Risk Factors and Diagnosis of Diabetic Foot Ulceration in Users of the Brazilian Public Health System

Abstract

Background. An individual with diabetes mellitus (DM) has an approximately 25% risk of developing ulcerations and/or destruction of the feet’s soft tissues. These wounds represent approximately 20% of all causes of hospitalizations due to DM. Objective. To identify the factors for the development of diabetic foot ulceration (DFU) among individuals treated by the Brazilian public health system. Methods. This cross-sectional study was conducted on individuals with diabetes mellitus, aged above 18 years, of both sexes, and during July-October 2018 within a public healthcare unit in Brazil. All participants were assessed based on their socioeconomic, behavioral, and clinical characteristics, along with vascular and neurological evaluations. All participants were also classified according to the classification of risk of developing DFU, in accordance with the International Working Group on the Diabetic Foot (IWGDF). Statistical analyses were conducted using the chi-squared test, chi-squared test for trend, and Fisher’s exact test, with a significance level of 5% (p<0.05). Results. The study consisted of 85 individuals. The DFU condition was prevalent in 10.6% of the participants. Adopting the classification proposed by IWGDF, observed risks for stratification categories 0, 1, 2, and 3 were 28.2%, 29.4%, 23.5%, and 8.2%, respectively. A statistically significant (p<0.05) association was observed between the development of DFU and the following variables: time since the diagnosis of diabetes and the appearance of the nails, humidity, and deformations on the feet. Conclusion. The present study found an elevated predominance of DM patients in the Brazilian public health system (SUS) featuring cutaneous alterations that may lead to ulcers; these individuals had elevated risks of developing DFU. Furthermore, it was revealed that the feet of patients were not physically examined during treatment.

An evaluation of risk factors affecting amputation in patients with diabetic foot Infection

“…In contrast to Selvin et al's study describing an increase in HbA 1c levels as increasing the risk of major amputation, Winkley et al reported that low HbA 1c levels were associated with higher mortality (26,27). HbA 1c was also not reported as a predictive factor for amputation in Cardoso et al's study (28). Serum HbA 1c levels were also not identified as a risk factor for amputation in the present study.…”

“…). The type of bacterium isolated was reported not to constitute a risk factor associated with mortality (28). In another, retrospective, study, 65% of cases resulted in amputation, and the most common bacteria were Staphyloccus spp.…”

Digital educational technology for care management of diabetes mellitus people’s feet

“…Research on the prevalence of DM ulcers with methodological rigor is scarce in the Brazilian context. In Brazil, it is estimated that the prevalence of foot ulcers reaches 4 to 10% of people with DM (6)(7) .…”

Módulo educativo em ambiente virtual de aprendizagem em Diabetes Mellitus

“…Entre las complicaciones crónicas de la DM, las úlceras del pie, también conocidas como pie diabético, y la amputación de las extremidades son las más graves y implican un mayor impacto socioeconómico. Las úlceras del pie tienen una incidencia anual del 2%, siendo que una persona con diabetes presenta un riesgo del 25% de desarrollar úlceras del pie durante toda la vida (10)(11)(12) .…”