Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study

Abstract

Background: Diabetic foot is an underestimated and redoubtable diabetes complication. The aims of our study were to assess diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGD F) classification, stratify patients into risk categories and identify factors associated with higher-risk grade. Methods: Cross-sectional setting over a period of 07 months, patients were randomly selected from the diabetic outpatients attending our unit of diabetology. Questionnaire and clinical examination were made by the same physician. Patients free of active foot ulcer were included. Results: Among 230 patients evaluated, 10 had an active foot ulcer and were excluded. Five patients (2.27%) had a history of foot ulcer and 3(1.36%) had a lower-limb amputation. Sensory neuropathy, as measured by the 5.07(10 g) Semmes-Weinstein monofilament testing, was present in 23.63% of patients, whereas 36.82% had a peripheral arterial disease based on clinical findings, and 43.63% had foot deformities. According to the IWGDF classification, Group 0: 72.72%, Group 1: 5.9%, Group 2: 17.73% and Group 3: 3.63%. After univariate analysis, patients in higherrisk groups were significantly more often female, had higher age and BMI, longer diabetes duration, elevated waist circumference, low school level, retinopathy and hyperkeratosis. Multivariate logistic regression analysis identified 3 significant independent factors associated with high-risk groups: retinopathy (OR = 2.529, CI95 [1.131-5.655], p = 0.024), hyperkeratosis (OR = 2.658, CI95 [1.222-5.783], p = 0.014) and school level (OR = 0.489, CI95 [0.253-9.44], p = 0.033). Conclusions: Risk factors for foot ulceration were rather common in outpatients with diabetes. The screening of patients at risk for foot ulceration should start early, integrated with sustainable patient education.

Profiles of diabetes care, control and complications in Benghazi, Libya 2020: A cross sectional study

“…[8] Also our results are less than rates observed in Tunisia (39.6%). [6] Most of the patients in this study only 11.1% of all patients were regularly exercising which is noticeably lower that the reported rates in Benghazi in 2002 and in Sudan (41.5% and 27.7% respectively). [4,10] Less than two-thirds ie, 63.5% of all patients had diabetes eye screening within the previous years which is lower than the 2002 study (49.2%).…”

“…However, this may be attributed to the fact that 48.3% had never checked their blood pressure. [4] This result was nearer to what was observed in Tripoli (20.8%); [11] and lower than what was by Buzaid and Nagem, [8] and Zantour (6) et al, [6] respectively. Dyslipidemia was found in 42.1%, and only a minority had never checked their lipid profile; this is aremarkable improvement form the 2002 study when 76% had never checked their lipid profile.…”

“…[5] The mean BMI is also marginally higher than results from Tunisia. [6] In contrast, the mean BMI is lower than BMI reported in Saudi Arabia. [7] Obesity reflected in BMI ≥30 kg/m 2 was found in 48.2% in the present study, less frequent than that described in another institution in the same city (68% in Benghazi Medical Center by Buzaid and Nagem [8] and in Bahrain (56.5%) [9] but higher than in Sudan (23.9%).…”

“…[4] Different educational levels were reported from Libya and other neighboring countries within the context of diabetes cohorts. For example, in Tripoli, 19.4% of patients had a university level, and 16.7% were illiterates; [11] while in Tunisia, 4% only had a university level and 39% were illiterates, [6] and in Sudan, 18.9% had a university level, and 29.2% were illiterates. [10] T2DM represents the majority in our study which was 97%; as compared to Roaeid and Kablan study, 87.2% were T2DM, [4] as well for Tunisia; T2DM represented 90%, while in Sudan 93.2% had T2DM, [10] there is recently diabetes speciality clinics and youth diabetic clinic at Benghazi medical center, where patients are followed by endocrinologests, so most of type one patients are following these clinics.…”

Study of socio-demographic, behavioural and clinical risk factors of diabetic foot in a tertiary care centre

“…Longer duration of diabetes was reported as a risk factor for diabetic foot by Shahi et al 21 Majority of participants were overweight (90%) and rest were obese in our study. Elevated BMI was associated with higher risk of developing diabetic foot in studies by Zantour et al and Sohn et al 22,23 However, Malgrange et al did not found this association. 24 The participants in our study had comorbidities like hypertension (80%), ischemic heart disease (64%) and hypercholesterolemia (72%).…”