Frequency of foot ulcers in people with type 2 diabetes, presenting to specialist diabetes clinic at a Tertiary Care Hospital, Lahore, Pakistan

Abstract

BackgroundDiabetic foot ulceration is a serious limb-threatening complication of diabetes. It is the common cause of hospital admissions and amputations.The objective of the study was to determine the prevalence of diabetic foot ulcers (DFU) and its association with age, gender, duration of diabetes, peripheral neuropathy (PN), peripheral arterial disease (PAD) and HbA1c.MethodsA total of 1940 people (≥ 30 years of age) with type 2 diabetes coming to the Sakina Institute of Diabetes and Endocrine Research (specialist diabetes clinic) at Shalamar Hospital, Lahore, Pakistan, were recruited over a period of 1 year from January 2016 to January 2017. The foot ulcers were identified according to the University of Texas classification. PN was assessed by biothesiometer and PAD by ankle-brachial index (< 0.9). Body weight, height, body mass index (BMI), HbA1c and duration of diabetes were recorded.ResultsThe prevalence of DFU was 7.02%, of which 4.5% of the ulcers were on the planter and 2.6% on the dorsal surface of the foot; 8.5% of the persons had bilateral foot ulcers and 0.4% subjects had Charcot deformity. There was significant association of foot ulcers with age, duration of diabetes, HbA1c, PN and PAD, whereas no association was observed with gender and BMI. PN and PAD were observed in 26.3 and 6.68% of people with diabetes respectively. Neuropathic ulcers and neuro-ischemic ulcers were identified in 74 and 19% of the study population. Logistic regression analysis revealed significant odds ratio for peripheral neuropathy 23.9 (95% confidence interval (5.41–105.6).ConclusionsPeripheral neuropathy is the commonest cause of foot ulcers. An optimum control of blood glucose to prevent neuropathy and regular feet examination of every person with diabetes may go a long way in preventing foot ulceration.

A multi centric study of diabetic foot ulcer: causes and complications

“…10 Younis et al found that 7.02% was the prevalence of ulcer over foot in diabetics. 11 Out of that, 4.5% had ulcer on the planter side while in our study it was in 60% of the cases. Presence of ulcer on dorsal side was seen in 2.6% of the cases while we found it in 6% of the cases.…”

“…They noticed that 19% of the cases had neuro-ischemic ulcers which is exactly the same found in the present study. 11 Assaad-Khalil et al found in their study that the prevalence of type 2 diabetes mellitus was 96.75%. 12 They found that as the duration of diabetes increased, the risk of diabetic foot increased significantly.…”

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

“…2 It is estimated that in middle and high income countries, up to 50% of patients with diabetes and foot ulceration have underlying peripheral artery disease (PAD), 3,4 whereas neuropathic ulcers are possibly more prevalent in low-income countries. 5,6 In patients with diabetes, PAD may remain undiagnosed until the patient presents with (severe) tissue loss, as many patients typically lack the classic preceding clinical symptoms of PAD such as claudication or rest pain. 7,8 Diagnostic tests may be less reliable due to the presence of peripheral neuropathy, medial arterial calcification, 9 and peripheral oedema.…”

Dressing Methodology for Diabetic Foot Ulcers

“…Majority of diabetic foot ulcer patients' studies by Mariam (2017), Younis et al (2018) has revealed that DFU is commonly seen in Type 2 Diabetes patients as a complication. It was found that the mean age of the study participants' was53 years suggesting that productive years of life were lost by diabetic foot patients warranting the health care professionals on the measures for prevention of foot complications.…”