Predictors of Diabetic Foot and Leg Ulcers in a Developing Country with a Rapid Increase in the Prevalence of Diabetes Mellitus (original) (raw)
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Journal of Diabetes and its Complications, 2019
The aim of this study was to identify the biomechanical, neurological and clinical parameters along with other demographics and life style risk factors that could explain the presence of foot ulcer in patients with diabetes in Africa. Methods: A total of 1270 (M/F:696/574) patients; 77(M/F:53/24) with ulcerated vs 1193 (M/F: 643/550) with non-ulcerated feet; participated in this study. A set of 28 parameters were collected and compared between the participants with and without active foot ulcers. Multivariate logistic regression was utilised to develop an explanatory model for foot ulceration. Results: Foot swelling (χ2(1,n=1270)=265.9,P=0.000,Phi=0.464) and impaired sensation to monofilament (χ2(2,n=1270)=114.2,P=0.000,Cramer'sV=0.300) showed strong association with presence of ulceration. A lower Temperature sensitivity to cold stimuli and limited ankle joint mobility were observed to be significant (P<0.05) contributors to ulceration. The logistic regression model can justify the presence of foot ulceration with 95.3% diagnostic accuracy, 99.1 % specificity and 37.3% sensitivity. Conclusion: Participants with ulcerated foot show distinct characteristics in few foot related parameters. Swollen foot, limited ankle mobility, and peripheral sensory neuropathy were significant characteristics of patients with diabetic foot ulcer. One out of three patients with ulcerated foot showed common characteristics that could be justified by the model.
Journal of International Medical Research, 2022
Objective Diabetes affected 463 million people globally in 2019, and this number is anticipated to reach 700 million by 2045. Diabetes results in lower limb amputation every 30 seconds. Egypt has a high prevalence of diabetic foot disease among patients with type 2 diabetes mellitus (T2DM). We aimed to identify high-risk patients for diabetic foot ulcers (DFUs) in Egypt. Methods We designed a cross-sectional study among adult patients with diabetes at Asyut University Hospital. Inlow’s 60-second diabetic foot screening tool was used to assess the risk of DFU. Neuropathy was assessed using the 10g monofilament test, and laboratory testing was performed to assess glycosylated hemoglobin (HbA1c) and diabetes control levels. Results Participants were aged 46.11 ± 9.18 years; 56% had T2DM and HbA1c levels >7%. In total, 47.9% of participants were at risk for DFUs. This risk was higher in patients who were older, male, widowed, working, illiterate, living in rural areas, and patients w...
Screening Techniques to Identify Occurrence of Diabetic Foot Ulceration Among People at High Risk
Port Said Scientific Journal of Nursing
Background Foot ulceration is an important health issue associated with significant levels of disability, pain and financial expense for those affected. Furthermore, foot ulcers can become life threatening when complicated by infection and might result in amputation when lesions don"t heal. Aim:-. Screen the occurrence of diabetic foot ulceration among people at high risk. Subjects and methods Prospective (cohort) study at Port Said city, 300diabetic patients were screened and followed twice, after three and six months. Three tools were used for data collection. Diabetic patient knowledge schedule, diabetic foot examination checklist, and foot ulcer checklist assessment. The patients were examined for presence of diabetic peripheral neuropathy , autonomic neuropathy ,sensory deficit , peripheral vascular disease , foot deformity , skin and nail problems. Patients were graded using (The international consensus on diabetic foot risk category 1999), according to their risk category. Results:-The following variables were significant risk factors with occurrence of diabetic foot ulcerations: previous foot ulcer, peripheral neuropathy, autonomic neuropathy, presence of other diabetic complications, retinopathy, diabetes duration and mean age group (53.14 ± 9.20). Ulcerations occur in 7.3% of studied sample after three and six months. Assessment of foot perception using monofilament had the best sensitivity. Peripheral neuropathy was observed in (27.3%) ,peripheral vascular disease was diagnosed in (40%) of studied sample , foot deformity (10.3%) .Recommendations .All patients with diabetes should be screened at least annually for evidence of risk factors for foot ulceration including neuropathy and vascular disease. Foot screening programs that identify those feet at risk should to be taught to all health care professionals involved in the care of the diabetic patient. Conclusion:-previous foot ulcer, peripheral neuropathy, autonomic neuropathy, presence of diabetes complications, retinopathy , mean age group (53.14 ± 9.20) and long duration of diabetes were significant risk factors related to occurrence of diabetic foot ulceration
Epidemiology and economic impact of foot ulcers
The foot in diabetes, 2006
In the year 2005, most of the estimated 150 million people worldwide afflicted by diabetes mellitus lived in developing countries. 1 Diabetic foot ulcers will complicate the disease in more than 15% of these people during their lifetimes. 2,3 In prospective cohort studies conducted among those with diabetes, history of a foot ulcer increased the risk of subsequent amputation by two-to over threefold. 4,5 Foot ulcers precede more than 80% of non-traumatic lower limb amputations. 6 In this chapter, we will review the definition of a 'foot ulcer' and the studies that estimate the incidence and prevalence of foot ulcers, making note of issues that need to be considered in their computation. We will also review risk factors for foot ulcers from wellconducted epidemiological studies, foot ulcer outcomes and the economic impact of foot ulcers. FOOT ULCER DEFINITION AND CLASSIFICATION In order to estimate accurately the occurrence of diabetic foot ulcers and risk factors associated with this diabetic complication, a common definition is needed. The International Consensus on the Diabetic Foot currently defines a diabetic foot ulcer as a full-thickness wound below the ankle in a patient with diabetes, irrespective of duration. 7 The International Working Group on the Diabetic Foot (IWGDF) also recommends that studies describing the occurrence of diabetic foot ulcers use a standard classification system to facilitate communication between health care providers, provide information about the healing potential of an ulcer and help guide management decisions. Use of such a system allows a patient to be followed up over time, allowing repeated classification of the foot ulcer. Classification systems should be sufficiently robust that intra-and inter-observer variability is low (i.e. the classification is reproducible) and should be applicable worldwide. This allows research results from one study to be compared to those of others, which is important in interpretability of results. 8 For foot ulcers, one challenge in this regard has been the numerous classification systems in existence. The most commonly used system internationally is Wagner's. 9 This system specifies ulcer depth and the presence of osteomyelitis or gangrene as a five-grade continuum: Grade 0 Pre-ulcerative lesion Grade 1 Partial-thickness wound up to but not through the dermis The Foot in Diabetes, 4th Edition.
International journal of endocrinology, 2018
This study was carried out to assess the incidence and risk factors of diabetic foot ulcer (DFU). In this prospective cohort study in a university hospital, all the participants were examined and followed up for new DFU as final outcome for two years. To analyze the data, the variables were first evaluated with a univariate analysis. Then variables with value < 0.2 were tested with a multivariate analysis, using backward-elimination multiple logistic regression. Among 605 patients, 39 cases had DFU, so we followed up the remaining 566 patients without any present or history of DFU. A two-year cumulative incidence of diabetic foot ulcer was 5.62% (95% CI 3.89-8.02). After analysis, previous history of DFU or amputation [OR = 9.65, 95% CI (2.13-43.78), value = 0.003], insulin usage [OR = 5.78, 95% CI (2.37-14.07), value < 0.01], gender [OR = 3.23, 95% CI (1.33-7.83), value = 0.01], distal neuropathy [OR = 3.37, 95% CI (1.40-8.09), value = 0.007], and foot deformity [OR = 3.02, 9...
Jurnal Keperawatan
Background: Diabetic Foot Ulcer (DFU) is common problem in Diabetes Mellitus (DM) patients in which early detection of DFU is very important. The screening tool for DFU had been developed by researcher previously in 2016. Purpose: This study aimed to test validities and reliabilities of the tool. Methods: The method in this study which included content validity by 4 experts, construct validity with 180 patients, internal consistency in 60 patients and intra-rater reliability. Results: The results showed that: 1) content validity was acceptable, I-CVI was 1.00 and S-CVI was 1.00; 2) internal consistency used Kuder-Richardson (KR – 20) was 0.806; 3) Intra-rater reliability used Intra-class Coefficient Correlation (ICC) for total score was 0.996 and Kappa 1.00 for duration of DM, history of ulceration, history of claudication, neuropathy sensory, abnormal skin, foot care, Kappa 0.93 for foot deformities, Kappa 0.92 for history of amputation, and Kappa 0.89 for peripheral vascular dis...
Prevalence and Risk Factor of Diabetic Foot Ulcers in a Regional Hospital, Eastern Indonesia
Open Journal of Nursing, 2016
Indonesia is one of the top ten diabetes mellittus (DM) countries. However as the main complication of DM, there was lack of studies related to diabetic foot ulcer (DFU). Thus, the aim of this study was to survey the prevalence of DFU risk factors and DFU among type 2 diabetes mellitus (T2DM) patients. An epidemiological study was conducted at an outpatient endocrine clinic in a regional hospital, eastern Indonesia. All T2DM participants attending research setting that were ≥ 18 years were included. Demographic and foot care behavior were assessed using minimum data sheet (MDS). Meanwhile, presence of risk factors was evaluated by using 5.07/10 g Semmes-Weinsten Monofilament (SWM) for neuropathy and presence of angiopathy was evaluated with Ankle Brachial Index (ABI) by using a hand held Doppler (Bidop ES-100V3, Hadeco-Kawasaki, Japan) both dorsal and posterior tibialis foot. At the end of study, 249 T2DM participants were enrolled. The prevalence of DFU risk factors was 55.4% (95% CI: 53.7%-57.0%), and prevalence of DFU was 12% (95% CI: 10.3%-13.6%). Based on a logistic regression, predictors for DFU risk factors included age (OR: 1.04; 95% CI: 1.005-1.074) and daily foot inspection (OR: 0.36; 95% CI: 0.186-0.703). Meanwhile, the predictors for presence of DFU were insulin (OR: 9.37; 95% CI: 2.240-39.182), shoes (OR: 0.05; 95% CI: 0.007-0.294), spiritual belief that DM was a disease (OR: 0.04; 95% CI: 0.004-0.326) and belief that DM was a temptation from God (OR: 0.13; 95% CI: 0.027-0.598). In conclusion, we recommend to educate high risk patients to understand positive foot care behavior as essentially preventive strategies to prevent presence risk and DFU.