every 1 to 3 months for patients with major risk factors, including previous ulcers or amputation.

These categories represent the guideline framework and should not be directly equated with OPTI-ONE's modified risk groups.

Importantly, patients with sensory loss or previous ulceration or amputation should have their feet inspected at every clinical visit.

For adults with type 1 diabetes, annual neuropathy screening is recommended beginning five years after diagnosis.

Thus, risk-based prevention already plays an important role in diabetes management, particularly when patients need examinations more frequently than once yearly.

Could Low-Risk Patients Safely Have Foot Exams Every Three Years?

One of OPTI-ONE's most notable findings concerns patients with the lowest complication risk.

Researchers observed that this group experienced very few serious foot problems over three years. Consequently, they suggested that extending screening intervals to three years might be worth considering for carefully selected patients.

For instance, someone without significant nerve damage, circulation problems, or other major complications may have a substantially lower risk than someone with previous ulceration.

Longer intervals could reduce unnecessary appointments while allowing clinicians to devote more attention to vulnerable patients.

However, there is an important distinction between identifying low-risk patients and proving that fewer examinations are safe.

OPTI-ONE was an observational study, not a randomized trial assigning patients to annual or three-year screening.

Therefore, it cannot determine whether a longer interval would delay the detection of new neuropathy, circulation problems, or early foot injuries.

Furthermore, the study's unknown-risk group highlights the practical importance of complete patient assessments.

Before clinicians can safely extend screening intervals, they need reliable methods for identifying low-risk individuals and detecting changes between visits.

Additional prospective research should test whether longer intervals maintain patient safety while reducing healthcare demands.

Until then, annual comprehensive examinations remain the recommended standard.

How Personalized Foot Screening Could Improve Type 1 Diabetes Care

A risk-based approach to foot screening for people with type 1 diabetes could make preventive care more efficient while ensuring that patients who need closer monitoring receive it.

For healthcare professionals, the goal would be to match screening intensity with the likelihood of complications.

This approach begins with a thorough evaluation of sensation, circulation, skin condition, foot structure, and medical history.

Clinicians should also consider kidney disease, retinopathy, previous wounds, and other relevant health factors.

Afterward, patients can be assigned an appropriate risk category and monitored according to established guidance.

Importantly, risk assessment is not permanent. A person considered low-risk today may develop neuropathy or circulation problems later.

Therefore, clinical teams must remain alert to new symptoms and changing health conditions.

Patient education also remains essential regardless of screening frequency.

People with diabetes should examine their feet regularly, wear properly fitting shoes, and report injuries or unusual changes promptly.

Moreover, unexplained swelling, redness, warmth, or open wounds require prompt medical assessment rather than waiting for a scheduled examination.

For additional clinical education on diabetes complications and prevention, visit Diabetes in Control.

Patients seeking personalized medical guidance can also consult a qualified healthcare professional through Healthcare.pro.

Ultimately, an effective screening program must balance efficiency, early detection, and individual patient safety.

Conclusion

The OPTI-ONE study challenges the assumption that every person with type 1 diabetes has an equal risk of serious foot complications.

Its findings suggest that carefully selected low-risk patients may eventually qualify for longer screening intervals, potentially extending to three years.

However, the evidence does not yet establish that changing the current schedule is safe.

For now, annual comprehensive foot examinations remain the standard, while patients with elevated risk require closer monitoring.

Future studies may help determine whether more personalized screening schedules can improve resource use without sacrificing prevention.

Frequently Asked Questions

1. Does everyone with type 1 diabetes need an annual foot examination?

Current ADA recommendations call for a comprehensive foot examination at least annually. Higher-risk patients need more frequent assessment, while the safety of longer intervals for low-risk patients remains under investigation.

2. What did the OPTI-ONE study discover about foot screening?

The study found that three-year foot complication risk varied considerably by patient risk category. Low-risk participants had a 0.55% cumulative risk, compared with 20.86% among very high-risk participants.

3. Can low-risk patients safely wait three years between foot examinations?

Not yet as a routine practice. OPTI-ONE supports further investigation of three-year intervals, but clinical studies must confirm that extended screening does not delay important diagnoses.

4. What factors increase the risk of diabetic foot complications?

Important factors include peripheral neuropathy, peripheral artery disease, previous foot ulcers, amputations, foot deformities, and kidney disease. These findings can indicate a need for more frequent examinations.

5. What should patients do between scheduled foot examinations?

Patients should inspect their feet regularly, maintain appropriate footwear, and report new injuries or changes. Any open wound, unusual swelling, redness, or increased warmth requires prompt medical attention.

This content is not medical advice. For any health issues, always consult a healthcare professional. In an emergency, call 911 or your local emergency services.