<p>Determinants of Diabetic Foot Ulcer Among Adult Patients with Diabetes Attending the Diabetic Clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: Unmatched Case–Control Study</p>

Abstract

Background: Diabetic foot ulcer is among the commonest complications of diabetic mellitus attributed to a number of morbidity and mortality cases in diabetic patients. Nowadays, the incidence of diabetic foot ulcer is increasing due to the increased prevalence of diabetes. However, the risk factors of the problem are less studied in Ethiopia. Hence, this study was conducted to assess the determinants of diabetic foot ulcer among adult patients with diabetes attending a diabetic clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia in 2019. Patients and Methods: An institution-based unmatched case-control study was conducted on 161 patients with diabetes (53 patients with diabetes with foot ulcer and 108 patients with diabetes without foot ulcer). Cases were selected from patients with diabetes with foot ulcer by consecutive sampling technique and controls from patients with diabetes without diabetic foot ulcer by systematic random sampling technique. A binary logistic regression model was used to assess the association between the dependent and independent variables. All variables with a P-value<0.25 were included in the multivariable analysis. Statistical significance was declared at P-value<0.05 with 95% confidence interval. Results: In this study, 28 (52.8%) cases and 55 (50.9%) controls were male. Taking insulin alone (AOR=2.75, 95% CI=1.04-7.23), having peripheral neuropathy (AOR=7.56, 95% CI=2.82-20.24), not inspecting feet daily (AOR=5.61, 95% CI=2.24-14.05), and using moisturizing cream between toes (AOR=3.35, 95% CI=1.35-8.32) were positively associated with diabetic foot ulcer, whereas employed (AOR=0.35, 95% CI=0.14-0.87) and combined treatment (insulin and oral hypoglycemic agents) (AOR=0.11, 95% CI=0.02-0.57) were negatively associated with diabetic foot ulcer. Conclusion: Diabetic foot ulcer was significantly associated with occupation, kind of treatment of diabetes mellitus taking, peripheral neuropathy, inspecting feet daily, and putting moisturizing cream between toes. It will be helpful if diabetic patients inspect their feet on a daily basis and do not put moisturizing cream between their toes.

Foot self‐care behaviour in type 2 diabetes adults with and without comorbid heart failure

“…There are a number of risk factors associated with the development of DFU. Studies have reported that peripheral neuropathy (Abdissa, Adugna, et al, 2020 ; Adem et al, 2020 ; Mariam et al, 2017 ; Woldemariam et al, 2020 ), poor foot self‐care behaviours (Mariam et al, 2017 ; Tola et al, 2021 ; Tolossa et al, 2020 ; Woldemariam et al, 2020 ) overweight and obesity (Adem et al, 2020 ; Mariam et al, 2017 ; Tola et al, 2021 ; Tolossa et al, 2020 ), taking insulin alone (Tola et al, 2021 ; Woldemariam et al, 2020 ), rural residence (Mariam et al, 2017 ; Tolossa et al, 2020 ), delayed DM follow‐up, history of infection and hypertension (Tola et al, 2021 ), and presence of foot callus, longer duration of DM and advancing age (Tolossa et al, 2020 ) are positively associated with DFU. In addition, a studies have shown that retinopathy, nephropathy, poor glycaemic control, smoking and height are positively associated with DFU (Banik et al, 2020 ; Rossboth et al, 2021 ).…”

The Magnitude and Associated Factors of Diabetic Foot Ulcer Among Patients with Chronic Diabetic Mellitus in Northeast Ethiopia, 2021

“…This is supported by a case-control study done in Tikur Anbessa Specialized Hospital in Ethiopia patients who take a combination of oral hypoglycemic medication and insulin were 89% less likely to develop diabetic foot ulcers than patients who took insulin only. 21 This study showed that patients who lived with DM for more than 5 years were 2.28 times more likely develop diabetic foot ulcer than patients who lived with DM for less than 5 years (AOR=2.28, 95% CI=3.04, 17.69). This is supported by a study done in Felege Hiwot referral hospital at Bahir Dar, Ethiopia that revealed that patients who follow for 6-10 years were 2.44 times more likely to develop DM complications than those who are living with DM for <5 years respectively.…”

“…20 In another case-control study done in Tikur Anbessa Hospital, Ethiopia patients with peripheral neuropathy were 7.56 times more likely to develop foot ulcers. 21 A possible explanation is that in patients with peripheral neuropathy, the sensitivity and loss of vibration sensation significantly increases the risk of trauma, and the patient is unaware of the onset of sores/ulcers. This study showed that patients with diabetes who take only oral hypoglycemic medication were 3.2 times more likely to develop diabetic foot ulcers than those patients who take a combination of oral hypoglycemic medication and insulin.…”

Validities and Reliabilities of Screening for Diabetic Foot Ulcer (DFU) among Diabetes Mellitus Patients with and without DFU

“…One possible explanation is that the instrument tool was easy and uncomplicated to use as well as having a manual provided. The reliability depends primarily on good standardization (Woldemariam et al, 2020) and instructions being easy to understand (Akila et al, 2021). Another possible explanation is that the risk factors were objective which influenced reliable scores or outcomes.…”