Prevalencia moderada de pie en riesgo de ulceración en diabéticos tipo 2 según IGWDF en el contexto de la atención primaria

Abstract

Objetivo: Determinar la prevalencia del pie en riesgo de ulceración (PRU) según International Working Group on Diabetic Foot (IWGDF) expresada por la presencia de neuropatía diabética periférica (NPD) y/o enfermedad arterial periférica (EAP) y/o deformidad (D) y sus factores asociados en diabéticos tipo 2 en la atención primaria de la salud (APS) de Trujillo. Materiales y métodos: Se captó una muestra de 301 diabéticos tipo 2 de centros de salud, públicos y privados del distrito de Trujillo, pertenecientes a la APS; posteriormente se estratificó según el sistema IWGDF para pie en riesgo, se consideraron diagnósticos de NPD, EAP y D. Se realizó estadística descriptiva y analítica con las variables evaluadas por SPSS versión 22. Además, se solicitó una acreditación de un comité de ética e investigación. Resultados: Los diabéticos tipo 2 mostraron los siguientes diagnósticos: el 13,3 % presentaron NPD, EAP en 18,6 % y D en 64,1 %. Además, se encontró que el 86,7 % no presentan PRU, el 4 % se encuentra en un riesgo leve y el 9,3 % en moderado; con una prevalencia total de 13,3 %. Finalmente, se encontraron como factores de riesgo asociados a la regularidad de atención, hipertensión arterial, hipoglicemia, actividad física y calzado ortopédico. Conclusiones: Estudio epidemiológico único en la APS peruana que muestra una prevalencia de nivel moderado en PRU, pero menor respecto a sus similares latinoamericanos, siendo el componente deformidad la más frecuentes; y con factores asociados positivos y muy débiles cuando se analizó los pacientes con y sin riesgo. Palabras clave: Prevalencia; Pie; Diabetes mellitus tipo 2; Factores de riesgo (Fuente: DeCS BIREME). Moderate prevalence of foot ulceration risk according to the IWGDF guidelines in type 2 diabetic patients attending the primary health care ABSTRACT Objective: To determine the prevalence of foot ulceration risk (FUR) according to the International Working Group on the Diabetic Foot (IWGDF) guidelines, demonstrated by the presence of peripheral diabetic neuropathy (PDN) and/or peripheral arterial disease (PAD) and/or deformity (D), as well as its associated factors, in type 2 diabetic patients attending the primary health care (PHC) in Trujillo. Materials and methods: A sample of 301 type 2 diabetic patients was collected from public and private health centers of the district of Trujillo belonging to the PHC. Subsequently, said sample was stratified according to the IWGDF guidelines on foot at risk, considering diagnoses such as PDN, PAD and D. Descriptive and analytical statistics were performed with the variables evaluated by the IBM SPSS Statistics V22.0. In addition, accreditation was requested from an ethics and research committee. Results: Type 2 diabetic patients showed the following diagnoses: 13.3 % presented PDN, 18.6 % PAD and 64.1 % D. Besides, it was found that 86.7 % have no FUR, 4 % are at slight risk of and 9.3 % are at moderate risk of developing foot ulcers, with a total prevalence of 13.3 %. Finally, the associated risk factors were medical atten...

Prevalence and incidence of diabetic peripheral neuropathy in Latin America and the Caribbean: A systematic review and meta-analysis

“…Brazil had the most scientific production with fourteen studies [53, 55-58, 60, 61, 64-66, 71, 72], Mexico with seven [52,54,67,68,70,73,74], Peru with four [59,69,74,77], and Cuba [51], Uruguay [63], and Ecuador with one study [62] [51,63,64], presenting combined prevalence. In twenty-one studies, patients were recruited from reference hospitals [51, 54-59, 61, 63-67, 69, 70, 72-74], four from primary care [52,53,60,68], and three from the general population [62,71,75]. According to the onset of DM, one study was made with newly detected DM (debut) [61], nine with DM patients with more than 5 years of illness [51, 56, 65, 68-70, 72, 77, 78], six with more than 10 years of disease [53,57,64,66,73,74], and eleven did not specify any time [52, 54, 55, 58-60, 62, 63, 71, 75, 76].…”

“…There were several methods for DPN diagnosis, we classified in four groups: a) >2 clinical signs, including nine studies [48,49,54,56,58,64,71,72,75]; b) >2 clinical signs and symptoms, including 14 studies [50, 52, 53, 57, 59-61, 63, 65, 66, 68-70]; c) >2 clinical signs + nerve conduction test (NCT), including one study [55]; and d) only NCT or sudomotor disfunction test, including four studies [51,62,67,74]…”

“…Regarding DM type, 22 studies included type 2 DM [ 52 – 57 , 59 – 62 , 66 , 68 – 78 ], three type 1 DM [ 58 , 65 , 67 ] and three in both types of DM [ 51 , 63 , 64 ], presenting combined prevalence. In twenty-one studies, patients were recruited from reference hospitals [ 51 , 54 – 59 , 61 , 63 – 67 , 69 , 70 , 72 – 74 ], four from primary care [ 52 , 53 , 60 , 68 ], and three from the general population [ 62 , 71 , 75 ]. According to the onset of DM, one study was made with newly detected DM (debut) [ 61 ], nine with DM patients with more than 5 years of illness [ 51 , 56 , 65 , 68 – 70 , 72 , 77 , 78 ], six with more than 10 years of disease [ 53 , 57 , 64 , 66 , 73 , 74 ], and eleven did not specify any time [ 52 , 54 , 55 , 58 –…”

“…There were several methods for DPN diagnosis, we classified in four groups: a) >2 clinical signs, including nine studies [ 48 , 49 , 54 , 56 , 58 , 64 , 71 , 72 , 75 ]; b) >2 clinical signs and symptoms, including 14 studies [ 50 , 52 , 53 , 57 , 59 – 61 , 63 , 65 , 66 , 68 – 70 ]; c) >2 clinical signs + nerve conduction test (NCT), including one study [ 55 ]; and d) only NCT or sudomotor disfunction test, including four studies [ 51 , 62 , 67 , 74 ]. According to Toronto Study Group, one study included confirmed DPN cases [ 55 ], 20 included probable DPN cases [ 48 – 50 , 52 – 54 , 57 , 59 – 61 , 63 – 66 , 68 – 73 , 75 ], three studies included possible DPN [ 56 , 58 , 72 ], and four included subclinical DPN [ 51 , 62 , 67 , 74 ].…”

“…The quality score range of the prevalence studies of DPN was from two to eight. There was one study of very low quality [ 50 ], 14 clinical studies were of low quality [ 48 , 51 , 54 , 55 , 60 – 62 , 64 , 66 – 69 , 71 , 72 ], eight studies were of moderate quality [ 49 , 52 , 53 , 57 , 74 , 75 ], and seven studies were of high quality [ 56 , 58 , 59 , 63 , 65 , 70 , 73 ]. The two studies included for incidence obtained a score of six according to the Newcastle-Ottawa scale [ 53 , 76 ] ( S3 and S4 Tables) .…”