Characteristics of a large cohort of patients with diabetes having at‐risk feet and outcomes in patients with foot ulceration referred to a tertiary care diabetes unit

Abstract

To identify in a large population cohort the clinical and biochemical characteristics of patients with diabetes at risk of foot ulceration and outcomes in those with foot ulcers. All patients with diabetes attending Baqai Institute of Diabetology and Endocrinology from January 2004 to April 2012 included in the study. Clinical, biochemical and socio-demographic data were collected and patients were categorised into those at no risk of ulceration, at risk of ulceration and those with foot ulcer, according to the University of Texas classification. Patients with foot ulceration followed for their final outcome, that is complete healing, persisted non-healed ulcer, lower extremity amputation, lost to follow-up or death. A total of 18 119 patients with diabetes underwent assessment, 3576 (19·7%) patients defined as at high risk for foot ulceration and 3731 (20·6%) presented with foot ulcer. Age, male gender, hypertension, higher glycated haemoglobin (HbA1c), history of smoking and presence of neuropathy were risk factors (P < 0·000) for foot ulceration. Amputation rate in patients with foot ulceration was significantly related to severity of ulceration at presentation. Preventive foot care practices were followed by 19·02% patients. One thousand eight hundred seventy three (50·2%) patients completely healed, 293 (11%) patients underwent amputation and 397 (10·1%) patients continued to be treated in the foot clinic. All patients with diabetes should be screened for neuropathy to identify those at risk of foot ulceration, as it is the major contributory factor for foot ulceration. The final outcome of foot ulceration was determined by the severity and grade of ulcer at presentation.

Risk factors for major amputation in hospitalised diabetic foot patients

“…Aziz et al reported an amputation rate of 28% in Singapore in their prospective study on 100 patients with diabetic foot infections treated at the National University Hospital of Singapore in 2011 . Riaz et al reported an amputation rate of 11% in Pakistan . Nather et al reported a 27·2% major amputation rate, and Zubair et al reported an overall amputation rate of 28·4% in a North Indian tertiary care hospital .…”

Strong association of anemia in people with diabetic foot ulcers (DFUs): Study from a specialist foot care center

“…Frequency of anemia in people with type 2 diabetes was observed 63% in Sharif A et al study and in people with DFU it is 59.04% in Wright JA et al study, while 89.6% anemic people with DFU underwent amputations in Costa RH et al study 8,11,12. Limited studies have been done to observe the association of anaemia with DFU 13. To the best of our knowledge, none of the studies from Pakistan reported it.…”

Demographic and socioeconomic profiles of patients admitted with diabetic foot complications in a tertiary hospital in Belem - Para

“…There are several scores to determine the severity of the diabetic ulcers [19][20] . The most used and accepted globally are those of Wagner and PEDIS, which, together with the classification of the University of Texas, try to encompass all the main aspects involved in the foot injury of a diabetic patient, such as the presence of ulcers, ischemia, and infection [20][21][22] . In the present study, no patient was classified as Wagner's grade 5 and PEDIS grade I.…”