Prevalence of foot ulcers in diabetic patients in Punjab, Pakistan

Abstract

Diabetes-related foot ulceration is prevalent and disabling, usually resulting in the amputation of the limb. The mortality rate is significant, and healed ulcers frequently reoccur. The main purpose of this study was to explore the prevalence of foot ulcers and their associated factors among diabetic patients in Punjab, Pakistan. Multistage cluster random sampling procedure was applied to perform a cross-sectional analysis in the state of Punjab, Pakistan. A sample of 1,503 people with diabetes, including 504 men and 999 women, were selected from different clusters. Data were collected from December 18, 2018, to June 30, 2019. Individuals of 18 years or above were selected. A binary multiple logistic regression analysis was utilized to find the factors associated with a diabetic foot ulcer. The overall prevalence of diabetic foot ulcers was 16.83% (95% CI: 14.9–18.7%). The prevalence among the female was 17.52% (95% CI: 15.2–19.9%), and the male was 15.48% (95% CI: 12.3–18.6%). In rural areas, prevalence was 13.91% (95% CI: 10.6–17.2%) compared to the prevalence of 17.96% (95% CI: 15.7–20.2%) in the urban area. Individuals 75 years and above had the highest prevalence of 66.67% (95% CI: 51.9–81.5%). According to the income status, subjects with monthly income above Rs. 61,000 had a prevalence of 24.24% (95% CI: 15.8–32.7%), and among overweight subjects was 25.49% (95% CI: 21.3–29.7%). This study found a relatively high prevalence of foot ulcers in Punjab, Pakistan. The results indicate that diabetic foot ulcers have become a major health problem in diabetic patients, and better strategies and preventive measures should be opted to deal with the epidemic.

Bacteriological analysis and antibiotic resistance in patients with diabetic foot ulcers in Dhaka

“…This could be attributed to a variety of factors. There is a higher male involvement in outdoor activities compared to females [36], and this heightens susceptibility to foot trauma and harm [41][42][43][44]. Contrary to our findings, studies from India, Pakistan and Malaysia reported that women had a higher risk of having DFU [42,44,45].…”

“…There is a higher male involvement in outdoor activities compared to females [36], and this heightens susceptibility to foot trauma and harm [41][42][43][44]. Contrary to our findings, studies from India, Pakistan and Malaysia reported that women had a higher risk of having DFU [42,44,45]. A reason for this can be that in some areas of Africa and South Asia, particularly in some developing nations, prevailing socio-cultural beliefs restricted women from achieving higher levels of education compared to men.…”

The prevalence of foot ulcers in diabetic patients in Pakistan: A systematic review and meta-analysis

“…The gender of the diabetic patients was provided in all papers. Regarding methodological quality bias, seven studies ( 27 , 29 – 32 , 35 , 36 ) had a low risk of bias, five studies ( 13 , 14 , 28 , 33 , 34 ) had a moderate level, and none had a high risk of bias. The authors' agreement on the retrieved data was strong (Kappa score = 0.82, p = 0.001).…”

“…These articles included only Pakistani nationals, with sample sizes ranging from 230 (32) to 2199 (29), with a median of 1503 diabetic patients. Seven studies were conducted in Punjab province (13,14,30,(33)(34)(35)(36), three studies were performed in Sindh (27-29), one was conducted in Azad Kashmir (31), and one study was conducted nationwide (32). Regarding the study design, a cross-sectional research design was utilized in 10 of the 12 studies; one study employed casecontrol, and the other used a prospective research design.…”

“…The pooled prevalence and subgroup meta-analysis for diabetic foot ulcers are summarized in Table 2. The prevalence of foot ulcers among diabetic patients was reported in 12 research articles (13,14,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) with a total of 14201 diabetic patients. The diabetic foot ulcer prevalence estimates in the included studies ranged from 2.11% (95% CI: 1.23-3.36%) to 50.90% (95% CI: 47.75-54.04%).…”