<p>Incidence of Diabetic Foot Ulcer and Its Predictors Among Diabetes Mellitus Patients at Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia: A Retrospective Follow-Up Study</p>

Abstract

The incidence of a diabetic foot ulcer (DFU) is increasing over the previous decade with an increasing prevalence of diabetes mellitus (DM). Despite the increasing incidence of DFU, there is limited information about the problem in Ethiopia. Hence, this study aimed to investigate the incidence of DFU and its predictors among newly diagnosed DM patients who were on follow-up at Felege Hiwot Referral Hospital. Methods: Institution-based retrospective follow-up study was conducted at Felege Hiwot Referral Hospital among newly diagnosed DM patients from January 1, 2009, to December 31, 2018. A simple random sampling method was used to select 401 study participants from a total of 723 eligible population. Data was entered using Epi-Data version 3.1 and exported to STATA version 14 for analysis. The incidence rate was estimated using person-years of observation and Nelson-Aalen cumulative hazard function, showing the cumulative probability of diabetic foot ulcer, was done. The best model (Gompertz) was selected using the AIC and log-likelihood method. Hazard ratio (HR) with its 95% confidence interval was computed and variables having a p-value less than 0.05 in the multivariable model were considered to be significantly associated with DFU. Results: A total of 387 patients were followed retrospectively for a median follow-up time of 95 months. Out of all, 66 (17.05%) patients developed DFU with an incidence rate of 4 cases per 100 person-years of observation. Diabetic nephropathy (adjusted hazard ratio (AHR) = 2.37, 95% CI: 1.33-54.24), diabetic retinopathy (AHR = 5.56, 95% CI: 2.64-11.74), and increased body mass index (AHR = 1.13, 95% CI: 1.01-1.27) were found to increase the hazard of DFU. Conclusion: The incidence of DFU was relatively high. Diabetic nephropathy, diabetic retinopathy, and body mass index were its significant predictors. Therefore, close monitoring of patients with co-morbidities and increased body mass index should be considered to reduce DFU.

Predictors of Foot Ulcers Among Diabetic Patients at a Tertiary Care Center, Egypt

“… 6 The lifetime risk of developing foot ulcers among diabetic patients ranges from 19% up to 34%, and about 85% of all diabetic lower limb amputations (DLLA) are preceded by DFUs. 7 , 8 Mortality rate following DLLA because of foot ulcers ranges from 24.6% within 5 years to 45.4% within 10 years. 9 Beside morbidity and mortality, DFUs impose a huge socio-economic burden on the patients and their families.…”

Diabetic Foot Ulcer Risk with Diabetic Kidney Disease and Renal Failure among 10,680 Patients

“…Patients with diabetes are at increased risk of foot ulcer development and progression. If the risk factors are already present, such as hypertension, cardiovascular disease, peripheral vascular disease and nephropathy or renal failure, then the risk is augmented with non-healing ulcer for a long time and poor prognosis with high morbidity and mortality [31][32][33][34][35][36][37]. Hence, according to our study it is recommended that physician should take detailed history, screening for risk factors, with complete laboratory analysis and management of risk factors simultaneously with best available medications to prevent further diabetes complications.…”

The association between body mass index and foot ulcer among patients with diabetes mellitus, Wad Medani, Sudan

“…[4] In a 2017 study in Khartoum the occurrence of DFU was 18.1%. [5] A study of DM patients in Ethiopia [6] showed a relatively high incidence of DFU (4 per 100 person-years). A high body mass index (BMI) was one of the significant predictors, along with nephropathy and retinopathy.…”